The Prognosis of Alcoholic Liver Disease Patients with Acute Kidney Injury: Chances of Survival and Transplantation

The Prognosis of Alcoholic Liver Disease Patients with Acute Kidney Injury: Chances of Survival and Transplantation

compared to the DDLT group. LDLT remains a promising and effective intervention in patients with end stage liver without access to deceased donors. Pr...

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compared to the DDLT group. LDLT remains a promising and effective intervention in patients with end stage liver without access to deceased donors. Primary outcomes

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Expedited Liver Transplant enables recovery of renal function in patients with high MELD (MELD ≥35) on renal replacement therapy at the time of isolated liver transplant. Background: A significant number of patients with high MELD score are on renal replacement therapy (RRT) at the time of transplant and only receive Liver Transplant (LT). Transplant physicians face clinical dilemma whether these patients would recover their renal function or they would be better served by simultaneous liver kidney transplantation. Our aim was to evaluate long term renal outcomes of patients with MELD≥35, who received LT while on RRT. Methods: We reviewed records of 1200 patients to identify patients with a MELD ≥35 who received liver transplant at our institution. Patients who received simultaneous liver and kidney transplant were excluded. Demographic data, etiology of liver disease, history of diabetes, renal sonogram features, duration of RRT pre-transplant and wait time for transplant were collected. Renal outcome was assessed at 1 month, 3 month, and 1 year based on the need and duration of renal replacement therapy after liver transplant and GFR (by MDRD formula). Number of patients who developed CKD 3 (GFR < 60ml/min) at 1 year after transplantation were identified. Additional outcome variables such as length of stay and survival were also analyzed. Results: We identified 85 patients with MELD from our database between 2006-2015. Median wait time after listing with MELD of ≥35 was 3.2±1.8 days. There were 23 deaths among this group of patients and 25 patients developed CKD 3 (GFR < 60ml/min) at 1 year. Table 1 outlines the clinical features and outcome in patients who received RRT vs those who did not need RRT prior to LTA. 41 patients were on RRT at the time of liver transplantation. Only 5 patients required long term dialysis after liver transplant and 2 required subsequent renal transplant, indicating complete recovery of renal function in majority of patients. The occurrence of CKD was similar between the patients who were on RRT and those who were not on RRT. Kaplan Meier survival analysis did not show a difference in survival between on RRT compared to those who were not on RRT (log rank test p value =not significant). Conclusion: The short wait time in patients with MELD ≥35 enables excellent recovery of renal function in patients on RRT and is similar to those not receiving RRT at the time of transplant. Expedited transplant with "Share 35" policy is likely to reduce the need for a future kidney transplant in patients who are on RRT at the time of liver transplant. Table 1

Total sample size = 870, DDLT = 801, LDLT =69. Secondary Outcomes

Su1423 THE PROGNOSIS OF ALCOHOLIC LIVER DISEASE PATIENTS WITH ACUTE KIDNEY INJURY: CHANCES OF SURVIVAL AND TRANSPLANTATION Adrienne Lenhart, Salwa Hussain, Reena Salgia Background: Acute kidney injury (AKI) in the setting of alcoholic liver disease (ALD) portends a poor prognosis in the absence of a liver transplant (LT). There is limited data on the outcome of renal replacement therapy (RRT) in patients with alcoholic hepatitis as a bridge to future transplant candidacy. Using a single-center tertiary care patient population, the primary aim was to evaluate the outcomes of RRT in patients with ALD and AKI with less than 6 months sobriety. The secondary aim was to determine patient factors that predict renal recovery and overall survival. Methods: Patients with ALD, defined as alcoholic hepatitis and/or alcoholic cirrhosis, with concurrent AKI secondary to hepatorenal syndrome (HRS) or acute tubular necrosis (ATN) were identified from January 2010 through December 2015. ALD was confirmed using history of alcohol use, lab values, and imaging. AKI was defined using standard definitions and urine sediments. Included patients were not considered LT candidates due to < 6 months sobriety. Patients with non-alcoholic liver disease or chronic kidney disease were excluded. Factors analyzed included patient age, gender, BMI, intermittent hemodialysis (iHD), continuous renal replacement therapy (CRRT), hepatorenal cocktail, MELD-Na score, Maddrey discriminant function (MDF), and comorbidities of hypertension, diabetes, and CAD. Results: A total of 47 patients were included (median MELD-Na score: 32 and MDF: 71). Of these patients, 21.3% (n=10) survived a 6-month sobriety period to be eligible for LT evaluation. Despite initiation of RRT, overall mortality of the cohort was 78.7%. Out of the 10 patients that survived, 4 received simultaneous liver-kidney (SLK) transplants and 6 recovered liver/kidney function and did not need transplant. Both MELDNa and MDF did not predict 6-month survival or renal recovery. Use of the hepatorenal cocktail also had no significant impact on 6-month survival or renal improvement. When comparing the etiology of AKI between HRS and ATN, there was no significant difference in survival or renal recovery. Modality of initial RRT with iHD compared to CRRT predicted improved survival (70% vs 10.3%, p=0.01) and nearly reached significance for renal recovery (40% vs 7.4%, p=0.05). Although age, gender, BMI, and other comorbidities did not correlate with survival or renal recovery, presence of hypertension favored renal recovery (66.7% with recovery vs 17.1% without recovery, p=0.02). Conclusion: Although ALD with AKI carries a high mortality irrespective of the etiology of renal failure, over 20% of patients in this study survived >6 months to be evaluated for LT. Among these patients, 40% received SLK transplants and 60% recovered and did not require transplant. In the inpatient assessment of patients with coexistent ALD and AKI, these outcomes should be considered when weighing the decision of RRT.

* P Value < 0.05

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AASLD Abstracts

AASLD Abstracts

EXPEDITED LIVER TRANSPLANT ENABLES RECOVERY OF RENAL FUNCTION IN PATIENTS WITH HIGH MELD (MELD ≥35) ON RENAL REPLACEMENT THERAPY AT THE TIME OF ISOLATED LIVER TRANSPLANT Bilal Ali, Chiranjeevi Gadiparthi, George Cholankeril, Sanjaya K. Satapathy, James Eason, Satheesh Nair