End-stage renal disease after liver transplantation in patients with pre-transplant chronic kidney disease

Renal dysfunction prior to liver transplantation has a marked impact on post-transplant kidney outcomes. AimThe aim of this study was to assess post-transplant renal function in patients with chronic kidney disease (CKD) receiving orthotopic liver transplantation (OLT) alone. MethodsRetrospective review of 40 OLT recipients with pre-transplant CKD (serum creatinine 2mg/dL for at least threemonths) at the University of Pennsylvania from February 2002 to July 2010. Primary outcome was estimated glomerular filtration rate (eGFR) up to three years post-transplant. Secondary outcomes included incidence of stage 4 CKD (eGFR<30mL/min), need for renal replacement therapy (RRT), meeting criteria for kidney transplant listing (eGFR20mL/min), and mortality. ResultsMedian patient age was 56.5yr and 48% patients had pre-transplant diabetes. Median serum creatinine at transplant was 2.7mg/dL (eGFR=24mL/min). Median eGFR at one, two, and three yr post-transplant was 35, 34, and 37mL/min, respectively. Twelve patients (30%) required RRT at a median of 1.21 yr post-transplant and 16 (40%) achieved an eGFR20mL/min at 1.09 yr post-transplant. Mortality was 35% at a median of 1.60 years post-transplant. ConclusionsOLT recipients with pre-transplant CKD have a substantial burden of post-transplant renal dysfunction and high short-term mortality, questioning the rationale for OLT alone in this population.