Association of Pre-Transplant Renal Function with Liver Graft and Patient Survival after Liver Transplantation in Patients with Nonalcoholic Steatohepatitis. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Molnar, M. Z., Joglekar, K., Jiang, Y., Cholankeril, G., Abdul, M. K., Kedia, S., Gonzalez, H. C., Ahmed, A., Singal, A., Bhamidimarri, K. R., Aithal, G. P., Duseja, A., Wong, V. W., Gulnare, A., Puri, P., Nair, S., Eason, J. D., Satapathy, S. K., Global NAFLD Consortium 2018


BACKGROUND: Nonalcoholic Steatohepatitis(NASH) is one of the top three indications for liver transplantation in western countries. It is unknown whether renal dysfunction at the time of liver transplantation has any effect on post-liver transplantation outcomes in recipients with NASH.METHODS: From the United Network for Organ Sharing-Standard Transplant Analysis and Research(UNOS-STAR) dataset, we identified 4,088 NASH recipients who received deceased donor liver transplant. We divided our recipients a priori into three categories: Group I with estimated glomerular filtration rate (eGFR)<30 ml/min/1.73m2 at the time of LT and/or received dialysis within 2 weeks preceding LT(n=937); Group II included recipients who had eGFR=30 ml/min/1.73m2 and did not receive renal replacement therapy prior to LT(n=2,812); and Group III included recipients who underwent SLK transplantation(n=339). We examined the association of pre-transplant renal dysfunction with death with functioning graft, all-cause mortality, and graft loss using competing risk regression and Cox proportional hazards models.RESULTS: The mean±SD age of the cohort at baseline was 58±8 years, 55% were male, 80% were Caucasian, and average exception MELD score was 24±9. The median follow-up period was 5 years (median=1,816 days, interquartile range (IQR):1,090-2,723 days). Compared to Group I recipients, Group II recipients had 19% reduced trend for risk for death with functioning graft[Sub-Hazard Ratio(SHR)(95% CI):0.81(0.64-1.02)] and similar risk for graft loss [SHR(95% CI):1.25(0.59-2.62)] while Group III recipients had similar risk for death with functioning graft[SHR(95% CI):1.23(0.96-1.57)] and graft loss [SHR(95% CI):0.18(0.02-1.37)] using adjusted competing risk regression model.CONCLUSIONS: Recipients with preserved renal function before liver transplantation showed trend toward lower risk of death with functioning graft compared to SLK recipients and those with pre-transplant severe renal dysfunction in patients with NASH. This article is protected by copyright. All rights reserved.

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