TY - JOUR
T1 - Decreased survival in liver transplant patients requiring chronic dialysis
T2 - A Canadian experience
AU - Al Riyami, Dawood
AU - Alam, Ahsan
AU - Badovinac, Kim
AU - Ivis, Frank
AU - Trpeski, Lilyanna
AU - Cantarovich, Marcelo
PY - 2008/5
Y1 - 2008/5
N2 - BACKGROUND. Chronic kidney disease is associated with increased mortality among nonrenal organ transplant recipients. End-stage renal disease (ESRD) is a serious complication after orthotopic liver transplantation (OLT). It is unclear if the outcomes of these individuals are different from nontransplant patients requiring dialysis or a kidney transplant. METHODS. We report the incidence of ESRD in OLT recipients and compare their outcomes to matched dialysis controls. We analyzed 4186 patients who received an OLT in Canada between January 1981 and December 2002 and 228 matched, nontransplant, chronic dialysis controls. RESULTS. The incidence of ESRD after OLT was 2.9% (n=120). The unadjusted mortality rate for those who required chronic dialysis was 49.2% compared with 26.8% in those who did not develop kidney failure (P<0.0001). The survival of OLT recipients on dialysis was lower than the matched chronic dialysis cohort (log-rank test, P=0.01). A kidney transplant was performed in 24% of the OLT recipients and 21% of the matched dialysis cohort, and their overall survival was similar. The OLT patients who remained on dialysis had a significantly lower survival when compared with matched dialysis patients who did not receive a kidney transplant (log-rank test, P=0.0002). CONCLUSIONS. Mortality was greater for OLT recipients on dialysis than would be expected from a matched, nontransplant, dialysis cohort. Kidney transplantation may abrogate some of this increased mortality risk.
AB - BACKGROUND. Chronic kidney disease is associated with increased mortality among nonrenal organ transplant recipients. End-stage renal disease (ESRD) is a serious complication after orthotopic liver transplantation (OLT). It is unclear if the outcomes of these individuals are different from nontransplant patients requiring dialysis or a kidney transplant. METHODS. We report the incidence of ESRD in OLT recipients and compare their outcomes to matched dialysis controls. We analyzed 4186 patients who received an OLT in Canada between January 1981 and December 2002 and 228 matched, nontransplant, chronic dialysis controls. RESULTS. The incidence of ESRD after OLT was 2.9% (n=120). The unadjusted mortality rate for those who required chronic dialysis was 49.2% compared with 26.8% in those who did not develop kidney failure (P<0.0001). The survival of OLT recipients on dialysis was lower than the matched chronic dialysis cohort (log-rank test, P=0.01). A kidney transplant was performed in 24% of the OLT recipients and 21% of the matched dialysis cohort, and their overall survival was similar. The OLT patients who remained on dialysis had a significantly lower survival when compared with matched dialysis patients who did not receive a kidney transplant (log-rank test, P=0.0002). CONCLUSIONS. Mortality was greater for OLT recipients on dialysis than would be expected from a matched, nontransplant, dialysis cohort. Kidney transplantation may abrogate some of this increased mortality risk.
KW - Chronic dialysis
KW - ESRD
KW - Kidney transplantation
KW - Liver transplantation
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=43449133300&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=43449133300&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e31816c4e6b
DO - 10.1097/TP.0b013e31816c4e6b
M3 - Article
C2 - 18475183
AN - SCOPUS:43449133300
SN - 0041-1337
VL - 85
SP - 1277
EP - 1280
JO - Transplantation
JF - Transplantation
IS - 9
ER -