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Renal Failure is Reversible in the Majority of Patients Transplanted for Alcohol-Associated Hepatitis: A Review of the UNOS Database

Y. Bekki, G. Im, T. Schiano, S. Florman

Icahn School of Medicine at Mount Sinai, RMTI, New York, NY

Meeting: 2022 American Transplant Congress

Abstract number: 128

Keywords: Alcohol, Kidney, Liver transplantation, Renal failure

Topic: Clinical Science » Liver » 52 - Liver: Kidney Issues in Liver Transplantation

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: 6:30pm-6:40pm

Location: Hynes Room 311

*Purpose: The simultaneous liver-kidney (SLK) allocation policy in 2017 created Safety Net kidney allocation priority for liver transplant (LT) recipients with renal failure. Renal failure is a common complication in patients with alcohol-associated hepatitis (AH), but the predictors of kidney recovery after LT and the impact of the SLK allocation policy have not been elucidated.

*Methods: Using UNOS data from 2012 to 2021, adult patients who underwent primary LT for AH were analyzed. Patients were categorized into 4 groups based on pre-LT renal replacement therapy (RRT) status, and transplant procedure (LT or SLK): RRT- LT, RRT-SLK, non-RRT-LT, and non-RRT-SLK. RRT-LT group was further evaluated for kidney recovery. (Figure 1)

*Results: RRT was indicated in nearly half (47.7%) of 821 LT recipients for AH: 356 patients (43.4%) in RRT-LT group and 36 (9.2%) in RRT-SLK group. After implementation of the new SLK allocation policy, the rate of SLK among recipients with RRT significantly decreased from 22.7% to 6.4% (p<0.01). As expected, patients with RRT had a significantly higher MELD score, and shorter waiting time than those without RRT (all p<0.01). Patient survival amongst the groups showed no significant difference (p=0.25). Among 353 patients in the RRT-LT group, 53 patients (15.0%) were listed for kidney transplant (KT) within 1 year after LT. After the implementation of SLK allocation policy, the rate to list for KT increased to 16.6% from 5.9%, but the difference did not reach statistical significance (p=0.07). Patients who were listed for KT showed a significantly higher bilirubin, creatinine (both p<0.01) and lower albumin (p=0.02) at listing for LT (Table 1). Multivariable regression analysis identified bilirubin [ (HR) 1.05, 95% CI 1.02-1.08], and albumin (HR 1.01, 95% CI 0.39-0.88) at listing for LT as predictors for KT listing after LT.

*Conclusions: Almost half of the patients with AH required RRT before LT, but renal failure resolved in the great majority (85.0%) of patients post-LT. The new SLK allocation policy effectively reduced SLK rates, but with higher rates of KT post-LT using the “safety net”. Serum bilirubin and albumin at the time of LT listing may help identify patients who will require KT after LT.

Table 1. LT recipient demographics in RRT-LT group
Variables Non-kidney listing (n=275) Kidney listed (n=53) Mortality (n=25) P value
Age (years) 41.2 ± 9.3 42.2 ± 10.5 40.1 ± 7.9 0.65
MELD score at listing 39.4 ± 5.1 40.8 ± 2.8 39.8 ± 3.7 0.10
Bili at listing 26.9 ± 11.5 33.1 ± 9.5 28.4 ± 13.7 < 0.01
INR at listing 2.4 ± 0.9 2.2 ± 0.6 2.3 ± 0.6 0.41
Creatinine at listing 3.5 ± 2.2 4.4 ± 2.4 2.9 ± 1.7 < 0.01
Alb at listing 3.1 ± 0.7 2.8 ± 0.6 3.0 ± 0.6 0.02
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To cite this abstract in AMA style:

Bekki Y, Im G, Schiano T, Florman S. Renal Failure is Reversible in the Majority of Patients Transplanted for Alcohol-Associated Hepatitis: A Review of the UNOS Database [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-failure-is-reversible-in-the-majority-of-patients-transplanted-for-alcohol-associated-hepatitis-a-review-of-the-unos-database/. Accessed May 8, 2025.

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