title: Early changes in kidney function predict long-term chronic kidney disease and mortality in patients after liver transplantation.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a well-known complication after liver transplantation (LT) and is associated with increased mortality. The purpose of this study was to determine risk factors of advanced CKD and mortality after LT.
  
  
  METHODS
  Four hundred forty-five adult patients underwent LT between June 1990 and September 2007 and survived more than 1 month. Multivariate Cox regression analyses were performed for time to CKD stage 4 (glomerular filtration rate [GFR] ≤30 mL/min), time to chronic dialysis, and all-cause mortality. Several patient and disease characteristics were used as independent pre- and posttransplant variables. We specifically analyzed a drop more than or equal to 30% in the estimated GFR (eGFR) during the first year posttransplant.
  
  
  RESULTS
  Diabetes mellitus pretransplant and a drop more than or equal to 30% in the eGFR between 3 and 12 months predicted CKD stage 4 (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.9-5.4, P<0.001 and OR 16.1, 95% CI 5.9-44.5, P<0.0001, respectively), the need for chronic dialysis (OR 3.8, 95% CI 1.1-13.2, P=0.03 and OR 14.6, 95% CI 3.0-71.4, P<0.001, respectively), and all-cause mortality (OR 1.9, 95% CI 1.2-2.9, P=0.004 and OR 2.6, 95% CI 1.6-4.4, P<0.001, respectively), more than 1 year after LT.
  
  
  CONCLUSIONS
  Diabetes mellitus pretransplant and a drop more than or equal to 30% in the eGFR within the first year are strong predictors of advanced CKD, chronic dialysis, and death more than 1 year after LT. These easily determined clinical variables define a population at risk for CKD who should be targeted for renal protection strategies.
authors: Department of Medicine, McGill University Health Center, Montréal, QC, Canada. marcelo.cantarovich@muhc.mcgill.ca
authors: Marcelo
authors: M
authors: Cantarovich
authors: Jean
authors: J
authors: Tchervenkov
authors: Steven
authors: S
authors: Paraskevas
authors: Peter
authors: P
authors: Ghali
authors: Philip
authors: P
authors: Wong
authors: Marc
authors: M
authors: Deschênes
authors: Prosanto
authors: P
authors: Chaudhury
authors: Mazen
authors: M
authors: Hassanain
authors: Dionisios
authors: D
authors: Vrochides
authors: Peter
authors: P
authors: Metrakos
authors: Jeffrey
authors: J
authors: Barkun
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008107:Liver Diseases / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors