Renal dysfunction and orthotopic liver transplantation: management strategies and indications for combined liver and kidney transplantation

Renal dysfunction in liver transplant patients: comparing patients transplanted for liver tumor or acute or chronic disease

Liver transplant patients are susceptible to renal dysfunction through a number of mechanisms. Our aim was to investigate if renal function differs among transplant indication groups. Consecutive liver transplantations (396) were divided in three groups: 277 with chronic liver disease (CLD), 90 with acute liver failure (ALF), and 29 with liver tumor. Data were recorded before and after transplantation. The glomerular filtration rate (GFR) was based on Cockcroft-Gault formula and renal function staged using the National Kidney Foundation guidelines. On the transplantation day, 4%, 15%, and 0% of patients in the CLD, ALF, and tumor groups, respectively, showed severely decreased GFR (</=29 ml/min/1.73 m(2)). The percentage with moderately or severely decreased GFR (<60 ml/min/1.73 m(2)) increased steadily in the CLD group (46% at 5 years) but decreased in the ALF group from the transplantation day (26% at 5 years). Of patients with moderately or severely decreased GFR at listing, 73% of the CLD and 35% of ALF patients continued to exhibit it at 1 year. The cumulative incidence of chronic renal failure was 16% at 10 years. MELD scores did not show notable correlation with post-transplant GFR. Renal dysfunction prior to transplantation often improved post-transplant in ALF patients, but was often irreversible in CLD patients. In CLD and tumor patients, renal function steadily deteriorated post-transplant.