Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus

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

Research output: Contribution to journalArticle

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

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Tacrolimus
Chronic Renal Insufficiency
Liver Transplantation
Glomerular Filtration Rate
Renal Replacement Therapy
Mortality
Calcineurin
Liver
Prothrombin Time
Alanine Transaminase
Hematocrit
Hepacivirus
Chronic Kidney Failure
Transplantation
Hypertension
Incidence
Population

Keywords

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

ASJC Scopus subject areas

  • Nephrology

Cite this

Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus. / Garces, G.; Contreras, Gabriel; Carvalho, D.; Jaraba, I. M.; Carvalho, C.; Tzakis, A.; Moon, J.; Ratnam, K.; Roth, David.

In: Clinical Nephrology, Vol. 75, No. 2, 01.02.2011, p. 150-157.

Research output: Contribution to journalArticle

Garces, G, Contreras, G, Carvalho, D, Jaraba, IM, Carvalho, C, Tzakis, A, Moon, J, Ratnam, K & Roth, D 2011, 'Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus', Clinical Nephrology, vol. 75, no. 2, pp. 150-157. https://doi.org/10.5414/CNP75150
Garces, G. ; Contreras, Gabriel ; Carvalho, D. ; Jaraba, I. M. ; Carvalho, C. ; Tzakis, A. ; Moon, J. ; Ratnam, K. ; Roth, David. / Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus. In: Clinical Nephrology. 2011 ; Vol. 75, No. 2. pp. 150-157.
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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.",
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AU - Garces, G.

AU - Contreras, Gabriel

AU - Carvalho, D.

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AU - Carvalho, C.

AU - Tzakis, A.

AU - Moon, J.

AU - Ratnam, K.

AU - Roth, David

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N2 - 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.

AB - 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.

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