title: Use of Renal Replacement Therapy May Influence Graft Outcomes following Liver Transplantation for Acute Liver Failure: A Propensity-Score Matched Population-Based Retrospective Cohort Study.
abstract: BACKGROUND
  Acute kidney injury is associated with a poor prognosis in acute liver failure but little is known of outcomes in patients undergoing transplantation for acute liver failure who require renal replacement therapy.
  
  
  METHODS
  A retrospective analysis of the United Kingdom Transplant Registry was performed (1 January 2001-31 December 2011) with patient and graft survival determined using Kaplan-Meier methods. Cox proportional hazards models were used together with propensity-score based full matching on renal replacement therapy use.
  
  
  RESULTS
  Three-year patient and graft survival for patients receiving renal replacement therapy were 77.7% and 72.6% compared with 85.1% and 79.4% for those not requiring renal replacement therapy (P<0.001 and P = 0.009 respectively, n = 725). In a Cox proportional hazards model, renal replacement therapy was a predictor of both patient death (hazard ratio (HR) 1.59, 95% CI 1.01-2.50, P = 0.044) but not graft loss (HR 1.39, 95% CI 0.92-2.10, P = 0.114). In groups fully matched on baseline covariates, those not receiving renal replacement therapy with a serum creatinine greater than 175 μmol/L had a significantly worse risk of graft failure than those receiving renal replacement therapy.
  
  
  CONCLUSIONS
  In patients being transplanted for acute liver failure, use of renal replacement therapy is a strong predictor of patient death and graft loss. Those not receiving renal replacement therapy with an elevated serum creatinine may be at greater risk of early graft failure than those receiving renal replacement therapy. A low threshold for instituting renal replacement therapy may therefore be beneficial.
authors.affiliation: Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Knight
authors.affiliation: Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
authors.forename: Gabriel C
authors.initials: GC
authors.lastname: Oniscu
authors.affiliation: Pipeline Futures Group, GSK, 1250 South Collegeville Rd, Collegeville, Pennsylvania, 19426, United States of America.
authors.forename: Luke
authors.initials: L
authors.lastname: Devey
authors.affiliation: Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Simpson
authors.affiliation: Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wigmore
authors.affiliation: Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom.
authors.forename: Ewen M
authors.initials: EM
authors.lastname: Harrison
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood / Q000209:etiology* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003404:Creatinine