Prevalence and progression of chronic kidney disease after a liver transplant: a prospective, real-life, observational, two-year multicenter study

Herrero, J.I.; Cuervas-Mons, Valentín; Gómez‐Bravo, Miguel Ángel; Fabregat, Joan; Otero, Alejandra; Bilbao, Itxarone; Salcedo, M.; González-Diéguez, M.L.; Fernández, José R.; Serrano, M.T.; Jiménez, Miguel; Rodrigo, Juan; Narváez, Isidoro; Sánchez, G. Hernández

doi:10.17235/reed.2018.5431/2017

Cited by 13 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is unclear whether AKI after LT is the primary driver of poorer mortality outcomes or whether this is merely a correlation[ 166 ]. CKD is also a common complication after LT with an incidence ranging between 20% and 80%[ 167 , 168 ]. Numerous observations have implicated calcineurin-inhibitor (CNI) as a major risk factor of CKD in recipients of a transplant[ 169 - 171 ], and some studies have advocated the use of tacrolimus or mycophenolate mofetil instead of cyclosporin to reduce the incidence of chronic renal dysfunction after transplantation[ 170 , 172 ].…”

Section: Challenges Of Treating Hcc In Patients With Renal Dysfunctionmentioning

confidence: 99%

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Yeh¹,

Chiang²,

Yen³

2021

WJG

View full text Add to dashboard Cite

The population of patients with hepatocellular carcinoma (HCC) overlaps to a high degree with those for chronic kidney disease (CKD) and end-stage renal disease (ESRD). The degrees of renal dysfunction vary, from the various stages of CKD to dialysis-dependent ESRD, which often affects the prognosis and treatment choice of patients with HCC. In addition, renal dysfunction makes treatment more difficult and may negatively affect treatment outcomes. This study summarized the possible causes of the high comorbidity of HCC and renal dysfunction. The possible mechanisms of CKD causing HCC involve uremia itself, long-term dialysis status, immunosuppressive agents for postrenal transplant status, and miscellaneous factors such as hormone alterations and dysbiosis. The possible mechanisms of HCC affecting renal function include direct tumor invasion and hepatorenal syndrome. Finally, we categorized the risk factors that could lead to both HCC and CKD into four categories: Environmental toxins, viral hepatitis, metabolic syndrome, and vasoactive factors. Both CKD and ESRD have been reported to negatively affect HCC prognosis, but more research is warranted to confirm this. Furthermore, ESRD status itself ought not to prevent patients receiving aggressive treatments. This study then adopted the well-known Barcelona Clinic Liver Cancer guidelines as a framework to discuss the indicators for each stage of HCC treatment, treatment-related adverse renal effects, and concerns that are specific to patients with pre-existing renal dysfunction when undergoing aggressive treatments against CKD and ESRD. Such aggressive treatments include liver resection, simultaneous liver kidney transplantation, radiofrequency ablation, and transarterial chemoembolization. Finally, focusing on patients unable to receive active treatment, this study compiled information on the latest systemic pharmacological therapies, including targeted and immunotherapeutic drugs. Based on available clinical studies and Food and Drug Administration labels, this study details the drug indications, side effects, and dose adjustments for patients with renal dysfunction. It also provides a comprehensive review of information on HCC patients with renal dysfunction from disease onset to treatment.

show abstract

Section: Challenges Of Treating Hcc In Patients With Renal Dysfunctionmentioning

confidence: 99%

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Yeh¹,

Chiang²,

Yen³

2021

WJG

View full text Add to dashboard Cite

show abstract

“…Few studies are available for comparison with the Spanish series because of varying CKD definitions and follow-up periods, and of CKD stratification other than GFR below 60 mL/min/1.73 m 2 (stages III, IV, and V). In a recent study by Allen et al (10) the rate of stage-III CKD at 1 and 5 years was 50% and 49%, respectively, and that of stage-IV CKD was 4% and 5%, respectively; these figures are clearly higher, even at 1 year, than those described by Herrero et al, namely 30.8% at 1 year and 26.4% at 30 months for stage III, and 0.5% for stage IV within both periods (9). Furthermore, the percentage of patients with GFR ≥ 60 mL/min/1.73 m 2 (CKD stages I and II) was 42% and 32% at 1 and 5 years in the series by Allen et al, hence clearly lower than in the Spanish series, where rates of 68.8% and 73.1% at 1 year and 30 months, respectively, are reported.…”

