Early changes in kidney function predict long-term chronic kidney disease and mortality in patients after liver transplantation.

BACKGROUND: Chronic kidney disease (CKD) is a well-known complication after liver transplantation (LT) and is associated with increased mortality. The purpose of this study was to determine risk factors of advanced CKD and mortality after LT.

METHODS: Four hundred forty-five adult patients underwent LT between June 1990 and September 2007 and survived more than 1 month. Multivariate Cox regression analyses were performed for time to CKD stage 4 (glomerular filtration rate [GFR] ≤30 mL/min), time to chronic dialysis, and all-cause mortality. Several patient and disease characteristics were used as independent pre- and posttransplant variables. We specifically analyzed a drop more than or equal to 30% in the estimated GFR (eGFR) during the first year posttransplant.

RESULTS: Diabetes mellitus pretransplant and a drop more than or equal to 30% in the eGFR between 3 and 12 months predicted CKD stage 4 (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.9-5.4, P<0.001 and OR 16.1, 95% CI 5.9-44.5, P<0.0001, respectively), the need for chronic dialysis (OR 3.8, 95% CI 1.1-13.2, P=0.03 and OR 14.6, 95% CI 3.0-71.4, P<0.001, respectively), and all-cause mortality (OR 1.9, 95% CI 1.2-2.9, P=0.004 and OR 2.6, 95% CI 1.6-4.4, P<0.001, respectively), more than 1 year after LT.

CONCLUSIONS: Diabetes mellitus pretransplant and a drop more than or equal to 30% in the eGFR within the first year are strong predictors of advanced CKD, chronic dialysis, and death more than 1 year after LT. These easily determined clinical variables define a population at risk for CKD who should be targeted for renal protection strategies.