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Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation
Published on: November 7, 2020
Renal disease burden following liver transplantation
D Y Kim1, C Lim, R Parasuraman
1Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. dkim3@hfhs.org
Insights
Chronic kidney disease (CKD) is common after liver transplants. Early CKD management post-orthotopic liver transplant (OLT) is crucial for improving patient outcomes and reducing complications.
Area of Science:
- Nephrology
- Transplant Surgery
- Immunology
Background:
- Chronic kidney disease (CKD) is a significant complication following orthotopic liver transplant (OLT).
- CKD post-OLT is linked to adverse outcomes, including cardiovascular events, mortality, and graft dysfunction.
- Early identification and management of renal disease are vital for improving long-term results in OLT recipients.
Purpose of the Study:
- To assess the prevalence and severity of renal disease at 6 months post-OLT.
- To understand the burden of kidney disease in the OLT patient population.
Main Methods:
- Retrospective review of orthotopic liver transplant (OLT) recipients from 1997-2004.
- Glomerular filtration rate (GFR) calculated using the Modification of Diet in Renal Disease (MDRD) study method.
- Analysis of GFR in pre-MELD and post-MELD eras.
Main Results:
- Out of 407 OLTs, 78% showed mild to moderate risk for renal failure at 6 months.
- 8% of patients had stage 4 or 5 CKD within 6 months post-transplant.
- No significant difference in GFR was observed between pre-MELD and post-MELD periods.
Conclusions:
- A substantial burden of renal disease exists at 6 months after OLT.
- Implementing CKD management strategies as early as 6 months post-transplant may improve outcomes for OLT recipients.
Unlabelled:
Significant chronic kidney disease (CKD) occurs following orthotopic liver transplant (OLT). Since CKD is associated with increased cardiovascular events, mortality, and hepatic allograft dysfunction, early recognition of CKD and implementation of changes may improve the long-term outcome. The purpose of this study was to determine the burden of renal disease following OLT.
Patients And Methods:
We retrospectively reviewed our OLT recipients from 1997 until 2004. We calculated glomerular filtration rates (GFR) using the Modification of Diet in Renal Disease study (MDRD) method. The GFRs were further subdivided into pre-MELD and post-MELD eras.
Results:
During the study period, we performed 407 OLTs. We censored data from living donor liver transplants (n = 14), combined liver-kidney transplants (n = 12), and from patients whom we did not have complete data for 6 months after transplant (n = 40). Mean MELD score at the time of transplant was 18 +/- 7 (mean +/- standard deviation). The mean GFR at 6 months following OLT was 63.7 +/- 30.2 mL/min per 1.73 m(2). Only 14% (n = 47) of our patients had normal renal function at 6 months, while 78% (n = 266) of our patients had mild to moderate risk for renal failure. Eight percent (n = 28) had stage 4 or 5 CKD. There were no differences between the pre-MELD and post-MELD GFRs.
Conclusions:
The burden of renal disease is significant in our patient population at 6 months posttransplantation. It may be important to introduce CKD management as early as 6 months after transplant to impact the outcomes of OLT recipients.
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