Kidney outcomes in patients with liver cirrhosis and chronic kidney disease receiving an orthotopic liver transplant alone.
Kidney transplant in patients with liver cirrhosis and nondialysis chronic kidney disease (CKD) is controversial. We report 14 liver cirrhotic patients who had persistently low MDRD-6 estimated glomerular filtration rate (e-GFR) <40 mL/min/1.73 m2 for ≥3 months and underwent either liver transplant alone (LTA; n=9) or simultaneous liver-kidney transplant (SLKT; n=5). Pretransplant, patients with LTA compared with SLKT had lower serum creatinine (2.5±0.73 vs 4.6±0.52 mg/dL, P=.001), higher MDRD-6 e-GFR (21.0±7.2 vs 10.3±2.0 mL/min/1.73 m2 , P=.002), higher 24-hour urine creatinine clearance (34.2±8.8 vs 18.0±2.2 mL/min, P=.002), lower proteinuria (133.2±117.7 vs 663±268.2 mg/24 h, P=.0002), and relatively normal kidney biopsy and ultrasound findings. Post-LTA, the e-GFR (mL/min/1.73 m2 ) increased in all nine patients, with mean e-GFR at 1 month (49.8±8.4), 3 months (49.6±8.7), 6 months (49.8±8.1), 12 months (47.6±9.2), 24 months (47.9±9.1), and 36 months (45.1±7.3) significantly higher compared to pre-LTA e-GFR (P≤.005 at all time points). One patient developed end-stage renal disease 9 years post-LTA and another patient expired 7 years post-LTA. The low e-GFR alone in the absence of other markers or risk factors of CKD should not be an absolute criterion for SLKT in patients with liver cirrhosis.
['Singh|Neeraj|N|http://orcid.org/0000-0002-0141-3371', 'Ahmadzadeh|Shahab|S|', 'Shokouh-Amiri|Hosein|H|', 'Qazi|Yasir A|YA|', 'Sequeira|Adrian|A|', 'Samant|Hrishikesh|H|', 'McMillan|Robert|R|', 'Zibari|Gazi B|GB|']
D000328:Adult D000368:Aged D000066491:Clinical Decision-Making D058625:End Stage Liver Disease D005260:Female D005500:Follow-Up Studies D005919:Glomerular Filtration Rate D006801:Humans D008103:Liver Cirrhosis D016031:Liver Transplantation D008297:Male D008875:Middle Aged D051436:Renal Insufficiency, Chronic D012189:Retrospective Studies D014184:Transplantation, Homologous D016896:Treatment Outcome
clinical decision-making hepatorenal syndrome kidney (native) function/dysfunction