Date: Sunday, April 30, 2017
Session Name: Poster Session B: Pediatric Liver Transplant - Clinical
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Among pediatric patients (≤18 yrs) awaiting liver transplantation (LT), limited data exist on the prognostic significance of acute (<90d) renal replacement therapy (RRT) prior to LT.
Retrospective case-matched analysis (1 pre-LT RRT : 3 non-RRT) reviewed pediatric LTs performed at a university transplant center (136 pediatric LTs in 125 patients, 2008-2015). Factors affecting patient and graft survival were analyzed.
Ten patients (12 LTs) received preoperative RRT, and were more often in the ICU, on vasopressors, and on mechanical ventilation (MV) pre-LT (p<0.05). Mean follow-up and post-LT length of stay (LOS) were similar between RRT and non-RRT groups. RRT patients had lower survival at hospital discharge and 30-days, 58% and 67%, respectively (p<0.05). Kaplan-Meier patient and graft survival were inferior in the RRT group (log-rank test p=0.046 & p=0.079) [Fig. 1]. A survival probability model using penalized regression predicted 30-day patient survival with 4 pre-LT variables: RRT duration, vasopressor need, MV, and LOS [Fig. 2].
In this largest series of acute RRT in pediatric LT, pre-LT RRT was associated with higher acuity and inferior short-term survival. Our model accurately differentiated survival probabilities, suggesting that recipients expected to have better post-LT outcomes can be identified even among the sickest patients.Fig. 1: Kaplan-Meier survival curves comparing (A) patient and (B) graft survival among RRT and non-RRT.Fig. 2: Penalized regression model predicts 30-day patient survival using 4 pre-LT variables: RRT duration, vasopressor need, MV, and LOS (A). ROC curve of the model, concordance-statistic= 0.91 (B). ROC, receiver operator characteristic.
CITATION INFORMATION: Wong M, Venick R, Agopian V, Ebaid S, McDiarmid S, Zarrinpar A, Farmer D, Busuttil R, Kaldas F. Acute Renal Replacement Therapy in Pediatric Liver Transplantation: A Predictor of Increased Risk. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:Wong M, Venick R, Agopian V, Ebaid S, McDiarmid S, Zarrinpar A, Farmer D, Busuttil R, Kaldas F. Acute Renal Replacement Therapy in Pediatric Liver Transplantation: A Predictor of Increased Risk. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/acute-renal-replacement-therapy-in-pediatric-liver-transplantation-a-predictor-of-increased-risk/. Accessed June 6, 2020.
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