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Friday, March 8, 2013

Chronic Kidney Disease After Liver Transplantation: Pretransplantation Risk Factors and Predictors During Follow-Up


Chronic Kidney Disease After Liver Transplantation: Pretransplantation Risk Factors and Predictors During Follow-Up

Background: Chronic renal impairment is an emerging problem in the management of patients after liver transplantation (LT). Methods: We prospectively analyzed predictors of chronic kidney disease (CKD) after LT in 179 patients followed for a median of 63 months. Diagnosis of CKD was based on an estimated glomerular filtration rate (GFR) of less than 60 mL/min according to the current position statement from the Kidney Disease Improving Global Outcome. Pretransplantation risk factors were evaluated. A Cox regression analysis, with time-dependent variables evaluated during follow-up, was applied to realize a prognostic model for CKD, and a prognostic index was also calculated. The validity of the model was tested in 149 independent LT patients with a median follow-up of 46 months. Results: The cumulative incidence of CKD was 45% at 5 years after LT. Estimated GFR at LT was the only pretransplantation independent risk factor (beta, 0.33; standard error (beta), 0.07; 95% confidence interval, 0.95-0.98). Development of arterial hypertension (hazards ratio [HR], 1.83), episodes of severe infection (HR, 2.15), and estimated GFR (HR, 0.89) after LT were identified as independent prognostic factors at the Cox regression time-dependent analysis. The model was able to identify the patients at higher risk for the development of CKD in the validation set. Conclusions: Lower renal function at transplantation is associated with a higher risk of CKD after transplantation. A predictive model based on the variation of posttransplantation variables during the course of follow-up can help the clinicians to estimate the probability of CKD in the next 12 months. (C) 2013 Lippincott Williams & Wilkins, Inc.

Página original: http://pdfs.journals.lww.com/transplantjournal/9000/00000/Chronic_Kidney_Disease_After_Liver.98648.pdf

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ALBERTO REINO BUELVAS
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