Renal function in patients undergoing transplantation for nonalcoholic steatohepatitis cirrhosis: Time to reconsider immunosuppression regimens?
✍ Scribed by Diarmaid D. Houlihan; Matthew J. Armstrong; Yana Davidov; James Hodson; Peter Nightingale; Ian A. Rowe; Sue Paris; Bridget K. Gunson; Simon B. Bramhall; David J. Mutimer; James M. Neuberger; Philip N. Newsome
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 116 KB
- Volume
- 17
- Category
- Article
- ISSN
- 1527-6465
- DOI
- 10.1002/lt.22382
No coin nor oath required. For personal study only.
✦ Synopsis
Nonalcoholic fatty liver disease is an independent risk factor for chronic kidney injury (CKI), yet the impact of liver transplantation (LT) on renal function in this at-risk group is not known. We compared the post-LT renal function of patients with nonalcoholic steatohepatitis (NASH) and a matched comparison group. Forty-eight consecutive patients who underwent transplantation for NASH between 2000 and 2008 in a single UK center were compared to non-NASH patients who were matched by age, sex, Model for End-Stage Liver Disease score, and estimated glomerular filtration rate (eGFR; calculated with the Modification of Diet in Renal Disease formula). In comparison with non-NASH patients, NASH patients had a significantly lower eGFR 3 months after LT (eGFR difference ¼ 8.85 mL/minute/1.73 m 2 , 95% confidence interval ¼ 2.93-14.77). After adjustments for the effects of the body mass index, tacrolimus levels, diabetes mellitus, hypertension, and hepatocellular carcinoma, the difference between the groups remained significant 3 months after LT (P ¼ 0.001). These data were then analyzed at numerous time points after LT (6, 12, and 24 months), and the time did not significantly affect the difference between the groups (P ¼ 0.17). Within 2 years, 31.2% of the NASH patients (15/48) had developed stage IIIb CKI, whereas only 8.3% of the non-NASH patients (4/48) did (P ¼ 0.009).
In conclusion, this study has identified NASH as an independent risk factor for renal dysfunction after LT. Renal-sparing immunosuppression regimens should be considered at the time of LT to reduce the development of kidney injury in NASH patients. The optimization of such regimens requires a prospective study.