Chronic Renal Failure after Transplantation of a Nonrenal Organ

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Abstract
Ojo et al. (Sept. 4 issue)1 describe a growing problem: renal failure after nonrenal transplantation. However, the authors use a calculated glomerular filtration rate (from the Modification of Diet in Renal Disease [MDRD] study2), which has not been validated in patients with liver failure. We compared the measured glomerular filtration rate with the calculated glomerular filtration rate in more than 1300 patients with liver failure.3 The MDRD equation had an r value of 0.67 and an r2 value of only 0.452. Therefore, using a calculated glomerular filtration rate in this population may be unwarranted. Our data indicated that the incidence of chronic renal failure or end-stage renal disease (ESRD) 13 years after liver transplantation was 18.1 percent.4 In 834 patients in whom the measured glomerular filtration rate was assessed, only post-transplantation renal function predicted an increased risk of chronic renal failure or ESRD. Careful management of immunosuppression can decrease the risk of chronic renal failure or ESRD.