Transplantation: Impact of pretransplant renal insufficiency

✍ Scribed by Phuong-Thu T. Pham; Alan H. Wilkinson

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 128 KB
• Volume: 14
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21454

✦ Synopsis

Although acute renal failure (ARF) immediately following orthotopic liver transplantation (OLT) occurs commonly, the incidence of chronic kidney disease (CKD) and end-stage renal disease increases with time. Data from the Scientific Registry of Transplant Recipients reveal that the cumulative incidences of stage 4 [estimated glomerular filtration rate (eGFR) Ͻ 29 mL/ minute] or 5 CKD (eGFR Ͻ 15 mL/minute) following OLT at 1, 3, and 5 years are 8%, 14%, and 18%, respectively. 1 Ideally, patients with a likelihood of developing stage 5 CKD within 1 year post-OLT should receive combined liver kidney transplantation (CLKT) to avoid added renal failure-related complications in the early postoperative period. Nonetheless, CLKT must be used judiciously because of the ever-increasing shortage of donor organs. For OLT candidates with mild to moderate chronic renal impairment or recent onset of ARF, the decision to perform OLTa or CLKT can be challenging because no single factor has been shown to be predictive of the degree of renal function recovery or CKD progression following successful OLT. Clinical studies evaluating risk factors for nonrecovery of renal function or rapid progression of CKD following OLT have yielded variable and conflicting results. 2 Campbell et al. 3 and Pham et al. 2,4 have previously suggested that the duration of pretransplant renal dysfunction has a negative impact on posttransplant renal function outcome. In contrast, Marik et al. 5 failed to demonstrate that the duration of pretransplant renal dysfunction was predictive of post-OLT renal outcome.