title: Risk of nephrogenic systemic fibrosis in liver transplantation patients.
abstract: OBJECTIVE
  The purpose of our study was to evaluate the exposure of our institution's liver transplantation population to gadolinium-based contrast agents and assess the rate of nephrogenic systemic fibrosis (NSF) within this unique group.
  
  
  METHODS
  Institutional review board approval was obtained for a retrospective review of medical records of patients who had undergone liver transplantation at our institution between 1997 and 2008. Informed consent was not required. Demographic information, history of gadolinium-based contrast agent exposure, stage of chronic kidney disease (CKD), and evidence of NSF were recorded.
  
  
  RESULTS
  A total of 2142 patients who had undergone liver transplantation at our institution between 1997 and 2008 were identified. Of this total, 33% (709/2142) had documented gadolinium-based contrast agent exposure peritransplantation. Patients in CKD1 and 2, CKD3, CKD4, and CKD5 comprised 50% (352/709), 28% (200/709), 8% (60/709), and 14% (97/709), respectively. Of patients in CKD5, 76% (74/97) required dialysis. Thorough review of all patients' medical records identified one biopsy-confirmed case of NSF in the 709 patients. This patient was also in CKD5 and required dialysis.
  
  
  CONCLUSIONS
  Within our institution, only 0.1% (1/709) of all liver transplantation patients exposed to gadolinium-based contrast agents or 1.4% (1/74) of CKD5 patients requiring dialysis had biopsy proof of NSF. This incidence is consistent with the rate of NSF in all patients exposed to gadolinium-based contrast agents regardless of liver transplantation reported in the literature. Therefore, liver transplantation may not be an independent risk factor in development of NSF in patients exposed to gadolinium-based contrast agents.
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7437, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Chow
authors.forename: Simin
authors.initials: S
authors.lastname: Bahrami
authors.forename: Steven S
authors.initials: SS
authors.lastname: Raman
authors.forename: Sepehr
authors.initials: S
authors.lastname: Rotchel
authors.forename: James W
authors.initials: JW
authors.lastname: Sayre
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: David S
authors.initials: DS
authors.lastname: Lu
mesh_terms: D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium