Renal Dysfunction after Living-Donor Liver Transplantation: Experience with 500 Cases

Abstract

Introduction. The possible risk factors for chronic kidney disease in transplant recipients have not been thoroughly investigated after living-donor liver transplantation. Material and Methods. A retrospective cohort study of consecutive adults who underwent living-donor liver transplantation between May 2004 and October 2016, in a single center, was conducted. Kidney function was investigated successively for all the patients throughout the study period, with 12 months being the shortest follow-up. Postoperative renal dysfunction was defined in accordance with the Chronic Kidney Disease Epidemiology Collaboration criteria. The patients' demographic data, preoperative and intraoperative parameters, and outcomes were recorded. A calcineurin inhibitor-based immunosuppressive regimen, either tacrolimus or cyclosporine, was used in all the patients. Results. Of the 413 patients included in the study, 33 (8%) who survived for ≥1 year experienced chronic kidney disease 1 year after living-donor liver transplantation. Twenty-seven variables were studied to compare between the patients with normal kidney functions and those who developed chronic kidney disease 1 year after living-donor liver transplantation. Univariate regression analysis for predicting the likelihood of chronic kidney disease at 1 year revealed that the following 4 variables were significant: operative time, P < 0.0005; intraoperative blood loss, P < 0.0005; preoperative renal impairment, P = 0.001; and graft-to-recipient weight ratio (as a negative predictor), P < 0.0005. In the multivariate regression analysis, only 2 variables remained as independent predictors of chronic kidney disease at 1 year, namely, operative time with a cutoff value of ≥714 minutes and graft-to-recipient weight ratio as a negative predictor with a cutoff value of <0.91. Conclusion. In this study, prolonged operative time and small graft-to-recipient weight ratio were independent predictors of chronic kidney disease at 1 year after living-donor liver transplantation.

Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry

“…In another study by Kim et al [ 31 ], 43.5% of the overall LT recipients were reported to have moderate renal dysfunction (defined as the 30≤ eGFR <60 mL/min/1.73 m 2 ). The rate of renal dysfunction post-LT varies considerably among recipients in other countries, with 8.0% in Egypt [ 33 ], 48.0% in Spain [ 34 ], and 46.7% in Brazil [ 35 ]. This disparity in post-LT renal dysfunction rates between these studies might arise from differences in pre-LT renal function status, source of graft (LDLT or DDLT), presence of diabetes/hypertension, post-LT care, timing of kidney function monitoring, or definitions used for renal dysfunction.…”

Kidney Function After Liver Transplantation in a Single Center

“…Moreover, blood loss during surgery was independently associated with the risk of post-LT AKI in the study of Zongyi et al [ 27 ] as well as in previously published research [ 20 , 23 ]. The role of intraoperative blood loss was also found to be a significant risk factor of chronic RD 1 year after LT in univariate regression analysis of 500 cases [ 41 ]. Recently, Mrzljak et al published Crostians’ data regarding early AKI after LT, indicating the negative role of red blood cell transfusion [ 42 ].…”

Association Between Trough Level of Tacrolimus and Change in Estimated Glomerular Filtration Rate 1 Year After Living Donor Liver Transplantation

“…Although there are few reports on the causes of CKD progression and eGFR changes after LDLT, previous reports have suggested that advanced age, low pre-transplant eGFR value, and graft-to-recipient weight ratio as negative predictors were the associated risk factors for CKD progression after LDLT [ 2 , 14 ].…”