title: Renal function in patients undergoing transplantation for nonalcoholic steatohepatitis cirrhosis: time to reconsider immunosuppression regimens?
abstract: Nonalcoholic fatty liver disease is an independent risk factor for chronic kidney injury (CKI), yet the impact of liver transplantation (LT) on renal function in this at-risk group is not known. We compared the post-LT renal function of patients with nonalcoholic steatohepatitis (NASH) and a matched comparison group. Forty-eight consecutive patients who underwent transplantation for NASH between 2000 and 2008 in a single UK center were compared to non-NASH patients who were matched by age, sex, Model for End-Stage Liver Disease score, and estimated glomerular filtration rate (eGFR; calculated with the Modification of Diet in Renal Disease formula). In comparison with non-NASH patients, NASH patients had a significantly lower eGFR 3 months after LT (eGFR difference = 8.85 mL/minute/1.73 m(2), 95% confidence interval = 2.93-14.77). After adjustments for the effects of the body mass index, tacrolimus levels, diabetes mellitus, hypertension, and hepatocellular carcinoma, the difference between the groups remained significant 3 months after LT (P = 0.001). These data were then analyzed at numerous time points after LT (6, 12, and 24 months), and the time did not significantly affect the difference between the groups (P = 0.17). Within 2 years, 31.2% of the NASH patients (15/48) had developed stage IIIb CKI, whereas only 8.3% of the non-NASH patients (4/48) did (P = 0.009). In conclusion, this study has identified NASH as an independent risk factor for renal dysfunction after LT. Renal-sparing immunosuppression regimens should be considered at the time of LT to reduce the development of kidney injury in NASH patients. The optimization of such regimens requires a prospective study.
authors.affiliation: Centre for Liver Research, National Institute for Health Research, University of Birmingham, Birmingham, United Kingdom. d.d.houlihan@bham.ac.uk
authors.forename: Diarmaid D
authors.initials: DD
authors.lastname: Houlihan
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Yana
authors.initials: Y
authors.lastname: Davidov
authors.forename: James
authors.initials: J
authors.lastname: Hodson
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Ian A
authors.initials: IA
authors.lastname: Rowe
authors.forename: Sue
authors.initials: S
authors.lastname: Paris
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: Simon B
authors.initials: SB
authors.lastname: Bramhall
authors.forename: David J
authors.initials: DJ
authors.lastname: Mutimer
authors.forename: James M
authors.initials: JM
authors.lastname: Neuberger
authors.forename: Philip N
authors.initials: PN
authors.lastname: Newsome
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000276:immunology* / Q000401:mortality; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005234:Fatty Liver / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000502:physiology*; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D065626:Non-alcoholic Fatty Liver Disease; D011183:Postoperative Complications / Q000276:immunology / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000276:immunology / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents