title: Native kidney function following liver transplantation using calcineurin inhibitors: single-center analysis with 20 years of follow-up.
abstract: BACKGROUND
  The incidence of chronic kidney disease (CKD) in liver transplant recipients has been estimated to be from 18% to 28% at 10 yr after transplantation. As outcomes from liver transplantation continue to improve, long-term native kidney function in these recipients becomes more critical to patient survival.
  
  
  METHODS
  We analyzed 1151 adult, deceased-donor, single-organ primary liver transplantations performed at our center between 7/17/84 and 12/31/07. Analysis of renal function was performed on 972 patients with liver allograft survival >1 yr.
  
  
  RESULTS
  Kaplan-Meier analysis revealed that 3%, 7%, and 18% of liver transplant recipients with allograft survival >1 yr developed end-stage renal disease (ESRD) at five, 10, and 20 yr, respectively. Significant independent risk factors for ESRD included dialysis during the transplant hospitalization, the stage of CKD at one yr, hypercholesterolemia, non-Caucasian race, and hepatitis C as the primary indication for liver transplantation. The initial immunosuppression of essentially all recipients was a calcineurin inhibitor-based regimen.
  
  
  CONCLUSIONS
  Close, long-term follow-up of liver transplant recipients permits optimal management of liver allograft and native renal function and can lead to excellent long-term outcomes despite a calcineurin inhibitor-based immunosuppressive regimen.
authors.affiliation: Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: LaMattina
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Mezrich
authors.forename: Luis A
authors.initials: LA
authors.lastname: Fernandez
authors.forename: Anthony M
authors.initials: AM
authors.lastname: D'Alessandro
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
authors.forename: Alexandru I
authors.initials: AI
authors.lastname: Musat
authors.forename: John D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: David P
authors.initials: DP
authors.lastname: Foley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016572:Cyclosporine / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus