Year 2018 / Volume 110 / Number 9
Original
Prevalence and progression of chronic kidney disease after liver transplant: a prospective, real-life, observational, two-year multicenter study

538-543

DOI: 10.17235/reed.2018.5431/2017

José Ignacio Herrero, Valentín Cuervas-Mons, Miguel Ángel Gómez-Bravo, Joan Fabregat, Alejandra Otero, Itxarone Bilbao, María Magdalena Salcedo, María Luisa González-Diéguez, Jose Ramón Fernández, María Trinidad Serrano, Miguel Jiménez, Juan Miguel Rodrigo, Isidoro Narváez, Gloria Sánchez,

Abstract
Introduction: chronic kidney disease is a frequent complication after liver transplantation. The use of calcineurin inhibitors is one of the causes of this complication. Current immunsuppression regimens that reduce the use of calcineurin inhibitors may be associated with an improved preservation of renal function. Objective: the study aimed to assess the evolution of renal function after liver transplantation in the current routine clinical practice. Methods: an observational, prospective, multicenter study in adult liver transplant recipients was performed. Two hundred and thirty patients with a good renal function before transplantation were assessed six months post-transplantation (baseline) and every six months until month 30. Results: at baseline, 32% of the patients had a reduction in the glomerular filtration rate below < 60 ml/min/1.73 m2. The mean glomerular filtration rate increased from 72.3 to 75.6 ml/min/1.73 m2 at baseline and month 30 respectively (p < 0.01). The mean serum creatinine levels (mg/dl) decreased from 1.13 to 1.09 (p < 0.01). The percentage of patients with stage 3 chronic kidney disease decreased from 31.7% to 26.4%, whereas the percentage of patients with stage 4 remained unchanged (0.4% at baseline and 0.5% at month 30). No patients progressed to end-stage kidney disease that required dialysis or renal transplantation. Conclusion: in the routine clinical practice, a moderate deterioration of renal function is frequent after liver transplantation. However, advanced chronic kidney disease is infrequent in patients with a good pre-transplant renal function.
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References
Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137-7.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter, Suppl. 2013;3(1):1-150.
Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-305.
Fabrizi F, Dixit V, Martin P, et al. Chronic kidney disease after liver transplantation: Recent evidence. Int J Artif Organs 2010;33:803-11.
Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med 2003;349:931-40.
Watt KD, Pedersen RA, Kremers WK, et al. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant 2010;10:1420-7.
Bahirwani R, Reddy KR. Outcomes after liver transplantation: chronic kidney disease. Liver Transpl 2009;15 Suppl 2:S70-S74.
O'Riordan A, Wong V, McCormick PA, et al. Chronic kidney disease post-liver transplantation. Nephrol Dial Transplant 2006;21:2630-6.
Gonwa TA, Mai ML, Melton LB, et al. End-stage renal disease (ESRD) after orthotopic liver transplantation (OLTX) using calcineurin-based immunotherapy: risk of development and treatment. Transplantation 2001;72:1934-9.
Aguiar D, Martínez-Urbistondo D, Baroja-Mazo A, et al. Real-world multicenter experience of immunosuppression minimization among 661 liver transplant recipients. Ann Transplant 2017;22:265-75.
Neuberger JM, Mamelok RD, Neuhaus P, et al. Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the 'ReSpECT' study. Am J Transplant 2009;9:327-36.
Saliba F, De Simone P, Nevens F, et al. Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study. Am J Transplant 2013;13:1734-45.
Otero A, Varo E, de Urbina JO, et al. A prospective randomized open study in liver transplant recipients: daclizumab, mycophenolate mofetil, and tacrolimus versus tacrolimus and steroids. Liver Transpl 2009;15:1542-52.
Moreno Planas JM, Cuervas-Mons Martinez V, Rubio Gonzalez E, et al. Mycophenolate mofetil can be used as monotherapy late after liver transplantation. Am J Transplant 2004;4:1650-5.
Castroagudin JF, Molina E, Romero R, et al. Improvement of renal function after the switch from a calcineurin inhibitor to everolimus in liver transplant recipients with chronic renal dysfunction. Liver Transpl 2009;15:1792-7.
Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70.
Sato K, Kawagishi N, Fujimori K, et al. Renal function status in liver transplant patients in the first month post-transplant is associated with progressive chronic kidney disease. Hepatol Res 2015;45:220-7.
Varo E, Banares R, Guilera M. Underestimation of chronic renal dysfunction after liver transplantation: ICEBERG study. World J Transplant 2015;5:26-33.
Moreno JM, Cuervas-Mons V, Rubio E, et al. Chronic renal dysfunction after liver transplantation in adult patients: prevalence, risk factors, and impact on mortality. Transplant Proc 2003;35:1907-8.
Castells L, Baliellas C, Bilbao I, et al. [Early detection, prevention and management of renal failure in liver transplantation]. Gastroenterol Hepatol 2014;37:480-91.
Centers for Disease Control and Prevention. Prevalence of chronic kidney disease and associated risk factors. United States, 1999- 2004. MMWR Morb Mortal Wkly Rep. 2007 Mar 2. 56(8):1615.
Barkmann A, Nashan B, Schmidt HH, et al. Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil. Transplantation 2000;69:1886-90.
Bilbao I, Castells L, Rojas L, et al. Immunosuppression based on mycophenolate mofetil in stable liver transplanted patients. Int Immunopharmacol 2006;6:1977-83.
Cantarovich M, Tzimas GN, Barkun J, et al. Efficacy of mycophenolate mofetil combined with very low-dose cyclosporine microemulsion in long-term liver-transplant patients with renal dysfunction. Transplantation 2003;76:98-102.
Herrero JI, Quiroga J, Sangro B, et al. Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil. Liver Transpl Surg 1999;5:414-20.
Jimenez-Perez M, Lozano Rey JM, Marin Garcia D, et al. Efficacy and safety of monotherapy with mycophenolate mofetil in liver transplantation. Transplant Proc 2006;38:2480-1.
Orlando G, Baiocchi L, Cardillo A, et al. Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension. Liver Transpl 2007;13:46-64.
Pfitzmann R, Klupp J, Langrehr JM, et al. Mycophenolate mofetil reduces calcineurin inhibitor-induced side effects after liver transplantation. Transplant Proc 2002;34:2936-7.
Teperman L, Moonka D, Sebastian A, et al. Calcineurin inhibitor-free mycophenolate mofetil/sirolimus maintenance in liver transplantation: the randomized spare-the-nephron trial. Liver Transpl 2013;19:675-89.
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Herrero J, Cuervas-Mons V, Gómez-Bravo M, Fabregat J, Otero A, Bilbao I, et all. Prevalence and progression of chronic kidney disease after liver transplant: a prospective, real-life, observational, two-year multicenter study. 5431/2017


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Publication history

Received: 19/12/2017

Accepted: 15/04/2018

Online First: 12/06/2018

Published: 31/08/2018

Article revision time: 114 days

Article Online First time: 175 days

Article editing time: 255 days


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