Post-liver transplant acute renal failure: factors predicting development of end-stage renal disease.
BACKGROUND
Acute renal failure (ARF) occurs in 5-50% of patients undergoing orthotopic liver transplantation (OLT). The aim of this study was to determine factors that might predict the development of end stage renal disease (ESRD) in patients who had ARF after OLT.


METHODS
We studied all OLT recipients between 9/1/1988 through 12/31/2000.


RESULTS
A total of 1602 patients underwent OLT during the study period. About 350 patients (22%) developed ARF requiring dialysis post-operatively. One hundred and twenty-three (39.8%) died within a year after OLT. Median follow up was 5.8 yr (range 1-12 yr). Forty-three patients (23%) developed ESRD over median of 3.79 yr (range 1-8 yr). Multivariate logistic regression analysis revealed creatinine levels > 1.7 mg/dL at 1 yr (p < 0.001), cyclosporine as immunosuppression (p = 0.026), and the presence of diabetes pre-OLT (p < 0.001) to be associated with the development of ESRD. The development of ESRD did not decrease patient survival (p = 0.111). ESRD patients who received subsequent kidney transplantation had significantly improved survival rates (p = 0.005).


CONCLUSIONS
Serum creatinine levels at 1 yr, cyclosporine as immunosuppression, and the presence of diabetes pre-OLT are independent predictive factors for the development of ESRD. ESRD patients who received kidney transplantation had higher 10-yr survival rates when compared with patients maintained on dialysis.
Paramesh
Anil S
AS
The Recanat/Miller Transplantation Institute, The Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
Roayaie
Sasan
S
Doan
Yvette
Y
Schwartz
Myron E
ME
Emre
Sukru
S
Fishbein
Thomas
T
Florman
Sander
S
Gondolesi
Gabriel E
GE
Krieger
Nancy
N
Ames
Scott
S
Bromberg
Jonathan S
JS
Akalin
Enver
E
D058186:Acute Kidney Injury / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D007677:Kidney Function Tests; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D013997:Time Factors
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine