Chronic kidney disease after orthotopic liver transplantation in recipients receiving tacrolimus

Introduction: Chronic kidney disease (CKD) is common in liver transplant recipients receiving calcineurin inhibitors. Method and population: The goals of this case-control studywere to identify risk factors associated with CKD and its effect on mortality in 294 liver transplant recipients receiving calcineurin inhibition with tacrolimus. Results: Hepatitis C virus (HCV) was the most common indication (42%) for transplantation. CKD 4 and 5 (estimated glomerular filtration rate (eGFR) of ≤ 29ml/min/1.73m²) developed in 10.8%of recipients during amean follow-up of 52 months. The incidence density of CKD was 2.56 per 100 patient-years. End-stage renal disease developed in 2.7%. By univariate analysis, CKD patients were older (mean ± sd, 57 ± 10 vs. 51 ± 11, p < 0.05) with hypertension (56 vs. 32%, p < 0.05), had lower preoperative hematocrit (31 ± 6 vs. 34 ± 5, p < 0.05), alanine aminotransferase (median (95% confidence limit) 46 (34 - 80) vs. 68 (56 - 77), < 0.05) and eGFR (56 ± 28 vs. 91 ± 35 ml/ min/1.73 m2, p < 0.05), had higher preoperative prothrombin time (16.1 (14.6 - 17.2) vs. 14.8 (14.5 - 15.1) seconds, p < 0.05), and required more perioperative renal replacement therapy (RRT) (41% vs. 6.5%, p < 0.05) compared to controls. Perioperative need for RRT (hazard ratio (95% CI) 2.72 (1.05 - 7.03)) and lower preoperative eGFR: 60 - 89 (4.08 (1.23 - 13.5)), 30 - 59 (4.26 (1.18 - 15.36)), and ≤ 29 (5.91 ((1.28 - 27.19)) vs. eGFR ≥ 90 ml/min/1.73 m2 were independently associated with development of CKD adjusting for important covariates. The development of CKD (2.36 (1.22 - 4.59)) was independently associated with late mortality with an attributable risk of 12.8%. Conclusion: Data demonstrate that CKD is an important clinical event associated with increased risk for death after primary liver transplantation.