Risk factors for consequent kidney impairment and differential impact of liver transplantation on renal function

Lee, Jung Pyo; Heo, Nam Ju; Joo, Kwon Wook; Yi, Nam Joon; Suh, Kyung Suk; Moon, Kyung Chul; Kim, Seong Gyun; Kim, Yon Su

doi:10.1093/ndt/gfq093

Cited by 69 publications

(66 citation statements)

References 32 publications

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“…This was confirmed by many investigators (Moreno et al, 2003, Kim et al, 2004and Burra et al, 2009. A multivariate Cox regression analysis performed by Lee et al revealed that the overall risk of CKD development was associated with low pre transplant eGFR in addition to post-transplant acute renal failure (Lee et al, 2010). In fact, Sharma et al, 2009 concluded that the estimated GFR at LT was the most important determinant of post-LT chronic renal failure.…”

Section: Pretransplant Renal Dysfunctionmentioning

confidence: 72%

“…Definitely, the incidence of CKD increases with time. The latest report on the epidemiology of CKD after liver transplantation has been offered by Lee et al (2010). A cohort of 431 recipients who underwent liver transplantation between 1997 and 2008 was included.…”

Section: Epidemiology Of Chronic Renal Dysfunctionmentioning

confidence: 99%

“…Although previously attributed largely to calcineurin inhibitor toxicity (Ojo et al, 2003, Pillebout et al, 2005, it has become clear that the onset of chronic renal failure following LT is multifactorial, and reported to be correlated with posttransplant acute renal failure (Lee et al, 2010 andTinti et al, 2010), pre-transplant renal dysfunction (Kamath et al, 2001;Burra et al, 2009 andTinti et al, 2011), hepatitis C status, age, female gender, diabetes mellitus, hypertension, Model for End Stage Liver Disease (MELD), pretransplant proteinuria (Lee et al, 2010), pretransplant hepatorenal syndrome, alcohol intake (Hetz et al, 2005, Pillebout et al, 2005and Randhawa & Shapiro, 2005, smoking and dyslipidemia (Sezer et al,2011).…”

Section: Risk Factors For Posttransplant Chronic Kidney Diseasementioning

confidence: 99%

“…In another study by Pillebout, chronic renal failure was attributed to (i) specific chronic cyclosporine/tacrolimus arteriolopathy; (ii) typical diabetic nephropathy; (iii) acute or chronic thrombotic microangiopathy attributed to cyclosporine/tacrolimus arteriolopathy or alpha-interferon (Pillebout et al, 2005). In hepatitis B, CNI toxicity and focal segmental sclerosis, but not immune-complex disease, were revealed as significant contributors to CKD after LT (Lee et al, 2010). The question whether those cases with glomerular lesions represent de novo glomerulonephritis or progression of pre-existing disease was unanswered; only prospective studies with serial kidney biopsies can address this point (Fabrizi et al, 2010).…”

Section: Glomerulonephritismentioning

confidence: 99%

“…After 5 years, GFR negatively correlated with prothrombin time (r=-0.29; P<.05). Overall risk of CKD development (eGFR < 60 mL/min/1.73 m 2 ) was associated with high Child-Pugh score and high Model for End-Stage Renal Disease (MELD) score (Lee et al, 2010). Especially in recipients whose pre-operative eGFR was high (>or=60 mL/min/1.73 m 2 ), rapid progression of kidney disease was associated with Child-Pugh score (in addition to high tacrolimus level and posttransplant acute renal failure) (Fabrizi et al, 2011).…”

Section: Child-pugh Score and High Model For End-stage Renal Disease mentioning

confidence: 99%

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Renal Dysfunction and Liver Transplantation

Allam¹

2012

Liver Transplantation - Technical Issues and Complications

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Section: Pretransplant Renal Dysfunctionmentioning

confidence: 72%

Section: Epidemiology Of Chronic Renal Dysfunctionmentioning

confidence: 99%

Section: Risk Factors For Posttransplant Chronic Kidney Diseasementioning

confidence: 99%

Section: Glomerulonephritismentioning

confidence: 99%

Section: Child-pugh Score and High Model For End-stage Renal Disease mentioning

confidence: 99%

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Renal Dysfunction and Liver Transplantation

