Abstract
774 Nephrotoxicity represents a serious side effect of immunosuppression following orthotopic liver transplantation (OLT), and is associated with high morbidity and mortality. Serum creatinine (SC) levels do not accurately reflect glomerular function and may be normal in the presence of reduced glomerular filtration rate (GFR). In addition, mildly abnormal renal indices may be tolerated in the setting of normal graft function, and the extent of renal impairment (RI) post OLT may be underestimated. The aim of this pilot study was to establish the extent of RI in OLT recipients with mildly elevated SC values to identify those most at risk for chronic RI, with a view to instigate renal rescue therapy. Methods: Of 208 consecutive patients (at least 12 months post OLT) screened, 75 (36.1% of total population) with a SC greater than 120μmol/l for three successive clinic visits were identified and selected for further investigation. Renal ultrasound, GFR, 24 hour urinary protein, and ANCA were performed. Patients were divided into two groups; mild RI (creatinine 120-149μmol/l), and moderate RI (creatinine 150-200μmol/l). Results: Patients with sustained creatinine levels greater than 150μmol/l. (n=21) had evidence of significant RI as evidenced by mean GFR 36 ml/min, mean diastolic pressure 90-95 mmHg, and reduced renal size on imaging. However, 54 patients with sustained creatinine values between 120-149μmol/L also had reduced GFR (mean 56 ml/min) but normal renal size and diastolic blood pressures (mean 75-80 mmHg). Serum bilirubin was less than 25μmol/L in 74 of 75 patients, and ANCA was negative in all cases. Conclusion: 10% of OLT recipients exhibit parameters of severe RI one year after OLT, and an additional 26% exhibit significantly impaired GFR manifest solely by a mild elevation in SC. These results indicate that renal impairment in OLT recipients is common and underestimated. We are extending this study to assess the potential role for dose modification or drug substitution in ameliorating renal dysfunction.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
