Ann Surg Treat Res.  2020 Jul;99(1):52-62. 10.4174/astr.2020.99.1.52.

Perioperative risk factors of progressive chronic kidney disease following liver transplantation: analyses of a 10-year follow-up single-center cohort

• Lee K
• Jeon J
• Kim JM
• Kim G
• Kim K
• Jang HR
• Lee JE
• Joh JW
• Lee SK
• Huh W

• KMID: 2503460
• DOI: http://doi.org/10.4174/astr.2020.99.1.52

Abstract

Purpose
The incidence of chronic kidney disease (CKD) has been increasing due to improved survival after liver transplantation (LT). Risk factors of kidney injury after LT, especially perioperative management factors, are potentially modifiable. We investigated the risk factors associated with progressive CKD for 10 years after LT.
Methods
This retrospective cohort study included 292 adult patients who underwent LT at a tertiary referral hospital between 2000 and 2008. Renal function was assessed by the e stimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula. The area under the curve of serial eGFR (AUC_eGFR) was calculated for each patient to assess the trajectory of eGFR over the 10 years. Low AUC_eGFR was considered progressive CKD. Linear regression analyses were performed to examine the associations between the variables and AUC_eGFR.
Results
Multivariable analysis showed that older age (regression coefficient = -0.53, P < 0.001), diabetes mellitus (DM) (regression coefficient = -6.93, P = 0.007), preoperative proteinuria (regression coefficient = -16.11, P < 0.001), preoperative acute kidney injury (AKI) (regression coefficient = -14.35, P < 0.001), postoperative AKI (regression coefficient = -3.86, P = 0.007), and postoperative mean vasopressor score (regression coefficient = -0.45, P = 0.034) were independently associated with progressive CKD.
Conclusion
More careful renoprotective management is required in elderly LT patients with DM or preexisting proteinuria. Postoperative AKI and vasopressor dose may be potentially modifiable risk factors for progressive CKD.

Keyword

Renal insufficiency; Kidney failure; Liver transplantation; Risk factors

Figure

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  Fig. 1 An example of serial changes in eGFR after transplantation and calculation of AUCeGFR. Month 0 corresponds to the time of transplantation. The initial 6 months following transplantation were excluded from AUC calculation. AUC was divided by individual follow-up duration (t). In patients who died or were lost to follow-up within 10 years, “t” corresponds to survival duration or follow-up duration, respectively. In other cases (patients who survived 10 years or more after transplantation with complete follow-up), “t” corresponds to 120 (months). AUC, area under the curve; eGFR, estimated glomerular filtration rate.

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  Fig. 2 The flow of study cohort.

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  Fig. 3 Time-dependent changes in eGFR according to the risk factors in the multivariable analysis. Each dot represents average eGFR according to subgroups of patients (Bars represent standard deviation). AKI, acute kidney injury; eGFR, estimated glomerular filtration rate. *P < 0.05, compared with the reference group (t-test).

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