Risk Factors and Long Term Outcome of Renal Impairment after Living Donor Liver Transplantation: What have we Learned so Far?

Abstract

Background: Renal impairment commonly occurs after liver transplantation (LT).The risk is high in cases of pre-transplant kidney failure, hepatorenal syndrome (HRS), and intra-operative or post-operative hypotension. In this study, we would like to point out the etiological profile of renal impairment in the setting of living donor liver transplantation (LDLT) in Egypt. Materials and Methods: 200 patients who underwent LDLT from the beginning of 2009 till June 2014 at the liver transplantation unit of Ain Shams Center for Organ Transplant (ASCOT) were included retrospectively in addition to 53 patients who underwent LDLT starting from June 2014 till June 2015 were included prospectively with post-operative one year follow up. All pre-operative, intra-operative and post-operative variables were analyzed and reported. Results: 57% of patients had acute kidney injury (AKI) post-transplantation. Low pre-operative GFR, HCV infection, intra-operative hypotension and post-operative use of cyclosporine significantly increased development of AKI post-operative. The 5 year cumulative incidence of chronic kidney disease (CKD) post-transplantation was 10.4 % of all transplanted cases. Pre-operative HCV-nephropathy, diabetic nephropathy and low GFR significantly increased CKD development post-operative. Conclusion: AKI is common occurring in about 57% of transplanted patients. CKD increases with time after LDLT. In patients who developed both AKI and CKD, low pre-operative GFR and cyclosporine use post-operative were the significant risk factors for CKD development.