Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Identification of which liver transplant candidates with severe kidney injury can have full recovery of renal function after liver only transplant is difficult. Avoiding unnecessary simultaneous liver-kidney (SLK) transplant can optimize use of scarce kidney grafts. Incorrect predictions of spontaneous renal recovery after liver transplant alone (LTA) can lead to increased morbidity and mortality after a missed opportunity for SLK. METHODS: In a retrospective study of all adult LTAs performed from 2002-2012 at our liver and kidney transplant center, we identified recipients with severe sub-acute kidney injury (defined as: serum creatinine < 2 mg/dL within 3 months before a LTA and subsequent serum creatinine≥2 mg/dL or renal replacement therapy (RRT)). Severity of kidney injury was assessed by AKIN class and RIFLE class. We used logistic regression models with the outcome of renal recovery (defined as: serum creatinine <2 mg/dL, not on RRT, and not listed for kidney after liver transplant (KAL)) at 2 years after LTA. RESULTS: Of 42 LTA recipients, 28 (67%) had renal recovery and 14 did not. The median (IQR) warm ischemic time (minutes) in recipients that with and without renal recovery after LTA was 31 (27-46) and 39 (34-49), p=0.011, respectively. At the time of LTA, the number in AKIN class 0/1/2/3 was 1/5/5/31 and the number in RIFLE class 0/1/2/3/4 was 4/2/4/30/2. AKIN and RILFE were not associated with renal recovery after LTA (p>0.05). Adjusting for severity of sub-acute kidney injury with either AKIN or RIFLE, increasing warm ischemic time was associated with lack of renal recovery, HR 1.08 (1.01-1.17, p=0.031) and HR 1.09 (1.01-1.18, p=0.020), respectively. For each minute of increased warm ischemic time, there was an 8% to 9% increase in the risk of lack of renal recovery after LTA. The association of increasing warm ischemic time with lack of renal recovery remained statistically significant (p<0.05) in separate models adjusting AKIN or RIFLE and for the following factors individually: recipient diabetes, hypertension, proteinuria, hematuria, hepatorenal syndrome, calcineurin inhibitor at discharge, cold ischemic time and donor age. CONCLUSIONS: In liver transplant candidates with severe sub-acute renal injury, operative measures to minimize warm ischemic time may improve renal recovery, avoid renal replacement therapy and the need for subsequent kidney transplant.
To cite this abstract in AMA style:Laskey H, Nydam T, Wiseman A, Biggins S. Predicting Renal Recovery After Liver Transplant With Severe Pretransplant Sub-Acute Kidney Injury: The Impact of Warm Ischemic Time [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/predicting-renal-recovery-after-liver-transplant-with-severe-pretransplant-sub-acute-kidney-injury-the-impact-of-warm-ischemic-time/. Accessed June 11, 2021.
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