An epidemiologic study of early renal replacement therapy after orthotopic liver transplantation.
The preoperative impairment of renal function is associated with the need for postoperative renal replacement therapy (RRT) in patients undergoing liver transplantation. The principal goal of this investigation was to identify other factors apparent before or during transplant that were independently associated with the need for RRT in the early posttransplant period. A total of 260 consecutive adult patients who received a primary liver transplant were studied. Twenty-eight patients required early RRT (RRT initiated within 1 wk of transplant); 23 for control of volume overload. Preoperative blood urea nitrogen (odds ratio [95% CI], 1.52 [1.15 to 2.01] per 10 mg/dl), serum creatinine (1.91 [1.06 to 3.44] per 1 mg/dl), and urine output (0.12 [0.03 to 0.44] L/d) were independently predictive of the need for early RRT and in combination formed a parsimonious model that discriminated well (area under the receiver operating characteristic curve, 0.877) and had excellent fit (P = 0.699 to reject model fit). No other potential predictors meaningfully improved predictions of which patients would require early RRT. Patients requiring early RRT consumed more healthcare resources than patients who did not require early RRT, spending more time in intensive care (15 +/- 13 d versus 7 +/- 11 d; P < 0.001) and in the hospital (34 +/- 27 d versus 19 +/- 20 d; P < 0.001). The need for early RRT was strongly associated with death before hospital discharge (29% mortality versus 4% mortality among all others; P < 0.001). The data demonstrate that dependency on RRT in the first week after orthotopic liver transplantation stems almost entirely from preoperative renal dysfunction.
Contreras
Gabriel
G
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
Garces
Galo
G
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
Quartin
Andrew A
AA
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
Cely
Cynthia
C
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
LaGatta
Mark A
MA
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
Barreto
Gaspar A
GA
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
Roth
David
D
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
Gomez
Emilio
E
Divisions of *Nephrology and Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Miami, Florida; and the Internal Medicine Residency Program and Division of Nephrology, University of Miami, Miami, Florida.
D000328:Adult; D005260:Female; D005544:Forecasting; D006295:Health Resources / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D013997:Time Factors