Introduction:
In the setting of end stage liver disease (ESLD), concomitant kidney dysfunction poses a complicating factor, as it is associated with significant morbidity, mortality and financial cost. Since creatinine and dialysis are integral components of the model for end stage liver disease (MELD) score, a higher proportion of these patients with kidney dysfunction qualify to receive a liver transplant. A number of patients develop residual chronic kidney disease (CKD) post liver transplant.
Methods:
This study was a single centre retrospective record review of all first-time adult liver-only transplant recipients from 01 January 2014 to 31 December 2018. Data collected included demographic and clinical parameters. Recipient glomerular filtration rates (eGFRs) were recorded at various time intervals pre- and post-transplant (anytime 3 months prior to transplant, at time of transplant and at 1 month, 3months, 6 months, 1 year and 2 years post-transplant). Outcome end points were mortality and development of CKD.
Results:
187 adult liver transplant recipients between 1 January 2014 and 31 December 2018 were included. 118 (63.1%) patients were male and 69 (36.9%) were female. 119 (64%) patients were white and 43 (23.1%) were black African. At transplant the median age was 53 years (IQR 20 years). In terms of aetiology, 56.7% had non-cholestatic disease, 17.1% had cholestatic disease, 10.2% had acute liver failure , 9.1% had malignancy, 5.9% had metabolic disease and 1.1% had venous outflow obstruction. 46 (24.6%) patients had diabetes pre-transplant and an additional 40 patients developed diabetes post-transplant.168 recipients, who survived 30 days post-transplant, were evaluated for the development of CKD over the subsequent 2 years. Among these, 50 (26.7%) patients developed CKD, the majority (41 patients, 91,1%) of which had stage 3 CKD at 2 years. 31 (16.6%) patients required dialysis in the post-transplant period, with the majority of those (87.1%) within the first 3 months post-transplant. Univariately analysis revealed age >50 years (p=0.0007), white ethnicity (RR, 2,35; 95% CI, 1.08 – 5.11; p=0.032), pre-transplant diabetes (RR, 1.86; 95% CI, 1.18 – 2.93; p=0.007), eGFR <60ml/min at transplant (RR, 2.01; 95% CI, 1.26 – 3.21; p=0.0034), and pre-transplant BMI >=30kg.m² (RR, 1.95; 95% CI, 1.13 – 3.36; p=0.016) as risk factors for post-transplant CKD. A mycophenolate-containing immunosuppressive regimen was protective against CKD (RR, 0.53; 95% CI, 0.29 – 0.97; p=0.039). 55 patients (29.4%) demised during the study period. Mortality was associated with malignant cause for ESLD (RR, 2.15; 95% CI, 1.02 –4.56; p=0.045), pre-transplant dialysis (RR, 2.38; 95% CI, 1.02 – 5.56; p=0.045), pre-transplant eGFR < 60ml/min (RR, 3.32; 95% CI, 1.164 – 6.74; p=0.0009), immunosuppression with everolimus (RR, 2.67; 95% CI, 1.09 – 6.57; p=0.032) and post-transplant dialysis (RR, 5.90; 95% CI, 2.48 – 13.99; p<0.0001).
Conclusions:
Kidney dysfunction in patients receiving a liver transplant is multifactorial and has implications for morbidity and mortality. Further studies are required to elicit the risk factors for ongoing kidney dysfunction post-liver transplant to determine which patients would benefit from simultaneous liver kidney transplantation vs a liver transplant alone
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.