Open Access Research article

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

Urs Wenger1, Thomas A Neff1, Christian E Oberkofler2, Manuel Zimmermann1, Paul A Stehberger1, Marcel Scherrer1, Reto A Schuepbach1, Silvia R Cottini1, Peter Steiger1 and Markus Béchir1*

Author Affiliations

1 Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, Zurich, CH 8091, Switzerland

2 Department of Visceral- and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland

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BMC Nephrology 2013, 14:37  doi:10.1186/1471-2369-14-37

Published: 14 February 2013

Abstract

Background

Renal failure with following continuous renal replacement therapy is a major clinical problem in liver transplant recipients, with reported incidences of 3% to 20%. Little is known about the significance of postoperative acute renal failure or acute-on-chronic renal failure to postoperative outcome in liver transplant recipients.

Methods

In this post hoc analysis we compared the mortality rates of 135 consecutive liver transplant recipients over 6 years in our center subject to their renal baseline conditions and postoperative RRT. We classified the patients into 4 groups, according to their preoperative calculated Cockcroft formula and the incidence of postoperative renal replacement therapy. Data then were analyzed in regard to mortality rates and in addition to pre- and peritransplant risk factors.

Results

There was a significant difference in ICU mortality (p=.008), hospital mortality (p=.002) and cumulative survival (p<.0001) between the groups. The highest mortality rate occurred in the group with RRT and normal baseline kidney function (20% ICU mortality, 26.6% hospital mortality and 50% cumulative 1-year mortality, respectively). The hazard ratio in this group was 9.6 (CI 3.2-28.6, p=.0001).

Conclusion

This study shows that in liver transplant recipient’s acute renal failure with postoperative RRT is associated with mortality and the mortality rate is higher than in patients with acute-on-chronic renal failure and postoperative renal replacement therapy.

Keywords:
Acute renal failure; Acute on chronic renal failure; Renal replacement therapy; Liver transplantation