Incidence and Risk Factors Associated With Chronic Kidney Disease After Liver Transplantation: A Review of a 20-Year Experience at a Single Center

• Published in: Transplantation proceedings 2024-04, Vol.56 (3), p.613-619
• Main Authors: Tovikkai, Chutwichai, Sawetwanichakul, Jirasawet, Kositamongkol, Prawat, Mahawithitwong, Prawej, Dumronggittigule, Wethit, Sangserestid, Pholasith, Assawasirisin, Charnwit, Limsrichamrern, Somchai, Sirivatanauksorn, Yongyut
• Format: Article
• Language: English
• Subjects: Adult; Female; Glomerular Filtration Rate; Humans; Incidence; Liver Transplantation - adverse effects; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - etiology; Retrospective Studies; Risk Factors
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2023.11.036

•Chronic kidney disease (CKD) is one of the most common complications after liver transplantation, with a high prevalence of approximately 60%.•Advanced age, pre-transplant kidney dysfunction, and posttransplant acute kidney injury are significant risk factors for developing CKD.•Patients who progressed to stages 4 to 5 CKD showed worse survival outcomes compared with those with stages 1 to 3 CKD.•Delayed calcineurin inhibitor introduction without antibody induction immunosuppressive protocol in patients with pre-transplant kidney dysfunction should be considered as a preventive strategy against the occurrence of CKD after liver transplantation. Chronic kidney disease (CKD) is one of the major complications after liver transplantation (LT), with a significant impact on patient outcomes. This study aims to investigate the incidence and risk factors of CKD in LT recipients at Siriraj Hospital over the past 20 years. There were 366 adult patients undergoing LT at Siriraj Hospital between January 2002 and December 2021. After excluding patients with pretransplant CKD stages 4 to 5, simultaneous liver–kidney transplantation, and patients who died after LT within 90 days, we retrospectively reviewed a total of 288 patients. Univariable and multivariable binary logistic regression analyses were used to identify the risk factors of post-transplant CKD. Of the 288 patients, 171 (59.4%) developed CKD after LT. The median time to develop CKD was 5.8 months (IQR, 3.8-15.3). Univariable and multivariable analyses revealed that age ≥55 years (odds ratio [OR] = 2.44; 95% CI, 1.34-4.42; P = .003), pretransplant kidney dysfunction defined as estimated glomerular filtration rate