[Kidney function and liver transplantation].

Area of Science:

• Nephrology
• Hepatology
• Transplantation Medicine

Context:

• Liver cirrhosis commonly leads to decreased renal function, with hepatorenal syndrome being a primary cause.
• Factors such as primary kidney failure, diabetes, hepatitis C, and surgical complications (e.g., vena cava clamping, polytransfusion, immunosuppression) further impact kidney function in liver transplant candidates.
• Liver transplantation is a critical intervention for end-stage liver disease, but it presents unique challenges to renal health.

Purpose:

• To analyze changes in kidney function during the first year after liver transplantation.
• To evaluate the impact of preoperative renal function on postoperative outcomes and survival.
• To identify risk factors for impaired renal function in the early post-transplant period.

Summary:

• A retrospective analysis of 319 primary liver transplantations revealed that impaired preoperative renal function is associated with increased postoperative complications and significantly worse first-year patient survival (91.7% vs. 69.9%).
• Despite transplantation, 76% of patients exhibited impaired kidney function one year post-surgery, irrespective of their initial renal status.
• Patients with improved renal function (>60 ml/min/1.73 m²) after the first year demonstrated better survival, while those with impaired function had a higher incidence of de novo diabetes mellitus (22.5% vs. 9.5%).

Impact:

• Preoperative renal function is a critical predictor of post-liver transplant outcomes, including survival and complication rates.
• A significant proportion of liver transplant recipients experience persistent renal dysfunction one year after surgery, necessitating vigilant monitoring.
• Personalized immunosuppressive strategies show promise in mitigating renal impairment and improving long-term renal function and patient survival after liver transplantation.