END-STAGE RENAL DISEASE (ESRD) AFTER ORTHOTOPIC LIVER TRANSPLANTATION (OLTX) USING CALCINEURIN-BASED IMMUNOTHERAPY1
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- 1 December 2001
- journal article
- research article
- Published by Wolters Kluwer Health in Transplantation
- Vol. 72 (12) , 1934-1939
- https://doi.org/10.1097/00007890-200112270-00012
Abstract
Background. The calcineurin inhibitors cyclosporine and tacrolimus are both known to be nephrotoxic. Their use in orthotopic liver transplantation (OLTX) has dramatically improved success rates. Recently, however, we have had an increase of patients who are presenting after OLTX with end-stage renal disease (ESRD). This retrospective study examines the incidence and treatment of ESRD and chronic renal failure (CRF) in OLTX patients. Methods. Patients receiving an OLTX only from June 1985 through December of 1994 who survived 6 months postoperatively were studied (n=834). Our prospectively collected database was the source of information. Patients were divided into three groups: Controls, no CRF or ESRD, n=748; CRF, sustained serum creatinine >2.5 mg/dl, n=41; and ESRD, n=45. Groups were compared for preoperative laboratory variables, diagnosis, postoperative variables, survival, type of ESRD therapy, and survival from onset of ESRD. Results. At 13 years after OLTX, the incidence of severe renal dysfunction was 18.1% (CRF 8.6% and ESRD 9.5%). Compared with control patients, CRF and ESRD patients had higher preoperative serum creatinine levels, a greater percentage of patients with hepatorenal syndrome, higher percentage requirement for dialysis in the first 3 months postoperatively, and a higher 1-year serum creatinine. Multivariate stepwise logistic regression analysis using preoperative and postoperative variables identified that an increase of serum creatinine compared with average at 1 year, 3 months, and 4 weeks postoperatively were independent risk factors for the development of CRF or ESRD with odds ratios of 2.6, 2.2, and 1.6, respectively. Overall survival from the time of OLTX was not significantly different among groups, but by year 13, the survival of the patients who had ESRD was only 28.2% compared with 54.6% in the control group. Patients developing ESRD had a 6-year survival after onset of ESRD of 27% for the patients receiving hemodialysis versus 71.4% for the patients developing ESRD who subsequently received kidney transplants. Conclusions. Patients who are more than 10 years post-OLTX have CRF and ESRD at a high rate. The development of ESRD decreases survival, particularly in those patients treated with dialysis only. Patients who develop ESRD have a higher preoperative and 1-year serum creatinine and are more likely to have hepatorenal syndrome. However, an increase of serum creatinine at various times postoperatively is more predictive of the development of CRF or ESRD. New strategies for long-term immunosuppression may be needed to decrease this complication.Keywords
This publication has 34 references indexed in Scilit:
- Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients at a Single CenterAnnals of Surgery, 2000
- Nephrotoxicity of immunosuppressive drugs: Long-term consequences and challenges for the futureAmerican Journal of Kidney Diseases, 2000
- RISKS AND COSTS OF END-STAGE RENAL DISEASE AFTER HEART TRANSPLANTATION1,2Transplantation, 1998
- CYCLOSPORINE-ASSOCIATED END-STAGE NEPHROPATHY AFTER CARDIAC TRANSPLANTATIONTransplantation, 1997
- IMPACT OF PRETRANSPLANT RENAL FUNCTION ON SURVIVAL AFTER LIVER TRANSPLANTATIONTransplantation, 1995
- A Comparison of Tacrolimus (FK 506) and Cyclosporine for Immunosuppression in Liver TransplantationNew England Journal of Medicine, 1994
- NEPHROTOXICITY FOLLOWING ORTHOTOPIC LIVER TRANSPLANTATIONTransplantation, 1994
- Cyclosporine-induced chronic nephropathyJournal of the American Society of Nephrology, 1991
- INTERSTITIAL FIBROSIS IN RENAL ALLOGRAFTS AFTER 12 TO 46 MONTHS OF CYCLOSPORIN TREATMENT: BENEFICIAL EFFECT OF LOW DOSES IN EARLY POST-TRANSPLANTATION PERIODThe Lancet, 1984
- Cyclosporine-Associated Chronic NephropathyNew England Journal of Medicine, 1984