Early kidney dysfunction post liver transplantation predicts late chronic kidney disease.
BACKGROUND
Acute and chronic renal dysfunction (ARD, CRD) are common complications after liver transplantation and are associated with poor outcome.


METHODS
We reviewed the results of 181 liver transplants performed in our institution between January 1, 1998 and December 31, 2000 in which the recipients were alive with good liver function at the end of the follow-up period (mean 2.7 years). Renal dysfunction was defined as a serum creatinine (Cr) greater than or equal to 2 mg/dL in both acute and chronic settings.


RESULTS
The incidence of ARD during the first posttransplant week was 39.2% (n=71), whereas late CRD occurred in 6.0% (n=11) of the patients by the end of the follow-up period. Among the variables we examined for association with CRD, five factors were found to be statistically significant in univariate analysis: pretransplant diabetes (PRTDM) (0.000), Cr greater than or equal to 2 during the first postoperative week (0.003), posttransplant diabetes (POTDM) (0.014), age greater than 50 (0.025), and tacrolimus level greater than 15 ng/mL at postoperative day 15 (0.058). In binary logistic regression analysis, PRTDM (odds ratio [OR]=5.7, 95% confidence interval [CI]) and early postoperative ARD (OR=10.2 95% CI) remained consistently significant. Nine of 11 patients with CRD also had a history of ARD during the first postoperative week. These patients progressed to CRD despite the fact that seven of nine had normalized their renal function by day 90 posttransplant.


CONCLUSIONS
We suggest that a combination of events during the first postoperative week after liver transplant serve as a physiologic "stress test" for the kidneys. Patients who fail the test (peak Cr >/=2 mg/dL during the first postoperative week) as well as the patients with diabetes mellitus are at increased risk of CRD. In such cases, conversion to a less nephrotoxic regimen may be beneficial.
Velidedeoglu
Ergun
E
Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Bloom
Roy D
RD
Crawford
Michael D
MD
Desai
Niraj M
NM
Campos
Luis
L
Abt
Peter L
PL
Markmann
Joseph W
JW
Mange
Kevin C
KC
Olthoff
Kim M
KM
Shaked
Abraham
A
Markmann
James F
JF
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000375:Aging; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015994:Incidence; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects
D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus