Clinical progression and predictors of renal outcomes following liver transplantation: long-term follow-up results from a Taiwanese center
Journal
Updates in Surgery
ISSN
2038-131X
2038-3312
Date Issued
2025-08-14
Author(s)
Abstract
Renal dysfunction post-liver transplant (LT) can escalate healthcare costs and mortality, yet remains under-studied. We retrospectively reviewed 393 consecutive adult liver recipients from 2004 to 2018 at one center, with longitudinal recording of estimated glomerular filtration rate (eGFR) pre- and post-LT. The outcomes encompassed post-LT mortality, new onset chronic kidney disease (CKD) stage 3 or higher, and progression of end stage renal disease (ESRD) among patients with pre-existing CKD. Cox regression analysis identified predictors of mortality and new-onset CKD stage 3 or higher. The multivariate analysis identified that post-LT eGFR < 60 mL/minute in the 1st year (HR = 1.94, 95% CI 1.164-3.233), P = 0.01), post-LT proteinuria in the 1st year (HR = 1.817, 95% CI 1.16-2.846, P < 0.01), hepatocellular carcinoma as LT cause (HR = 2.284, 95% CI 1.323-3.942, P < 0.01) and living donor graft (HR = 2.563, 95% CI 1.222-5.372, P = 0.01) were predictors for mortality. Cumulative incidences of new onset CKD stage 3 or higher at 1, 3, 5, 10, 15 years post-LT were 23.8%, 30.8%, 34.7%, 45.9%, 52.9%, respectively, and were associated with older age (HR = 1.035, 95% CI 1.012-1.059, P < 0.01), male sex (HR = 1.506, 95% CI 1.006-2.253, P = 0.047), pre-existing diabetes (HR = 1.533, 95% CI 1.092-2.207, P = 0.014), and pre-LT proteinuria (HR = 1.574, 95% CI 1.013-2.446, P = 0.044). The ESRD progression rates in pre-existing CKD recipients at 1, 3, 5, 7, 10 years post-LT were 8.7%, 18.8%, 28.8%, 33.9%, 51.9%, respectively. Significant cumulative incidences of new CKD stage 3 or higher and ESRD progression exists in LT recipients during long-term follow-up. Several mortality and renal dysfunction predictors were identified, emphasizing the need for early renal protection for liver recipients.
Subjects
Chronic kidney disease
Estimated glomerular filtration rate
Liver transplant
Proteinuria
Renal function
SDGs
Publisher
Springer Science and Business Media LLC
Type
journal article