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Early Allograft Dysfunction After Liver Transplantation Is Associated With Short- and Long-Term Kidney Function
H M Wadei1, D D Lee1, K P Croome1
1Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL.
Summary
Early allograft dysfunction (EAD) after liver transplantation (LT) increases the risk of acute kidney injury (AKI) and end-stage renal disease (ESRD). Addressing EAD is crucial for improving long-term kidney function and patient survival post-transplant.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- Early allograft dysfunction (EAD) post-liver transplantation (LT) is linked to ischemia-reperfusion injury and systemic inflammation.
- EAD can precipitate extrahepatic organ dysfunction, including the kidneys.
Purpose of the Study:
- To investigate the association between EAD and new-onset acute kidney injury (AKI) requiring renal replacement therapy within one month post-LT.
- To assess the impact of EAD on the development of end-stage renal disease (ESRD) within one year post-LT.
- To evaluate the effect of combined EAD and AKI on patient and graft survival.
Main Methods:
- Retrospective analysis of 1325 primary liver transplant recipients.
- Comparison of AKI and ESRD incidence between patients with and without EAD.
- Multivariate logistic regression to identify independent risk factors for AKI and ESRD.
- Survival analysis comparing outcomes based on EAD and AKI status.
Main Results:
- EAD occurred in 27% of recipients (358/1325).
- AKI developed in 5.6% (71/1325) and ESRD in 2.9% (38/1325).
- EAD significantly increased the risk of AKI (9% vs 4%) and ESRD (6% vs 2%) (p < 0.001).
- Multivariate analysis confirmed EAD as an independent risk factor for AKI (OR 3.5) and ESRD (OR 3.1).
- Patients with both EAD and AKI had significantly worse 1-, 3-, 5-, and 10-year patient and graft survival.
Conclusions:
- Post-LT EAD is a significant risk factor for developing AKI and ESRD.
- EAD negatively impacts both short- and long-term renal function after liver transplantation.
- Targeting EAD may be a key strategy to mitigate renal complications and improve outcomes in LT recipients.
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