BACKGROUND: Chronic renal impairment is an emerging problem in the management of patients after liver transplantation (LT). METHODS: We prospectively analyzed predictors of chronic kidney disease (CKD) after LT in 179 patients followed for a median of 63 months. Diagnosis of CKD was based on an estimated glomerular filtration rate (GFR) of less than 60 mL/min according to the current position statement from the Kidney Disease Improving Global Outcome. Pretransplantation risk factors were evaluated. A Cox regression analysis, with time-dependent variables evaluated during follow-up, was applied to realize a prognostic model for CKD, and a prognostic index was also calculated. The validity of the model was tested in 149 independent LT patients with a median follow-up of 46 months. RESULTS: The cumulative incidence of CKD was 45% at 5 years after LT. Estimated GFR at LT was the only pretransplantation independent risk factor (beta, 0.33; standard error (beta), 0.07; 95% confidence interval, 0.95-0.98). Development of arterial hypertension (hazards ratio [HR], 1.83), episodes of severe infection (HR, 2.15), and estimated GFR (HR, 0.89) after LT were identified as independent prognostic factors at the Cox regression time-dependent analysis. The model was able to identify the patients at higher risk for the development of CKD in the validation set. CONCLUSIONS: Lower renal function at transplantation is associated with a higher risk of CKD after transplantation. A predictive model based on the variation of posttransplantation variables during the course of follow-up can help the clinicians to estimate the probability of CKD in the next 12 months. Copyright © 2013 Lippincott Williams & Wilkins.

Chronic kidney disease after liver transplantation: Pretransplantation risk factors and predictors during follow-up / Giusto, Michela; Marina, Berenguer; Carlo, Merkel; Victoria, Aguilera; Angel, Rubin; GINANNI CORRADINI, Stefano; Stefano Ginanni, Corradini; Mennini, Gianluca; Rossi, Massimo; Martin, Prieto; Merli, Manuela. - In: TRANSPLANTATION. - ISSN 0041-1337. - STAMPA. - 95:9(2013), pp. 1148-1153. [10.1097/tp.0b013e3182884890]

Chronic kidney disease after liver transplantation: Pretransplantation risk factors and predictors during follow-up

GIUSTO, MICHELA;GINANNI CORRADINI, Stefano;MENNINI, Gianluca;ROSSI, MASSIMO;MERLI, Manuela
2013

Abstract

BACKGROUND: Chronic renal impairment is an emerging problem in the management of patients after liver transplantation (LT). METHODS: We prospectively analyzed predictors of chronic kidney disease (CKD) after LT in 179 patients followed for a median of 63 months. Diagnosis of CKD was based on an estimated glomerular filtration rate (GFR) of less than 60 mL/min according to the current position statement from the Kidney Disease Improving Global Outcome. Pretransplantation risk factors were evaluated. A Cox regression analysis, with time-dependent variables evaluated during follow-up, was applied to realize a prognostic model for CKD, and a prognostic index was also calculated. The validity of the model was tested in 149 independent LT patients with a median follow-up of 46 months. RESULTS: The cumulative incidence of CKD was 45% at 5 years after LT. Estimated GFR at LT was the only pretransplantation independent risk factor (beta, 0.33; standard error (beta), 0.07; 95% confidence interval, 0.95-0.98). Development of arterial hypertension (hazards ratio [HR], 1.83), episodes of severe infection (HR, 2.15), and estimated GFR (HR, 0.89) after LT were identified as independent prognostic factors at the Cox regression time-dependent analysis. The model was able to identify the patients at higher risk for the development of CKD in the validation set. CONCLUSIONS: Lower renal function at transplantation is associated with a higher risk of CKD after transplantation. A predictive model based on the variation of posttransplantation variables during the course of follow-up can help the clinicians to estimate the probability of CKD in the next 12 months. Copyright © 2013 Lippincott Williams & Wilkins.
2013
liver transplantation; prediction; mdrd; chronic kidney disease; prognosis
01 Pubblicazione su rivista::01a Articolo in rivista
Chronic kidney disease after liver transplantation: Pretransplantation risk factors and predictors during follow-up / Giusto, Michela; Marina, Berenguer; Carlo, Merkel; Victoria, Aguilera; Angel, Rubin; GINANNI CORRADINI, Stefano; Stefano Ginanni, Corradini; Mennini, Gianluca; Rossi, Massimo; Martin, Prieto; Merli, Manuela. - In: TRANSPLANTATION. - ISSN 0041-1337. - STAMPA. - 95:9(2013), pp. 1148-1153. [10.1097/tp.0b013e3182884890]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/513404
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