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Renal Risk Index and Acute Kidney Injury in Liver Transplant Patients.

J. Neal, Y. Sun, J. Erley, J. Shen, C. Sonnenday, P. Sharma, J. Park.

University of Michigan, Ann Arbor, MI.

Meeting: 2016 American Transplant Congress

Abstract number: B170

Keywords: Post-operative complications, Prediction models, Renal dysfunction, Risk factors

Session Information

Date: Sunday, June 12, 2016

Session Name: Poster Session B: Kidney Issue in Liver Transplantation

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

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Purpose: Renal risk index (RRI) has been validated in liver transplant (LT) to predict post-transplant ESRD. We examined the clinical utility of RRI as a prognostic tool for acute kidney injury (AKI) after LT.

Methods: Data were collected from adult LT recipients at University of Michigan between 1/1/10 and 9/8/15. RRI was calculated using 14 pre-transplant characteristics (https://rri.med.umich.edu). Renal outcomes within the first 7 days of LT were classified by RIFLE criteria as: no AKI (Class N), risk (Class R), injury (Class I), or failure (Class F). Patients (pts) who received chronic dialysis for > 3 months pre-LT or died within 7 days post-LT were excluded. All pts received tacrolimus as part of immunosuppression. We compared RRI among Classes N-F using Kruskal-Wallis test. Next we combined N and R (Class NR) and I and F (Class IF or severe AKI). Mann-Whitney U test was used to compare RRI between Class NR and IF.

Results: Of the 296 pts, 212 (71.6%) developed severe AKI and 41 (13.9%) required dialysis within the first 7 days of LT. Distribution of RRI was significantly different among Classes N-F. Mean RRI in Class NR was significantly higher than Class IF. Mean eGFR for Class IF was significantly lower than Class NR at 6 months and 1 year after LT. Only 2 pts from Class NR and 6 pts from Class IF developed ESRD at 1 year. All data are presented in mean ± SD.

AKI Class

Class N (N=44)

Class R (N=40)

Class I (N=104)

Class F (N=108)

P value 
RRI 1.86±1.92 1.22±1.73 1.95±1.53 3.32±4.17 <0.0001
Severe AKI Class Class NR (N=84) Class IF (N=212)  
RRI   1.56±1.68 2.64±3.23 <0.0001
MDRD4 eGFR at 6 months (mL/min) 74±30 66±25 0.04
MDRD4 eGFR at 1 year (mL/min) 72±30 61±27 0.003

Conclusion: Severe AKI was common in the early post-LT period. A higher RRI at LT was associated with severe AKI in the early post-LT period. Majority of pts with severe AKI recovered their renal function; however, they were more likely to have lower eGFR at 6 months and 1 year after LT. Strategies for renal protection targeting high RRI pts should be tested to decrease the incidence of post-LT AKI and progression to CKD.

CITATION INFORMATION: Neal J, Sun Y, Erley J, Shen J, Sonnenday C, Sharma P, Park J. Renal Risk Index and Acute Kidney Injury in Liver Transplant Patients. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Neal J, Sun Y, Erley J, Shen J, Sonnenday C, Sharma P, Park J. Renal Risk Index and Acute Kidney Injury in Liver Transplant Patients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-risk-index-and-acute-kidney-injury-in-liver-transplant-patients/. Accessed February 25, 2021.

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