title: Impact of the etiology of acute kidney injury on outcomes following liver transplantation: acute tubular necrosis versus hepatorenal syndrome.
abstract: Acute kidney injury (AKI) at the time of liver transplantation (LT) has been associated with increased morbidity and mortality. In patients with potentially reversible renal dysfunction, predicting whether there will be sufficient return of native kidney function is sometimes difficult. Previous studies have focused mainly on the effect of the severity of renal dysfunction or the duration of pretransplant dialysis on posttransplant outcomes. We performed a retrospective analysis of patients who underwent LT at our center after Model for End-Stage Liver Disease-based allocation so that we could determine the impact of the etiology of AKI [acute tubular necrosis (ATN) versus hepatorenal syndrome (HRS)] on post-LT outcomes. The patients were stratified according to the severity of AKI at the time of LT as described by the Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (RIFLE) classification: risk, injury, or failure. The RIFLE failure group was further subdivided according to the etiology of AKI: HRS or ATN. The patient survival and renal outcomes 1 and 5 years after LT were significantly worse for those with ATN. At 5 years, the incidence of chronic kidney disease (stage 4 or 5) was statistically higher in the ATN group versus the HRS group (56% versus 16%, P < 0.001). A multivariate analysis revealed that the presence of ATN at the time of LT was the only variable associated with higher mortality 1 year after LT (P < 0.001). Our study is the first to demonstrate that the etiology of AKI has the greatest impact on patient and renal outcomes after LT.
authors.affiliation: Division of Nephrology, Department of Medicine, Los Angeles, CA 90033, USA. nadim@usc.edu
authors.forename: Mitra K
authors.initials: MK
authors.lastname: Nadim
authors.forename: Yuri S
authors.initials: YS
authors.lastname: Genyk
authors.forename: Chris
authors.initials: C
authors.lastname: Tokin
authors.forename: Jenny
authors.initials: J
authors.lastname: Fieber
authors.forename: Wanwarat
authors.initials: W
authors.lastname: Ananthapanyasut
authors.forename: Wei
authors.initials: W
authors.lastname: Ye
authors.forename: Rick
authors.initials: R
authors.lastname: Selby
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000368:Aged; D005260:Female; D006530:Hepatorenal Syndrome / Q000150:complications*; D006801:Humans; D007683:Kidney Tubular Necrosis, Acute / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies