Chronic Kidney Disease and Related Long-Term Complications After Liver Transplantation

Sharma, Pratima; Bari, Khurram

doi:10.1053/j.ackd.2015.06.001

Cited by 53 publications

(55 citation statements)

References 58 publications

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“…It is important to recognize that the presence of CKD will not only affect survival of patients while wait‐listed for liver transplantation (LT), but it can also affect posttransplant renal outcomes and longterm graft and patient survival . To that end, there has been a new streamlined United Network for Organ Sharing policy that went into effect in 2017 for the prioritization of simultaneous liver‐kidney transplantation based on the duration and severity of CKD .…”

Section: Discussionmentioning

confidence: 99%

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis

Wong

Reddy

O’Leary³

et al. 2019

Liver Transpl

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We hypothesize that the prevalence of chronic kidney disease (CKD) among patients with cirrhosis has increased due to the increased prevalence of CKD‐associated comorbidities, such as diabetes. We aimed to assess the characteristics of hospitalized patients with cirrhosis with CKD and its impact on renal and patient outcomes. The North American Consortium for the Study of End‐Stage Liver Disease (NACSELD) prospectively enrolled nonelectively admitted patients with cirrhosis and collected data on demographics, laboratory results, in‐hospital clinical course, and postdischarge 3‐month outcomes. CKD positive (CKD+) patients, defined as having an estimated glomerular filtration rate (eGFR; Modification of Diet in Renal Disease–4 variable formula) of ≤60 mL/minute for >3 months, were compared with chronic kidney disease negative (CKD–) patients for development of organ failures, hospital course, and survival. There were 1099 CKD+ patients (46.8% of 2346 enrolled patients) who had significantly higher serum creatinine (2.21 ± 1.33 versus 0.83 ± 0.21 mg/dL in the CKD– group) on admission, higher prevalence of nonalcoholic steatohepatitis cirrhosis etiology, diabetes, refractory ascites, and hospital admissions in the previous 6 months compared with the CKD– group (all P < 0.001). Propensity matching (n = 922 in each group) by Child‐Pugh scores (9.78 ± 2.05 versus 9.74 ± 2.04, P = 0.70) showed that CKD+ patients had significantly higher rates of superimposed acute kidney injury (AKI; 68% versus 21%; P < 0.001) and eventual need for dialysis (11% versus 2%; P < 0.001) than CKD– patients. CKD+ patients also had more cases of acute‐on‐chronic liver failure as defined by the NACSELD group, which was associated with reduced 30‐ and 90‐day overall survival (P < 0.001 for both). A 10 mL/minute drop in eGFR was associated with a 13.1% increase in the risk of 30‐day mortality. In conclusion, patients with CKD should be treated as a high‐risk group among hospitalized patients with cirrhosis due to their poor survival, and they should be monitored carefully for the development of superimposed AKI.

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Section: Discussionmentioning

confidence: 99%

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis

Wong

Reddy

O’Leary³

et al. 2019

Liver Transpl

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“…1–3 The continued increase in LT waitlist and the increasing recipients’ medical acuities have led to consequent increase in the number of simultaneous liver and kidney transplantations (SLKT). 4 SLKT promises less kidney allograft rejection than staged kidney transplantation after liver transplantation (KALT) based on the findings that liver allografts provide immunoprotection for renal allografts from the same donor. 5–8 Despite reports of inferior patient and graft survival outcomes when compared to kidney transplantation alone (KTA), 9,10 SLKT continues to be a viable option based on evidence of better kidney function and patient and graft survival when compared to liver transplantation alone among recipients with RD.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting kidney delayed graft function among recipients of simultaneous liver‐kidney transplantation: A single‐center experience

Korayem

Agopian

Lunsford

et al. 2019

Clinical Transplantation

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Background: Kidney delayed graft function (kDGF) remains a challenging problem following simultaneous liver and kidney transplantation (SLKT) with a reported incidence up to 40%. Given the scarcity of renal allografts, it is crucial to minimize the development of kDGF among SLKT recipients to improve patient and graft outcomes. We sought to assess the role of preoperative recipient and donor/graft factors on developing kDGF among recipients of SLKT. Methods: A retrospective review of 194 patients who received SLKT in the period from January 2004 to March 2017 in a single center was performed to assess the effect of preoperative factors on the development of kDGF. Results: Kidney delayed graft function was observed in 95 patients (49%). Multivariate analysis revealed that donor history of hypertension, cold static preservation of kidney grafts [versus using hypothermic pulsatile machine perfusion (HPMP)], donor final creatinine, physiologic MELD, and duration of delay of kidney transplantation after liver transplantation were significant independent predictors for kDGF. kDGF is associated with worse graft function and patient and graft survival. Conclusions: Kidney delayed graft function has detrimental effects on graft function and graft survival. Understanding the risks and combining careful perioperative patient management, proper recipient selection and donor matching, and graft preservation using HPMP would decrease kDGF among SLKT recipients.

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“…Three main stages during liver transplantation have previously been recognized to have an impact on longterm postoperative kidney function: Pretransplant renal failure in end‐stage liver disease. Additional kidney injury during the transplantation procedure. Posttransplant kidney injury. …”

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confidence: 99%

Chronic Kidney Disease After Liver Transplantation: Impact of Extended Criteria Grafts

et al. 2019

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The use of extended criteria donor (ECD) grafts has been associated with acute kidney injury (AKI) after liver transplantation. However, the relation between graft quality and development of chronic kidney disease (CKD) remains unknown. Therefore, the aim of this study was to analyze the impact of ECD grafts for CKD after liver transplantation. All patients (2007‐2015) transplanted for end‐stage liver disease at our center were assessed. Longterm kidney function was divided into 4 groups: no CKD (estimated glomerular filtration rate [eGFR], ≥60 mL/minute/1.73 m2), mild CKD (eGFR, 30‐59 mL/minute/1.73 m2), severe CKD (eGFR, 15‐29 mL/minute/1.73 m2), and end‐stage renal disease (ESRD). Marginal donation after brain death (DBD) grafts (donor age, >70 years; body mass index, >35 kg/m2; cold storage, >12 hours) and donation after circulatory death (DCD) grafts were considered ECD grafts. Overall, 926 patients were included, and 43% received an ECD graft (15% marginal DBD; 28% DCD). After 5 years, 35% developed CKD; severe CKD and ESRD occurred in only 2% and 1%, respectively. CKD rates were comparable for all 3 graft groups (standard group, 36%; marginal DBD group, 29%; DCD group, 35%; standard versus marginal DBD groups, P = 0.16; standard versus DCD group, P = 0.80). None of the ECD criteria were identified as independent risk factors in a Cox regression model for CKD. Risk factors included recipient age, female sex, and preoperative kidney function. Furthermore, recipients who had severe acute kidney injury (AKI; Kidney Disease: Improving Global Outcomes stages 2 and 3) had a 1.8‐fold increased risk for CKD. Longterm kidney function of recipients with severe AKI depended on the recovery of kidney function in the first postoperative week. In conclusion, there is no direct relation between the use of ECD grafts and CKD after liver transplantation. However, caution should be taken in recipients who experience severe AKI, regardless of graft type.

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Chronic Kidney Disease and Related Long-Term Complications After Liver Transplantation

Cited by 53 publications

References 58 publications

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis

Impact of Chronic Kidney Disease on Outcomes in Cirrhosis

Factors predicting kidney delayed graft function among recipients of simultaneous liver‐kidney transplantation: A single‐center experience

Chronic Kidney Disease After Liver Transplantation: Impact of Extended Criteria Grafts

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