Abstract: SA-PO055
Outcomes of CRRT in Patients with End Stage Liver Disease (ESLD)
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Spolnik, Margaret, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Gardner, Maryn, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Ghabril, Marwan, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Orman, Eric S., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Moe, Sharon M., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Anderson, Melissa D., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
Patients with ESLD have high mortality when dialysis is required. In 2015, a hepato-renal service was started in order to improve outcomes of patients with combined kidney-liver failure. We compared outcomes of all ESLD patients that underwent CRRT (venous-venous hemofiltration) before and after the implementation of the novel inpatient rounding service.
Methods
Patients undergoing CRRT with a concomitant diagnosis of ESLD (based on ICD-9/10 codes) were identified in the pre year (all of 2013 n = 46) and the post hepatorenal service year (all of 2016, n = 39). Charts were then manually reviewed to confirm diagnoses, and compare the cohorts by t-test/Mann/Whitney for continuous variables, and chi-square/Fisher's exact for categorical variables.
Results
There were no differences in the two cohorts (2013 and 2016) for age, gender, BMI, cause of ESLD, ascites, etoh intake, smoking and baseline co-morbidities on admission. More patients had a history of CKD in 2013 than in 2016 (p<0.002). CRRT was started after 4 and 7 days from admission (median, 2013 and 2016 respectively). At the time of initiation of CRRT, there was no difference between the two cohorts in laboratory data (albumin, sodium, INR, creatinine, bilirubin), or MELD score. The outcomes of patients in both cohorts are shown in Table 1.
Conclusion
Patients with ESLD requiring CRRT have very high mortality within 90 days unless transplanted, higher than predicted by MELD scores. The implemtation of a hepato-renal inpatient rouding service staffed by both Nephrology and Hepatology facilitated collaborative and consistent decisions about goals of care in these critically ill patients, increasing the proportion of patients transplanted.
Outcomes of ESLD patients receiving CRRT
| Admit MELD Score (mean/SD) | Transplanted p = 0.04 | Alive at 30 days from admission | Alive at 90 days from admission (p = 0.35) | Discharged home/LTAC at 90 days (p = 1.0) | ||
| 2013 | 33 ± 7.0 | 0 out of 46 | 6 out of 46 | 4 (8%) | 3 | |
| 2016 | 31 ± 7.2 | 5 out of 39 (three livers, one liver-kidney, one multi-visceral) | 7 out of 39 (3 on dialysis, 4 transplant) Multi visceral tx died | 7 (18%) | 6 | |