Renal function status in liver transplant patients in the first month post-transplant is associated with progressive chronic kidney disease

Renal dysfunction is a common complication of liver transplantation (LT), related to hepatorenal syndrome with end-stage liver disease or calcineurin-inhibitor nephrotoxicity. Chronic kidney disease (CKD) is also a common problem in long-term survivors post-LT. This study was done to investigate the association between renal functional status soon after LT and the development of CKD. Methods: We retrospectively evaluated 63 patients who were aged 18years or older, and underwent LT at Tohoku University Hospital. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease study equation for Japan. Results: Before transplantation, 25 patients (39.7%) were diagnosed with CKD (eGFR, <60mL/min per 1.73m²). The incidence of CKD was 22.4% (13/58) at 2years, 23.2% (13/56) at 3years and 22.7% (12/54) at 5years. The patients with CKD at 2years post-transplant were more likely to have a history of glomerulonephritis, and were significantly older at the time of LT, compared to those without CKD. Levels of eGFR of less than 60mL/min per 1.73m² in the first month post-transplant and a volume of intraoperative blood loss of more than 300mL/kg were predictive factors for the development of CKD at 2years post-transplant and thereafter. Conclusion: We have shown that there is an improvement of renal function in the majority of patients after LT. Regardless of the presence of pre-existing CKD, both renal function status at the first month post-transplant and a volume of intraoperative blood loss were predictive factors for the development of CKD at 2years post-transplant and thereafter.