Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus.
BACKGROUND
Chronic kidney disease (CKD) is common in liver transplant recipients receiving calcineurin inhibitors.


METHODS
The goals of this case-control study were to identify risk factors associated with CKD and its effect on mortality in 294 liver transplant recipients receiving calcineurin inhibition with tacrolimus.


RESULTS
Hepatitis C virus (HCV) was the most common indication (42%) for transplantation. CKD 4 and 5 (estimated glomerular filtration rate (eGFR) of <=29 ml/min/1.73 m2) developed in 10.8% of recipients during a mean follow-up of 52 months. The incidence density of CKD was 2.56 per 100 patient-years. End-stage renal disease developed in 2.7%. By univariate analysis, CKD patients were older (mean±sd, 57±10 vs. 51±11, p<0.05) with hypertension (56 vs. 32%, p<0.05), had lower preoperative hematocrit (31±6 vs. 34±5, p<0.05), alanine aminotransferase (median (95% confidence limit) 46 (34–80) vs. 68 (56–77), <0.05) and eGFR (56±28 vs. 91±35 ml/ min/1.73 m2, p<0.05), had higher preoperative prothrombin time (16.1 (14.6–17.2) vs. 14.8 (14.5–15.1) seconds, p<0.05), and required more perioperative renal replacement therapy (RRT) (41% vs. 6.5%, p<0.05) compared to controls. Perioperative need for RRT (hazard ratio (95% CI) 2.72 (1.05–7.03)) and lower preoperative eGFR: 60–89 (4.08 (1.23–13.5)), 30–59 (4.26 (1.18–15.36)), and<=29 (5.91 ((1.28–27.19)) vs. eGFR>=90 ml/min/1.73 m2 were independently associated with development of CKD adjusting for important covariates. The development of CKD (2.36 (1.22–4.59)) was independently associated with late mortality with an attributable risk of 12.8%.


CONCLUSIONS
Data demonstrate that CKD is an important clinical event associated with increased risk for death after primary liver transplantation.
Denver Nephrology PC, Denver, CO, USA.
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Ratnam
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D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005431:Florida; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects*; D013997:Time Factors
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus