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

Fabrizio Fabrizi; Maria F Donato; Roberta Cerutti; Federica Invernizzi; Giulia Porata; Giulia Frontini; Francesca Raffiotta; Tullia De Feo; Carlo M Alfieri; Pietro Lampertico; Giorgio Rossi; Piergiorgio Messa

doi:10.1016/j.nefro.2021.01.009

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

Nefrologia (Engl Ed). 2021 Jun 7:S0211-6995(21)00092-8. doi: 10.1016/j.nefro.2021.01.009. Online ahead of print.

[Article in English, Spanish]

Affiliations

¹ Division of Nephrology, Dialysis and Renal Transplantation, Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation, Milano, Italy. Electronic address: fabrizio.fabrizi@policlinico.mi.it.
² Division of Gastroenterology and Hepatology, Maggiore Policlinico Hospital and Ca' Granda IRCCS Foundation , Milano, Italy.
³ Division of Nephrology, Dialysis and Renal Transplantation, Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation, Milano, Italy.
⁴ North Italy Transplant Program, Organ and Tissue Transplantation Immunology, Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation, Milano, Italy.
⁵ Division of Nephrology, Dialysis and Renal Transplantation, Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation, Milano, Italy; University School of Medicine, Milano, Italy.
⁶ Division of Gastroenterology and Hepatology, Maggiore Policlinico Hospital and Ca' Granda IRCCS Foundation , Milano, Italy; University School of Medicine, Milano, Italy.
⁷ Hepatobiliary and Liver Transplant Unit, Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation, Milano, Italy; University School of Medicine, Milano, Italy.

PMID: 34112530
DOI: 10.1016/j.nefro.2021.01.009

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, ≥60mL/min/1.73m²), mild CKD (eGFR, 30-59mL/min/1.73m²), severe CKD (eGFR, 15-29mL/min/1.73m²), 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.

Keywords: 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.