Background and rationale: Chronic kidney disease remains an important risk factor for morbidity and mortality among LT recipients, but its exact incidence and risk factors are still unclear.Material and methods: We carried out a retrospective cohort study of consecutive adults who underwent liver transplant (January 2009-December 2018) and were followed (at least 6 months) at our institution. CKD was defined following the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guidelines. Long-term kidney function was classified into 4 groups: no CKD (eGFR, >= 60 mL/min/1.73 m(2)), mild CKD (eGFR, 30-59 mL/min/1.73 m(2)), severe CKD (eGFR, 15-29 mL/min/1.73 m(2)), and end-stage renal disease (ESRD).Results: We enrolled 410 patients followed for 53.2 +/- 32.6 months. 39 had CKD at baseline, and 95 developed de novo CKD over the observation period. There were 184 (44.9%) anti-HCV positive, 47 (11.5%) HBsAg positive, and 33 (8.1%) HBV/HDV positive recipients. Recipient risk factors for baseline CKD were advanced age (P = 0.044), raised levels of serum uric acid (P < 0.0001), and insulin dependent DM (P = 0.0034). Early post-transplant AKI was common (n=95); logistic regression analysis found that baseline serum creatinine was an independent predictor of early post-LT AKI (P = 0.0154). According to our Cox proportional hazards model, recipient risk factors for de novo CKD included aging (P < 0.0001), early post-transplant AKI (P = 0.007), and baseline serum creatinine (P = 0.0002). At the end of follow-up, there were 116 LT recipients with CKD - 109 (93.9%) and 7 (6.1%) had stage 3 and advanced CKD, respectively. Only two of them are undergoing long-term dialysis.Conclusion: The incidence of CKD was high in our cohort of LT recipients, but only a slight decline in kidney function over time was recorded. Prevention of post-transplant AKI will improve kidney function in the long run. We need more studies to analyze the function of kidneys among LT recipients over extended follow-ups and their impact on mortality.

Acute kidney injury and chronic kidney disease after liver transplant: A retrospective observational study / F. Fabrizi, M.F. Donato, R. Cerutti, F. Invernizzi, G. Porata, G. Frontini, F. Raffiotta, T. De Feo, C.M. Alfieri, P. Lampertico, G. Rossi, P. Messa. - In: NEFROLOGIA. - ISSN 0211-6995. - 42:1(2021), pp. 27-35. [10.1016/j.nefro.2021.01.009]

Acute kidney injury and chronic kidney disease after liver transplant: A retrospective observational study

F. Invernizzi;G. Porata;G. Frontini;F. Raffiotta;T. De Feo;C.M. Alfieri;P. Lampertico;G. Rossi
Penultimo
;
P. Messa
Ultimo
2021

Abstract

Background and rationale: Chronic kidney disease remains an important risk factor for morbidity and mortality among LT recipients, but its exact incidence and risk factors are still unclear.Material and methods: We carried out a retrospective cohort study of consecutive adults who underwent liver transplant (January 2009-December 2018) and were followed (at least 6 months) at our institution. CKD was defined following the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guidelines. Long-term kidney function was classified into 4 groups: no CKD (eGFR, >= 60 mL/min/1.73 m(2)), mild CKD (eGFR, 30-59 mL/min/1.73 m(2)), severe CKD (eGFR, 15-29 mL/min/1.73 m(2)), and end-stage renal disease (ESRD).Results: We enrolled 410 patients followed for 53.2 +/- 32.6 months. 39 had CKD at baseline, and 95 developed de novo CKD over the observation period. There were 184 (44.9%) anti-HCV positive, 47 (11.5%) HBsAg positive, and 33 (8.1%) HBV/HDV positive recipients. Recipient risk factors for baseline CKD were advanced age (P = 0.044), raised levels of serum uric acid (P < 0.0001), and insulin dependent DM (P = 0.0034). Early post-transplant AKI was common (n=95); logistic regression analysis found that baseline serum creatinine was an independent predictor of early post-LT AKI (P = 0.0154). According to our Cox proportional hazards model, recipient risk factors for de novo CKD included aging (P < 0.0001), early post-transplant AKI (P = 0.007), and baseline serum creatinine (P = 0.0002). At the end of follow-up, there were 116 LT recipients with CKD - 109 (93.9%) and 7 (6.1%) had stage 3 and advanced CKD, respectively. Only two of them are undergoing long-term dialysis.Conclusion: The incidence of CKD was high in our cohort of LT recipients, but only a slight decline in kidney function over time was recorded. Prevention of post-transplant AKI will improve kidney function in the long run. We need more studies to analyze the function of kidneys among LT recipients over extended follow-ups and their impact on mortality.
Acute kidney injury; Chronic kidney disease; Enfermedad renal crónica; Hepatitis vírica; Lesión renal aguda; Liver transplantation; Solid organ transplantation; Trasplante de órgano sólido; Trasplante hepático; Viral hepatitis
Settore MED/12 - Gastroenterologia
2021
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/922094
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