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End‐stage renal disease after liver transplantation in patients with pre‐transplant chronic kidney disease
Author(s) -
Bahirwani Ranjeeta,
Forde Kimberly A.,
Mu Yifei,
Lin Fred,
Reese Peter,
Goldberg David,
Abt Peter,
Reddy K. Rajender,
Levine Matthew
Publication year - 2014
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.12298
Subject(s) - medicine , renal function , kidney disease , transplantation , creatinine , population , kidney transplantation , liver disease , renal replacement therapy , liver transplantation , urology , gastroenterology , surgery , environmental health
Renal dysfunction prior to liver transplantation has a marked impact on post‐transplant kidney outcomes. Aim The aim of this study was to assess post‐transplant renal function in patients with chronic kidney disease ( CKD ) receiving orthotopic liver transplantation ( OLT ) alone. Methods Retrospective review of 40 OLT recipients with pre‐transplant CKD (serum creatinine ≥2 mg/dL for at least three months) at the U niversity of P ennsylvania from F ebruary 2002 to J uly 2010. Primary outcome was estimated glomerular filtration rate (e GFR ) up to three years post‐transplant. Secondary outcomes included incidence of stage 4 CKD (e GFR < 30 mL/min), need for renal replacement therapy ( RRT ), meeting criteria for kidney transplant listing (e GFR ≤ 20 mL/min), and mortality. Results Median patient age was 56.5 yr and 48% patients had pre‐transplant diabetes. Median serum creatinine at transplant was 2.7 mg/dL (e GFR = 24 mL/min). Median e GFR at one, two, and three yr post‐transplant was 35, 34, and 37 mL/min, respectively. Twelve patients (30%) required RRT at a median of 1.21 yr post‐transplant and 16 (40%) achieved an e GFR ≤ 20 mL/min at 1.09 yr post‐transplant. Mortality was 35% at a median of 1.60 years post‐transplant. Conclusions OLT recipients with pre‐transplant CKD have a substantial burden of post‐transplant renal dysfunction and high short‐term mortality, questioning the rationale for OLT alone in this population.