PMID- 35357707
OWN - NLM
STAT- MEDLINE
DCOM- 20220922
LR  - 20240229
IS  - 1527-3350 (Electronic)
IS  - 0270-9139 (Print)
IS  - 0270-9139 (Linking)
VI  - 76
IP  - 4
DP  - 2022 Oct
TI  - Variability in serum creatinine is associated with waitlist and post-liver 
      transplant mortality in patients with cirrhosis.
PG  - 1069-1078
LID - 10.1002/hep.32497 [doi]
AB  - 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), we investigated the impact of variation in clinical function on 
      pre-liver transplantation (LT) and post-LT outcomes. APPROACH AND RESULTS: We 
      included adults listed for LT from 2011 through 2018. We excluded those with any 
      exceptions, those on hemodialysis at listing, and those with fewer than three 
      clinical updates in the United Network for Organ Sharing database. Our primary 
      exposure was the serum creatinine coefficient of variation (sCr CoV). Logistic 
      regression determined the associations between our exposures and higher sCr CoV. 
      Competing risk regression determined the associations between our exposures and 
      waitlist mortality, accounting for LT as a competing risk. Cox regression 
      determined the associations between our exposures and either listing for kidney 
      transplant or death. We divided our 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%). We 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). We 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 we all see in clinical practice. These 
      data highlight that all fluctuations in sCr are associated with worse pre-LT and 
      post-LT outcomes.
CI  - (c) 2022 American Association for the Study of Liver Diseases.
FAU - Cullaro, Giuseppe
AU  - Cullaro G
AUID- ORCID: 0000-0002-2935-0245
AD  - Department of Medicine, University of California-San Francisco, San Francisco, 
      California, USA.
FAU - Hsu, Chi-Yuan
AU  - Hsu CY
AD  - Division of Nephrology, Department of Medicine, University of California-San 
      Francisco, San Francisco, California, USA.
FAU - Lai, Jennifer C
AU  - Lai JC
AUID- ORCID: 0000-0003-2092-6380
AD  - Department of Medicine, University of California-San Francisco, San Francisco, 
      California, USA.
LA  - eng
GR  - K23 AG048337/AG/NIA NIH HHS/United States
GR  - P30 DK026743/DK/NIDDK NIH HHS/United States
GR  - L30 DK133959/DK/NIDDK NIH HHS/United States
GR  - K23AG048337/AG/NIA NIH HHS/United States
GR  - R01 AG059183/AG/NIA NIH HHS/United States
GR  - R01AG059183/AG/NIA NIH HHS/United States
GR  - K23 DK131278/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20220415
PL  - United States
TA  - Hepatology
JT  - Hepatology (Baltimore, Md.)
JID - 8302946
RN  - AYI8EX34EU (Creatinine)
SB  - IM
CIN - Hepatology. 2023 Aug 1;78(2):E35-E36. PMID: 37119206
CIN - Hepatology. 2023 Aug 1;78(2):E33-E34. PMID: 37119211
MH  - *Acute Kidney Injury
MH  - Adult
MH  - Creatinine
MH  - Female
MH  - Humans
MH  - Liver Cirrhosis/complications/surgery
MH  - *Liver Transplantation
MH  - *Renal Insufficiency, Chronic/complications/surgery
MH  - Retrospective Studies
MH  - Waiting Lists
PMC - PMC10321149
MID - NIHMS1904956
COIS- Dr. Cullaro received grants from Mallinckrodt. Dr. Lai consults for Axcella 
      Health.
EDAT- 2022/04/01 06:00
MHDA- 2022/09/23 06:00
PMCR- 2023/10/01
CRDT- 2022/03/31 12:07
PHST- 2022/03/14 00:00 [revised]
PHST- 2022/02/14 00:00 [received]
PHST- 2022/03/20 00:00 [accepted]
PHST- 2022/04/01 06:00 [pubmed]
PHST- 2022/09/23 06:00 [medline]
PHST- 2022/03/31 12:07 [entrez]
PHST- 2023/10/01 00:00 [pmc-release]
AID - 10.1002/hep.32497 [doi]
PST - ppublish
SO  - Hepatology. 2022 Oct;76(4):1069-1078. doi: 10.1002/hep.32497. Epub 2022 Apr 15.