Renal function status in liver transplant patients in the first month post-transplant is associated with progressive chronic kidney disease.
OBJECTIVE
Renal dysfunction is a common complication of liver transplantation (LT), related to hepatorenal syndrome with end-stage liver disease or calcineurin-inhibitor nephrotoxicity. Chronic kidney disease (CKD) is also a common problem in long-term survivors post-LT. This study was done to investigate the association between renal functional status soon after LT and the development of CKD.


METHODS
We retrospectively evaluated 63 patients who were aged 18 years or older, and underwent LT at Tohoku University Hospital. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease study equation for Japan.


RESULTS
Before transplantation, 25 patients (39.7%) were diagnosed with CKD (eGFR, <60 mL/min per 1.73 m(2) ). The incidence of CKD was 22.4% (13/58) at 2 years, 23.2% (13/56) at 3 years and 22.7% (12/54) at 5 years. The patients with CKD at 2 years post-transplant were more likely to have a history of glomerulonephritis, and were significantly older at the time of LT, compared to those without CKD. Levels of eGFR of less than 60 mL/min per 1.73 m(2) in the first month post-transplant and a volume of intraoperative blood loss of more than 300 mL/kg were predictive factors for the development of CKD at 2 years post-transplant and thereafter.


CONCLUSIONS
We have shown that there is an improvement of renal function in the majority of patients after LT. Regardless of the presence of pre-existing CKD, both renal function status at the first month post-transplant and a volume of intraoperative blood loss were predictive factors for the development of CKD at 2 years post-transplant and thereafter.
Advanced Surgical Science and Technology Division, Department of Surgery, Graduate School of Medicine, University of Tohoku, Sendai, Japan.
Kazushige
K
Sato
Naoki
N
Kawagishi
Keisei
K
Fujimori
Noriaki
N
Ohuchi
Susumu
S
Satomi
calcineurin inhibitor; chronic kidney disease; estimated glomerular filtration rate; intraoperative blood loss; liver transplantation