Chronic renal outcome after living donor liver transplantation

Abstract

Chronic kidney disease (CKD) is one of the common complications after deceased donor liver transplantation. Although the worldwide pressing shortage in deceased donors has directed attention to living donor liver transplantation (LDLT), LDLT cohort data focusing on chronic renal dysfunction is limited. A total of 280 adult LDLT recipients (median 49 yr, 156 men) at the University of Tokyo hospital between 1996 and 2006 were reviewed. A total of 224 pre-transplant liver failure patients (80.0%) showed an estimated glomerular filtration rate (eGFR) of more than 60 mL/min/1.73 m(2). However, during follow-up at a mean of 1222 d after transplantation, eGFR declined to 60 mL/min/1.73 m(2) and 30 mL/min/1.73 m(2) in 150 (53.2%) and 21 (7.5%), respectively, and four patients (1.4%) required maintenance renal replacement therapy. Multivariate Cox proportional hazard model regression analysis revealed that recipient age (HR, 3.42 per 10-yr increment; p < 0.001) and pre-transplant eGFR (HR, 0.85 per 10-mL/min/1.73 m(2) increment; p = 0.04) were associated independently with a post-transplant decrease in eGFR to less than 30 mL/min/1.73 m(2). We conclude that higher age and lower pre-transplant eGFR of an LDLT recipient indicate a high likelihood of subsequent development of advanced CKD. Preventive or therapeutic intervention should be optimized for these high-risk patients.

Comparing 10‐yr renal outcomes in deceased donor and living donor liver transplants

“…Patients with a higher pre‐transplant eGFR appear to have a similar decline in both DDLT and LDLT groups. Similar findings were noted by Nishi et al, who demonstrated that LDLTs have a more rapid deterioration of renal function, especially in the first year . A study from Toronto, specifically looking at patients who had undergone LT for hepato‐renal syndrome, showed similar creatinine levels in between the two groups at five yr, but the rate of eGFR decline was not reported .…”

Association Between Renal Dysfunction and Major Adverse Cardiac Events After Liver Transplantation: Evidence from an International Randomized Trial of Everolimus-Based Immunosuppression

“…A single-center retrospective analysis of 202 primary liver transplants has reported a doubling of the risk for both cardiovascular events and cardiovascular mortality in patients with eGFR <60 mL/min/1.73 m 2 [ 6 ]. With 25–50% of patients showing moderate or severe renal dysfunction after liver transplantation [ 6 , 10 , 11 ], the impact of renal function on cardiovascular events is highly relevant. However, prospective studies of the association between renal function and cardiovascular events in liver transplant patients have hitherto been lacking.…”

Pretransplant urinary proteome analysis does not predict development of chronic kidney disease after liver transplantation

“…Multiple studies have reported a significant relationship between pre‐transplant serum creatinine and post‐transplant CKD . In a previous study, we observed that patients with normal insulin clearance and normal serum creatinine can have severe histological injuries, which suggests that impaired kidney function can be delayed compared to histological lesions .…”