Abstract
BackgroundChronic kidney disease is a significant complication after liver transplantation (LT), but the role of pre-existing renal insufficiency and proteinuria remains unclear among LT recipients receiving sirolimus.MethodsWe assessed the effects of proteinuria and baseline renal function on long-term renal and survival outcomes among 576 LT recipients who received SRL in a medical center between 2005 and 2014. Renal outcomes were the incidences of >50% reduction in their baseline estimated glomerular filtration rate and end stage kidney disease requiring renal replacement therapy. Proteinuria was identified using morning dipstick results (≥30 mg/dL) at baseline and within the first year after the initiation of SRL therapy. A Kaplan-Meier analysis was performed to estimate time to event. Factors associated with the outcomes were determined using the Cox proportional hazards model with a significance level set at P <0.05.ResultsDuring the study period, renal function deteriorated in 135 (25.3%) patients and 68 (11.8%) patients died. Persistent and new onset proteinuria contributed to a high rate of mortality and the deterioration of renal function (both log-rank tests, P <0.0001). After adjustments, new onset proteinuria within the first year after the initiation of SRL therapy increased the risk of deteriorating renal function, regardless of baseline estimated glomerular filtration rate. Moreover, pre-existing (hazard ratio = 1.91; P <0.001) and new onset diabetes (hazard ratio = 2.34; P <0.0001) were significantly associated with new onset proteinuria among SRL users.ConclusionsThese findings support the effective monitoring and early management of the predictable risks for proteinuria among new SRL users in order to delay the progression of renal disease.
Highlights
Chronic kidney disease is a significant complication after liver transplantation (LT), but the role of pre-existing renal insufficiency and proteinuria remains unclear among LT recipients receiving sirolimus
The study demonstrates that pre-existing renal insufficiency and proteinuria appear to be associated with an increased incidence of renal function deterioration and mortality among LT recipients who received SRL
Our study demonstrated that a higher mortality rate and faster renal function decline was associated with baseline proteinuria and impaired renal function
Summary
Chronic kidney disease is a significant complication after liver transplantation (LT), but the role of pre-existing renal insufficiency and proteinuria remains unclear among LT recipients receiving sirolimus. Chronic kidney disease (CKD) is a common complication among liver transplantation (LT) recipients; up to 20% of patients receiving LT progress to CKD stage 4 or 5 at five years post-transplant [1]. Despite the various pre- and post-operative factors contributing to the increased CKD in LT recipients, long-term use of calcineurin inhibitors (CNIs) accounts for a major cause of nephrotoxicity [3,4,5]. CNI-related chronic renal impairment may improve after switching to SRL in both renal and liver transplantation [6, 7]. The use of SRL, or other mTOR inhibitors, in LT patients has been increasing in routine clinical practice
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