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Acute kidney injury and chronic kidney disease after liver transplant: A retrospective observational study
Fabrizio Fabrizi1, Maria F Donato2, Roberta Cerutti1
1Division of Nephrology, Dialysis and Renal Transplantation, Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation, Milano, Italy.
Insights
Chronic kidney disease (CKD) affects many liver transplant (LT) recipients, with risk factors including age and prior kidney injury. Preventing acute kidney injury post-transplant can improve long-term kidney function.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Medicine
Background:
- Chronic kidney disease (CKD) is a significant concern for liver transplant (LT) recipients, impacting morbidity and mortality.
- The precise incidence and risk factors for CKD in this population require further elucidation.
Purpose of the Study:
- To determine the incidence and identify risk factors for CKD in adult LT recipients.
- To analyze the progression of kidney function over time and the impact of acute kidney injury (AKI).
Main Methods:
- A retrospective cohort study of 410 adult LT recipients from January 2009 to December 2018.
- CKD diagnosis based on KDIGO 2012 guidelines; kidney function categorized into four stages.
- Risk factors analyzed using logistic regression and Cox proportional hazards models.
Main Results:
- CKD was prevalent, with 39 patients at baseline and 95 developing de novo CKD.
- Risk factors for baseline CKD included advanced age, high serum uric acid, and diabetes.
- Early post-transplant AKI and baseline serum creatinine predicted de novo CKD; 116 patients had CKD at follow-up.
Conclusions:
- The incidence of CKD is high in LT recipients, though kidney function decline may be gradual.
- Preventing post-transplant AKI is crucial for preserving long-term kidney function.
- Further research is needed on long-term kidney function and mortality in LT recipients.
Background And Rationale:
Chronic kidney disease remains an important risk factor for morbidity and mortality among LT recipients, but its exact incidence and risk factors are still unclear.
Material And Methods:
We carried out a retrospective cohort study of consecutive adults who underwent liver transplant (January 2009-December 2018) and were followed (at least 6 months) at our institution. CKD was defined following the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guidelines. Long-term kidney function was classified into 4 groups: no CKD (eGFR, ≥60mL/min/1.73m2), mild CKD (eGFR, 30-59mL/min/1.73m2), severe CKD (eGFR, 15-29mL/min/1.73m2), and end-stage renal disease (ESRD).
Results:
We enrolled 410 patients followed for 53.2±32.6 months. 39 had CKD at baseline, and 95 developed de novo CKD over the observation period. There were 184 (44.9%) anti-HCV positive, 47 (11.5%) HBsAg positive, and 33 (8.1%) HBV/HDV positive recipients. Recipient risk factors for baseline CKD were advanced age (P=0.044), raised levels of serum uric acid (P<0.0001), and insulin dependent DM (P=0.0034). Early post-transplant AKI was common (n=95); logistic regression analysis found that baseline serum creatinine was an independent predictor of early post-LT AKI (P=0.0154). According to our Cox proportional hazards model, recipient risk factors for de novo CKD included aging (P<0.0001), early post-transplant AKI (P=0.007), and baseline serum creatinine (P=0.0002). At the end of follow-up, there were 116 LT recipients with CKD - 109 (93.9%) and 7 (6.1%) had stage 3 and advanced CKD, respectively. Only two of them are undergoing long-term dialysis.
Conclusion:
The incidence of CKD was high in our cohort of LT recipients, but only a slight decline in kidney function over time was recorded. Prevention of post-transplant AKI will improve kidney function in the long run. We need more studies to analyze the function of kidneys among LT recipients over extended follow-ups and their impact on mortality.
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