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Published on: April 12, 2021
Secular Trends in Development of End-Stage Renal Disease Following Liver Transplantation
Jessica M Ruck1, Maria A Parra1, Laura B Zeiser1
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Background:
Renal dysfunction is common among liver transplant candidates and can resolve, persist, or develop de novo following liver transplantation (LT). In light of the 2017 policy changes to simultaneous liver-kidney transplant and the post-LT kidney transplant safety net eligibility, we evaluated risk factors for and change in the incidence of post-LT renal dysfunction.
Methods:
Using SRTR data for adult deceased-donor liver-only transplant recipients 2010-2022, we evaluated secular trends in and risk factors for the development of post-LT ESRD at 1 year and overall using multivariable logistic and Cox regression. We compared observed versus expected incidence of ESRD at 1-year post-LT using weighting by odds.
Results:
Among 77 565 LT recipients, 6032 (7.8%) developed ESRD during the study period, of whom 2354 (39.0%) developed ESRD within the first year after LT. In a multivariable model, diabetes (aOR 1.63, 95% CI 1.48-1.79, p < 0.001), pre-LT eGFR (aOR 0.97 per unit, 95% CI 0.97-0.97, p < 0.001), and MELD category remained independently associated with ESRD within 1-year post-LT. Odds of ESRD by 1 year post-LT were 47% higher than expected post-2017 after accounting for changes in donor and recipient characteristics.
Conclusions:
The rising 1-year post-LT ESRD risk highlights the need to reassess safety net eligibility beyond 1 year and prioritize counseling on risk minimization, including post-transplant diabetes management and potential adjustments to immunosuppression protocols to improve outcomes.
