title: Survival of liver transplant candidates with acute renal failure receiving renal replacement therapy.
abstract: BACKGROUND
  Acute renal failure (ARF) in the setting of end-stage liver disease has a dismal prognosis without liver transplantation. Renal replacement therapy (RRT) is a common bridge to liver transplant despite a paucity of supportive data. We investigated our single-center patient population to determine efficacy of RRT in liver transplant candidates with ARF.
  
  
  METHODS
  We identified 102 liver transplant candidates receiving RRT for ARF between April 30, 1999 and January 31, 2004. Patients that had initiated RRT intra- or postoperatively or received outpatient hemodialysis or peritoneal dialysis prior to admission were excluded. Survival to liver transplant, short-term mortality following liver transplant, and selected clinical characteristics were examined.
  
  
  RESULTS
  Of patients who received RRT, 35% survived to liver transplant or discharge. Mortality was 94% in patients not receiving a liver and was associated with a higher Acute Physiological and Chronic Health Evaluation (APACHE) II, lower mean arterial pressure, and the use of continuous renal replacement therapy (CRRT). Patients receiving CRRT had greater severity of illness than those on hemodialysis. The 1-year mortality of patients initiating RRT prior to liver transplant was 30% versus 9.7% for all other liver recipients (P < 0.0045).
  
  
  CONCLUSIONS
  RRT is justifiable for liver transplant candidates with ARF. Though mortality was high, a substantial percentage (31%) of patients survived to liver transplant. Postoperative mortality is increased compared with all other liver transplant recipients, but is acceptable considering the near-universal mortality without transplantation.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599-7155, USA.
authors.forename: Leslie P
authors.initials: LP
authors.lastname: Wong
authors.forename: Molly P
authors.initials: MP
authors.lastname: Blackley
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Andreoni
authors.forename: Hyunsook
authors.initials: H
authors.lastname: Chin
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Falk
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Klemmer
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017582:Renal Replacement Therapy / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis