Estimation of glomerular filtration rates before and after orthotopic liver transplantation: Evaluation of current equations

Gonwa, Thomas A.; Jennings, Linda W.; Martin, L.; Stark, Paul C.; Levey, Andrew S.; Klintmalm, Göran B.

doi:10.1002/lt.20017

Cited by 297 publications

(296 citation statements)

References 24 publications

(47 reference statements)

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“…The primary end point, however, was adjusted for baseline GFR; thus, this does not appear to be a significant confounding factor. The accuracy of measured GFR versus calculated CL cr in liver transplant patients, as described by Gonwa et al (22), should also be considered. Given the nature of the study (multicenter, multinational), calculated GFR was deemed the most reasonable measure of renal clearance across the study sites, given the impractical and cumbersome nature of other, more accurate means in the context and time of this clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus Conversion Regimen Versus Continued Calcineurin Inhibitors in Liver Allograft Recipients: A Randomized Trial

Abdelmalek

Humar

Stickel

et al. 2012

American Journal of Transplantation

110

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A large prospective, open-label, randomized trial evaluated conversion from calcineurin inhibitor (CNI)-to sirolimus (SRL)-based immunosuppression for preservation of renal function in liver transplantation patients. Eligible patients received liver allografts 6-144 months previously and maintenance immunosuppression with CNI (cyclosporine or tacrolimus) since early posttransplantation. In total, 607 patients were randomized (2:1) to abrupt conversion (<24 h) from CNI to SRL (n = 393) or CNI continuation for up to 6 years (n = 214). Between-group changes in baseline-adjusted mean Cockcroft-Gault GFR at month 12 (primary efficacy end point) were not significant. The primary safety end point, noninferiority of cumulative rate of graft loss or death at 12 months, was not met (6.6% vs. 5.6% in the SRL and CNI groups, respectively). Rates of death at 12 months were not significantly different, and no true graft losses (e.g. liver transplantation) were observed during the 12-month period. At 52 weeks, SRL conversion was associated with higher rates of biopsy-confirmed acute rejection (p = 0.02) and discontinuations (p < 0.001), primarily for adverse events. Adverse events were consistent with known safety profiles. In conclusion, liver transplantation patients showed no demonstrable benefit 1 year after conversion from CNI-to SRL-based immunosuppression.

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Section: Discussionmentioning

confidence: 99%

Sirolimus Conversion Regimen Versus Continued Calcineurin Inhibitors in Liver Allograft Recipients: A Randomized Trial

Abdelmalek

Humar

Stickel

et al. 2012

American Journal of Transplantation

110

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“…1,[5][6][7][8] This wide range is partly explained by a lack of consensus criteria as to what constitutes CKD in these populations and by shortcomings of estimating equations that depend on serum creatinine. 9 Transplant candidates and recipients often have lower muscle mass and less creatinine generation than the populations in which these equations were developed, limiting the accuracy of the equations. 10,11 This problem is exemplified in a large cohort study in which I 125 iothalamate GFR measurements were performed in 1447 liver transplant candidates before and sequentially after transplantation.…”

Section: Prevalence Of Ckd After Nonrenal Organ Transplantationmentioning

confidence: 99%

“…Of all formulas, the sixvariable MDRD fared best, although it lacked precision and underestimated renal function in patients beyond the first posttransplantation year. 9 Recent studies suggest that the formulas are similarly limited in estimating kidney function in lung and heart recipients as well. 12,13 The largest and most comprehensive study of CKD prevalence after solid-organ transplantation used a definition of GFR of Ͻ30 ml/min per 1.73 m 2 body surface area, calculated with the fourvariable MDRD equation.…”

Section: Prevalence Of Ckd After Nonrenal Organ Transplantationmentioning

confidence: 99%

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom

Reese

2007

Journal of the American Society of Nephrology

163

138

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“…However the MDRD-4 formula is the formula reported by most laboratories, as it was equally accurate as the original six-variable formula in screening for patients with chronic stable kidney disease. In cirrhosis, C-G and both MDRD formulae typically overestimate true GFR, particularly in those patients below 50 years old or those with ascites [33] . Due to inaccuracies of the MDRD-4 equation in determining renal function in patients with an eGFR > 60 mL/min, a new creatinine-based equation known as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, using the same variables with MDRD-4 formula, has been proposed, but its superiority in patients with cirrhosis has not been validated [34] .…”

Section: What Are the Alternatives To Measuring Serum Creatinine?mentioning

confidence: 99%

Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria

Agarwal

Davenport

2014

WJH

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Renal function in patients with advanced cirrhosis is an important prognostic factor for survival both prior to and following liver transplantation. The importance of renal function is reflected by the introduction of the model for end stage liver disease (MELD) score, which includes serum creatinine. The MELD score has been shown to predict the short term risk of death for transplant wait listed patients and is currently used by many countries to allocate liver transplants on the basis of severity of underlying illness. Changes in serum creatinine are also used to stage acute kidney injury. However prior to liver transplantation the serum creatinine typically over estimates underlying renal function, particularly when a colorimetric Jaffe based assay is used, and paradoxically then under estimates renal function post liver transplantation, particularly when immunophyllins are started early as part of transplant immunosuppression. As acute kidney injury is defined by changes in serum creatinine, this potentially leads to over estimation of the incidence and severity of acute kidney injury in the immediate post-operative period. Key words: Serum creatinine; Acute kidney injury; Liver transplantationCore tip: Acute kidney injury is defined and severity graded based on changes in serum creatinine. Increasing concentrations of bilirubin interefere with laboratory determination of creatinine and reduce creatinine estimations. Post transplantation serum creatinine increases due to a combination of fall bilirubin and the loading doses of calcineurin inhibitor immunosupressants. This combination leads to an over estimation of the lesser grades of acute kidney injury post liver transplantation.Agarwal B, Davenport A. Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria. World J Hepatol 2014; 6(10): 696-703 Available from:

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Estimation of glomerular filtration rates before and after orthotopic liver transplantation: Evaluation of current equations

Abstract: The ability to estimate rather than measure the glomerular filtration rate (GFR) in patients before and after liver transplantation would be helpful in estimating risk, dosing drugs, and assessing long-term toxicity of calcineurin

Cited by 297 publications

References 24 publications

Sirolimus Conversion Regimen Versus Continued Calcineurin Inhibitors in Liver Allograft Recipients: A Randomized Trial

Sirolimus Conversion Regimen Versus Continued Calcineurin Inhibitors in Liver Allograft Recipients: A Randomized Trial

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria

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