mentioning

confidence: 68%

“…In this issue of The Spanish Journal of Gastroenterology (Revista Española de Enfermedades Digestivas), Herrero et al (9) discuss the evolution of renal function from the sixth month post-LT and over a period of 30 months in LT patients with preserved renal function at LT (GFR ≥ 60 mL/min/1.73 m 2 and no evidence of renal damage). Considering the concept of CKD as defined in the KDIGO guidelines, that is, as a GFR lower than 60 mL/min/1.73 m 2 , in the study by Herrero et al the rate of stage-III CKD at 2 years was 26.4%, and that of stage-IV CKD was 0.5%.…”

mentioning

confidence: 99%

“…Although Allen et al do not report on IS type or level, a clear difference between both studies lies in the percentage of patients undergoing transplantation with a GFR lower than 60 mL/min/1.73 m 2 before LT, which was 27% in the series by Allen et al versus 0% in the series by Herrero et al The study by Allen et al also found a very interesting result, namely an increase in mortality rate dependent upon GFR; thus, death risk rises nearly three times for a GFR of 15-29 mL/min/1.73 m 2 , and up to 5 times for GFR levels lower than 15 mL/min/1.73 m 2 (10). As discussed by Herrero et al (9), a greater number of patients with renal function impairment pre-transplantation, together with a higher usage of calcineurin inhibitors (CNIs), may have contributed to greater renal function impairment in the large series by Ojo (4), and may also account for the differences found with the series by Allen et al…”

mentioning

confidence: 99%

See 1 more Smart Citation

Protecting renal function: a relevant decision for liver transplantation

Pons

2018

Rev Esp Enferm Dig

View full text Add to dashboard Cite

show abstract

“…Herrero et al (35) showed the key elements accounting for excellent renal function in the long term: good renal function before transplantation, stable CNI levels, minimization of CNI levels in patients with damaged renal function. One important variable in our study was the variation of the immunosuppression during co-administration of the 3D regimens, with higher trough levels at the beginning of antiviral therapy despite adjusting the CNI according to recommendations.…”

Section: Discussion Discussionmentioning

confidence: 99%

Impact of Sustained Virological Response on Metabolic Profile and Kidney Function in Cured HCV Liver Transplant Recipients

Iacob¹,

Onica²,

Iacob³

et al. 2021

SGO

View full text Add to dashboard Cite

Background: Long-term morbidity and mortality following liver transplantation (LT) is influenced by HCV-related extrahepatic complications and effects of immunosuppressive therapy. Aim: To investigate if sustained virological response (SVR) after therapy with direct acting antivirals (DAA) in recipients with post-transplant recurrent hepatitis C can influence metabolic factors and renal function. Methods: Metabolic profile, cardiovascular risk scores, non-invasive evaluation of fibrosis, renal function was assessed in 89 HCV LT recipients at SVR and 24 months after cure. Results: Liver stiffness measurement evaluated by transient elastography, APRI, FIB-4 and NAFLD fibrosis scores decreased significantly between baseline, SVR and 24 months after SVR. In contrast, BARD score increased significantly (p=0.001). Steatosis grade 3 was significantly encountered in a higher percentage at 24 months after SVR compared to baseline (77.5% vs 22.5%, p<0.0001). The metabolic and cardiovascular risk profile (MetS and Framingham scores), respectively, remained stable during the timeline. All liver function tests such as alanine and aspartate aminotransferase, gamma glutamyl transferase, total bilirubin improved between initiation of antivirals, SVR and 24 months after SVR; platelets increased significantly (p<0.0001 for each variable). The renal function evaluated by creatinine serum level (p=0.03) and estimated glomerular filtration rate (p=0.02) was significantly deteriorated over time. Conclusions: Eradication of recurrent HCV infection has a clear benefit for liver-related complications, but has no impact on HCV extrahepatic manifestations. Prospective studies with non-HCV cohorts are required to compare the impact of immunosuppression on metabolic and renal complications.

show abstract

Prevalence and progression of chronic kidney disease after a liver transplant: a prospective, real-life, observational, two-year multicenter study

Abstract: in the routine clinical practice, a moderate deterioration of renal function is frequent after liver transplantation. However, advanced chronic kidney disease is infrequent in patients with a good pre-transplant renal function.

Cited by 13 publications

References 27 publications

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges

Protecting renal function: a relevant decision for liver transplantation

Impact of Sustained Virological Response on Metabolic Profile and Kidney Function in Cured HCV Liver Transplant Recipients

Contact Info

Product

Resources

About