Higher Baseline Serum Creatinine Levels AreAssociated with an Increased Incidence of Renal Replacement Therapy in Patients with Hepatorenal Syndrome Type 1 on the Liver Transplant Waitlist
1Hepatology, University Hospitals Cleveland Medical Center & Case Western Reserve University, Cleveland, OH, 2Gastroenterology, Hepatology, Transplant Hepatology, Saint Louis University School of Medicine, St Louis, MO, 3Hepatology, Mallinckrodt Pharmaceuticals, Clinton, NJ
Meeting: 2022 American Transplant Congress
Abstract number: 130
Keywords: Liver, Liver cirrhosis, Liver transplantation, Waiting lists
Topic: Clinical Science » Liver » 53 - Liver: Cirrhosis - Portal Hypertension and Other Complications
Session Information
Session Name: Cirrhosis: Complications, Portal Hypertension and Renal Management
Session Type: Rapid Fire Oral Abstract
Date: Sunday, June 5, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 6:50pm-7:00pm
Location: Hynes Room 311
*Purpose: Pretransplant and posttransplant renal replacement therapy (RRT) is associated with increased morbidity and mortality in liver transplant recipients, including those with Hepatorenal syndrome type 1 (HRS-1). A pooled analysis using a prospective database of 2 randomized, placebo-controlled, phase 3 studies was conducted to determine the impact of baseline serum creatinine (SCr) on the incidence of RRT in patients (pts) listed for a liver transplant.
*Methods: CONFIRM and REVERSE, the 2 largest placebo-controlled studies for pts with HRS-1 were included in this analysis. Group comparisons were performed using Chi-squared and Fisher’s exact tests.
*Results: Pooled analysis included transplant-listed pts from the intent-to-treat population (terlipressin, n=92; placebo, n=59). Pt characteristics were similar with comparable baseline model for end-stage liver disease (MELD) scores in the terlipressin and placebo groups (mean [SD]: 32.7 [6.23] vs 32.5 [5.64], respectively). In pts who were transplant-listed at baseline, the incidence of RRT at any time after study enrollment was lower in the terlipressin group vs the placebo group (43.5% vs 57.6%, respectively; P=.090). Further, the incidence of RRT was significantly higher in pts with a higher baseline SCr at Days 30, 60, and 90 (P<.001, P=.002, and P=.003, respectively; Table). Although pts in the terlipressin group had a lower incidence of RRT vs the placebo group for all baseline SCr subgroups at Days 30, 60, and 90, the differences were not statistically significant (P>.05 for all comparisons).
*Conclusions: Baseline SCr is a key indicator of the incidence of RRT in transplant listed pts with HRS-1. Higher baseline SCr results in an increased need for RRT and could be a key factor in poor transplant outcomes in pts with HRS-1 suggesting that earlier recognition and treatment of HRS-1 could lead to better transplant outcomes.
| Patients with Renal Replacement Therapy, n, (%) |
Baseline Serum Creatinine ≥2.25–<3.5 mg/dL (n = 88) |
Baseline Serum Creatinine ≥3.5–≤5 mg/dL (n = 46) |
Baseline Serum Creatinine >5 mg/dL (n = 12) |
P value |
| By Day 30 visit | 30 (34.1) | 23 (50.0) | 11 (91.7) | <.001 |
| By Day 60 visit | 35 (39.8) | 25 (54.3) | 11 (91.7) | .002 |
| By Day 90 visit | 37 (42.0) | 26 (56.5) | 11 (91.7) | .003 |
To cite this abstract in AMA style:
Sclair SN, Befeler A, Jamil K. Higher Baseline Serum Creatinine Levels AreAssociated with an Increased Incidence of Renal Replacement Therapy in Patients with Hepatorenal Syndrome Type 1 on the Liver Transplant Waitlist [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/higher-baseline-serum-creatinine-levels-areassociated-with-an-increased-incidence-of-renal-replacement-therapy-in-patients-with-hepatorenal-syndrome-type-1-on-the-liver-transplant-waitlist/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress