P012 Incidence of chronic kidney disease in Northern Ireland liver transplant recipients- a 10 year retrospective review

Abstract

<h3>Background and Aims</h3> Post-transplant renal dysfunction is one of the most important and common complications experienced by liver transplant (LT) recipients, leading to increased morbidity and mortality. 5-year cumulative incidence of end-stage renal disease (ESRD) is reported as 18%-22%. Risk factors contributing to this include peri-operative events, immunosuppression and metabolic risk factors. There are no specific practice guidelines for chronic kidney disease (CKD) identification and management among LT recipients. Our aim was to review the incidence of CKD, and risk factors for it, in our LT cohort, who are followed up in a single centre in Northern Ireland (NI). <h3>Method</h3> An electronic database identified all LT recipients in NI over a 10 year period from 2010–2019. Electronic care records were used to collect patient information and relevant laboratory values. Data was analysed for those in whom 1 year follow-up information was available. <h3>Results</h3> 218 patients in NI (123 male, 95 female) underwent LT between 1st January 2010 and 31st December 2019. Age ranged from 13 to 71 at time of transplant (mean 44 years old). Complete records are available for 204 patients allowing at least one year follow-up. 13 patients were transplanted as super-urgent fulminant cases, with the rest transplanted on the elective list. 7 patients had known pre-existing CKD. 32 patients had hypertension and 43 were diabetic pre-transplant. Post-transplant, 101 patients were hypertensive, and 72 were known to be diabetic. At 1 year, 1 patient had CKD 5,10/204 had CKD and 110/204 patients had CKD 3. 94/204 (46%) had a deterioration by at least 1 CKD stage. Of the 93 patients in whom 5 year data is available, 1 patient had CKD 5 (1.1%), 2 had CKD 4 (2.2%), and 48 had CKD 3 (51.6%). 37 patients (20.4%) are known to renal services. Based on NI GAIN guidelines, a further 22 patients (15.3%) meet criteria for routine referral to nephrology based on sustained reduction of &gt;25% eGFR in one year based on recent blood results. <h3>Conclusion</h3> Within LT recipients in Northern Ireland, the incidence of ESRD is much lower than quoted in the historical literature (1.1% of current patients with CKD 5 and 2.2% CKD 4). A substantial proportion have CKD 3 (51.6%). 61% of patients have risk factors in addition to calcineurin inhibitors. Care of these patients should include regular monitoring of renal function as well as aggressive management of risk factors such as diabetes mellitus and hypertension.