Pre-transplant Kidney Function Predicts Chronic Kidney Disease After Liver Transplant: Meta-Analysis of Observational Studies

Abstract

An increased risk of chronic kidney disease frequently exists among liver transplant recipients with reduced renal function at transplant. The occurrence of chronic kidney disease after liver transplantation has a major impact on mortality. Additional studies are needed to understand better the natural history of chronic kidney disease among liver transplant recipients.

Early serum tacrolimus levels predict long-term chronic kidney disease after liver transplantation

“…2,3,7,11,23,24,28,35,36 However, it should be pointed out that our results could have been influenced by the small number of cases of CKD stages 4 and 5. On the other hand, renal dysfunction in the first six months post-LT was associated with CKD and mortality in the first two years after LT in this study.…”

Elevated Fasting Plasma Glucose before Liver Transplantation is Associated with Lower Post-Transplant Survival

“…Additionally, serum Cr in cirrhotic patients who have less muscle volume than healthy controls was not shown to accurately reflect renal function [30,31]. However, renal dysfunction can predict progressive mortality in cirrhotic patients [30,31], and poor pre-transplant renal function can predict chronic kidney disease after LT [32]. It has not been previously shown that a small elevation of Cr in cirrhotic patients in pre-LT is a prognosis factor after LT. Our study suggests that a low serum level of Cr can be a useful predictor of survival after LT and may reflect liver function more accurately than renal function before LT.…”

Renal Dysfunction and Liver Transplantation

“…A stratified analysis including only studies provided with baseline GFR, revealed that the summary estimate of RR and 95% CIs for occurrence of chronic renal failure after liver transplantation in patients with diminished renal function at transplantation was 2.12 (95% CI, 1.01-4.46, p=0.01) (Fabrizi et al, 2011). Even relatively mild elevations in pre-transplant creatinine >1.5 mg/dL may portend poor long term renal function.…”

“…Overall risk of CKD development (eGFR < 60 mL/min/1.73 m 2 ) was associated with high Child-Pugh score and high Model for End-Stage Renal Disease (MELD) score (Lee et al, 2010). Especially in recipients whose pre-operative eGFR was high (>or=60 mL/min/1.73 m 2 ), rapid progression of kidney disease was associated with Child-Pugh score (in addition to high tacrolimus level and posttransplant acute renal failure) (Fabrizi et al, 2011).…”