Factors influencing renal function after liver transplantation. Results from the MOST, an international observational study

• Published in: Digestive and liver disease 2009-05, Vol.41 (5), p.350-356
• Main Authors: Burra, P, Senzolo, M, Masier, A, Prestele, H, Jones, R, Samuel, D, Villamil, F
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Antiviral Agents - therapeutic use; Comorbidity; Cyclosporine; Diabetes Mellitus - epidemiology; Female; Follow-Up Studies; Gastroenterology and Hepatology; Glomerular Filtration Rate; Graft Rejection - epidemiology; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C virus; Humans; Hypertension - epidemiology; Immunosuppressive Agents - therapeutic use; Liver Failure - drug therapy; Liver Failure - surgery; Liver transplant; Liver Transplantation - statistics & numerical data; Male; Middle Aged; Prospective Studies; Renal function; Renal Insufficiency - diagnosis; Renal Insufficiency - epidemiology; Retrospective Studies; Risk Factors; Tissue Donors - statistics & numerical data; Treatment Outcome; Young Adult
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2008.09.018

Abstract Introduction Renal failure, both acute and chronic, is a common complication after liver transplantation and can seriously jeopardise long-term outcome. Given organ shortage it should be essential to determine which patients will experience progressive and severe renal dysfunction after liver transplantation (LT). Aim To correlate pre-transplant renal function and risk factors for renal failure after liver transplantation with occurrence of renal failure at 1 and 5 years after LT, with particular attention to hepatitis C virus (HCV) infection. Methods Data from patients enrolled in the liver section of Neoral® MOST (Multinational Observational Study in Transplantation) study were used for the analysis. HCV status, pre-transplant serum creatinine level, recipient gender, recipient age, pre-transplant arterial hypertension, pre-transplant diabetes mellitus, pre-transplant antiviral therapy, the time of the transplant (before or after 2000) and immunosuppressive regimen were collected for each patient. Post-transplant occurrence of renal failure at 1 and 5 years was defined as a GFR < 60 mL/min/1.73 m2 (Stage III of the National Kidney Foundation). Results Data from 1948 patients enrolled in the study were considered. Glomerular filtration rate (GFR) was evaluated in 406 patients at 1 year and in 233 patients at 5 years after LT. The prevalence of HCV infection was 35% in the former and 37% in the latter. The median GFR was 70 mL/min/1.73 m2 after 1 year and 69 mL/min after 5 years, significantly lower in HCV-positive (HCV+) than in HCV-negative (HCV−) patients both 1 and 5 years after LT ( p < 0.001). GFR before transplant correlated with GFR at 1 month, 1 and 3 years ( p < 0.0001 for all correlations). Multivariate analysis confirmed HCV status, pre-LT serum creatinine levels and recipient gender as significant predictors of 1-year GFR ( p < 0.001 for all three). Further analysis of the effect of recipient gender indicated that the only significant risk factor observed in both male and female patients was HCV positivity. Only 1-year GFR was an independent predictor of 5-year GFR ( p < 0.001). HCV+ status, cyclosporine (CsA) exposure, antiviral therapy and diabetes mellitus had no significant influence on 5-year GFR. Conclusions HCV status and pre-LT serum creatinine levels were independent predictors of renal function a year after LT, together with GFR before transplant. The negative impact of HCV positivity on renal function was not confirmed in t