Impact of Early Allograft Dysfunction on Renal Function Outcomes Following Liver Transplantation

Background and Objectives: Early allograft dysfunction (EAD) after liver transplantation (LT) is associated with adverse graft and patient outcomes. However, its effects on kidney outcomes remain unclear. We retrospectively investigated the association between EAD and various kidney events following LT. Materials and Methods: We included 92 LT recipients. EAD was defined by the presence of ≥1 of the following: total bilirubin level ≥ 10 mg/dL or international normalized ratio ≥ 1.6 on postoperative day 7, or aspartate aminotransferase or alanine aminotransferase level > 2000 U/L within the first 7 days post-LT. Kidney outcomes included acute kidney injury (AKI), acute kidney disease (AKD), kidney replacement therapy (KRT) performance, and changes in estimated glomerular filtration rate (eGFR). Results: AKI incidence was comparable between the non-EAD and EAD groups; however, stage 3 AKI incidence was higher in the EAD group (65.0% vs. 22.2%; p = 0.001). AKD occurred more frequently in the EAD group (75.0% vs. 30.6%, p = 0.001). KRT was required more frequently within 7 days of LT in the EAD group (70.0%) than in the non-EAD group (15.3%) (p < 0.001). Multivariate analysis identified EAD as an independent predictor of KRT requirement (p < 0.001). EAD was associated with prolonged (≥7 days) KRT requirement (p = 0.025). In the receiver operating characteristic curves, all EAD components were associated with KRT requirement following LT. The baseline and 3-month eGFR levels were comparable; however, a trend toward a steeper decline was noted in eGFR in the EAD group than that in the non-EAD group (p = 0.090). The burden of hospitalization and calcineurin inhibitor exposure were similar between the groups. Conclusions: EAD appears to be independently associated with adverse kidney outcomes following LT. Preventive strategies targeting EAD are required to improve post-transplant prognosis and mitigate kidney-related complications.