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Pretransplant renal function according to CKD ‐ EPI cystatin C equation is a prognostic factor of death after liver transplantation
Author(s) -
Uguen Thomas,
Jezequel Caroline,
Ropert Martine,
HousselDebry Pauline,
Latournerie Marianne,
Lainé Fabrice,
Deugnier Yves,
Vigneau Cécile,
Boudjema Karim,
Guyader Dominique,
BardouJacquet Edouard
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12989
Subject(s) - cystatin c , renal function , medicine , creatinine , kidney disease , liver transplantation , urology , transplantation , kidney transplantation , gastroenterology , cystatin , endocrinology
Background & Aims In patients with cirrhosis, cystatin C (CystC) based equations may be more accurate indicators of glomerular filtration rate ( GFR ) than creatinine (Pcr) based equations. Renal function before liver transplantation ( LT ) is thought to impact survival after LT . We aimed at assessing pretransplant creatinine and CystC based equations with respect to their predictive value on long‐term survival after LT . Methods From 2001 to 2011, CystC was determined at pre‐ LT evaluation in 682 patients together with GFR assessed using MDRD ‐4, MDRD ‐6, CKD ‐ EPI ‐cystatin C, CKD ‐ EPI ‐creatinine and CKD ‐ EPI ‐creatinine‐cystatin C equations. Patients were classified according to the Kidney Disease Outcomes Quality Initiative classification ( KDOQI ). Results Median age at LT was 55 [49–60] years with a median MELD score of 13.5 [8.3–19.2] and a median post‐transplant follow‐up of 60 [26–89] months. Using CKD ‐ EPI Cystatin C and the KDOQI classification, 21.1% of patients were stage 1, 43.1% stage 2, 29.1% stage 3 and 6.5% stage 4. Kaplan–Meier survival estimates were significantly different between KDOQI stages when determined using the CKD ‐ EPI ‐CystatinC equation. This was not the case when using the other equations. At multivariate analysis, GFR and KDOQI estimated using the CKD ‐ EPI ‐CystatinC equation were significantly associated with death ( HR :0.992; CI 95%:0.986–0.999 and 1.24; CI 95%:1.02–1.50 respectively). When assessed using the MDRD ‐4, MDRD ‐6, CKD ‐ EPI ‐Creatinine‐CystatinC and CKD ‐ EPI ‐Creatinine equations GFR was not significantly associated with death. Conclusions Estimated pre‐ LT renal function is predictive of post‐ LT survival only when assessed using the CKD ‐ EPI cystatin C equation. This supports the use of Cystatine C and of its related equation for the assessment of renal function before liver transplantation.