• Roberto C Narciso, Leonardo R Ferraz, Cassio J O Rodrigues, Júlio C M Monte, Sérgio Mie, Oscar F P Dos Santos, Ângela T Paes, Miguel Cendoroglo, Bertrand L Jaber, Marcelino S Durão, and Marcelo C Batista.
• Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
• Int J Artif Organs. 2013 Jul 1;36(7):498-505.

BackgroundPatients undergoing orthotropic liver transplant (LTx) often present with chronic kidney disease (CKD). Identification of patients who will progress to end-stage renal disease (ESRD) might allow not only the implementation of kidney protective measures but also simultaneous kidney transplant.Study DesignRetrospective cohort study in adults who underwent LTx at a single center. ESRD, death, and composite of ESRD or death were studied outcomes.Results331 patients, who underwent LTx, were followed up for 2.6 ± 1.4 years; 31 (10%) developed ESRD, 6 (2%) underwent kidney transplant after LTx and 25 (8%) remained on chronic hemodialysis. Patients with preoperative eGFR lesser than 60 ml/min per 1.73 m2 had a 4-fold increased risk of developing ESRD after adjustment for sex, diabetes mellitus, APACHE II score, use of nephrotoxic drugs, and severe liver graft failure (HR = 3.95, 95% CI 1.73, 9.01; p = 0.001). Other independent risk factors for ESRD were preoperative diabetes mellitus and post-operative severe liver graft dysfunction.ConclusionThese findings emphasize low eGFR prior to LTx as a predictor for ESRD or death. The consideration for kidney after liver transplant as a treatment modality should be taken into account for those who develop chronic kidney failure after LTx.

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