LATE-ONSET RENAL FAILURE AFTER LIVER TRANSPLANTATION: ROLE OF POSTTRANSPLANT ALCOHOL USE1

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Abstract
Late-onset renal failure is being increasingly recognized as a complication in patients undergoing liver transplantation for hepatitis C virus (HCV).However, its precise incidence, predisposing risk factors, and impact on outcome after liver transplantation, have not been defined. The development of late-onset renal failure (defined as serum creatinine persistently >2.0 mg/dl, occurring more than 6 months posttransplant) was assessed in 120 consecutive liver transplant recipients who survived at least 6 months after transplantation. Fifty-seven percent (68/120) of the patients had undergone transplantation for liver disease due to HCV. The median follow-up was 5 years. Late-onset renal failure developed in 28% (33/120)of the patients. Posttransplant alcohol use (P =0.0001), posttransplant diabetes (P =0.0042), and recurrent HCV hepatitis (P =0.019) were significantly associated with late onset renal failure. In multivariate analysis, alcohol use (O.R. 10.7, 95%; CI 2.4–35.9, P =0.001) and diabetes (O.R. 2.1, 95%; CI 1.1–9.9, P =.03) were independently significant predictors of late onset renal failure. When only patients transplanted for HCV were analyzed, posttransplant alcohol use (P =0.004) was the only significant independent predictor of late-onset renal failure. HCV genotype 1b, as compared with other HCV genotypes, was associated with a higher rate of late-onset renal failure in patients with HCV; 70% of the patients with genotype 1b versus 32% of those with 1a and 33% of those with 2b, developed late onset renal failure (P =0.03). At a median follow up of 5 years, mortality in patients with HCV with late-onset renal failure was 52% as compared with 2% in those without renal failure (P =.0001). Late-onset renal failure in patients with HCV portended a grave outcome. Alcohol use was an independent predictor of late-onset renal failure in patients with HCV and represents a potentially modifiable risk factor for late-onset renal failure in these patients.