Allam¹

2012

Liver Transplantation - Technical Issues and Complications

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Critical care issues in patients after liver transplantation

et al. 2011

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The majority of patients who undergo liver transplantation (LT) spend some time in the intensive care unit during the postoperative period. For some, this is an expected part of the immediate posttransplant recovery period, whereas for others, the stay is more prolonged because of preexisting conditions, intraoperative events, or postoperative complications. In this review, 4 topics that are particularly relevant to the postoperative intensive care of LT recipients are discussed, with an emphasis on current knowledge specific to this patient group. Infectious complications are the most common causes of early posttransplant morbidity and mortality. The common patterns of infection seen in patients after LT and their management are discussed. Acute kidney injury and renal failure are common in post-LT patients. Kidney injury identification, etiologies, and risk factors and approaches to management are reviewed. The majority of patients will require weaning from mechanical ventilation in the immediate postoperative period; the approach to this is discussed along with the approach for those patients who require a prolonged period of mechanical ventilation. A poorly functioning graft requires prompt identification and appropriate management if the outcomes are to be optimized. The causes of poor graft function are systematically reviewed, and the management of these grafts is discussed.

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Clinical outcomes of patients with hepatorenal syndrome after living donor liver transplantation

Lee¹,

Kwon²,

Park³

et al. 2012

Liver Transpl

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Liver transplantation (LT) is the treatment of choice for hepatorenal syndrome (HRS). However, the clinical benefits of living donor liver transplantation (LDLT) are not yet well established. We, therefore, investigated the outcomes of patients with HRS who underwent LDLT and patients with HRS who received transplants from deceased donors. This study focused on 71 patients with HRS out of a total of 726 consecutive adult Korean patients who underwent LT at a single Asian center. We compared 48 patients who underwent LDLT with 23 patients who underwent deceased donor liver transplantation (DDLT). Patients with HRS showed poorer survival than patients without HRS (P ¼ 0.01). Poorer survival was associated with higher in-hospital mortality for patients with HRS (18.3% versus 5.2%, P < 0.001). In comparison with DDLT, LDLT was associated with younger donors and shorter ischemic times. The survival rate with LDLT was significantly higher than the survival rate with DDLT (P ¼ 0.02). Among patients with high Model for End-Stage Liver Disease scores (!30) or type 1 HRS, the survival rates for the LDLT group were not inferior to those for the DDLT group. LDLT significantly improved recipient survival after adjustments for several risk factors (hazard ratio ¼ 0.20, 95% confidence interval ¼ 0.05-0.85, P ¼ 0.03). Kidney function was significantly improved after LT, and there was no difference between LDLT and DDLT. No patients in the HRS cohort required maintenance renal replacement therapy. In conclusion, LDLT may be a beneficial option for patients with HRS. Liver Transpl 18:1237-1244, 2012. V C 2012 AASLD.Received November 28, 2011; accepted June 9, 2012. See Editorial on Page 1138Hepatorenal syndrome (HRS) is characterized by the rapid progression of functional renal failure, and patients with HRS have an extremely poor prognosis. 1 Renal dysfunction associated with HRS not only affects overall survival but also influences outcomes and survival after liver transplantation (LT). [2][3][4] LT is an effective cure for both liver disease and associated renal failure and is, therefore, the treatment of choice for patients with end-stage liver disease and HRS. [5][6][7] Long-term survival after LT for patients with HRS is excellent, with the 3-year survival rate approaching Additional Supporting Information may be found in the online version of this article.

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Risk factors for consequent kidney impairment and differential impact of liver transplantation on renal function

Abstract: Judicious use of CNIs should be applied to liver recipients to prevent kidney dysfunction.

Cited by 69 publications

References 32 publications

Renal Dysfunction and Liver Transplantation

Renal Dysfunction and Liver Transplantation

Critical care issues in patients after liver transplantation

Clinical outcomes of patients with hepatorenal syndrome after living donor liver transplantation

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