Decreased survival in liver transplant patients requiring chronic dialysis: a Canadian experience.
BACKGROUND
Chronic kidney disease is associated with increased mortality among nonrenal organ transplant recipients. End-stage renal disease (ESRD) is a serious complication after orthotopic liver transplantation (OLT). It is unclear if the outcomes of these individuals are different from nontransplant patients requiring dialysis or a kidney transplant.


METHODS
We report the incidence of ESRD in OLT recipients and compare their outcomes to matched dialysis controls. We analyzed 4186 patients who received an OLT in Canada between January 1981 and December 2002 and 228 matched, nontransplant, chronic dialysis controls.


RESULTS
The incidence of ESRD after OLT was 2.9% (n=120). The unadjusted mortality rate for those who required chronic dialysis was 49.2% compared with 26.8% in those who did not develop kidney failure (P<0.0001). The survival of OLT recipients on dialysis was lower than the matched chronic dialysis cohort (log-rank test, P=0.01). A kidney transplant was performed in 24% of the OLT recipients and 21% of the matched dialysis cohort, and their overall survival was similar. The OLT patients who remained on dialysis had a significantly lower survival when compared with matched dialysis patients who did not receive a kidney transplant (log-rank test, P=0.0002).


CONCLUSIONS
Mortality was greater for OLT recipients on dialysis than would be expected from a matched, nontransplant, dialysis cohort. Kidney transplantation may abrogate some of this increased mortality risk.
Al Riyami
Dawood
D
Department of Medicine, Multiorgan Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, Québec, Canada.
Alam
Ahsan
A
Badovinac
Kim
K
Ivis
Frank
F
Trpeski
Lilyanna
L
Cantarovich
Marcelo
M
D000328:Adult; D002170:Canada; D002423:Cause of Death; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D015993:Life Tables; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors