Influence of portal hypertension-associated upper gastrointestinal bleeding and acute kidney injury on liver transplantation prognosis.

Background: Given that prioritization for liver transplantation (LT) is based primarily on the model for end-stage liver disease (MELD) scores, patients with lower MELD scores, who experience chronic anemia and recurrent hypotension due to gastrointestinal bleeding (GIB), tend to be marginalized.

Methods: A total of 581 patients with no evidence of acute kidney injury (AKI) or chronic kidney disease 2 months before LT constituted a retrospective cohort. Within this cohort, a nested case-control study was conducted that included 134 patients with preoperative GIB (GIB(+)) and 246 matched patients without preoperative GIB (GIB(-)). A subgroup analysis was conducted based on the occurrence of AKI (AKI(- /+)) within 2 months prior to LT.

Results: The incidence of preoperative AKI was significantly higher in patients with GIB(+) compared with patients with GIB(-) (14.9% vs 8.1%, P=0.039), along with higher rates of postoperative complications and prolonged hospital stay; however, long-term survival rates were similar between the two groups. Subgroup analysis also revealed that the postoperative incidence of AKI and mortality rates at 60 days were elevated in patients with preoperative GIB(+) AKI(+) compared with patients with GIB(+) AKI(-). Furthermore, 5-year survival rates were significantly lower for patients with GIB(+) AKI(+) (65.0% vs 82.5%, P = 0.040). However, no significant difference was observed between the two subgroups of AKI(+) (GIB(+) versus GIB(-)) and the two subgroups of AKI(-) in relation to postoperative complications, short-term mortality, and long-term survival rates.

Conclusions: Patients who experience preoperative GIB face an elevated risk of developing AKI, which is significantly correlated with a poorer prognosis for LT. A more proactive approach is needed to assess the transplant priority of patients with GIB on the waiting list.