Format

Send to

Choose Destination
Liver Int. 2017 Feb;37(2):290-298. doi: 10.1111/liv.13182. Epub 2016 Jul 4.

Reduced impact of renal failure on the outcome of patients with alcoholic liver disease undergoing liver transplantation.

Author information

1
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.
2
Department of Gastroenterology, Ajou University School of Medicine, Suwon, South Korea.
3
Department of Medicine, University of Alabama at Birmingham, Montgomery, AL, USA.
4
Department of Gastroenterology and Hepatology, University Hospital Marques de Valdecilla, Santander, Spain.
5
Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin, Madison, WI, USA.

Abstract

BACKGROUND & AIMS:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

alcoholic liver disease; liver transplantation; non-alcoholic liver disease; outcome; renal failure

PMID:
27258535
PMCID:
PMC5136341
DOI:
10.1111/liv.13182
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center