Liver transplantation
Complication
The Burden of Chronic Kidney Disease in Long-Term Liver Transplant Recipients

https://doi.org/10.1016/j.transproceed.2008.03.099Get rights and content

Abstract

Background

Chronic kidney disease (CKD) is an important risk factor for morbidity and mortality post–liver transplantation (OLT). This study focused on investigating the incidence and risk factors associated with the development CKD after OLT.

Methods

We performed a retrospective cohort study of recipients followed at least 5 years at our institution. CKD was diagnosed and classified according to National Kidney Foundation and the Kidney Disease Outcomes Quality Initiative guidelines.

Results

There were 231 patients, 64% men, 67% Caucasian, 16% African-American, and 17% others, with a mean age of 56 ± 13 years. The mean glomerular filtration rate (GFR) of the population was 56 ± 28 mL/min/1.73 m2. CKD was defined as GFR less than 60 mL/min; 144 patients (61%) were identified as having CKD. When these patients were compared to the non-CKD group, the former were significantly older (62 ± 9 vs 52 ± 12 years, P = .03), more likely to be hypertensive (59% vs 38%, P = .003), and required more antihypertensive medications (0.83 ± 0.81 vs 0.52 ± 0.77, P = .02); 26% of all patients had diabetes. However, the incidence of diabetes (43.3% vs 19.3%, P = .02) as well as the incidence of insulin dependency (21.6% vs 12.5%, P = .001) was significantly higher in the CKD population. Mean uric acid levels were higher in CKD patients compared to non-CKD patients (8.00 ± 2.00 mg/dL vs 6.70 ± 1.99 mg/dL respectively, P = .001); patients with uric acid more than 6.0 had a 1.7 risk of having CKD.

Conclusions

CKD defined as GFR < 60 mL/min is highly prevalent in long-term OLT survivors. Older age, elevated systolic blood pressure, insulin-dependent diabetes mellitus, and elevated uric acid levels are independently associated with CKD.

Section snippets

Materials and Methods

This study included all adult patients (18 years of age or older) who received OLT at The Mount Sinai Medical Center from January 1997 to December 1999. The cutoff date for our analysis was January 1, 2005. A total of 502 OLT were performed during this period, and 284 patients (57%) were alive. Of the 284 survivors, 231 patients who were regularly followed at our post-OLT clinic were included in the study. Preoperative variables analyzed were: age, sex, race, body mass index (BMI, defined as

Patient Population

The median follow-up was 73 months (range, 60 to 84 months). There were 231 patients in the study and the patient demographics are shown in Table 1. There were 147 men (64%) and 84 women (36%), Caucasian (67%) and African-American (16%), with a mean age of 56 ± 12 years. The indications for OLT were: hepatitis C virus (HCV; n = 111), primary biliary cirrhosis (n = 32), alcoholic liver disease (n = 23), hepatitis B virus (n = 23), cryptogenic cirrhosis (n = 16), autoimmune hepatitis (n = 10),

Discussion

In this retrospective cohort study of stable OLT patients followed at our center, we found a very high incidence of CKD. Although CKD is common in long-term OLT recipients, previous studies have not clearly defined the exact incidence. In our study, only 10% of OLT recipients had a GFR of more than 90 mL/min, and the mean GFR for the entire population was 56 mL/min (stage III CKD). Hypertension was significantly more prevalent in the CKD group and appeared more difficult to control. These

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