TY - JOUR
T1 - Ascites development is associated with worse outcome in patients after kidney transplantation
AU - Leung, Marcia
AU - Humphrey, Megan L.
AU - Chen, Ling-Xin
AU - Sarkar, Souvik
N1 - Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: We provide detailed analysis and outcomes in patients post-kidney transplant (KT) developing ascites, which has never been categorically reported. Methods: Ascites was identified by ICD9/10 codes and detailed chart review in patients post-KT from 01/2004-06/2019. The incidence of patient death and graft loss were determined per 100-person-years, and the incidence rate ratio was obtained. Results: Of 3329 patients receiving KT, 83 (2.5%) patients had new-onset ascites, of whom 58% were male, 21% blacks, and 29% whites. Seventy-five percentage were on hemodialysis. Patients were maintained primarily on tacrolimus and mycophenolate for immunosuppression. Only 14% of patients with ascites had the appropriate diagnostic workup. There was a trend toward an increased mortality in patients with ascites (incidence rate ratio, IRR [95% CI]: 1.8 [0.92, 3.19], p =.06), and a significantly higher incidence of graft loss (IRR: 5.62 [3.97, 7.76], p <.001), compared with non-ascites patients. When classified by ascites severity, determined by imaging, moderate/severe ascites patients had the worst clinical outcomes, with a mortality of 32% and graft failure in 57%, compared with 9% and 10%, respectively, in those without ascites. Conclusion: In this large cohort employing stepwise analysis of ascites post-KT, worse outcomes were noted, dictating the need for optimized management to improve clinical outcomes.
AB - Background: We provide detailed analysis and outcomes in patients post-kidney transplant (KT) developing ascites, which has never been categorically reported. Methods: Ascites was identified by ICD9/10 codes and detailed chart review in patients post-KT from 01/2004-06/2019. The incidence of patient death and graft loss were determined per 100-person-years, and the incidence rate ratio was obtained. Results: Of 3329 patients receiving KT, 83 (2.5%) patients had new-onset ascites, of whom 58% were male, 21% blacks, and 29% whites. Seventy-five percentage were on hemodialysis. Patients were maintained primarily on tacrolimus and mycophenolate for immunosuppression. Only 14% of patients with ascites had the appropriate diagnostic workup. There was a trend toward an increased mortality in patients with ascites (incidence rate ratio, IRR [95% CI]: 1.8 [0.92, 3.19], p =.06), and a significantly higher incidence of graft loss (IRR: 5.62 [3.97, 7.76], p <.001), compared with non-ascites patients. When classified by ascites severity, determined by imaging, moderate/severe ascites patients had the worst clinical outcomes, with a mortality of 32% and graft failure in 57%, compared with 9% and 10%, respectively, in those without ascites. Conclusion: In this large cohort employing stepwise analysis of ascites post-KT, worse outcomes were noted, dictating the need for optimized management to improve clinical outcomes.
KW - ascites
KW - graft
KW - kidney
KW - portal hypertension
KW - transplant
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U2 - 10.1111/ctr.14198
DO - 10.1111/ctr.14198
M3 - Article
C2 - 33345373
AN - SCOPUS:85099049661
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
ER -