Long-Term Outcome of Liver Transplant Recipients After the Development of Renal Failure Requiring Dialysis: A Study Using the National Health Insurance Database in Taiwan

SummaryImmunosuppressive drugs play a crucial role in the inhibition of immune reaction and prevention of graft rejection aswell as in the pharmacotherapy of autoimmune disorders. Effective immunosuppression should provide an adequate safety profile and improve treatment outcomes and the patients' quality of life. High-risk transplant recipients may be identified, but a definitive prediction model has still not been recognized. Therapeutic drug monitoring (TDM) for immunosuppressive drugs is an essential, but at the same time insufficient tool due to low predictability of drug exposition and marked pharmacokinetic variability. Parallel therapeutic, biochemical and clinical monitoring may successfully optimize and individualize therapy for transplanted recipients, providing optimal medical outcomes. Modern pharmacotherapy management should include new biomarkers with better sensitivity and specificity that can identify early cell damage. The aim of this study was to point out the importance of finding new biomarkers that would enable early detection of adverse drug events and cell damage in organ transplant recipients. We wanted to confirm the importance of routine biochemical monitoring in improving the safety of immunosuppressive treatment.

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“…This may provide a better prognosis for clinical outcomes and improve the quality of life with decreasing medical costs (21, 22). …”

Section: Biomarkers After Organ Transplantation and Risk Managementmentioning

confidence: 99%

Current Biochemical Monitoring and Risk Management of Immunosuppressive Therapy after Transplantation

Catić‐Đorđević

Cvetković

Stefanović

et al. 2017

Journal of Medical Biochemistry

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“…According to the previous reports, the incidence of post-LT CKD ranged from 11.7% to 54% 2 – 10 . Based on data of 1771 liver recipients in Taiwan National Health Insurance Research Database, Wang et al 7 revealed that 323 (18.2%) patients required renal replacement therapy after LT and had a higher mortality.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a nomogram model for predicting chronic kidney disease after liver transplantation: a multi-center retrospective study

Lin

Dong³

et al. 2023

Sci Rep

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Chronic kidney disease (CKD) is a frequent complication after liver transplantation (LT) and associated with poor prognosis. In this study, we retrospectively analyzed 515 adult patients who underwent LT in our center. They were randomly divided into a training set (n = 360) and an internal test set (n = 155). Another 118 recipients in other centers served as external validation set. Univariate and multivariate COX regression analysis were used to determine risk factors. A nomogram model was developed to predict post-LT CKD. The incidence of post-LT CKD in our center was 16.9% (87/515) during a median follow-up time of 22.73 months. The overall survival of recipients with severe CKD (stage IV and V) were significantly lower than those with non or mild CKD (stage III) (p = 0.0015). A nomogram model was established based on recipient’s age, anhepatic phase, estimated glomerular filtration rate and triglyceride levels at 30 days after LT. The calibration curves for post-LT CKD prediction in the nomogram were consistent with the actual observation in both the internal and external validation set. In conclusion, severe post-LT CKD resulted in a significantly reduced survival in liver recipient. The newly established nomogram model had good predictive ability for post-LT CKD.

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“…Kidney disease following liver transplantation (LT) is associated with significant morbidity and mortality. ( 1‐4 ) The etiology of renal dysfunction after LT is multifactorial. Since the implementation of the Model for End‐Stage Liver Disease (MELD) allocation system, the prevalence of impaired renal function before transplant has increased, which is associated with an increased likelihood of post‐LT chronic kidney disease (CKD).…”

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confidence: 99%

Black Race Is Associated With Higher Rates of Early‐Onset End‐Stage Renal Disease and Increased Mortality Following Liver Transplantation

et al. 2021

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Black race is a risk factor for end-stage renal disease (ESRD). Racial disparities in the risks of early and long-term renal complications after liver transplantation (LT) have not been systematically studied. This study evaluated racial differences in the natural history of acute and chronic renal insufficiency after LT. This was a retrospective single-center cohort study of 763 non-Hispanic White and 181 Black LT recipients between 2008 and 2017. Black race was investigated as an independent predictor of the following outcomes: (1) receipt and duration of early post-LT hemodialysis and (2) time to post-LT ESRD. The interaction of race and post-LT ESRD on survival was also studied. Black recipients had higher rates of pre-LT hypertension (P < 0.001), but diabetes mellitus and renal function before LT were not different by race (all P > 0.05). Overall, 15.2% of patients required early hemodialysis immediately after LT with no difference by race (covariate-adjusted odds ratio, 0.89; P = 0.71). Early dialysis discontinuation was lower among Black recipients (covariate-adjusted hazard ratio [aHR], 0.47; P = 0.02), whereas their rate of post-LT ESRD was higher (aHR, 1.91; P = 0.005). Post-LT survival after ESRD was markedly worse for Black (aHR, 11.18; P < 0.001) versus White recipients (aHR, 5.83; P < 0.001; interaction P = 0.08). Although Black and White LT recipients had comparable pretransplant renal function, post-LT renal outcomes differed considerably, and the impact of ESRD on post-LT survival was greater for Black recipients. This study highlights the need for an individualized approach to post-LT management to improve outcomes for all patients.

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Long-Term Outcome of Liver Transplant Recipients After the Development of Renal Failure Requiring Dialysis: A Study Using the National Health Insurance Database in Taiwan

Cited by 4 publications

References 10 publications

Current Biochemical Monitoring and Risk Management of Immunosuppressive Therapy after Transplantation

Current Biochemical Monitoring and Risk Management of Immunosuppressive Therapy after Transplantation

Development and validation of a nomogram model for predicting chronic kidney disease after liver transplantation: a multi-center retrospective study

Black Race Is Associated With Higher Rates of Early‐Onset End‐Stage Renal Disease and Increased Mortality Following Liver Transplantation

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