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• W2954111203 abstract "Liver transplantation has been a life-saving treatment for many patients with end-stage liver failure and long-term graft survival is desired. Although pre-transplantation renal function has an impact on patient survival, previous reports were based mainly on deceased donor liver transplantation. Living donor liver transplantation (LDLT) is associated with lower recipient mortality and is performed less frequently than deceased donor liver transplantation. Consequently, there are few reports investigating the effect of renal function on prognosis in LDLT. Hepatorenal syndrome plays a crucial role in deteriorated renal function before transplantation, but associated factors remain to be elucidated. Therefore, we investigated the significance of renal function in LDLT from a nephrologist’s view point. We studied 248 patients who received LDLT in our hospital between 1998–2017 to elucidate the risk factors for poor prognosis. Patient information including age, sex, causes of liver dysfunction, history of diabetes or hypertension was collected along with donor background information and results of blood examinations. The clinical course after LDLT was observed and the primary endpoint was graft loss. Survival time analysis and Cox multivariate regression analysis were performed. Multivariate regression analyses were performed to determine the factors associated with renal function before and after LDLT. Patient characteristics were: 53.9 ± 11.7 years of age at transplantation, 143 men and 105 women. The average observation period was 5.5±4.9 years. Among 248 patients, 85 patients reached the endpoint. According to survival analysis, transplanted liver prognoses were significantly worsened in patients with chronic kidney disease (estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2) (p <0.05, Log-rank test). Prognoses in patients who needed hemodialysis during the perioperative period were significantly worse (p <0.001). Cox regression model, adjusted for donor and recipient ages, sex, HCV infection, history of diabetes and hypertension, and eGFR showed that recipient age (p <0.01, HR 1.04), donor age (p <0.001, HR 1.03) and lower eGFR (p = 0.03, HR 0.990) were independent risk factors for poor prognosis. Multivariate regression analysis indicated that hemoglobin, bilirubin, prothrombin time, serum albumin, recipient age, presence of hematuria, and use of diuretics were significantly associated with pre-transplant renal function. Among these, use of diuretics and presence of hematuria were not associated with eGFR at one year after LDLT. eGFR was more strongly correlated with graft prognosis (p = 0.01, HR 0.984) in another COX proportional multivariate regression model which factored in the use of diuretics and presence of hematuria, in addition to previously described variables. Pre-transplant renal function was shown to be a strong predictor for prognosis following LDLT. As liver transplantation resolves hepatorenal syndrome and liver cirrhosis, we should evaluate pre-transplant renal function, considering whether the associated factors would affect post-transplant renal function. On the contrary, renal function, after adjusting for reversible factors such as use of diuretics, could predict prognosis more accurately after LDLT." @default.
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• W2954111203 date "2019-07-01" @default.
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• W2954111203 title "SAT-274 PRE-TRANSPLANT RENAL FUNCTION PREDICTS TRANSPLANTED LIVER PROGNOSES IN LIVING DONER LIVER TRANSPLANTATION" @default.
• W2954111203 doi "https://doi.org/10.1016/j.ekir.2019.05.311" @default.
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