title: Underestimation of chronic renal dysfunction after liver transplantation: ICEBERG study.
abstract: OBJECTIVE
  To compare prevalence of chronic renal dysfunction (CRD) according to serum creatinine (sCr) vs estimated glomerular filtration rate (eGFR) among maintenance liver transplant patients.
  
  
  METHODS
  The ICEBERG study was an observational, retrospective, cross-sectional, and multicenter study. Consecutive adult patients (aged 18 years or older) with liver transplantation (LT) performed at least two years previously were recruited. Multi-organ transplant recipients were excluded. Chronic renal dysfunction was defined according to sCr based criteria in routine clinical practice (≥ 2 mg/dL) and eGFR using MDRD-4 equation (< 60 mL/min per 1.73 m(2)). Agreement between sCr definition and eGFR assessment was evaluated using the Kappa index. Cox regression analysis was applied to identify predictive factors for developing CRD after LT.
  
  
  RESULTS
  A total of 402 patients were analyzed (71.6% males). Mean ± SD age at transplant was 52.4 ± 9.8 years. Alcoholic cirrhosis without hepatocellular carcinoma was the most common reason for LT (32.8%). Mean time since LT was 6.9 ± 3.9 years. Based on sCr assessment, 35.3% of patients (95%CI: 30.6-40.0) had CRD; 50.2% (95%CI: 45.3-55.1) according to eGFR. In 32.2% of cases, sCr assessment had underestimated CRD. Multivariate analysis showed the following factors associated with developing CRD: eGFR < 60 mL/min per 1.73 m(2) at three months post-transplant [hazard ratio (HR) = 4.76; 95%CI: 2.78-8.33; P < 0.0001]; calcineurin inhibitor use (HR = 2.31; 95%CI: 1.05-5.07; P = 0.0371); male gender (HR = 1.98; 95%CI: 1.09-3.60; P = 0.0260); and ≥ 10 years post-transplantation (HR = 1.95; 95%CI: 1.08-3.54; P = 0.0279).
  
  
  CONCLUSIONS
  Seven years after LT, CRD affected half our patients, which was underestimated by sCr. An eGFR < 60 mL/min per 1.73 m(2) three months post-LT was predictive of subsequent CRD.
authors: Evaristo Varo, Liver Transplant Unit, Hospital Clínico Universitario Santiago de Compostela, 15706 Santiago de Compostela, Spain.
authors: Evaristo
authors: E
authors: Varo
authors: Evaristo Varo, Liver Transplant Unit, Hospital Clínico Universitario Santiago de Compostela, 15706 Santiago de Compostela, Spain.
authors: Rafael
authors: R
authors: Bañares
authors: Evaristo Varo, Liver Transplant Unit, Hospital Clínico Universitario Santiago de Compostela, 15706 Santiago de Compostela, Spain.
authors: Magda
authors: M
authors: Guilera
keywords: Calcineurin inhibitor; Chronic renal dysfunction; Glomerular filtration rate; Liver transplantation; Prevalence