title: Minimal Improvement in Glomerular Filtration Rate in the First Year After Liver Transplantation.
abstract: BACKGROUND
  Renal function is an important predictor of liver transplantation (LT) outcome. This study examines the change in glomerular filtration rate (GFR, mL/min per m) in the first year after LT, with subgroup analysis by baseline GFR, model for end-stage liver disease (MELD), age, sex, race, and diabetes/hypertension.
  
  
  METHODS
  The records of 1275 consecutive deceased donor, liver, and liver/kidney transplants were reviewed retrospectively, with the liver/kidney data analyzed separately. Glomerular filtration rate was calculated using the modification of diet in renal disease equation.
  
  
  RESULTS
  Among liver only patients, 25% had GFR less than 60 (mL/min per 1.73 m) at LT, and this increased to 39% at 1 year. There were 42% of patients with normal renal function (GFR > 90) at baseline, and this decreased to 18% at 1 year. Only patient subgroups with MELD > 25 experienced any 1-year improvement in GFR, whereas all lower MELD groups experienced a significant decline in GFR. At 1 year after transplantation, there were 42% of recipients that had an absolute GFR decrease greater than 20 mL/min per 1.73 m, and 39% that decreased greater than 25% from their transplant baseline. Only 22% had an absolute improvement in GFR greater than 5 mL/min per 1.73 m.
  
  
  CONCLUSIONS
  Sixty-four percent of liver transplant recipients overall experience a decrease in GFR 1 year after transplantation. Recipients with severe kidney disease at transplant (GFR < 30) are the group most likely to experience improvement in GFR after transplantation. However, at 1 year, as a group, they remain at GFR less than 60 (stage III chronic kidney disease). These results suggest that severe renal dysfunction may be marginally reversible after LT, but only 22% of the recipients in this cohort experienced any post-LT improvement in renal function.
authors: 1 Department of Surgery, Transplant Section, Indiana University School of Medicine, Indianapolis, IN.
authors: Richard S
authors: RS
authors: Mangus
authors: Andrew J
authors: AJ
authors: Lutz
authors: Jonathan A
authors: JA
authors: Fridell
authors: Chandrashekhar A
authors: CA
authors: Kubal
authors: Weston J
authors: WJ
authors: Bush
authors: A Joseph
authors: AJ
authors: Tector
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D020127:Recovery of Function; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult