Abstract
BackgroundFemale sex has been reported as an independent predictor of severe post-liver transplantation (LT) chronic kidney disease. We performed a by sex post-hoc analysis of the SURF study, that investigated the prevalence of renal impairment following LT, aimed at exploring possible differences between sexes in the prevalence and course of post-LT renal damage.MethodsAll patients enrolled in the SURF study were considered evaluable for this sex-based analysis, whose primary objective was to evaluate by sex the proportion of patients with estimated Glomerular Filtration Rate (eGFR) < 60 ml/min/1.73m2 at inclusion and follow-up visit.ResultsSeven hundred thirty-eight patients were included in our analysis, 76% males. The proportion of patients with eGFR < 60 mL/min/1.73 m2 was significantly higher in females at initial study visit (33.3 vs 22.8%; p = 0.005), but also before, at time of transplantation (22.9 vs 14.7%; p = 0.0159), as analyzed retrospectively. At follow-up, such proportion increased more in males than in females (33.9 vs 26.0%, p = 0.04). Mean eGFR values decreased over the study in both sexes, with no significant differences. Statistically significant M/F differences in patient distribution by O’Riordan eGFR levels were observed at time of transplant and study initial visit (p = 0.0005 and 0.0299 respectively), but not at follow-up.ConclusionsThough the limitation of being performed post-hoc, this analysis suggests potential sex differences in the prevalence of renal impairment before and after LT, encouraging further clinical research to explore such differences more in depth.
Highlights
Female sex has been reported as an independent predictor of severe post-liver transplantation (LT) chronic kidney disease
The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines recommend glomerular filtration rate (GFR) evaluation as the best global index of renal function, and state that it should be estimated based on formulas that consider the serum creatinine level and at least some of the following variables: age, sex, race and body surface [9]
An estimated Glomerular Filtration Rate (eGFR) below 60 mL/ min/1.73m2 is considered an index of renal damage [10, 11], and a recent systematic review of the methodology used in studies reporting chronic kidney disease prevalence reports that an eGFR < 60 mL/min/1.73m2 was used to define Chronic Kidney Disease (CKD) in 92% of studies [12]
Summary
Female sex has been reported as an independent predictor of severe post-liver transplantation (LT) chronic kidney disease. Long-term outcomes of liver transplant recipients are not as satisfactory, Colombo et al BMC Nephrology (2019) 20:475 dialysis [5, 6], and those not receiving renal replacement therapy may be at greater risk of early graft failure than those receiving renal replacement therapy. The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines recommend glomerular filtration rate (GFR) evaluation as the best global index of renal function, and state that it should be estimated based on formulas that consider the serum creatinine level and at least some of the following variables: age, sex, race and body surface [9]. Data from the literature show that patients undergone LT who have a GFR < 60 mL/min/1.73m2 3 months following transplant are at high risk of developing chronic kidney disease [11, 13]
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