Reduced impact of renal failure on the outcome of patients with alcoholic liver disease undergoing liver transplantation.
Pretransplant renal failure is commonly reported to be a poor prognostic indicator affecting survival after liver transplantation (LT). However, whether the impact of renal failure on patient outcome varies according to the aetiology of the underlying liver disease is largely unknown.



We investigated the association between renal failure at the time of LT and patient outcome in patients with alcoholic liver disease (ALD) (n = 6920), non-alcoholic steatohepatitis (NASH) (n = 2956) and hepatitis C (HCV) (n = 14 922) using the United Network for Organ Sharing (UNOS) database between February 2002 and December 2013. A total of 24 798 transplant recipients were included.



The presence of renal failure was more frequently seen in patients with ALD (23.95%) and NASH (23.27%) compared to patients with HCV (19.38%) (P < 0.001). In multivariate analysis, renal failure was an independent predictor of poor survival. Renal failure showed detrimental effect on patient survival in the overall series (HR = 1.466, P < 0.0001). Importantly, the impact of renal failure was less marked in patients with ALD (HR = 1.31, P < 0.0001) than in patients with NASH (HR = 1.73, P < 0.0001) or HCV (HR = 1.52, P < 0.0001). Despite a higher model for end-stage liver disease (MELD) score at the time of LT, ALD patients with renal failure had better long-term prognosis than non-ALD patients.



Renal failure at the time of LT conferred a lower patient and graft survival post-LT. However, renal failure has less impact on the outcome of patients with ALD than that of patients with non-alcoholic liver disease after LT.
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
Jaeyoun
J
Cheong
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Joseph A
JA
Galanko
Department of Medicine, University of Alabama at Birmingham, Montgomery, AL, USA.
Sumant
S
Arora
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Department of Gastroenterology and Hepatology, University Hospital Marques de Valdecilla, Santander, Spain.
Joaquin
J
Cabezas
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Nambi J
NJ
Ndugga
Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, Madison, WI, USA.
Michael R
MR
Lucey
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Paul H
PH
Hayashi
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Alfred Sidney
AS
Barritt
Division of Gastroenterology and Hepatology, Department of Medicine, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Ramon
R
Bataller
D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications* / Q000601:surgery; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D051437:Renal Insufficiency / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States
alcoholic liver disease; liver transplantation; non-alcoholic liver disease; outcome; renal failure