Independent risk factors and natural history of renal dysfunction in liver transplant recipients

Abstract

Renal dysfunction is common after liver transplantation. However, there are only limited data on the predictors and natural history of renal dysfunction after liver transplantation. In this study, we determined independent predictors and the natural history of renal dysfunction in 172 consecutive liver transplant recipients. Survival and time to development of permanent renal dysfunction (renal dysfunction defined as a sustained decrease in estimated glomerular filtration rate (GFR) of > 30 mL/min/1.73 m 2 from baseline for at least 6 months, severe renal failure defined as absolute GFR <30 mL/min/1.73 m 2 for at least 6 months) were determined using the Kaplan-Meier method. Cox regression analysis was used to test the independent effect of a given set of variables on time to development of such an event. Nine percent of patients required immediate dialysis, 35% developed permanent renal dysfunction, and 7% developed severe renal failure. The rate of decline in renal dysfunction was maximal, 6.5 mL/min/1.73 m 2 /mo, at 1 month after liver transplantation. Pre-existing diabetes mellitus, major surgical infection, and waiting time on the transplant list were independent risk factors for immediate dialysis. Presence of serum creatinine > 1.2 mg/dL at any time before liver transplantation and a baseline GFR <70 mL/min/1.73 m 2 were independent predictors of permanent renal dysfunction. Diabetes mellitus, coronary artery disease, and primary graft nonfunction predicted the development of severe renal failure. GFR stabilized around 9 months, and presence of decreased GFR > 30mL/min/1.73 m 2 from baseline at 9 months predicted development of permanent renal dysfunction. An absolute GFR of <30mL/min/1.73 m 2 occurring as early as 3 months after liver transplantation predicted severe renal failure. Severe renal failure was associated with a significantly lower survival by Cox regression analysis. We have identified risk factors and the natural history of permanent renal dysfunction and severe liver failure in liver transplant recipients. These observations may be useful in the development of nonnephrotoxic immunosuppressive regimens for high-risk liver transplant recipients. (Liver Transpl 2003;9:741-747.) L ong-term outcome of liver transplantation has improved over the past 2 decades because of better surgical experience, with the introduction of calcineurin inhibitors, and more importantly, because of better selection criteria. However, about 10% to 20% of long-term survivors develop permanent renal dysfunction or failure, which has been attributed to a number of factors, including the use of calcineurin inhibitors. 1,2 A significant proportion (range, 5% to 50%) of liver transplantation procedures is complicated by acute renal failure in the immediate postoperative period, with more frequent occurrence in those who have hepatorenal syndrome at the time of liver transplantation. [3][4][5][6][7][8] In the subgroup of patients who develop acute renal failure and survive, 80% to 90% regain some degree of renal function, ...

Controversies in the management of hepatitis C virus infection after liver transplantation

“…95 Renal insufficiency is common in liver transplant recipients. 96 This is secondary to the effects of calcineurin inhibitors used for primary immunosuppression. Cyclosporine and tacrolimus also bind to red blood cells, and may exacerbate the severity of RBVinduced hemolysis.…”

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

“…[7][8][9][10][11][12][13][14][15][16] The risk of ESKD in adult SOT recipients varies by organ transplanted. 4 This variability may be explained by differences in the burden of baseline comorbidities, variations in intensity of immunosuppressive regimens, and distinct rates of peritransplant AKI.…”

Old Immunosuppressive Agents: Newer Approach in liver Transplant Recipients to Achieve Rejection Free and Nephron Preserving Protocol

“…Patients with higher MELD scores invariably have a degree of renal dysfunction or even renal failure requiring renal replacement therapy mainly for hepatorenal syndrome type I or type II. Also, up to 20% of patients who were not on dialysis pre-transplant may require dialysis in post-transplant period [2,3]. Various immunosuppressive approaches have been cited with use of antibody preparation in group of patient with pre-existing renal dysfunction including IL-2 inhibitors and Thymoglobulin [4].…”