Transplantation: Impact of pretransplant renal insufficiency

79Citations
Citations of this article
57Readers
Mendeley users who have this article in their library.

Abstract

Pre-liver transplant renal dysfunction is associated with decreased survival following transplantation and is also a prognostic indicator of posttransplant chronic kidney disease. Selection of patients for combined liver/kidney transplantation versus orthotopic liver transplantation alone (OLTa) is often difficult given the lack of a reliable method to predict which patients will have ongoing severe renal dysfunction in the absence of concomitant kidney transplantation. We hypothesized that most patients with pretransplant renal dystunotion (serum creatinine ≥ 1.5 mg/dL for at least 2 weeks prior to and at time of transplant) will not experience a rapid decline in estimated glomerular filtration rates (eGF) post-OLTa to the point of necessitating consideration for kidney transplantation, even in the setting of calcineurin inhibitor-based immunosuppression. We performed a single-center retrospective study of 60 OLTa patients with pretransplant renal dysfunction transplanted between 2000 and 2005. Kaplan-Meier analysis was performed of the time interval to develop eGFR < 20 mL/ minute post-OLTa. At OLTa, the mean patient age was 59 years, and median serum creatinine was 1.8 mg/dL; 42% patients were hepatitis C-positive, 32% were diabetic, 38% had kidney dysfunction > 12 weeks, and 5% were receiving hemodialysis. After 36 months median follow-up post-OLTa, only 8 patients (13%) with significant renal dysfunction pre-OLTa achieved eGFR < 20 mUminute. Patients with pretransplant kidney dysfunction > 12 weeks were at increased risk for eGFR < 20 mL/minute (hazard ratio = 5.3, P = 0.04), a risk that escalated after adjustment for age and serum creatinine at transplant (hazard ratio = 8.9, P = 0.01). Significant predictors of eGFR < 20 mUminute post-OLTa in this patient cohort were the presence of diabetes and the serum creatinine level at transplant. In conclusion, few patients with preexisting renal dysfunction, especially if <12 weeks duration, experience a significant drop in eGFR post-OLta. © 2008 AASLD.

References Powered by Scopus

Chronic renal failure after transplantation of a nonrenal organ

1943Citations
N/AReaders
Get full text

Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation

471Citations
N/AReaders
Get full text

Impact of pretransplant renal function on survival after liver transplantation

403Citations
N/AReaders
Get full text

Cited by Powered by Scopus

Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK)

299Citations
N/AReaders
Get full text

Management of the critically ill patient with cirrhosis: A multidisciplinary perspective

245Citations
N/AReaders
Get full text

Simultaneous liver-kidney transplantation summit: Current state and future directions

210Citations
N/AReaders
Get full text

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Cite

CITATION STYLE

APA

Bahirwani, R., Campbell, M. S., Siropaides, T., Markmann, J., Olthoff, K., Shaked, A., … Reddy, K. R. (2008). Transplantation: Impact of pretransplant renal insufficiency. Liver Transplantation, 14(5), 665–671. https://doi.org/10.1002/lt.21367

Readers over time

‘10‘11‘12‘13‘14‘15‘16‘17‘18‘19‘20‘21‘22‘23‘24‘25036912

Readers' Seniority

Tooltip

PhD / Post grad / Masters / Doc 20

54%

Researcher 9

24%

Professor / Associate Prof. 6

16%

Lecturer / Post doc 2

5%

Readers' Discipline

Tooltip

Medicine and Dentistry 34

89%

Social Sciences 2

5%

Decision Sciences 1

3%

Pharmacology, Toxicology and Pharmaceut... 1

3%

Save time finding and organizing research with Mendeley

Sign up for free
0