Longitudinal Renal Function in Liver Transplant Recipients With Acute-on-Chronic Liver Failure

Abstract

INTRODUCTION: To analyze the impact of acute-on-chronic liver failure (ACLF) immediately before liver transplantation (LT) on short-term kidney function. METHODS: In this retrospective study, we included 416 of 687 consecutive patients who had an estimated glomerular filtration rates (eGFRs) at 3-month post-LT. We compared the non-ACLF (N 5 356), ACLF with eGFR ‡30 mL/min/1.73 m2 (A-HGFR, N 5 32), and ACLF with eGFR <30 mL/min/1.73 m2 (A-LGFR, N 5 28) groups at LT and for 2 kidney-related outcomes: (i) slope of eGFR by linear mixed model and (ii) time to development of composite kidney outcomes (eGFR < 15 mL/min/1.73 m2 or need for dialysis). RESULTS: The mean eGFRs at LT in non-ACLF, A-HGFR, and A-LGFR groups were significantly different as follows: 83.9 6 29.5, 56.5 6 31.2, and 21.6 6 5.0 mL/min/1.73 m2, respectively. The eGFR slope significantly increased in A-LGFR group (17.26 mL/min/1.73 m2/mo), whereas it remained stable in A-HGFR group (11.05 mL/min/1.73 m2/mo) and significantly declined in non-ACLF group (27.61 mL/min/1.73 m2/mo) by the first 3-month period. On the other hand, the eGFR slope in all groups stabilized after 3 months post-LT. A-LGFR group showed significantly increased risk of developing composite kidney outcomes in adjusted analysis (hazard ratio 5 3.61, 95% confidence interval: 1.35–9.70) compared with the non-ACLF group. However, this significance disappeared after the further adjustment for eGFR at 3-month post-LT (hazard ratio 5 1.91, 95% confidence interval: 0.70–5.23). DISCUSSION: The slopes of eGFR before 3-month post-LT were significantly different among non-ACLF, A-HGFR, and A-LGFR groups. The renal dysfunction in A-LGFR group stabilized after partial recovery by 3-month post-LT (eGFR reset point).