title: Early Allograft Dysfunction After Liver Transplantation Is Associated With Short- and Long-Term Kidney Function Impairment.
abstract: Early allograft dysfunction (EAD) after liver transplantation (LT) is related to ischemia-reperfusion injury and may lead to a systemic inflammatory response and extrahepatic organ dysfunction. We evaluated the effect of EAD on new-onset acute kidney injury (AKI) requiring renal replacement therapy within the first month and end-stage renal disease (ESRD) within the first year post-LT in 1325 primary LT recipients. EAD developed in 358 (27%) of recipients. Seventy-one (5.6%) recipients developed AKI and 38 (2.9%) developed ESRD. Compared with those without EAD, recipients with EAD had a higher risk of AKI and ESRD (4% vs. 9% and 2% vs. 6%, respectively, p < 0.001 for both). Multivariate logistic regression analysis showed an independent relationship between EAD and AKI as well as ESRD (odds ratio 3.5, 95% confidence interval 1.9-6.4, and odds ratio 3.1, 95% confidence interval 11.9-91.2, respectively). Patients who experienced both EAD and AKI had inferior 1-, 3-, 5-, and 10-year patient and graft survival compared with those with either EAD or AKI alone, while those who had neither AKI nor EAD had the best outcomes (p < 0.001). Post-LT EAD is a risk factor for both AKI and ESRD and should be considered a target for future intervention to reduce post-LT short- and long-term renal dysfunction.
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: H M
authors.initials: HM
authors.lastname: Wadei
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: D D
authors.initials: DD
authors.lastname: Lee
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: K P
authors.initials: KP
authors.lastname: Croome
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: M L
authors.initials: ML
authors.lastname: Mai
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: E
authors.initials: E
authors.lastname: Golan
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: R
authors.initials: R
authors.lastname: Brotman
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: A P
authors.initials: AP
authors.lastname: Keaveny
authors.affiliation: Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
authors.forename: C B
authors.initials: CB
authors.lastname: Taner
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000473:pathology; D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000473:pathology; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055031:Primary Graft Dysfunction / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors
keywords: clinical research/practice; complication: medical/metabolic; delayed graft function (DGF); graft survival; kidney disease; kidney transplantation/nephrology; liver allograft function/dysfunction; liver transplantation/hepatology