Liver and Bile
Hepatology. 2022;76(4):1069–78
Variability in serum creatinine is associated with waitlist and post-liver transplant mortality in patients with cirrhosis
Background and aims: Kidney function in patients with cirrhosis is dynamic. After controlling for the presence of chronic kidney disease (CKD) and acute kidney injury (AKI), the authors investigated the impact of variation in clinical function on pre-liver transplantation (LT) and post-LT outcomes.
Approach and results: They included adults listed for LT from 2011 through 2018 and excluded those with any exceptions, those on hemodialysis at listing, and those with fewer than 3 clinical updates in the United Network for Organ Sharing database. The primary exposure was the serum creatinine coefficient of variation (sCr CoV). Logistic regression determined the associations between the exposures and higher sCr CoV. Competing risk regression determined the associations between the exposures and waitlist mortality, accounting for LT as a competing risk. Cox regression determined the associations between the exposures and either listing for kidney transplant or death. The authors divided this cohort into tertiles of sCr CoV: low variability, 8.8% (interquartile range [IQR], 6.6–10.8%); intermediate variability, 17.4% (IQR, 14.8–20.4%); high variability, 36.8% (IQR, 29.5–48.8%). They demonstrate that women, those with CKD, and those with advanced liver disease were more likely to have a greater sCr CoV. Compared to those with low variability, those with high variability had significantly higher waitlist mortality (34.7% vs. 19.6% vs. 11.7%, p < 0.001). They highlight that the sCr CoV was associated with higher waitlist and post-LT mortality – an association independent of baseline sCr, the degree of underlying liver disease, the presence of AKI, or the presence of CKD.
Conclusion: This study informs the long-term impact of the variation in kidney function one can see in clinical practice. These data highlight that all fluctuations in serum creatinine are associated with worse pre- and post-liver transplantation outcomes.