Renal replacement therapy prior to liver transplant and inpatient mortality in patients without advanced kidney disease: A nationwide study

Abstract

Abstract Background and Aim The utility of renal replacement therapy (RRT) before liver transplant (LT) in patients without end‐stage renal disease (ESRD) or advanced chronic kidney disease (CKD‐IV/V) is debatable and lacks data support. We aimed to evaluate the impact of RRT on patients undergoing LT. Methods We used the National Readmission Database (2016–2019) to identify all index hospitalizations undergoing RRT before LT (cases). A matched comparison cohort of similar hospitalizations without RRT before LT was identified (controls) after 1:1 propensity score matching for age, gender, and available comorbidities. Results We matched 364 cases (RRT before LT) to 364 controls (LT without prior RRT). There was no statistical difference in all‐cause inpatient mortality (4.9% vs 3.6% P = 0.4). A significantly greater proportion of cases were associated with ICU admission (40.7% vs 17.0%, P < 0.001) and RRT requirement post LT (100% vs 17%, P < 0.001). There was no difference in 30‐ (hazard ratio [HR] 1.1, 0.4–2.6), 60‐ (HR 0.9, 0.4–1.8), or 90‐day (HR 0.8, 0.4–1.6) inpatient mortality between the groups. Also, 180‐day survival estimates were comparable (P = 0.5). The results were similar in patients with no chronic kidney disease (CKD) and CKD‐III. Conclusion RRT prior to LT, in patients without advanced CKD or ESRD, was associated with greater instances of ICU stay and need for future RRT. Also, 30‐, 60‐, and 90‐day inpatient mortality rates were similar, and 180‐day survival estimates were comparable.

Keywords

• liver transplant
• nationwide analysis
• renal replacement therapy