Early kidney dysfunction post liver transplantation predicts late chronic kidney disease

Velidedeoğlu, Ergun; Bloom, Roy D.; Crawford, Michael; Desai, Niraj M.; Campos, Luís; Abt, Peter L.; Markmann, Joseph W.; Mange, Kevin C.; Olthoff, Kim M.; Shaked, Abraham; Markmann, James F.

doi:10.1097/01.tp.0000114609.99558.41

Cited by 64 publications

(54 citation statements)

References 15 publications

(20 reference statements)

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“…69,70 Liver recipients with preexisting as well as newly acquired diabetes are at higher risk for developing CKD. 71 Despite the fact that liver transplant patients generally require less immunosuppression than recipients of other solid organs, CNI-related CKD occurs commonly. At the same time, a strategy of CNI minimization should be safely achievable in this patient group.…”

Section: Liver Transplantationmentioning

confidence: 99%

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom

Reese

2007

Journal of the American Society of Nephrology

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163

138

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Section: Liver Transplantationmentioning

confidence: 99%

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom

Reese

2007

Journal of the American Society of Nephrology

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163

138

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“…Late renal failure is associated with both pre-and postliver transplant factors, including higher concentrations of CNIs both early and late posttransplant (7,8) and can be predicted by creatinine levels in the first posttransplant year (9,10). Strategies to minimize the adverse renal effects of CNIs in patients include reducing the CNI dose (11)(12)(13)(14) or complete withdrawal of the CNI (14,15), while adding other immunosuppressive agents such as mycophenolate mofetil (MMF) (12)(13)(14)16) or sirolimus (11,15) (17)(18)(19) …”

Section: Introductionmentioning

confidence: 99%

Delayed Introduction of Reduced-Dose Tacrolimus, and Renal Function in Liver Transplantation: The ‘ReSpECT’ Study

Neuberger

Mamelok

Neuhaus

et al. 2009

American Journal of Transplantation

253

194

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We report a multicenter, prospective, randomized, open-label trial investigating the effect of lower levels and delayed introduction of tacrolimus on renal function in liver transplant recipients. Adult patients with good renal function undergoing primary liver transplant were randomized to either: group A (standarddose tacrolimus [target trough levels >10 ng/mL] and corticosteroids; n = 183); group B (mycophenolate mofetil [MMF] 2g/day, reduced-dose tacrolimus [target trough levels ≤8 ng/mL], and corticosteroids; n = 170); group C (daclizumab induction, MMF, reduced-dose tacrolimus delayed until the fifth day posttransplant and corticosteroids, n = 172). The primary endpoint was change from baseline in estimated glomerular filtration rate (eGFR) at 52 weeks. The eGFR decreased by 23.61, 21.22 and 13.63 mL/min in groups A, B and C, respectively (A vs C, p = 0.012; A vs B, p = 0.199). Renal dialysis was required less frequently in group C versus group A (4.2% vs. 9.9%; p = 0.037). Biopsy-proven acute rejection rates were 27.6%, 29.2% and 19.0%, respectively. Patient and graft survival was similar. In conclusion, daclizumab induction, MMF, corticosteroids and delayed reduced-dose tacrolimus was associated with less nephrotoxicity than therapy with standard-dose tacrolimus and corticosteroids without compromising efficacy or tolerability.

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“…In a population-based cohort analysis including 69 321 patients after non-renal organ transplantation, 7.6% of the patients developed postoperative acute renal failure (defined by 50% reduction in glomerular filtration rate or a need for urgent dialysis) [1]. Previous estimations of the incidence of acute renal failure after orthotopic liver transplantation in adults vary between 31% and 94%, depending on the definition used [2][3][4][5][6]. Its multifactorial origin complicates the identification of risk factors to develop prevention strategies.…”

mentioning

confidence: 99%

Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients*

Rueggeberg¹,

Boehm²,

Napieralski³

et al. 2008

Anaesthesia

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SummaryThe purpose of this prospective observation cohort study was to develop and validate a risk stratification model for prediction of acute renal failure after liver transplantation. Data from 71 orthotopic liver transplantation recipients were used to develop a risk stratification model by binary logistic regression analysis containing the following variables: pretransplant hepatitis B and ⁄ or C infection; arterial hypertension; intra-operative mean arterial blood pressure before induction of anaesthesia; units of packed red blood cells required; hypotension (mean arterial blood pressure £50 mmHg); and maximum lactate concentration. Validation of the model on 167 consecutive patients revealed a sensitivity of 0.78, a specifity of 0.92, a negative predictive value of 0.96 and a positive predictive value of 0.62. This risk stratification model enables identification of orthotopic liver transplantation recipients with no or low risk for acute renal failure directly at the end of the transplantation procedure. Acute renal failure is a common and severe complication after major surgery and organ transplantation. In a population-based cohort analysis including 69 321 patients after non-renal organ transplantation, 7.6% of the patients developed postoperative acute renal failure (defined by 50% reduction in glomerular filtration rate or a need for urgent dialysis) [1]. Previous estimations of the incidence of acute renal failure after orthotopic liver transplantation in adults vary between 31% and 94%, depending on the definition used [2][3][4][5][6]. Its multifactorial origin complicates the identification of risk factors to develop prevention strategies. Acute renal failure can occur early in the postoperative course and seems to be related to pre-operative conditions and to the operative procedure. Impaired renal function and especially the need for post-transplant renal replacement therapy is associated with prolonged hospitalisation, increased mortality [2,[7][8][9], and significant financial cost [10].These observations prompted this prospective observational study, with the aim of developing a prediction model to identify patients at risk for acute renal failure requiring renal replacement therapy directly at the end of the transplantation procedure. Therefore we investigated only pre-and intra-operative risk factors for the development of acute renal failure after orthotopic liver transplantation, postoperative risk factors such as nephrotoxic drugs or postoperative complications having been extensively studied in the past.

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Early kidney dysfunction post liver transplantation predicts late chronic kidney disease

Cited by 64 publications

References 15 publications

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Delayed Introduction of Reduced-Dose Tacrolimus, and Renal Function in Liver Transplantation: The ‘ReSpECT’ Study

Development of a risk stratification model for predicting acute renal failure in orthotopic liver transplantation recipients*

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