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NDT Advance Access published online on May 30, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl247
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 13, 2006
Accepted April 11, 2006

Original Article

Chronic kidney disease post-liver transplantation

Aisling O’Riordan 1 *, Vincent Wong 1, P. Aiden McCormick 2, John E. Hegarty 2, and Alan J. Watson 1

1 Department of Nephrology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
2 National Liver Transplant Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland

* To whom correspondence should be addressed.
Aisling O’Riordan, E-mail: aisling32{at}ireland.com



  Abstract

Background. Renal disease is a recognized complication of orthotopic liver transplantation (OLT). We aimed to determine the incidence of all stages of chronic kidney disease (CKD), as defined in the Kidney Disease Outcomes Quality Initiative Guidelines. We also wanted to determine the risk factors for development of CKD and its impact on patient survival.

Methods. All patients who underwent cadaveric OLT, from January 1993 until July 2004, were analysed. The glomerular filtration rate (GFR) was determined using the equation developed by the Modification of Diet in Renal Disease Study. Thirty potential risk factors were examined by univariate and multivariate ordinal logistic regression analysis. Kaplan-Meier survival analysis, the log-rank test and Cox regression analysis were performed to evaluate the survival data.

Results. A total of 230 patients were included (107 males and 123 females) with a mean age of 47.7 years (4.5-70.35). Mean follow-up was 5.57 years (0.53-16.5). The following was the 10 year cumulative incidence for each stage of CKD: 0/1, 9.61%; 2, 53.71%; 3, 56.77%; 4, 6.11%; 5, 2.62%. Female gender, age, pre-OLT proteinuria, lower GFR from 1 year and higher creatinine from 6 months were associated with progression of CKD. The use of tacrolimus had a favourable impact. A GFR <30 ml/min, the need for re-transplantation and fulminant hepatic failure were all associated with reduced patient survival.

Conclusions. Moderate CKD was very prevalent. We identified the risk factors for progression of CKD and also that severe CKD was associated with reduced patient survival.

Keywords: calcineurin inhibitor; chronic kidney disease; end-stage renal disease; glomerular filtration rate; liver transplantation; survival.
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