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Chronic renal outcome after living donor liver transplantation
Author(s) -
Nishi Hiroshi,
Shibagaki Yugo,
Kido Ryo,
Tamura Sumihito,
Nangaku Masaomi,
Sugawara Yasuhiko,
Fujita Toshiro
Publication year - 2012
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12013
Subject(s) - medicine , transplantation , renal function , hazard ratio , kidney disease , liver transplantation , proportional hazards model , cohort , urology , gastroenterology , kidney transplantation , chronic liver disease , surgery , confidence interval , cirrhosis
Chronic kidney disease ( CKD ) is one of the common complications after deceased donor liver transplantation. Although the worldwide pressing shortage in deceased donors has directed attention to living donor liver transplantation ( LDLT ), LDLT cohort data focusing on chronic renal dysfunction is limited. A total of 280 adult LDLT recipients (median 49 yr, 156 men) at the U niversity of T okyo hospital between 1996 and 2006 were reviewed. A total of 224 pre‐transplant liver failure patients (80.0%) showed an estimated glomerular filtration rate ( eGFR ) of more than 60 mL/min/1.73 m 2 . However, during follow‐up at a mean of 1222 d after transplantation, eGFR declined to 60 mL/min/1.73 m 2 and 30 mL/min/1.73 m 2 in 150 (53.2%) and 21 (7.5%), respectively, and four patients (1.4%) required maintenance renal replacement therapy. Multivariate C ox proportional hazard model regression analysis revealed that recipient age ( HR , 3.42 per 10‐yr increment; p < 0.001) and pre‐transplant eGFR (HR, 0.85 per 10‐mL/min/1.73 m 2 increment; p = 0.04) were associated independently with a post‐transplant decrease in eGFR to less than 30 mL/min/1.73 m 2 . We conclude that higher age and lower pre‐transplant eGFR of an LDLT recipient indicate a high likelihood of subsequent development of advanced CKD . Preventive or therapeutic intervention should be optimized for these high‐risk patients.