The Risk Factors and Natural History of Chronic Kidney Disease in Liver Transplant Recipients

Heo, Nam Ju; Sohn, Min Jeong; Lee, Jung Hwan; Kim, Su Jin; Joo, Kwon Wook; Kim, Yon Su; Ahn, Curie; Han, Jin Suk; Kim, Suhnggwon; Lee, Jung Sang; Suh, Kyung Suk

Abstract

BACKGROUND
With the increasing success of liver transplantation, more patients are developing renal dysfunction. The goal of the current study was to assess the natural history of renal dysfunction and to identify patients at risk for the development of chronic kidney disease in liver transplant recipients. METHODS: Cumulative incidence of chronic kidney disease (defined as a sustained decrease in estimated glomerular filtration rate of <60 mL/min/m2 for at least 3 months) was determined using the Kaplan - Meier method. Cox regression analysis was used to test the independent effect of potential risk factors on time to development of chronic kidney disease. In addition, mycophenolate mofetil was introduced in conjuncion with rapid reduction of calcineurin inhibitors (CNI) in some cases of patients with renal dysfunction, and the change of renal function was analyzed. RESULTS: The cumulative incidence of chronic kidney disease was 28.7% and the incidence of severe renal dysfunction was 2.3%. Pre - transplant renal dysfunction and older age are risk factors of chronic kidney disease. Renal dysfunction at 3 months after transplantation was a significant predictor for the development of chronic kidney disease. A significant improvement of renal function was seen in patients with rapid reduction of CNI. CONCLUSION: We have identified risk factors and the natural history of chronic kidney disease in liver transplant recipients. These observations may be useful in the development of less - nephrotoxic immunosuppressive regimens for liver transplant recipients at high - risk of renal dysfunction.