Risk and prediction of kidney failure early after liver transplantation

Abstract

Background

Kidney disease is common after liver transplantation (LT), but postoperative kidney failure is difficult to predict. Current guidelines recommend simultaneous liver-kidney transplantation (SLKT) in patients with pre-LT estimated glomerular filtration rate (eGFR) below 30–40 mL/min, which might be too liberal. The aim of this study was to evaluate the risk of kidney failure after LT. We also assessed the predictive ability of pretransplantation eGFR using various equations.

Methods

This single-center study included patients undergoing primary LT 2006–2020. Patients undergoing simultaneous liver-kidney transplantations or on dialysis before LT were analysed separately. We calculated 5 different eGFR equations measured just before LT and assessed their predictive ability using Kaplan-Meier cumulative incidence estimates.

Results

Among 556 LT patients with a median follow-up of 5.0 years (IQR 2.0–8.5), 20 developed kidney failure during follow-up, 7 of them within 1-year post LT. Six of these 7 suffered from major perioperative complications. Depending on the eGFR equation used, the incidence of kidney failure within 1-year was 3.9–6.7% at pre-LT eGFR-values <30 mL/min, 1.2–3.1% at eGFR 30–60 mL/min, and 0.6–0.9% at eGFR >60 mL/min.

Conclusions

Kidney failure within 1-year post-LT could not be reliably predicted by pre-LT eGFR. However, kidney failure was uncommon even in patients with severely reduced pre-LT glomerular filtration rate (eGFR <30 mL/min), and extremely rare in patients unaffected by major perioperative complications. Our data prompts further consideration regarding the guidelines for SLKT in patients with a reduced preoperative eGFR.

Keywords:

• Liver transplantation
• chronic kidney disease
• kidney failure
• simultaneous liver-kidney transplantation
• estimated glomerular filtration rate
• hepatobiliary disease

Acknowledgments

The authors thank Leena Toivonen (Transplant coordinator, Helsinki University Hospital) for compiling and maintaining the Finnish Liver Transplant Registry.

Author’s contributions

TI, VS, FÅ, and IH participated in the research design, preparation of the manuscript and interpretation of data; TI and VE participated in data acquisition; TI participated in statistical analysis; AN participated in the preparation of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s)

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Additional information

Funding

This study was supported by grants from the Sigrid Jusélius Foundation and Helsinki University Hospital Abdominal Center’s Research Fund, both of which played no role in the analysis of the data or the preparation of this manuscript.