The first and second author contributed equally to this manuscript.
Chronic renal dysfunction following liver transplantation
Article first published online: 12 MAR 2008
Copyright © 2008 Blackwell Munksgaard
Volume 22, Issue 3, pages 333–340, May/June 2008
How to Cite
Schmitz, V., Laudi, S., Moeckel, F., Puhl, G., Stockmann, M., Tran, Z. V., Kahl, A., Neumann, U. and Neuhaus, P. (2008), Chronic renal dysfunction following liver transplantation. Clinical Transplantation, 22: 333–340. doi: 10.1111/j.1399-0012.2008.00806.x
- Issue published online: 12 MAR 2008
- Article first published online: 12 MAR 2008
- Accepted for publication 16 January 2008
- liver transplantation;
- renal dysfunction;
- risk factors
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 ≥1 episode of serum creatinine increase ≥1.8 mg/dL ≥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.