Perioperative risk factors of progressive chronic kidney disease following liver transplantation: analyses of a 10-year follow-up single-center cohort

Abstract

Purpose The incidence of chronic kidney disease (CKD) has been increasing due to improved survival after liver transplantation (LT). Risk factors of kidney injury after LT, especially perioperative management factors, are potentially modifiable. We investigated the risk factors associated with progressive CKD for 10 years after LT. Methods This retrospective cohort study included 292 adult patients who underwent LT at a tertiary referral hospital between 2000 and 2008. Renal function was assessed by the e stimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula. The area under the curve of serial eGFR (AUC eGFR ) was calculated for each patient to assess the trajectory of eGFR over the 10 years. Low AUC eGFR was considered progressive CKD. Linear regression analyses were performed to examine the associations between the variables and AUC eGFR . Results Multivariable analysis showed that older age (regression coefficient = −0.53, P < 0.001), diabetes mellitus (DM) (regression coefficient = −6.93, P = 0.007), preoperative proteinuria (regression coefficient = −16.11, P < 0.001), preoperative acute kidney injury (AKI) (regression coefficient = −14.35, P < 0.001), postoperative AKI (regression coefficient = −3.86, P = 0.007), and postoperative mean vasopressor score (regression coefficient = −0.45, P = 0.034) were independently associated with progressive CKD. Conclusion More careful renoprotective management is required in elderly LT patients with DM or preexisting proteinuria. Postoperative AKI and vasopressor dose may be potentially modifiable risk factors for progressive CKD.

A Systematic Review of the Literature on Chronic Kidney Disease Following Liver Transplantation

“…At 12 months, the highest proportion of patients with CKD (stage 3a or higher) was reported in those with post-transplant AKI. This might be expected, as the development of AKI after liver transplantation has been associated with an increased risk of CKD [ 36 , 37 ].…”

Risk Factors and Prognosis of New-Onset Chronic Kidney Disease Following Orthotopic Liver Transplantation: A Retrospective Case-Control Study

“…Previous studies indicated that diabetes is related to the onset and development of CKD [ 32 ]. Lee et al showed that preoperative diabetes was an independent risk factor for the development of CKD within 10 years after OLT [ 33 ]. In this study, the prevalence of preoperative diabetes in the 174 recipients was 21.8%.…”