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Abstract
Background
In the Model for End-Stage Liver Disease (MELD) era of organ allocation, renal replacement
therapy (RRT) has been done in many liver transplant patients. In this setting the
time and probability of kidney function recovery is essential for patient and transplant
program management.
Methods
In this study we evaluated a sample of stable post-intensive care dialysis patients
from a group of 297 adults who were submitted to orthotopic liver transplantation
(OLT) in an urban tertiary medical center from 1 June 2005 to 31 December 2009. We
evaluated the average time of renal function recovery (out of need for RRT) in OLT
patients on post-intensive care hemodialysis (HD) and determined risk factors for
chronic dialysis support during a 1-year follow-up period. Patients were censored
at recovery of kidney function, death on HD or end of the follow-up period. The Cox
proportional hazards model was used to compare the relative risk (RR) of remaining
or not in HD after 1 year and predictor variables.
Results
We evaluated the clinical records of 83 patients (50 ± 14 years, 64% male, 22% pre-OLT
diabetes mellitus (DM), 31% HCV-related disease, MELD 27.5 ± 11.8, 17% acute re-OLT,
37% pre-OLT RRT, pre-OLT serum creatinine 1.5 ± 1.4 mg/dl, 28% pre-OLT proteinuria).
During the study period, 70 (84%) patients were removed from dialysis; of these, six
(7%) remained on HD for more than 90 days until renal function recovery, 184 days
being the longest period required. Nine (11%) patients died on HD and only four (5%)
patients were on HD after 1 year. The median of recovery time was 28 days (from 6
to 184 days). Classic risk factors for renal disease, like age and DM, acute re-OLT
requirement and pre-OLT RRT, were significant predictors of chronic RRT. In the multivariate
analysis, the most important prognostic factor for chronic RRT was the presence of
pre-OLT RRT (HR = 1.89, 95% CI = 1.145 to 3.129, P = 0.013).
Conclusion
Given the shortage of available organs, kidney transplantation after or concomitant
to OLT must be considered cautiously, especially in OLT patients who were not submitted
to pre-OLT RRT.
This is an Open Access article distributed under the terms of the Creative Commons
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Conference name:
Sixth International Symposium on Intensive Care and Emergency Medicine for Latin America