title: End-stage renal disease after liver transplantation in patients with pre-transplant chronic kidney disease.
abstract: Renal dysfunction prior to liver transplantation has a marked impact on post-transplant kidney outcomes.
  
  
  OBJECTIVE
  The aim of this study was to assess post-transplant renal function in patients with chronic kidney disease (CKD) receiving orthotopic liver transplantation (OLT) alone.
  
  
  METHODS
  Retrospective review of 40 OLT recipients with pre-transplant CKD (serum creatinine ≥2 mg/dL for at least three months) at the University of Pennsylvania from February 2002 to July 2010. Primary outcome was estimated glomerular filtration rate (eGFR) up to three years post-transplant. Secondary outcomes included incidence of stage 4 CKD (eGFR < 30 mL/min), need for renal replacement therapy (RRT), meeting criteria for kidney transplant listing (eGFR ≤ 20 mL/min), and mortality.
  
  
  RESULTS
  Median patient age was 56.5 yr and 48% patients had pre-transplant diabetes. Median serum creatinine at transplant was 2.7 mg/dL (eGFR = 24 mL/min). Median eGFR at one, two, and three yr post-transplant was 35, 34, and 37 mL/min, respectively. Twelve patients (30%) required RRT at a median of 1.21 yr post-transplant and 16 (40%) achieved an eGFR ≤ 20 mL/min at 1.09 yr post-transplant. Mortality was 35% at a median of 1.60 years post-transplant.
  
  
  CONCLUSIONS
  OLT recipients with pre-transplant CKD have a substantial burden of post-transplant renal dysfunction and high short-term mortality, questioning the rationale for OLT alone in this population.
authors.affiliation: Division of Gastroenterology and Hepatology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Ranjeeta
authors.initials: R
authors.lastname: Bahirwani
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Forde
authors.forename: Yifei
authors.initials: Y
authors.lastname: Mu
authors.forename: Fred
authors.initials: F
authors.lastname: Lin
authors.forename: Peter
authors.initials: P
authors.lastname: Reese
authors.forename: David
authors.initials: D
authors.lastname: Goldberg
authors.forename: Peter
authors.initials: P
authors.lastname: Abt
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.forename: Matthew
authors.initials: M
authors.lastname: Levine
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: kidney dysfunction; liver transplantation; renal insufficiency