Renal disease burden following liver transplantation.
Significant chronic kidney disease (CKD) occurs following orthotopic liver transplant (OLT). Since CKD is associated with increased cardiovascular events, mortality, and hepatic allograft dysfunction, early recognition of CKD and implementation of changes may improve the long-term outcome. The purpose of this study was to determine the burden of renal disease following OLT.


METHODS
We retrospectively reviewed our OLT recipients from 1997 until 2004. We calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease study (MDRD) method. The GFRs were further subdivided into pre-MELD and post-MELD eras.


RESULTS
During the study period, we performed 407 OLTs. We censored data from living donor liver transplants (n = 14), combined liver-kidney transplants (n = 12), and from patients whom we did not have complete data for 6 months after transplant (n = 40). Mean MELD score at the time of transplant was 18 +/- 7 (mean +/- standard deviation). The mean GFR at 6 months following OLT was 63.7 +/- 30.2 mL/min per 1.73 m(2). Only 14% (n = 47) of our patients had normal renal function at 6 months, while 78% (n = 266) of our patients had mild to moderate risk for renal failure. Eight percent (n = 28) had stage 4 or 5 CKD. There were no differences between the pre-MELD and post-MELD GFRs.


CONCLUSIONS
The burden of renal disease is significant in our patient population at 6 months posttransplantation. It may be important to introduce CKD management as early as 6 months after transplant to impact the outcomes of OLT recipients.
Kim
D Y
DY
Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. dkim3@hfhs.org
Lim
C
C
Parasuraman
R
R
Raoufi
M
M
Yoshida
A
A
Arenas
J
J
Denny
J
J
Malinzak
L
L
Almarastani
M
M
Moonka
D
D
Brown
K
K
Sherbondy
M
M
Gordon
S
S
Abouljoud
M
M
D000328:Adult; D002908:Chronic Disease; D017281:Cost of Illness; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000191:economics* / Q000453:epidemiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008824:Michigan; D012189:Retrospective Studies; D012720:Severity of Illness Index