Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus

G. Garces, G. Contreras, D. Carvalho, I. M. Jaraba, C. Carvalho, A. Tzakis, J. Moon, K. Ratnam, D. Roth

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Introduction: Chronic kidney disease (CKD) is common in liver transplant recipients receiving calcineurin inhibitors. Method and population: The goals of this case-control studywere to identify risk factors associated with CKD and its effect on mortality in 294 liver transplant recipients receiving calcineurin inhibition with tacrolimus. Results: Hepatitis C virus (HCV) was the most common indication (42%) for transplantation. CKD 4 and 5 (estimated glomerular filtration rate (eGFR) of ≤ 29ml/min/1.73m2) developed in 10.8%of recipients during amean follow-up of 52 months. The incidence density of CKD was 2.56 per 100 patient-years. End-stage renal disease developed in 2.7%. By univariate analysis, CKD patients were older (mean ± sd, 57 ± 10 vs. 51 ± 11, p < 0.05) with hypertension (56 vs. 32%, p < 0.05), had lower preoperative hematocrit (31 ± 6 vs. 34 ± 5, p < 0.05), alanine aminotransferase (median (95% confidence limit) 46 (34 - 80) vs. 68 (56 - 77), < 0.05) and eGFR (56 ± 28 vs. 91 ± 35 ml/ min/1.73 m2, p < 0.05), had higher preoperative prothrombin time (16.1 (14.6 - 17.2) vs. 14.8 (14.5 - 15.1) seconds, p < 0.05), and required more perioperative renal replacement therapy (RRT) (41% vs. 6.5%, p < 0.05) compared to controls. Perioperative need for RRT (hazard ratio (95% CI) 2.72 (1.05 - 7.03)) and lower preoperative eGFR: 60 - 89 (4.08 (1.23 - 13.5)), 30 - 59 (4.26 (1.18 - 15.36)), and ≤ 29 (5.91 ((1.28 - 27.19)) vs. eGFR ≥ 90 ml/min/1.73 m2 were independently associated with development of CKD adjusting for important covariates. The development of CKD (2.36 (1.22 - 4.59)) was independently associated with late mortality with an attributable risk of 12.8%. Conclusion: Data demonstrate that CKD is an important clinical event associated with increased risk for death after primary liver transplantation.

Original languageEnglish (US)
Pages (from-to)150-157
Number of pages8
JournalClinical Nephrology
Volume75
Issue number2
DOIs
StatePublished - Feb 1 2011

Keywords

  • Chronic kidney disease
  • Hepatitis C
  • Liver transplantation
  • Survival
  • Tacrolimus

ASJC Scopus subject areas

  • Nephrology

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    Garces, G., Contreras, G., Carvalho, D., Jaraba, I. M., Carvalho, C., Tzakis, A., Moon, J., Ratnam, K., & Roth, D. (2011). Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus. Clinical Nephrology, 75(2), 150-157. https://doi.org/10.5414/CNP75150