title: Low estimated glomerular filtration rate and chronic kidney failure following liver transplant: a retrospective cohort study.
abstract: BACKGROUND
  Patients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant.
  
  
  METHODS
  Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes.
  
  
  RESULTS
  331 patients, who underwent LTx, were followed up for 2.6 ± 1.4 years; 31 (10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m2 had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1.73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction.
  
  
  CONCLUSIONS
  These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. The consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.
authors.affiliation: Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Narciso
authors.forename: Leonardo R
authors.initials: LR
authors.lastname: Ferraz
authors.forename: Cassio J O
authors.initials: CJ
authors.lastname: Rodrigues
authors.forename: Júlio C M
authors.initials: JC
authors.lastname: Monte
authors.forename: Sérgio
authors.initials: S
authors.lastname: Mie
authors.forename: Oscar F P
authors.initials: OF
authors.lastname: Dos Santos
authors.forename: Ângela T
authors.initials: ÂT
authors.lastname: Paes
authors.forename: Miguel
authors.initials: M
authors.lastname: Cendoroglo
authors.forename: Bertrand L
authors.initials: BL
authors.lastname: Jaber
authors.forename: Marcelino S
authors.initials: MS
authors.lastname: Durão
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Batista
mesh_terms: D001938:Brazil; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome