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Liver transplantation (LT) is the primary therapeutic option for managing patients with decompensated cirrhosis and/or hepatocellular carcinom. In the postoperative (PO) period of LT, one-third of patients develop acute kidney injury (AKI), with 8%-10% of them progressing to chronic kidney disease (CKD) which is associated with high morbidity and mortality. This study aims to investigate the frequency of CKD in the first year post-LT and the correlation between AKI in the first seven days PO period and CKD development during this first year.
This is a retrospective observational descriptive and analytical study. Patients without pre-existing CKD submitted to LT from January 2012 to July 2022 at a tertiary hospital were retrospectively evaluated. Patients undergoing dual kidney-liver transplantation or retransplantation were excluded from the study. The frequency of CKD was investigated using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and the results were compared with the presence of AKI in the immediate PO period.
A total of 99 patients were included, with 72% being male, 24% having hypertension, and 17% having diabetes. The frequency of CKD was 54%, with 58% of these patients in stage 2, 36% in stage 3, and 4% in stage 4. Only 2% of patients presented with CKD G1, with urinary albumin-to-creatinine ratio (UACR) of 234mg/g and estimated glomerular filtration rate (eGFR) of 92mL/min/1.73m². No patient had CKD G5. Among patients who developed CKD in the first year post-LT, 55% had AKI in the first 7 days PO, and AKI was significantly associated with risk of CKD in the first year of post-LT (p<0.001).
CKD is a prevalent condition among patients in the PO period of LT, affecting more than half of the patients in this study. Due to its association with increased morbidity and mortality, screening for CKD, along with early diagnosis and treatment, is essential for liver transplant recipients.