title: Chronic renal outcome after living donor liver transplantation.
abstract: Chronic kidney disease (CKD) is one of the common complications after deceased donor liver transplantation. Although the worldwide pressing shortage in deceased donors has directed attention to living donor liver transplantation (LDLT), LDLT cohort data focusing on chronic renal dysfunction is limited. A total of 280 adult LDLT recipients (median 49 yr, 156 men) at the University of Tokyo hospital between 1996 and 2006 were reviewed. A total of 224 pre-transplant liver failure patients (80.0%) showed an estimated glomerular filtration rate (eGFR) of more than 60 mL/min/1.73 m(2). However, during follow-up at a mean of 1222 d after transplantation, eGFR declined to 60 mL/min/1.73 m(2) and 30 mL/min/1.73 m(2) in 150 (53.2%) and 21 (7.5%), respectively, and four patients (1.4%) required maintenance renal replacement therapy. Multivariate Cox proportional hazard model regression analysis revealed that recipient age (HR, 3.42 per 10-yr increment; p < 0.001) and pre-transplant eGFR (HR, 0.85 per 10-mL/min/1.73 m(2) increment; p = 0.04) were associated independently with a post-transplant decrease in eGFR to less than 30 mL/min/1.73 m(2). We conclude that higher age and lower pre-transplant eGFR of an LDLT recipient indicate a high likelihood of subsequent development of advanced CKD. Preventive or therapeutic intervention should be optimized for these high-risk patients.
authors.affiliation: Division of Nephrology and Endocrinology, University of Tokyo School of Medicine, Tokyo, Japan. hrnishi-tky@umin.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishi
authors.forename: Yugo
authors.initials: Y
authors.lastname: Shibagaki
authors.forename: Ryo
authors.initials: R
authors.lastname: Kido
authors.forename: Sumihito
authors.initials: S
authors.lastname: Tamura
authors.forename: Masaomi
authors.initials: M
authors.lastname: Nangaku
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Toshiro
authors.initials: T
authors.lastname: Fujita
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate