Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Liver Transpl. 2024 Nov 1;30(11):1106-1115. doi: 10.1097/LVT.0000000000000445. Epub 2024 Jul 30.
Acute kidney injury (AKI) frequently complicates the course of hospitalized patients with cirrhosis and negatively affects their prognosis. How AKI response influences the timing of liver transplantation (LT) remains unclear. We sought to assess the impact of AKI response to treatment on survival and LT rates in patients with cirrhosis awaiting LT. This was a retrospective multicenter study of cirrhosis patients waitlisted for LT and hospitalized with AKI in 2019. The exposure was AKI response versus no response during hospitalization. Outcomes were 90-day overall and transplant-free survival, and rates of LT with time to transplant. We adjusted for age, sex, race, cirrhosis etiology, site, and Model for End-Stage Liver Disease-Sodium (MELD-Na) score. Among the 317 patients in this study, 170 had an AKI response (53.6%), and 147 had no response (46.4%). Compared to nonresponders, responders had better 90-day overall survival (89.4% vs. 76.2%, adjusted subhazard ratio for mortality 0.34, p =0.001), and transplant-free survival (63.5% vs. 25.2%, aHR for probability of death or transplant 0.35, p <0.001). The LT rate was lower in responders (45.9% vs. 61.2%, adjusted subhazard ratio 0.55, p =0.005); 79% of transplants in responders occurred after discharge, at a median of 103 days, while 62% of transplants in nonresponders occurred during hospitalization, with the remainder occurring postdischarge at a median of 58 days. In patients with cirrhosis waitlisted for LT who are hospitalized with AKI, AKI response to therapy is associated with improved 90-day survival, despite a reduced LT rate and longer time to LT.
急性肾损伤（AKI）常使住院肝硬化患者的病情复杂化，并对其预后产生负面影响。AKI 反应如何影响肝移植（LT）的时机仍不清楚。我们旨在评估肝硬化患者 AKI 治疗反应对等待 LT 患者的生存率和 LT 率的影响。这是一项回顾性多中心研究，纳入了 2019 年因 AKI 住院的等待 LT 的肝硬化患者。暴露因素为住院期间 AKI 的反应与无反应。结局为 90 天整体和无移植生存率，以及随时间推移进行 LT 的比率。我们调整了年龄、性别、种族、肝硬化病因、部位和终末期肝病模型钠（MELD-Na）评分。在这项研究的 317 名患者中，170 名患者有 AKI 反应（53.6%），147 名患者无反应（46.4%）。与无反应者相比，有反应者的 90 天整体生存率更好（89.4% vs. 76.2%，死亡率调整后的亚危险比为 0.34，p=0.001），无移植生存率也更好（63.5% vs. 25.2%，死亡或移植的概率调整后的亚危险比为 0.35，p<0.001）。反应者的 LT 率较低（45.9% vs. 61.2%，调整后的亚危险比为 0.55，p=0.005）；反应者中 79%的移植发生在出院后，中位数为 103 天，而非反应者中 62%的移植发生在住院期间，其余的发生在出院后，中位数为 58 天。在因 AKI 住院的等待 LT 的肝硬化患者中，尽管 LT 率降低且 LT 时间延长，但治疗后 AKI 反应与改善的 90 天生存率相关。
