Pretransplant Kidney Function Predicts Sustained Kidney Dysfunction After Living-Donor Liver Transplantation

10.6221/AN.202409_38(3).0002

Zih-Jie Yan；Chun-Chieh Tsai；Ping-Fang Chiu；Chia-Lin Wu

living-donor liver transplantation ； kidney dysfunction ； pretransplant kidney function

Acta Nephrologica

38卷3期（2024 / 09 / 01）

146 - 152

英文

BACKGROUND: Impaired renal function after liver transplantation would increase the mortality rate. There are few published Taiwanese data on living-donor liver transplantation (LDLT) to evaluate the renal dysfunction after transplantation. We aimed to investigate whether pre-transplant renal function correlates with the renal dysfunction one year after LDLT. METHODS: Patients who received LDLT between January 2003 and January 2019 were enrolled. The primary outcome was sustained estimated glomerular rate (eGFR) of less than 60 mL/min/1.73 m^2 one year after LDLT. RESULTS: A total of 403 patients were enrolled in this study, including 84 with sustained kidney dysfunction (eGFR < 60 mL/min/1.73 m^2 at one year) and 319 without kidney dysfunction (eGFR > 60 mL/min/1.73 m^2). Patients with sustained kidney dysfunction were older (58.6 ± 7.1 vs. 53.5 ± 8.4 years, P < 0.001), had lower serum albumin level (2.7 ± 0.6 vs. 2.9 ± 0.7 g/dL, P = 0.037), and more were diabetic (31% vs. 14.1%, P < 0.001). Multivariable logistic regression showed that age (adjusted odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.13; P < 0.001), eGFR (adjusted OR per 10 mL/ min/1.73 m^2, 0.74; 95% CI, 0.68-0.82; P < 0.001), diabetes (adjusted OR, 2.60; 95% CI, 1.28-5.27; P = 0.008) and perioperative acute kidney injury (AKI) (adjusted OR, 2.54; 95% CI, 1.42-4.55; P = 0.002) were independent predictors for sustained kidney dysfunction. Furthermore, the association of pretransplant eGFR with the risk of kidney dysfunction one year after LDLT was linear (P < 0.001). CONCLUSION: We found that pretransplant kidney function as well as age, diabetes and perioperative AKI were independent risk factors for sustained kidney dysfunction one year after LDLT. With regard to recipients with pretransplant eGFR of less than 60 mL/min/1.73 m^2, nephrologists should screen to find out correctable factors for CKD and intervene early.