Beginning Kidney Replacement Therapy Before or After Liver Transplantation: Does the Timing of Dialysis Matter? A Cohort Study.

@article{scherer2026beginning,
  title = {{Beginning Kidney Replacement Therapy Before or After Liver Transplantation: Does the Timing of Dialysis Matter? A Cohort Study.}},
  author = {Patricia Faria Scherer and Adriano Luiz Ammirati and Bento Fortunato Cardoso Dos Santos and Julio Cesar Martins Monte and Marcelo Costa Batista and Marisa Petrucelli Doher and Oscar Fernando Pavão Dos Santos and Thais Nemoto Matsui and Thiago Domingos Corrêa and Virgílio Gonçalves Pereira and Carolina Devite Bittante and Marcelino de Souza Durão},
  journal = {Journal of transplantation},
  year = {2026},
  month = oct,
  doi = {10.1155/joot/6880648},
  url = {https://europepmc.org/article/MED/42903445},
  note = {CC BY},
}

TY  - JOUR
TI  - Beginning Kidney Replacement Therapy Before or After Liver Transplantation: Does the Timing of Dialysis Matter? A Cohort Study.
AU  - Patricia Faria Scherer
AU  - Adriano Luiz Ammirati
AU  - Bento Fortunato Cardoso Dos Santos
AU  - Julio Cesar Martins Monte
AU  - Marcelo Costa Batista
AU  - Marisa Petrucelli Doher
AU  - Oscar Fernando Pavão Dos Santos
AU  - Thais Nemoto Matsui
AU  - Thiago Domingos Corrêa
AU  - Virgílio Gonçalves Pereira
AU  - Carolina Devite Bittante
AU  - Marcelino de Souza Durão
PY  - 2026
DA  - 2026/10/19
JO  - Journal of transplantation
DO  - 10.1155/joot/6880648
UR  - https://europepmc.org/article/MED/42903445
AB  - Introduction  Acute kidney injury (AKI) in liver transplant patients is associated with increased morbidity, mortality, and reduced graft survival. However, the impact of the timing of dialysis initiation-before versus after transplantation-remains unclear.Objectives  To characterize liver transplant recipients with Kidney Disease: Improving Global Outcomes (KDIGO) Stage 3 AKI-requiring dialysis (AKI-D) according to the timing of kidney replacement therapy (KRT) initiation (pre- versus posttransplant) and to evaluate 90-day mortality. Secondary objectives included identifying independent predictors of dialysis dependence and assessing liver graft function at 90 days.Methods  This retrospective, single-center cohort study included all consecutive adult liver transplant recipients who received dialysis in a Brazilian intensive care unit (ICU) between 1999 and 2015. The study was approved by the Research Ethics Committee of the Federal University of Sao Paulo (UNIFESP), with a waiver of informed consent. Patients were grouped according to the timing of dialysis initiation: pre- or postliver transplantation. Multiple logistic regression was used to identify predictors of 90-day mortality and dialysis dependence. Ninety-day liver graft survival was analyzed using a multivariate Cox model.Results  A total of 356 liver transplant patients with AKI-D were included. Of these, 109 (30.6%) initiated dialysis within 4 weeks before transplantation and 247 (69.4%) within 4 weeks after transplantation. The timing of dialysis initiation was not associated with 90-day mortality or dialysis dependence. Independent predictors of 90-day mortality included graft dysfunction and use of continuous KRT as the initial modality. Impaired pretransplant renal function and a history of diabetes mellitus were predictors of 90-day dialysis dependence. Posttransplant dialysis was associated with a twofold increased risk of liver graft failure.Conclusion  The timing of dialysis initiation (pre- versus posttransplantation) was not associated with 90-day mortality or dialysis dependence. However, initiation of dialysis after transplantation was associated with an increased risk of liver graft dysfunction.
SN  - 2090-0007
SN  - 2090-0015
ER  -