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Impact of acute kidney injury following liver transplantation on long‐term outcomes
Author(s) -
Trinh Emilie,
Alam Ahsan,
Tchervenkov Jean,
Cantarovich Marcelo
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12863
Subject(s) - medicine , acute kidney injury , kidney disease , incidence (geometry) , creatinine , proportional hazards model , calcineurin , liver transplantation , transplantation , cohort , renal function , kidney transplantation , stage (stratigraphy) , gastroenterology , paleontology , physics , optics , biology
Background The incidence of acute kidney injury ( AKI ) after liver transplantation ( LT x) ranges from 17% to 94%. AKI is associated with prolonged hospitalization and increased early mortality. In our cohort study, we examined the impact of AKI on long‐term patient survival and on the incidence of stage 4‐5 chronic kidney disease ( CKD ). Methods We studied 491 LT x recipients at a single center between 1990 and 2012. We identified 278 pts (56.6%) with AKI defined as either an increase in serum creatinine ( SC r) ≥26.5 μmol/L within 48 hour or elevation in SC r 1.5× baseline within 7 days ( KDIGO criteria). Results In a multivariable Cox proportional hazards model, survival was worse in patients with AKI ( HR : 1.41, 95% CI 1.03‐1.92). Severe (stage 3) AKI was associated with worse patient survival ( HR : 2.29, 95% CI 1.46‐3.58). The risk of developing stage 4‐5 CKD was also higher in patients with AKI (17.5% vs 9.1%) with a HR of 2.39 (95% CI 1.27‐4.47). Delaying initiation of calcineurin inhibitors >48H was not associated with a decreased risk of CKD . Conclusions Our findings suggest that AKI after LT x is associated with poor long‐term outcomes, including worse survival and higher incidence of CKD stage 4‐5. Strategies to prevent and manage LT x patients with AKI need to be developed.