*Purpose: Pre-liver transplant (LT) renal dysfunction predicts worse outcomes post-LT but the reasons for this are unclear. We aimed at identifying the effect of pre-LT kidney function on return to the operating room (RTO) within 90 days after LT.

*Methods: Data on 2,836 LT alone performed between 2/98 and 5/16 were retrospectively reviewed. Simultaneous liver-kidney transplant recipients were excluded. The cohort was divided into 3 groups according to serum creatinine and renal replacement therapy (RRT) at LT. Group 1 (n=2,188): creatinine ≤1.5 mg/dl, group 2 (n=464): creatinine >1.5 mg/dl and no RRT; group 3 (n=184): on dialysis at LT. A univariate analysis was performed to identify predictors of RTO within 90 days from LT. A Cox logistic hazards ratios were constructed to identify independent predictors of RTO after LT.

*Results: Of the 2,836 LT recipients, 554 (19%) required RTO within 90 days from LT. Post-LT bleeding was the most common reason for RTO occurring in 210 (38%) of cases. RTO was 18% in group 1, 24% in group 2 and 32% in group 3 (P<0.001). Bleeding accounted for 35%, 43% and 48% of RTO cases in group 1, 2 and 3, respectively (P=0.07).Predictors of RTO on univariate analysis are presented in Table 1. Cox logistic regression demonstrated that pre-LT renal dysfunction is an independent predictor of RTO after LT with the highest risk being in patients on RRT at LT (Table 2). 1-year survival for patients on RRT at LT (group 3) was 81% for those who had no RTO and 63% for the RTO patients, Log Rank P<0.05.

*Conclusions: 1) Pre-LT renal dysfunction is an independent predictor of post-LT RTO. 2) The incidence of RTO for bleeding increases in parallel to the decline in kidney function. 3) LT recipients on RRT at LT who RTO have lower 1-year survival compared to those who had no RTO after LT. 4) RTO could partially account for the lower survival for recipients on RRT at LT.

« Back to 2019 American Transplant Congress