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Patients with cirrhosis awaiting liver transplant who responded to treatment for acute kidney injury had better 90-day survival outcomes but fewer transplants.
Patients with cirrhosis awaiting liver transplantation (LT) who responded positively to treatment for acute kidney injury (AKI) experienced meaningfully better 90-day survival rates despite a diminished rate of liver transplant and longer wait times for transplantation, according to a retrospective multicenter study published in Liver Transplantation.
“AKI frequently complicates the course of hospitalized patients with cirrhosis and negatively affects their prognosis,” Andrew S. Allegretti, MD, MSc, and colleagues wrote. “How AKI response influences the timing of LT remains unclear.”
In the HRS-HARMONY consortium study, the investigators aimed to evaluate the impact of AKI response to treatment on survival and LT rates in cirrhosis patients awaiting LT. Dr. Allegretti and colleagues noted that AKI often complicates prognosis and outcomes for hospitalized patients with cirrhosis.
The study included 317 patients with cirrhosis awaiting LT who were hospitalized with AKI at 11 transplant centers in the US. Dr. Allegretti and colleagues assessed the patients’ response to AKI treatment and measured outcomes such as 90-day survival, liver transplantation rates, and resource utilization during hospitalization.
Among 317 patients, 170 (53.6%) responded to AKI treatment, while 147 (46.4%) did not. Responders had significantly better 90-day overall survival (89.4% vs. 76.2%) and transplant-free survival (63.5% vs 25.2%) when compared with non-responders. However, patients who responded to AKI treatment reported a lower liver transplant rate (45.9% vs 61.2%). Among responders, 79% of transplants occurred after discharge, at an average of 103 days, while 62% of transplants in non-responders transpired during hospitalization, with the remainder occurring post-discharge at an average of 58 days, whereas 62% of transplants in non-responders occurred during hospitalization, with the remainder occurring post-discharge 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,” Dr. Allegretti and colleagues wrote.
