Long-Term Survival and Outcomes of Combined Liver-Kidney (Simultaenous and Sequential) Transplants in Spain

Abstract

Renal dysfunction often complicates the course of orthotopic liver transplant (OLT) recipients and is associated with an increase morbidity and mortality. The aim of this study was to determine the incidence of renal disease (acute and chronic), possible risk factors and to determine the impact on the patient survival. Clinical data included age, gender, aetiology for hepatic failure, presence of diabetes mellitus, hypertension, hepatitis B and C infection, renal dysfunction pre transplant (RD pre) and immunosuppression. Laboratorial data included serum creatinine at day 1, 7, 21, month 6, and every year. The glomerular fi ltration rate (GFR) was determined by Cockcroft-Gault equation. We studied, retrospectively, from September 1992 to March 2007, 708 OLT recipients, 82 being retransplanted. Mean age 44 ±12.6 years, 64% males, 17% diabetic, 18.8% with hypertension, 19.9% with C hepatitis and 3.8% B hepatitis. Renal dysfunction was known in 21.6%. Mean follow-up was 3.6 years (0-15). Mean transplant survival was 75% at 12 months and 69% at 3 years. 152 patients died. Uni and multivariate analysis were performed and a p<0.05 was considered signifi cant. Renal dysfunction in this population was observed in more than 50% and was divided in 2 groups: acute renal failure (ARF) in the immediate post transplant period (33.8%) and chronic kidney disease (CKD) according to KDIGO defi nition (50.2%). ARF occurred in 33.8% of the patients. Only 14% recovered the renal function with GFR > 60 ml/min (r = 0.686, p <0.001), 15.5% did not recovered renal function and are on dialysis (r= 0.454, p <0.001), 30.5% died (r= 0.222, p<0.001).In the time of this study, half of the population had CKD 3, 29% with a GFR< 45 ml/min, 9% had CKD 4 and 5.6% CKD5d. Persisting renal failure (GFR < 45 ml/min) was positively correlated with age (r=0.199, p<0.001), diabetes (r=0.88, p=0.032), alcohol (r=0.097, p=0.015), RD pre (r=0.279, p<0.0001), ARF post transplant (r=0,319 p<0.0001) and with high mortality (r=0.188, p<0.0001). On multivariate analysis, it was positively correlated with age (p<0.001), RD pre (p<0.001), ARF post transplant (p=0.03) and with mortality (p=0.015). It was not correlated with aetiology of hepatic failure. Mortality was also correlated, on multivariate analysis, with RD pre (p=0.006), ARF post transplant (p<0.001), CKD stage 3 post transplant (p=0.002), CKD 5d (p<0.001) and haemodialysis treatment (p<0.001). There was no correlation between mortality and need of re transplant. In conclusion, OLT recipients are disposed to renal complications that have a negative impact in the survival of these patients. Renal dysfunction seems to be more important than the need of re transplant in what concerns clinical prognostic. POSTER BOARD NUMBER P4 -37CHRONIC KIDNEY DISEASE FOLLOWING 1987 ORTHOTOPIC LIVER TRANSPLANTATION.