End-stage renal disease after liver transplantation in patients with pre-transplant chronic kidney disease

Ranjeeta Bahirwani, Kimberly A. Forde, Yifei Mu, Fred Lin, Peter Reese, David Goldberg, Peter Abt, K. Rajender Reddy, Matthew Levine

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

Renal dysfunction prior to liver transplantation has a marked impact on post-transplant kidney outcomes. Aim: The aim of this study was to assess post-transplant renal function in patients with chronic kidney disease (CKD) receiving orthotopic liver transplantation (OLT) alone. Methods: Retrospective review of 40 OLT recipients with pre-transplant CKD (serum creatinine ≥2 mg/dL for at least three months) at the University of Pennsylvania from February 2002 to July 2010. Primary outcome was estimated glomerular filtration rate (eGFR) up to three years post-transplant. Secondary outcomes included incidence of stage 4 CKD (eGFR < 30 mL/min), need for renal replacement therapy (RRT), meeting criteria for kidney transplant listing (eGFR ≤ 20 mL/min), and mortality. Results: Median patient age was 56.5 yr and 48% patients had pre-transplant diabetes. Median serum creatinine at transplant was 2.7 mg/dL (eGFR = 24 mL/min). Median eGFR at one, two, and three yr post-transplant was 35, 34, and 37 mL/min, respectively. Twelve patients (30%) required RRT at a median of 1.21 yr post-transplant and 16 (40%) achieved an eGFR ≤ 20 mL/min at 1.09 yr post-transplant. Mortality was 35% at a median of 1.60 years post-transplant. Conclusions: OLT recipients with pre-transplant CKD have a substantial burden of post-transplant renal dysfunction and high short-term mortality, questioning the rationale for OLT alone in this population.

Original languageEnglish (US)
Pages (from-to)205-210
Number of pages6
JournalClinical Transplantation
Volume28
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Keywords

  • Kidney dysfunction
  • Liver transplantation
  • Renal insufficiency

ASJC Scopus subject areas

  • Transplantation

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