Incidence and Risk Factors of Renal Dysfunction after Liver Transplantation in Adult.
- Author:
Seong Gyun KIM
1
;
Hyung Jik KIM
;
Jung Pyo LEE
;
Sang Goo LEE
;
Yon Su KIM
;
Curie AHN
;
Jin Suk HAN
;
Suhnggwon KIM
;
Jung Sang LEE
;
Kyung Suk SUH
Author Information
1. Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
- Publication Type:Original Article
- Keywords:
Liver transplantation;
Renal failure;
Risk factors
- MeSH:
Acute Kidney Injury;
Adult*;
Biliary Atresia;
Calcineurin;
Carcinoma, Hepatocellular;
Creatinine;
Cyclosporine;
Female;
Fibrosis;
Hepatolenticular Degeneration;
Humans;
Incidence*;
Korea;
Liver Cirrhosis, Alcoholic;
Liver Transplantation*;
Liver*;
Male;
Prednisolone;
Prognosis;
Renal Insufficiency;
Retrospective Studies;
Risk Factors*;
Seoul;
Survivors;
Tacrolimus
- From:Korean Journal of Nephrology
2003;22(5):574-580
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Patients survival after liver transplantation continue to improve, and renal dysfunction is not uncommon complication in the posttransplant setting and influences to prognosis. But this important complication has not been extensively evaluated in Korea. The aim of this study was to determine the incidence of renal insufficiency and to identify the risk factors associated with renal insufficiency in long-term survivor over 6 months after liver transplantation at Seoul National University Hospital. METHODS: A retrospective study was done of 62 adult (44 males, 18 females; mean age 45 years, range 16-64) patients surviving more than 6 months (mean 17 months, range 6-63) after liver transplantation in the period of November 1996 to July 2001. Renal function of patients was classified by estimated endogenous creatinine clearance using Cockcroft-Gault formula. Potential risk factors for renal insufficiency were investigated. In addition, in the cases of patient who received mycophenolate mofetil (MMF) with calcineurin inhibitors (CNI) in reduced dosages for presumed CNI-induced nephrotoxicity, the change of renal function was analyzed retrospectively. RESULTS: The underlying diseases leading to transplantation included HBV-related cirrhosis in 43, hepatoma in 11, HCV-related cirrhosis in 2, alcoholic cirrhosis in 2, Wilson's disease in 1, and biliary atresia in 1 case (s). The immunosuppressive therapy included tacrolimus in 48 cases and cyclosporine in 14 cases combined with prednisolone. In all, 26 patients among study period, received MMF. Of all patients, 8 (13%) kept normal renal function (Ccr> or = 90), 27 (43.5%) developed mild dysfunction (60< or =Ccr< 90), 27 (43.5%) developed moderate dysfunction (30< or =Ccr< 60), and none of these patients developed severe renal dysfunction (Ccr< 30). Compared with control patients (Ccr> 60), renal dysfunction patients (Ccr< 60) had a lower preoperative creatinine clearance (p=0.007) and a lower 3-month creatinine clearance (p=0.032). But there were no differences seen among groups in age, sex, immunosuppresive protocol (tacrolimus vs. cyclosporine), mean tacrolimus serum level, developement of postoperative acute renal failure (ARF), and frequency of ARF among 6 months after transplantation. There was no statistically significant (p=0.057) but some recovery of renal function in the cases of patient who received MMF with low dose CNI. CONCLUSION: Patients who are more than 6 months after liver transplantation have renal dysfunction at a high rate (87%). Patients who develop moderate renal dysfunction have a lower preoperative and 3-month creatinine clearance. For renoprotective effect of MMF with reduced dosage of CNI, long-term randomized controlled studies are warranted.
