Kidney disease in non-kidney solid organ transplantation

Table 2 Kidney disease after liver

Ref.	Total number of patients, n	Risk factors associated with kidney disease	Study conclusion
Ojo et al[2]	36849	Pre-transplant GFR ≤ 29 mL/min/1.73 m2 (RR = 3.78), post-operative renal failure (RR = 2.11), pre-transplant dialysis (RR = 1.45), hepatitis C (RR = 1.22), and pre-transplant diabetes mellitus (RR = 1.39)	8% with CKD IV/V at 1 yr; 18.1% at 5 yr. Pre-transplant GFR, particularly that of ≤ 29 mL/min/1.73 m2, post-operative renal failure, pre-transplant dialysis, hepatitis C, and pre-transplant diabetes mellitus associated with CKD
Cohen et al[27]	353	1 yr mGFR correlated with 3 yr mGFR (r = 0.72)	At 3 and 5 yr in both the entire group (n = 353) and intensive follow-up group (n = 191), mean mGFR was > 50 mL/min/BSA at 3 (56.5 and 56.4) and 5 yr (56.6 and 53.9). Near doubling of transplant recipients with mGFR < 40 at 3 yr posttransplant (39/191, 20.4%) vs pre-transplant (10/191, 10.5%). 15 patients (4.2%) developed ESKD. Mean time to ESKD was 7.5 yr after transplant (range = 2.5-11.3 yr). The incidence of ESKD within 10 yr was 10% ± 3%, 95%CI: 3%-15%
Herlenius et al[28]	152	mGFR 3 mo post-liver transplant below 30 mL/min/1.73 m2 predicted CKD IV, V (P = 0.03)	At 5 yr, 8 (5%) of the patients were on dialysis. GFR decreased by 36% at 5 yr and 42% at 10 yr. mGFR 3 mo post-liver transplant below 30 mL/min/1.73 m2 predicted CKD IV, V (P = 0.03)
Wilkinson and Pham[29]		AKI risk factors: Delayed graft function, poor liver allograft function, BMI, use of cyclosporine-A and pre-transplant AKI; CKD risk factors: Acute kidney injury, need for hemodialysis, hepatorenal syndrome, calcineurin inhibitor use, diabetes mellitus, hepatitis C, and age	17%-95% rate of AKI with a mortality rate of 25%-74% in those on RRT vs 52% not requiring RRT; 10%-20% incidence of CKD, 2%-8% rate of ESRD with a mortality rate between 25%-50%
Gonwa et al[30]	834	Cr by 1 mg/dL above the average of the group conferred the following risk for CRF or ESRD: Cr at 4 wk (OR = 1.598, 95%CI: 1.076-2.372), Cr at 3 mo (OR = 2.254, 95%CI: 1.262-4.025), and 1 yr Cr (OR = 2.582, 95%CI: 1.633-4.083)	“severe renal dysfunction”, CRF + ESRD in 18.1% of (OLTx) recipients after 13 yr of follow up; 6 yr after the onset of ESRD, patients receiving HD without a transplant had a survival of only 27% compared with 71.4% in the kidney transplant group (P = 0.04)
O'Riordan et al[26]	230	Univariate: Age, female gender, liver transplant from CMV positive donor to CMV positive recipient, and pre-liver transplant diabetes, pre-transplant proteinuria. Multivariate: Pre-OLT total urinary protein (OR = 7.48, 95%CI: 1.04-53.97) and female gender (OR = 7.84, 95%CI: 2.04-30.08, P < 0.005) were the most predictive	5 yr post-liver transplant, 71% had CKD; pre-OLT total urinary protein (OR = 7.48, 95%CI: 1.04-53.97) and female gender (OR = 7.84, 95%CI: 2.04-30.08, P < 0.005) were the most predictive of CKD progression. In multivariate Cox regression analysis, GFR < 30 mL/min (HR = 3.05, 95%CI: 1.21-7.70, P = 0.02) was associated with patient survival. Similarly, survival was significantly for those with GFR < 30 mL/min compared to those with GFR > 30 mL/min in Kaplan-Meier analysis (log rank P = 0.04)
Wyatt and Arons[31]	358		Mortality in 358 liver transplant recipients who sustained AKI, irrespective of whether they required RRT or not: AKI without RRT (aOR = 8.69, 95%CI: 3.25-23.19, P < 0.0001); AKI requiring RRT (aOR = 12.07, 95%CI: 3.90-37.32, P < 0.0001)
Bahirwani et al[32]	40	Univariate: Pre-transplant diabetes (HR = 4.23, 95%CI: 1.12-15.93, P = 0.03) and African American race (HR = 3.44, 95%CI: 1.04-11.35, P = 0.04). Multivariate: No significant predictors of CKD	53% of recipients developed CKD stage 4 at 3 yr. At a median follow up of 1.21 yr post-transplant, 12 (30%) of recipients were on RRT
Cabezuelo et al[33]	184	Early acute renal failure: Pretransplant acute renal failure (OR = 10.2, P = 0.025), serum albumin (OR = 0.3, P = 0.001), duration of dopamine treatment (OR = 1.6, P = 0.001), and grade II-IV dysfunction of the liver graft (OR = 5.6, P = 0.002). Late postoperative risk factors: Re-operation (OR = 3.1, P = 0.013) and bacterial infection (OR = 2.9, P = 0.017)	12% of the cohort required RRT
Pham et al[34]			The percentage of renal function recovery for those who were on dialysis for ≤ 30 d, 31-60 d, and 61-90 d were 71%, 56%, and 24%
Al Riyami et al[35]	4186		Despite a low incidence of ESRD (2.9%) in their cohort, the unadjusted mortality rate for those with AKI requiring dialysis compared to those who did not was 49.2% vs 26.8%, respectively (P < 0.001)
Kollman et al[36]	681; 57 DCD, 446 DBD; 178 LDLT	Perioperative AKI (defined as AKI within the first 7 postoperative days) was observed more often in the DCD group (61%; DBD, 40%; and LDLT, 44%; P = 0.01)	Perioperative AKI associated with DCDLT. No significant differences in stage 3 AKI per RIFLE, AKI recovery, and progression to CKD. Patient survival was significantly lower in OLTx recipients who received DCD or DBD organs and required perioperative RRT in multivariate analysis (HR = 7.90; 95%CI: 4.51-13.83; P < 0.001)

GFR: Glomerular filtration rate; RR: Relative risk; CKD: Chronic kidney disease; mGFR: Measured glomerular filtration rate; BSA: Body surface area; ESKD: End stage kidney disease; CI: Confidence interval; AKI: Acute kidney injury; BMI: Body mass index; RRT: Renal replacement therapy; ESRD: End stage renal disease; Cr: Creatinine; CRF: Chronic renal failure; CI: Confidence interval; OR: Odds ratio; OLTx: Orthotopic liver transplant; CMV: Cytomegalovirus; HR: Hazard ratio; aOR: Adjusted odds ratio; DCD: Donation after circulatory death; DBD: Donation after brain death; LDLT: Living donor liver transplantation; DCDLT: Donation after circulatory death liver transplantation; RIFLE: Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease.