TY - JOUR
T1 - Liver transplantation in recipients receiving renal replacement therapy
T2 - Outcomes analysis and the role of intraoperative hemodialysis
AU - Agopian, V. G.
AU - Dhillon, A.
AU - Baber, J.
AU - Kaldas, F. M.
AU - Zarrinpar, A.
AU - Farmer, D. G.
AU - Petrowsky, H.
AU - Xia, V.
AU - Honda, H.
AU - Gornbein, J.
AU - Hiatt, J. R.
AU - Busuttil, R. W.
PY - 2014/7
Y1 - 2014/7
N2 - The Model for End-Stage Liver Disease (MELD) system has dramatically increased the number of recipients requiring pretransplant renal replacement therapy (RRT) prior to liver transplantation (LT). Factors affecting post-LT outcomes and the need for intraoperative RRT (IORRT) were analyzed in 500 consecutive recipients receiving pretransplant RRT, including comparisons among recipients not receiving IORRT (No-IORRT, n-=-401), receiving planned IORRT (Pl-IORRT, n-=-70), and receiving emergent, unplanned RRT after LT initiation (Em-IORRT, n-=-29). Despite a median MELD of 39, overall 30-day, 1-, 3- and 5-year survivals were 93%, 75%, 68% and 65%, respectively. Em-IORRT recipients had significantly more intraoperative complications (arrhythmias, postreperfusion syndrome, coagulopathy) compared with both No-IORRT and Pl-IORRT and greater 30-day graft loss (28% vs. 10%, p-=-0.004) and need for retransplantation (24% vs. 10%, p-=-0.099) compared with No-IORRT. A risk score based on multivariate predictors of IORRT accurately identified recipients with chronic (sensitivity 84%, specificity 72%, concordance-statistic [c-statistic] 0.829) and acute (sensitivity 93%, specificity 61%, c-statistic 0.776) liver failure requiring IORRT. In this largest experience of LT in recipients receiving RRT, we report excellent survival and propose a practical model that accurately identifies recipients who may benefit from IORRT. For this select group, timely initiation of IORRT reduces intraoperative complications and improves posttransplant outcomes. This analysis of liver transplantation in high-acuity recipients receiving pretransplant renal replacement therapy reports excellent long-term survival and describes a novel predictive model to identify the subset of recipients who may benefit from intraoperative renal replacement therapy.
AB - The Model for End-Stage Liver Disease (MELD) system has dramatically increased the number of recipients requiring pretransplant renal replacement therapy (RRT) prior to liver transplantation (LT). Factors affecting post-LT outcomes and the need for intraoperative RRT (IORRT) were analyzed in 500 consecutive recipients receiving pretransplant RRT, including comparisons among recipients not receiving IORRT (No-IORRT, n-=-401), receiving planned IORRT (Pl-IORRT, n-=-70), and receiving emergent, unplanned RRT after LT initiation (Em-IORRT, n-=-29). Despite a median MELD of 39, overall 30-day, 1-, 3- and 5-year survivals were 93%, 75%, 68% and 65%, respectively. Em-IORRT recipients had significantly more intraoperative complications (arrhythmias, postreperfusion syndrome, coagulopathy) compared with both No-IORRT and Pl-IORRT and greater 30-day graft loss (28% vs. 10%, p-=-0.004) and need for retransplantation (24% vs. 10%, p-=-0.099) compared with No-IORRT. A risk score based on multivariate predictors of IORRT accurately identified recipients with chronic (sensitivity 84%, specificity 72%, concordance-statistic [c-statistic] 0.829) and acute (sensitivity 93%, specificity 61%, c-statistic 0.776) liver failure requiring IORRT. In this largest experience of LT in recipients receiving RRT, we report excellent survival and propose a practical model that accurately identifies recipients who may benefit from IORRT. For this select group, timely initiation of IORRT reduces intraoperative complications and improves posttransplant outcomes. This analysis of liver transplantation in high-acuity recipients receiving pretransplant renal replacement therapy reports excellent long-term survival and describes a novel predictive model to identify the subset of recipients who may benefit from intraoperative renal replacement therapy.
KW - Hemodialysis
KW - liver transplantation
KW - outcomes
KW - pretransplant renal failure
KW - renal disease in liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=84902965592&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84902965592&partnerID=8YFLogxK
U2 - 10.1111/ajt.12759
DO - 10.1111/ajt.12759
M3 - Article
C2 - 24854341
AN - SCOPUS:84902965592
VL - 14
SP - 1638
EP - 1647
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 7
ER -