Underestimation of chronic renal dysfunction after liver transplantation: ICEBERG study

Table 1 Demographics and clinical characteristics of the 402 liver transplant recipients

Variables	n (%)
Age at transplant (yr), mean ± SD	52.4 ± 9.8
Gender (male)	288 (71.6)
Ethnicity (Caucasian)	400 (99.5)
Donor age, mean ± SD	47.0 ± 18.9
Time since transplantation (yr), mean ± SD	6.9 ± 3.9
Pre-transplant comorbidities
Diabetes mellitus	71 (17.7)
Hypertension	36 (9.0)
Dyslipidemia	13 (3.2)
Coronary heart disease	8 (2.0)
Reason for transplantation
Alcoholic cirrhosis without hepatocellular carcinoma	132 (32.8)
Hepatocellular carcinoma (in HCV or HBV-related liver cirrhosis, alcoholic cirrhosis or non-cirrhotic liver)	92 (22.9)
HCV-related liver cirrhosis without hepatocellular carcinoma	74 (18.4)
Cholestatic liver disease	24 (6.0)
HBV-related liver cirrhosis without hepatocellular carcinoma	23 (5.7)
Acute liver failure	9 (2.2)
Others	45 (11.2)
Induction therapy	68 (16.9)
Immunosuppressive treatment (at discharge)
Monotherapy	34 (8.5)
Cyclosporine	14 (3.5)1
Tacrolimus	20 (5.0)1
Combined therapies	368 (91.5)
Cyclosporine-based	155 (38.6)1
Tacrolimus-based	149 (37.1)1
mTOR inhibitor-based	63 (15.7)1
Others	1 (0.3)1

¹Percentages with respect to the total population. HCV: Hepatitis C virus; HBV: Hepatitis B virus; mTOR: Mammalian target of rapamycin.

Table 2 Chronic renal dysfunction based on serum creatinine definition and estimated glomerular filtration rate assessment (modification of diet in renal disease-4) n (%)

		CRD diagnosis according to serum creatinine definition
		Yes	No	Total
CRD diagnosis according to eGFR (MDRD-4)	Creatinine ≥ 2 mg/dL and eGFR < 60 mL/min per 1.73 m2	62 (98.4)1	1 (1.6)1	63 (31.2)2
	Creatinine < 2 mg/dL and eGFR < 60 mL/min per 1.73 m2	75 (54.0)1	64 (46.0)1	139 (68.8)2
	Creatinine < 1.25 mg/dL	3 (4.0)3	28 (43.8)3
	Creatinine 1.25 - < 1.50 mg/dL	19 (25.3)3	30 (46.9)3
	Creatinine 1.50 - < 2.0 mg/dL	53 (70.7)3	6 (9.4)3
	Total	137 (67.8)2	65 (32.2)2	202 (100)

¹Row percentages;

²Percentages with respect to the total number of patients with CRD diagnosis according to eGFR;

³Column percentages. CRD: Chronic renal dysfunction; eGFR: Estimated glomerular filtration rate; MDRD: Modification of diet in renal disease.

Table 3 Chronic renal dysfunction: concordance between serum creatinine definition and estimated glomerular filtration rate assessment (modification of diet in renal disease-4) n (%)

		CRD diagnosis according to serum creatinine definition
		Yes	No	Total
CRD diagnosis according to eGFR assessment (MDRD-4)	Yes	137 (67.8)1	65 (32.2)1	202 (50.2)2
	No	5 (2.5)1	195 (97.5)1	200 (49.8)2
	Total	142 (35.3)2	260 (64.7)2	402 (100)

¹Row percentages;

²Percentages with respect to the total population. CRD: Chronic renal dysfunction; eGFR: Estimated glomerular filtration rate; MDRD: Modification of diet in renal disease.

Table 4 Predictive factors associated with developing chronic renal dysfunction in liver transplant recipients

Variables	HR (95%CI)	P-value
Three months post-transplant eGFR (< 60 vs≥ 60 mL/min per 1.73 m2)	4.76 (2.78-8.33)	< 0.0001
CNI treatment at discharge (CNI vs non-CNI)	2.31 (1.05-5.07)	0.0371
Recipient gender (male vs female)	1.98 (1.09-3.60)	0.026
Year of transplantation ( ≤ 1999 vs > 1999)	1.95 (1.08-3.54)	0.0279

Other analyzed but non-significant variables were: donor gender (male or female), reason for transplantation (hepatitis C virus-related or not), antibody induction therapy at transplantation (yes or no), biopsy-confirmed graft rejection (yes or no), post-transplant diabetes mellitus (yes or no), post-transplant hypertension (yes or no), and pre-transplant eGFR (< 60 or ≥ 60 mL/min per 1.73 m²). eGFR: Estimated glomerular filtration rate; CNI: Calcineurin inhibitors.