Predictive factors for chronic renal failure one year after orthotopic liver transplantation.
Chronic renal failure (CRF) is increasingly prevalent in solid-organ-transplant patients. This is in part related to the long-term use of calcineurin inhibitor (CNI) agents. However, in orthotopic liver-transplant (OLT) patients, the effects of superimposed hepatitis C virus (HCV)-related renal lesions could also be a factor. The aim of this cohort study (February 2000 to September, 2003) was to identify the predictive factors at one year post-transplantation for CRF in OLT patients associated with induction therapies. CRF was defined as having a creatinine clearance (CC) lower than 60 mL/min. Of the 97 transplants performed during that period, 72 were still functioning after one year. Of these, 33 patients (45.8%) had CRF. In univariate analysis, the predicting factors for CRF were recipient sex (female), initial liver disease (HCV-related cirrhosis), pre-transplant CC (<80 mL/mn), and post-transplant serum creatinine >130 micromol/L at day 3 and months (M) 1, 3, and 6. In multivariate analysis, the independent predictive factors for CRF included female sex [OR: 11.5 (2.3-58.3); p = 0.003], HCV infection [OR: 5.01 (1.1-22.7); p = 0.03], pre-OLT CC <80 mL/mn [OR: 5.4 (1.2-23.7); p = 0.025], and serum creatinine at M6 greater than 130 micromol/L [OR: 19.6 (3.7-102.5); p = 0.0004]. Among all of the predictive factors for post-OLT CRF, only one is modifiable: post-transplant serum creatinine, which could be, to some extent, related to the long-term use of CNIs.
Guitard
Joelle
J
Multiorgan Transplant Unit, University Hospital, CHU Rangueil, Toulouse, France.
Ribes
David
D
Kamar
Nassim
N
Muscari
Fabrice
F
Cointault
Olivier
O
Lavayssière
Laurence
L
Suc
Bertrand
B
Esposito
Laure
L
Peron
Jean-Marie
JM
Rostaing
Lionel
L
D000328:Adult; D000368:Aged; D002121:Calcium Channel Blockers / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012737:Sex Factors
D002121:Calcium Channel Blockers; D003404:Creatinine