One-Year Follow-up of the Changes in Renal Function After Liver Transplantation in Patients Without Chronic Kidney Disease

• After liver transplantation (LT), impaired renal function increases morbidity and mortality.
• Risk factors of decreased renal function include hepatitis C, age, female sex, diabetes mellitus, hypertension, preexisting proteinuria, a reduced eGFR before or 6–12 months after LT, and calcineurin inhibitor (tacrolimus).
• This study found that renal function was significantly decreased during the 1st year after LT.
• This study found that renal function before LT was an independent risk factor for worsening renal function in LT recipients without chronic kidney disease.
• We did not find any correlation between renal function change and tacrolimus.

BackgroundImpaired renal function is a strong risk factor for morbidity and mortality after liver transplantation (LT). There is clearly a progressive deterioration in renal function after LT. The greatest loss of renal function occurs within the 1st year after LT. Several factors, including calcineurin inhibitors, are associated with decreased renal function. The aims of the present study were to identify changes in renal function before and after LT and to determine the risk factors related to decreased renal function after LT.MethodsWe reviewed medical records of 106 LT recipients without moderate to severe chronic kidney disease (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m2). We investigated eGFR changes from before to 1 year after LT with the use of propensity score matching. Statistical significance of differences between clinical parameters and 1-year eGFR changes was assessed with the use of univariate and multivariate analyses.ResultsMean age was 49.5 ± 10.9 years, and 66% of the patients were male. Mean differences in 1-year eGFR and serum creatinine were −32.0 ± 29.2 mL/min/1.73 m2 and 0.3 ± 0.3 mg/dL, respectively. Variables significantly associated with renal dysfunction 1 year after LT were old age, low pre-LT eGFR, low post-LT hemoglobin, and perioperative acute kidney injury. Multivariate analysis showed that pre-LT renal function was an independent risk factor for decreased renal function after LT. However, there was no significant correlation between 1-year eGFR change and serum tacrolimus level.ConclusionsRenal function significantly decreased the 1st year after LT, and baseline renal function was an independent risk factor for worsening renal function in LT recipients.