PO069 – AKD according to KDIGO Guideline in ADVANCED LIVER CIRRHOSIS: FLUCTUATION of eGFR and OUTCOME POST-TRANSPLANTION

Autori: F. Fiacco (1), F. Melandro (2), I. Umbro (3), A. Zavatto (1), A. Cappoli (1), E. Poli (1), S. Ginanni Corradini (1), M. Merli (1), F. Tinti (3), P.B. Berloco (2), M. Rossi (2), A.P. Mitterhofer (1)
Affiliazioni:  (1) Department of Clinical Medicine (2) Transplant Unit (3) Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Policlinico Umberto I, Sapienza University of Rome

Introduction: Renal dysfunction in end stage liver disease (ESLD) can occur as a result of systemic conditions that affect both the liver and the kidney with activation of vasoconstrictor systems, decrease of renal blood flow, ultimately leading to chronic kidney ischaemia. In this scenario patients are particularly prone to isolated decrease of glomerular filtration rate (GFR) from the baseline. According to KDIGO guideline, acute kidney injury (AKI) is defined as increase in sCr≥50% within 7 days or 0.3 mg/dl within 48 hours, chronic kidney disease (CKD) as GFR<60 ml/min for >3 months and acute kidney disease (AKD) as decrease in GFR≥35% for <3 months. However the assessment of parameters required for each diagnosis, such as baseline eGFR, its variations and timing during follow-up, are challenging especially in outpatients monitoring and AKI, CKD and AKD represent overlapping syndromes. The presence of eGFR variations in patients with ESLD and its effect on renal function before and after liver transplantation (Tx) has been poorly studied and not completely clarified.

The aim of this study is to evaluate eGFR variations in ESLD and to investigate the association with post-Tx outcome, in terms of early and long term renal function and patient survival.

Methods: Single Centre study from a cohort of 112 waitlisted patients for Tx in the Liver Unit of Sapienza University of Rome; from this cohort all patients transplanted from October 2008 to October 2011 were considered (59 patients). Acute liver failure (4 patients) and combined liver-kidney transplants (4 patients) were excluded.  Fifty-one transplantation recipients were retrospectively evaluated from listing to transplant (L-Tx time), intra-operatively (Tx time) and up to 5 years post-transplant (post-Tx time). Variations between the highest and the lowest eGFR occurring within 3 months were considered as fluctuations (eGFR-F). Fluctuations of eGFR >50% were defined as eGFR drops (DeGFR). Early graft dysfunction (EGD), AKI within 7 days, CKD and short and long term patient survival were considered as outcomes.

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

&nbsp;

Results: All patients presented eGFR-F, whereas DeGFR were present in 18/51 (35.3%) (DeGFR+ group). These patients presented higher levels of Model for End-stage Liver Disease (MELD) score, pre-Tx bilirubin and a significantly greater incidence of post-Tx AKI stages 2-3 compared to patients without drops (DeGFR-). In post-Tx time, AKI occurred in 26 out of 51 (51%) recipients. Among them, 15/26 (58%) presented AKI stage 1, 8/26 (31%) stage 2, and 3/26 (11%) stage 3. In particular, AKI stages 2-3 occurred in 8/18 (44%) DeGFR+ compared to 3/33 (9%) DeGFR- recipients.

Among all variables considered at multivariable logistic regression analysis, DeGFR was the only independent predictive factor of the occurrence of AKI post-Tx. The occurrence of AKI post-Tx was associated with the development of CKD at 3 months and 5 years post-Tx. Survival at 5 years post-Tx was 80.4% (41/51 patients), divided between the two groups as follows: 72.2% (13/18 patients) in DeGFR+ vs. 84.8% (28/33 patients) in DeGFR-.

 Conclusions: Drops of eGFR, recognized by KDIGO guideline for diagnosis of AKD, are more frequently observed in patients with a worse degree of ESLD and are associated with a worse post-Tx kidney outcome.

Bibliografia: