Chronic renal dysfunction following liver transplantation

Clin Transplant. May-Jun 2008;22(3):333-40. doi: 10.1111/j.1399-0012.2008.00806.x. Epub 2008 Mar 12.

Abstract

With most of the immunosuppressive protocols consisting of calcineurin inhibitors (CI), nephrotoxicity has become a major long-term complication often compromising outcome. In a single-center retrospective study, we reviewed 1173 liver transplantations to identify variables indicative for the occurrence of chronic renal dysfunction (CRD) (defined as > or = 1 episode of serum creatinine increase > or = 1.8 mg/dL > or = 2 wk). Chronic renal dysfunction was found in 137 (11.7%) of all transplants [82 (7%) early (after 3-12 months), 55 (4.7%) late-onset (> 12 months)]. Compared to 5-/10-yr survival rates in non-CRD transplants (84/74%) survival was significantly decreased in early (66/46%), but unchanged in late-onset CRD (98/86%). Rates of alcoholic cirrhosis and prior renal dysfunction were significantly increased in patients with CRD. In a multivariate logistic regression analysis, only cyclosporine A (CyA) as immunosuppression remained an independent risk factor. No correlations to age, gender, rejection/retransplantation or diabetes were found. Surprisingly, renal function (creatinine) showed no difference between patients on CI monotherapy (FK/CyA) compared to those who had mycophenolate mofetil (MMF) added. In liver transplantation, early onset CRD significantly compromises survival. CyA-based immunosuppression appears to have a stronger impact than FK. The fact that patients with long-term severe chronic renal dysfunction failed to improve under MMF rescue therapy emphasizes the importance of new diagnostic strategies to earlier identify at-risk patients.

MeSH terms

  • Calcineurin Inhibitors
  • Creatinine / blood
  • Cyclosporine / adverse effects
  • Diabetes Complications
  • Female
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Kidney Failure, Chronic / etiology*
  • Liver Cirrhosis, Alcoholic / complications
  • Liver Transplantation* / mortality
  • Male
  • Middle Aged
  • Postoperative Complications
  • Recurrence
  • Renal Dialysis
  • Retrospective Studies
  • Risk Factors

Substances

  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Cyclosporine
  • Creatinine