Low estimated glomerular filtration rate and chronic kidney failure following liver transplant: A retrospective cohort study

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Narciso, Roberto Camargo [UNIFESP]
Ferraz, Leonardo Rolim
Rodrigues, Cassio Jose de Oliveira [UNIFESP]
Monte, Julio Cesar Martins [UNIFESP]
Mies, Sergio
Santos, Oscar Fernando Pavao dos [UNIFESP]
Paes, Angela Tavares
Cendoroglo Neto, Miguel [UNIFESP]
Jaber, Bertrand L.
Durao, Marcelino de Souza [UNIFESP]
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Background: Patients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant.Study Design: Retrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes.Results: 331 patients, who underwent LTx, were followed up for 2.6 +/- 1.4 years; 31(10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m(2) had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1,73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction.Conclusion: These findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. the consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.
International Journal of Artificial Organs. Milan: Wichtig Editore, v. 36, n. 7, p. 498-505, 2013.