Background Hepatorenal syndrome-acute kidney injury (HRS-AKI) is a complication of advanced liver disease in patients with ascites and circulatory dysfunction. Little data remain on the relationship between HRS-AKI outcomes and different etiologies of liver disease post-liver transplant (LT). Objectives The primary aim was to evaluate the effect of HRS-AKI on renal outcomes in patients with acute alcohol-associated hepatitis (AAH) compared to chronic liver disease (CLD) after LT. The secondary aim was to evaluate the impact of acuity and chronicity of alcohol-associated liver disease in patients with HRS-AKI post-LT renal outcomes. Design A retrospective observational study of patients undergoing urgent inpatient liver transplant evaluation (LTE) for cirrhosis and AAH at single academic LT center between October 2017 and July 2021 was conducted. Methods Patients with HRS-AKI were selected based on indication for LTE: acute AAHHRS or CLDHRS. CLDHRS was categorized by disease etiology: cirrhosis due to alcohol (A-CLDHRS) versus cirrhosis from other causes (O-CLDHRS). CLD patients without HRS-AKI were labeled CLDno HRS. Results A total of 210 subjects underwent LTE; 25% were evaluated for AAH and 75% were evaluated for CLD. Hepatorenal syndrome was more common in subjects evaluated for AAH (37/47) than CLD (104/163) (78.7 versus 63.8%, p = 0.04). For the primary outcome, AAHHRS subjects required ⩾30 days post-LT renal replacement therapy (RRT) more often than subjects with CLDHRS (p = 0.02) and CLDno HRS (p < 0.01). There was no significant difference in other forms of long-term renal outcomes including kidney transplant referral and kidney transplant among cohorts. In subgroup analysis, 30-days post-LT RRT was more common in AAHHRS than in A-CLDHRS (p = 0.08). Logistic regression showed that AAHHRS conferred a 20× and 3.3× odds of requiring ⩾30 days post-LT RRT compared to CLDno HRS and CLDHRS, respectively. Postoperative complications were similar across cohorts, but had a significant effect on 30-day renal outcome post-LT. Conclusions Patients with AAH were more likely to develop HRS and require RRT pre- and post-LT at our center. The etiology of hepatic decompensation and postoperative complications affect renal recovery post-LT. The systemic inflammation of AAH in addition to conditions favoring renal hypoperfusion may contribute to the unfavorable outcomes of HRS-AKI after LT in this patient population.

中文翻译：

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急性酒精相关性肝炎中肝肾综合征-急性肾损伤的进展：肝移植后的肾脏结局。

背景 肝肾综合征-急性肾损伤（HRS-AKI）是腹水和循环功能障碍患者晚期肝病的并发症。关于 HRS-AKI 结局与肝移植 (LT) 后肝病不同病因之间关系的数据很少。目的 主要目的是评估 LT 后 HRS-AKI 对急性酒精相关性肝炎 (AAH) 患者与慢性肝病 (CLD) 患者肾脏结局的影响。第二个目的是评估酒精相关性肝病的严重程度和慢性程度对 HRS-AKI LT 后肾脏结局的影响。设计 对 2017 年 10 月至 2021 年 7 月期间在单一学术 LT 中心接受紧急住院肝移植评估 (LTE) 肝硬化和 AAH 的患者进行了回顾性观察研究。方法 根据 LTE 适应症选择 HRS-AKI 患者：急性 AAHHRS 或 CLDHRS。CLDHRS 按疾病病因分类：酒精性肝硬化 (A-CLDHRS) 与其他原因引起的肝硬化 (O-CLDHRS)。没有 HRS-AKI 的 CLD 患者被标记为 CLDno HRS。结果 共有 210 名受试者接受了 LTE；25% 的人接受了 AAH 评估，75% 的人接受了 CLD 评估。接受 AAH 评估的受试者中，肝肾综合征 (37/47) 比 CLD (104/163) 更常见（78.7% vs 63.8%，p = 0.04）。对于主要结局，AAHHRS 受试者比 CLDHRS (p = 0.02) 和 CLDno HRS (p < 0.01) 受试者更需要 LT 后 30 天肾脏替代治疗 (RRT)。其他形式的长期肾脏结局（包括肾移植转诊和队列间肾移植）没有显着差异。在亚组分析中，LT 后 30 天 RRT 在 AAHHRS 中比在 A-CLDHRS 中更常见 (p = 0.08)。Logistic 回归显示，与 CLDno HRS 和 CLDHRS 相比，AAHHRS 需要 LT 后 30 天 RRT 的几率分别是 20 倍和 3.3 倍。各队列的术后并发症相似，但对 LT 后 30 天的肾脏结局有显着影响。结论 AAH 患者更有可能发生 HRS，需要在我们中心的 LT 前后进行 RRT。肝脏失代偿和术后并发症的病因会影响 LT 后肾脏的恢复。AAH 的全身炎症以及有利于肾脏灌注不足的情况可能导致该患者群体 LT 后出现 HRS-AKI 的不良结果。