The effect of kidney diseases on survival in liver transplant patients

Abstract

Liver transplantation (LTx) is a life-saving procedure for patients with chronic end-stage liver disease or acute liver failure. It is well known that kidney diseases such as acute kidney injury (AKI) and chronic kidney disease (CKD) are highly prevalent in LTx patients. We aimed to assess the effect of kidney disease on survival in LTx patients. In this study, we included 85 patients (mean age 43.7 ± 12.7, male/female 53/32) who underwent orthotopic liver transplantation between 2001 and 2009 and analyzed their medical records and laboratory results. The effect of renal dysfunction including CKD and AKI on survival in LTx patients was assessed by Kaplan-Meier survival analysis. Median duration of follow-up was 48.4 months (2.6-163 months). Before transplantation, eleven patients (12.9%) were diagnosed with CKD and nine (10.5%) with AKI. AKI developed in 17 patients (20%) in the early post-operative phase, among which five had pretransplant CKD. We found that the number of male patients and the number of red blood cell transfusions were statistically higher in LTx patients with AKI than in those without AKI (p < 0.05). Eight patients died in the follow-up period. Estimated survival rates of patients were 93.9, 92.7 and 90.8% at 1st, 3rd and 5th years, respectively. The survival rate of patients with pre-LTx CKD was worse than that of patients with normal kidney function (70.7 vs. 95.8% in the 3rd year, p = 0.043). We also found that the survival rate of patients with post-LTx AKI was lower than in patients with normal kidney function (66.7 vs. 96.6% in the 5th year, p < 0.001). Our results suggest that post-LTx AKI determined by age and pre-LTx CKD had a negative effect on survival of LTx patients. These patients should be followed up and carefully managed in the perioperative period with the aim of minimizing the kidney dysfunction.