title: Chronic kidney disease stage progression in liver transplant recipients.
abstract: OBJECTIVE
  There is little information on chronic kidney disease (CKD) stage progression rates and outcomes in liver transplant recipients. Identifying modifiable risk factors may help prevent CKD progression in liver transplant recipients.
  
  
  METHODS
  We performed a retrospective review of 1151 adult, deceased-donor, single-organ primary liver transplants between July 1984 and December 2007 and analyzed kidney outcomes and risk factors for CKD stage progression. Seven hundred twenty-nine patients had an available estimated GFR at 1 year posttransplant to establish a baseline stage. The primary end point was the CKD progression from one stage to a higher stage (lower GFR).
  
  
  RESULTS
  Kaplan-Meier estimates of patient survival were 91%, 74%, and 64% at 5, 10, and 15 years, respectively. Estimates of liver allograft survival were 89%, 71%, and 60% at the same time points. At 1 year, 7%, 34%, 56%, 3%, and 1% of patients were in CKD stages 1, 2, 3, 4, and 5. The incidence of stage progression was 28%, 40%, and 53% at 3, 5, and 10 years. The incidence of ESRD was 2.6%, 7.5%, and 18% at 5, 10, and 20 years. Multivariable Cox regression analyses demonstrated that CKD stage at 1 year, pretransplant diabetes and urinary tract infections/hypercholesterolemia in the first year proved to be independent risk factors for stage progression (hazard ratio 1.9, 0.28, 1.39, and 1.46, respectively, P < 0.05).
  
  
  CONCLUSIONS
  Future studies will determine whether treatment of risk factors in the first posttransplant year prevent CKD progression in liver transplant recipients.
authors.affiliation: Department of Medicine, University of Wisconsin, H4/564 CSC, 600 Highland Avenue, Madison, WI 53792, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Lamattina
authors.forename: David P
authors.initials: DP
authors.lastname: Foley
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Mezrich
authors.forename: Luis A
authors.initials: LA
authors.lastname: Fernandez
authors.forename: Vijay
authors.initials: V
authors.lastname: Vidyasagar
authors.forename: Anthony M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: Alexandru I
authors.initials: AI
authors.lastname: Musat
authors.forename: Milagros D
authors.initials: MD
authors.lastname: Samaniego-Picota
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.forename: Munoz D R
authors.initials: MD
authors.lastname: Alejandro
authors.forename: Glen E
authors.initials: GE
authors.lastname: Leverson
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
mesh_terms: D000328:Adult; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014922:Wisconsin / Q000453:epidemiology