title: Acute renal failure and chronic kidney disease following liver transplantation.
abstract: Acute renal failure (ARF) and chronic kidney disease (CKD) are common complications after liver transplantation (LTx). The incidence of ARF post-LTx varies between 48% and 94%; 8% to 17% of patients require renal replacement therapy (RRT). The most common cause of ARF early after LTx is ischemic acute tubular necrosis, followed later by cyclosporine toxicity and sepsis. Preoperative serum creatinine >1.5 mg/dL and early hepatic allograft dysfunction are risk factors for the occurrence of postoperative ARF. Of patients with ARF due to the hepatorenal syndrome, approximately two-thirds will recover, although recovery may be delayed 3 months or longer after LTx. Mortality after LTx is affected modestly by the presence of ARF pretransplant (<2-fold increase), but increases markedly (up to 8-fold) in the face of ARF posttransplant. Mortality does not appear to be influenced by the mode of RRT used. The risk of CKD after LTx is approximately 18% at 5 years and increases to approximately 25% by 10 years after transplantation. Calcineurin inhibitor toxicity is the most common cause. Specific prognosticators for predicting CKD after LTx are presently lacking. The occurrence of CKD after LTx markedly impairs long-term survival.
authors: Division of Kidney Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, CO, USA.
authors: Rajesh
authors: R
authors: Yalavarthy
authors: Charles L
authors: CL
authors: Edelstein
authors: Isaac
authors: I
authors: Teitelbaum
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006530:Hepatorenal Syndrome; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D007683:Kidney Tubular Necrosis, Acute; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D017582:Renal Replacement Therapy; D012307:Risk Factors