title: The 4-week serum creatinine level predicts long-term renal dysfunction after adult living donor liver transplantation.
abstract: OBJECTIVE
  Recipients after liver transplantation. (OLT) often experience renal dysfunction. Acute kidney injury (AKI) and chronic kidney disease (CKD) after OLT occur among 20% to 50% and 30% to 90% of recipients, respectively; 2% to 5% of them deteriorate into end-stage renal disease each year. Since the predictable factors for CKD have not been well identified. We sought to investigate the incidence and predictors of CKD at 5 years after OLT.
  
  
  METHODS
  Between August 2002 and December 2005, we enrolled 77 patients who underwent adult living donor OLT with over 2 years of follow-up. The strategies to prevent renal dysfunction included induction with basiliximab to delay the use of tacrolimus: addition of mycophenolate mofetil to reduce the tacrolimus dosage; avoidance of the calcineurin inhibitor using sirolimus or administration of an angiotensin II receptor antagonist. The clinical variables were reviewed for analysis.
  
  
  RESULTS
  The mean follow-up was 76 ± 14 months. The incidence of AKI (over 50% increase level of creatinine) was 29%. Ten (13.0%) patients developed CKD (creatinine > 2 mg/dL). One (1.3%) subject developed end-stage renal disease requiring hemodialysis. Upon multivariate analysis the development of CKD was significantly associated with the posttransplant 4-week creatinine level: 0.92 ± 0.23 versus 1.37 ± 0.93 mg/dL (P = .008).
  
  
  CONCLUSIONS
  The 4-week creatinine value was predictive of the occurence of CKD over 5 years after OLT.
authors.affiliation: Liver Transplant Program, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Niao-Sung, Kaohsiung, Taiwan.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Lin
authors.forename: C-C
authors.initials: CC
authors.lastname: Lin
authors.forename: C-C
authors.initials: CC
authors.lastname: Wang
authors.forename: S-H
authors.initials: SH
authors.lastname: Wang
authors.forename: Y-W
authors.initials: YW
authors.lastname: Liu
authors.forename: C-C
authors.initials: CC
authors.lastname: Yong
authors.forename: T-L
authors.initials: TL
authors.lastname: Lin
authors.forename: W-F
authors.initials: WF
authors.lastname: Li
authors.forename: A M
authors.initials: AM
authors.lastname: Concejero
authors.forename: C-L
authors.initials: CL
authors.lastname: Chen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000503:physiopathology; D000328:Adult; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects; D000077552:Basiliximab; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000009:adverse effects; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D057911:Angiotensin Receptor Antagonists; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D003404:Creatinine; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus