A meta‐analysis on the prevalence of chronic kidney disease in liver transplant candidates and its associated risk factors and outcomes

Abstract

Pre-liver transplant (LT) chronic kidney disease (CKD) has emerged as a leading cause of post-operative morbidity. We aimed to report the prevalence, associated risk factors, and clinical outcomes in patients with pre-LT CKD. Meta-analysis and systematic review were conducted for included cohort and cross-sectional studies. Studies comparing healthy and patients with s pre-LT CKD were included. Outcomes were assessed with pooled hazard ratios. 15 studies were included, consisting of 82,432 LT patients and 26,754 with pre-LT CKD. Pooled prevalence of pre-LT CKD was 22.35% (CI: 15.30%-32.71%). Diabetes mellitus, hypertension, viral hepatitis, and non-alcoholic fatty liver disease, and older age were associated with increased risk of pre-LT CKD: (OR 1.72 CI: 1.15-2.56, P = 0.01), (OR 2.23 CI: 1.76-2.83, P < 0.01), (OR 1.09; CI: 1.05-1.13, P < 0.01), (OR 1.73; CI: 1.10-2.71 P = 0.03), and (MD: 2.92 years; CI: 1.29-4.55years; P < 0.01) respectively. Pre-LT CKD was significantly associated with increased mortality (HR 1.38; CI: 1.2-1.59; P < 0.01), post-LT end-stage renal disease and post-LT CKD. Almost a quarter of pre-LT patients have CKD and it is significantly associated with post-operative morbidity and mortality. However, long-term outcomes remain unclear due to a lack of studies reporting such outcomes.

Evolving challenges with long‐term care of liver transplant recipients

“…Unsurprisingly, pre‐existing CKD is associated with increased post‐transplant CKD, but it is also associated with inferior graft survival, increased infection, increased post‐transplant ESRD, and higher post‐operative mortality 120,122 . Increasing numbers of pre‐transplant candidates have CKD, in part due to rising prevalence of metabolic risk factors and MASH emerging as the leading cause of LT.…”

“…Increasing numbers of pre‐transplant candidates have CKD, in part due to rising prevalence of metabolic risk factors and MASH emerging as the leading cause of LT. The institution of the MELD scoring system in 2002 has both increased the number of transplant candidates with CKD as well as increased donor prioritization to patients with renal dysfunction, 122 and the risk of post‐transplant ESRD has increased in each subsequent year 123 …”

“…119 Unsurprisingly, pre-existing CKD is associated with increased posttransplant CKD, but it is also associated with inferior graft survival, increased infection, increased post-transplant ESRD, and higher postoperative mortality. 120,122 Increasing numbers of pre-transplant candidates have CKD, in part due to rising prevalence of metabolic risk factors and MASH emerging as the leading cause of LT. The institution of the MELD scoring system in 2002 has both increased the number of transplant candidates with CKD as well as increased donor prioritization to patients with renal dysfunction, 122 and the risk of post-transplant ESRD has increased in each subsequent year.…”

“…120,122 Increasing numbers of pre-transplant candidates have CKD, in part due to rising prevalence of metabolic risk factors and MASH emerging as the leading cause of LT. The institution of the MELD scoring system in 2002 has both increased the number of transplant candidates with CKD as well as increased donor prioritization to patients with renal dysfunction, 122 and the risk of post-transplant ESRD has increased in each subsequent year. 123 Etiologies of post-transplant kidney disease are likely multifactorial but include pre-transplant kidney injury, post-operative acute tubular necrosis (ATN), exposure to CNIs, post-transplant DM, HTN, and obesity.…”

De novo metabolic syndrome after liver transplantation: a meta-analysis on cumulative incidence, risk factors, and outcomes

“…Liver transplant (LT) is often the only curative treatment for patients with end-stage liver disease, dramatically improving survival. [1] However, the development of metabolic syndrome (MS) following LT has been shown to reduce survival, potentially mitigating the survival benefits of LT. [2,3] In particular, post-transplant metabolic syndrome (PTMS) has been associated with increased risk of cardiovascular disease (CVD), [4] post-LT NAFLD, [5] progression of chronic kidney disease, [6] malignancy, [7] and infectious complications. [2] PTMS is characterized by obesity, arterial hypertension, insulin resistance, and dyslipidemia.…”