Rapid decline in 51Cr-ethylenediaminetetraacetic acid-measured renal function during the first weeks following liver transplantation.
BACKGROUND
Renal dysfunction is a serious late complication after liver transplantation (LTX), but there are no studies addressing the early changes associated with this complication.


METHODS
We prospectively studied glomerular filtration rate (GFR) before and at 1, 3 and 12 weeks after LTX using 51Cr-labelled ethylenediaminetetraacetic acid clearance in 37 adult consecutive patients who underwent non-acute first LTX.


RESULTS
The mean (±SD) age was 49.5 ± 9.5 years, and the male:female sex ratio was 21:16. Diagnoses were autoimmune liver diseases (17), alcoholic cirrhosis (10) and other diseases (10). Immunosuppressive treatment consisted predominantly of triple-drug therapy. A total of 27 of the 37 patients were eligible for GFR analysis at all times. The mean (±SD) GFR was 86 ± 26 mL/min/1.73 m2 before LTX, and 77 ± 30 mL/min/1.73 m2 at 1 week, 64 ± 27 mL/min/1.73 m2 at 3 weeks and 64 ± 23 mL/min/1.73 m2 at 12 weeks after LTX, comparable to a reduction in mean GFR compared with baseline values of 10% (P = 0.1907), 25% (P = 0.0010) and 26% (P = 0.0007). Age and number of blood transfusions during surgery were identified as risk factors for this decline as well as gender, but not pre-transplant diagnosis, model of end-stage liver disease score, cold ischaemia time or post-transplant area under the curve tacrolimus during Days 0-14.


CONCLUSIONS
Using measured rather than estimated GFR, our results show that severe renal impairment occurs during the first week after LTX. These results emphasize the need for more studies addressing renoprotective treatment strategies.
['Hornum|Mads|M|', 'Penninga|Luit|L|', 'Rostved|Andreas A|AA|', 'Christensen|Karl B|KB|', 'Oturai|Peter|P|', 'Plagborg|Ulla|U|', 'Feldt-Rasmussen|Bo|B|', 'Hillingsø|Jens G|JG|', 'Rasmussen|Allan|A|']
D058186:Acute Kidney Injury D015415:Biomarkers D002860:Chromium Radioisotopes D004492:Edetic Acid D005260:Female D005919:Glomerular Filtration Rate D006801:Humans D016031:Liver Transplantation D008297:Male D008875:Middle Aged D011446:Prospective Studies D012307:Risk Factors
renal dysfunction immunosuppression risk factor estimated glomerular filtration rate surgical complications