title: Proteinuria can predict prognosis after liver transplantation.
abstract: BACKGROUND
  Proteinuria is a manifestation of renal dysfunction and it has been demonstrated to be a significant prognostic factor in various clinical situations. The study was designed to analyze prognosis of patients receiving liver transplantation as well as to determine predictive performance of perioperative proteinuria.
  
  
  METHODS
  We retrospectively reviewed data of patients who had received a liver transplant in a medical center between 2002 and 2010. Demographic information and clinical characteristic parameters were recorded on the day of intensive care unit admission before operation and on postoperative days 1, 7, and 14.
  
  
  RESULTS
  Among a total of 323 patients, in-hospital mortality and 90-day mortality rates were 13.0 % (42/323) and 14.2 % (46/323), respectively. Patients with proteinuria on admission had higher rates of acute kidney injury (26.8 % vs. 8.8 %, p < 0.001), severe infection episodes (48.8 % vs. 30.7 %, p = 0.023), hospital death (31.1 % vs. 10.1 %, p < 0.001), and 90-day mortality (37.7 % vs. 10.9 %, p < 0.001). Multivariate analysis showed that proteinuria on admission and Sequential Organ Failure Assessment (SOFA) score were independent predictors of in-hospital mortality. The discriminatory ability of proteinuria plus SOFA was even better than that of SOFA alone, especially on postoperative day 1.
  
  
  CONCLUSIONS
  The presence of proteinuria before liver transplantation is supposed to be recognized as a negative predictor for in-hospital survival. Moreover, the presence of proteinuria after liver transplantation can assist in the early prediction of poor short-term prognosis for patients receiving liver transplantation.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Heng-Chih
authors.initials: HC
authors.lastname: Pan
authors.affiliation: Division of General Internal Medicine and Geriatrics Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Ying-Jen
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Jhe-Ping
authors.initials: JP
authors.lastname: Lin
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Ming-Jung
authors.initials: MJ
authors.lastname: Tsai
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Jenq
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. weichen@cgmh.org.tw.|Laboratory of Immunology, Department of General Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan. weichen@cgmh.org.tw.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Ming-Hung
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Fan
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Chih-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Chang
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan.|Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Chang Gung University College of Medicine, Taoyuan, Taiwan. cyc2356@gmail.com.|Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan. cyc2356@gmail.com.
authors.forename: Yung-Chang
authors.identifier: http://orcid.org/0000-0003-3062-8467
authors.initials: YC
authors.lastname: Chen
mesh_terms: D000368:Aged; D003422:Critical Care; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology*; D012189:Retrospective Studies
keywords: Liver transplantation; Mortality; Prognosis; Proteinuria; SOFA