Non-Renal Risk Factors for Chronic Kidney Disease in Liver Recipients with Functionally Intact Kidneys at 1 Month
Authors
Deok-Gie Kim ; Shin Hwang ; Jong Man Kim ; Je Ho Ryu ; Young Kyoung You ; Donglak Choi ; Bong-Wan Kim ; Dong-Sik Kim ; Yang Won Nah ; Tae-Seok Kim ; Jai Young Cho ; Geun Hong ; Jae Do Yang ; Jaryung Han ; Suk-Won Suh ; Kwan Woo Kim ; Yun Kyung Jung ; Ju Ik Moon ; Jun Young Lee ; Sung Hwa Kim ; Jae Geun Lee ; Myoung Soo Kim ; Kwang-Woong Lee ; Dong Jin Joo
Citation
JOURNAL OF CLINICAL MEDICINE, Vol.11(14) : 4203, 2022-07
Chronic kidney disease (CKD) is a critical complication of liver transplants, of which non-renal risk factors are not fully understood yet. This study aimed to reveal pre- and post-transplant risk factors for CKD (<60 mL/min/1.73 m2), examining liver recipients with functionally intact kidneys one month after grafting using nationwide cohort data. Baseline risk factors were analyzed with multivariable Cox regression analyses and post-transplant risk factors were investigated with the time-dependent Cox model and matched analyses of time-conditional propensity scores. Of the 2274 recipients with a one-month eGFR ≥ 60 mL/min/1.73 m2, 494 (22.3%) developed CKD during a mean follow-up of 36.6 ± 14.4 months. Age, female sex, lower body mass index, pre-transplant diabetes mellitus, and lower performance status emerged as baseline risk factors for CKD. Time-dependent Cox analyses revealed that recurrent hepatocellular carcinoma (HR = 1.93, 95% CI 1.06-3.53) and infection (HR = 1.44, 95% CI 1.12-1.60) were significant post-transplant risk factors for CKD. Patients who experienced one of those factors showed a significantly higher risk of subsequent CKD compared with the matched controls who lacked these features (p = 0.013 for recurrent hepatocellular carcinoma, and p = 0.003 for infection, respectively). This study clarifies pre- and post-transplant non-renal risk factors, which lead to renal impairment after LT independently from patients' renal functional reserve.