title: Late-onset renal failure after liver transplantation: role of posttransplant alcohol use.
abstract: BACKGROUND
  Late-onset renal failure is being increasingly recognized as a complication in patients undergoing liver transplantation for hepatitis C virus (HCV). However, its precise incidence, predisposing risk factors, and impact on outcome after liver transplantation, have not been defined.
  
  
  METHODS
  The development of late-onset renal failure (defined as serum creatinine persistently >2.0 mg/dl, occurring more than 6 months posttransplant) was assessed in 120 consecutive liver transplant recipients who survived at least 6 months after transplantation. Fifty-seven percent (68/120) of the patients had undergone transplantation for liver disease due to HCV. The median follow-up was 5 years.
  
  
  RESULTS
  Late-onset renal failure developed in 28% (33/120)of the patients. Posttransplant alcohol use (P=0.0001), posttransplant diabetes (P=0.0042), and recurrent HCV hepatitis (P=0.019) were significantly associated with late onset renal failure. In multivariate analysis, alcohol use (O.R. 10.7, 95%; CI 2.4-35.9, P=0.001) and diabetes (O.R. 2.1, 95%; CI 1.1-9.9, P=.03) were independently significant predictors of late onset renal failure. When only patients transplanted for HCV were analyzed, posttransplant alcohol use (P=0.004) was the only significant independent predictor of late-onset renal failure. HCV genotype 1b, as compared with other HCV genotypes, was associated with a higher rate of late-onset renal failure in patients with HCV; 70% of the patients with genotype 1b versus 32% of those with 1a and 33% of those with 2b, developed late onset renal failure (P=0.03). At a median follow up of 5 years, mortality in patients with HCV with late-onset renal failure was 52% as compared with 2% in those without renal failure (P=.0001).
  
  
  CONCLUSIONS
  Late-onset renal failure in patients with HCV portended a grave outcome. Alcohol use was an independent predictor of late-onset renal failure in patients with HCV and represents a potentially modifiable risk factor for late-onset renal failure in these patients.
authors.affiliation: Veterans Affairs Medical Center and University of Pittsburgh, Pennsylvania 15240, USA.
authors.forename: T
authors.initials: T
authors.lastname: Gayowski
authors.forename: N
authors.initials: N
authors.lastname: Singh
authors.forename: L
authors.initials: L
authors.lastname: Keyes
authors.forename: C F
authors.initials: CF
authors.lastname: Wannstedt
authors.forename: M M
authors.initials: MM
authors.lastname: Wagener
authors.forename: H
authors.initials: H
authors.lastname: Vargas
authors.forename: T
authors.initials: T
authors.lastname: Laskus
authors.forename: J
authors.initials: J
authors.lastname: Rakela
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
authors.forename: I R
authors.initials: IR
authors.lastname: Marino
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors