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Published on: November 7, 2020
Non-Renal Risk Factors for Chronic Kidney Disease in Liver Recipients with Functionally Intact Kidneys at 1 Month
Deok-Gie Kim1, Shin Hwang2, Jong Man Kim3
1Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea.
Insights
This study identified key non-renal risk factors for chronic kidney disease (CKD) after liver transplantation. Recurrent liver cancer and infections significantly increase CKD risk in transplant recipients.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Medicine
Background:
- Chronic kidney disease (CKD) is a significant post-liver transplant complication.
- Non-renal risk factors contributing to CKD development after liver transplantation (LT) require further elucidation.
- Understanding these factors is crucial for improving long-term outcomes in liver recipients.
Purpose of the Study:
- To identify pre- and post-transplant non-renal risk factors for developing CKD (eGFR <60 mL/min/1.73 m2) in liver transplant recipients.
- To analyze risk factors in patients with initially preserved kidney function one month post-transplant.
- To inform clinical strategies for preventing renal impairment after LT.
Main Methods:
- Nationwide cohort data of liver transplant recipients with a baseline eGFR ≥ 60 mL/min/1.73 m2 at one month post-transplant were analyzed.
- Multivariable Cox regression was used for baseline risk factor analysis.
- Time-dependent Cox models and propensity score matching were employed to investigate post-transplant risk factors, including recurrent hepatocellular carcinoma and infections.
Main Results:
- Among 2274 recipients, 494 (22.3%) developed CKD over a mean follow-up of 36.6 months.
- Baseline risk factors included older age, female sex, lower BMI, pre-transplant diabetes mellitus, and poorer performance status.
- Post-transplant, recurrent hepatocellular carcinoma (HR=1.93) and infections (HR=1.44) were significant independent risk factors for CKD development.
Conclusions:
- Pre-transplant factors like age, sex, diabetes, and performance status influence CKD risk.
- Post-transplant factors, specifically recurrent hepatocellular carcinoma and infections, substantially elevate the risk of developing CKD, irrespective of initial renal function.
- Identifying and managing these non-renal risk factors is vital for mitigating CKD progression in liver transplant recipients.
Abstract:
Chronic kidney disease (CKD) is a critical complication of liver transplants, of which non-renal risk factors are not fully understood yet. This study aimed to reveal pre- and post-transplant risk factors for CKD (<60 mL/min/1.73 m2), examining liver recipients with functionally intact kidneys one month after grafting using nationwide cohort data. Baseline risk factors were analyzed with multivariable Cox regression analyses and post-transplant risk factors were investigated with the time-dependent Cox model and matched analyses of time-conditional propensity scores. Of the 2274 recipients with a one-month eGFR ≥ 60 mL/min/1.73 m2, 494 (22.3%) developed CKD during a mean follow-up of 36.6 ± 14.4 months. Age, female sex, lower body mass index, pre-transplant diabetes mellitus, and lower performance status emerged as baseline risk factors for CKD. Time-dependent Cox analyses revealed that recurrent hepatocellular carcinoma (HR = 1.93, 95% CI 1.06−3.53) and infection (HR = 1.44, 95% CI 1.12−1.60) were significant post-transplant risk factors for CKD. Patients who experienced one of those factors showed a significantly higher risk of subsequent CKD compared with the matched controls who lacked these features (p = 0.013 for recurrent hepatocellular carcinoma, and p = 0.003 for infection, respectively). This study clarifies pre- and post-transplant non-renal risk factors, which lead to renal impairment after LT independently from patients’ renal functional reserve.
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