title: Chronic kidney disease after liver transplantation: pretransplantation risk factors and predictors during follow-up.
abstract: BACKGROUND
  Chronic renal impairment is an emerging problem in the management of patients after liver transplantation (LT).
  
  
  METHODS
  We prospectively analyzed predictors of chronic kidney disease (CKD) after LT in 179 patients followed for a median of 63 months. Diagnosis of CKD was based on an estimated glomerular filtration rate (GFR) of less than 60 mL/min according to the current position statement from the Kidney Disease Improving Global Outcome. Pretransplantation risk factors were evaluated. A Cox regression analysis, with time-dependent variables evaluated during follow-up, was applied to realize a prognostic model for CKD, and a prognostic index was also calculated. The validity of the model was tested in 149 independent LT patients with a median follow-up of 46 months.
  
  
  RESULTS
  The cumulative incidence of CKD was 45% at 5 years after LT. Estimated GFR at LT was the only pretransplantation independent risk factor (beta, 0.33; standard error (beta), 0.07; 95% confidence interval, 0.95-0.98). Development of arterial hypertension (hazards ratio [HR], 1.83), episodes of severe infection (HR, 2.15), and estimated GFR (HR, 0.89) after LT were identified as independent prognostic factors at the Cox regression time-dependent analysis. The model was able to identify the patients at higher risk for the development of CKD in the validation set.
  
  
  CONCLUSIONS
  Lower renal function at transplantation is associated with a higher risk of CKD after transplantation. A predictive model based on the variation of posttransplantation variables during the course of follow-up can help the clinicians to estimate the probability of CKD in the next 12 months.
authors: Division of Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Italy.
authors: Michela
authors: M
authors: Giusto
authors: Marina
authors: M
authors: Berenguer
authors: Carlo
authors: C
authors: Merkel
authors: Victoria
authors: V
authors: Aguilera
authors: Angel
authors: A
authors: Rubin
authors: Stefano
authors: S
authors: Ginanni Corradini
authors: Gianluca
authors: G
authors: Mennini
authors: Massimo
authors: M
authors: Rossi
authors: Martin
authors: M
authors: Prieto
authors: Manuela
authors: M
authors: Merli
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors