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Pre-transplant Kidney Function Predicts Chronic Kidney Disease After Liver Transplant: Meta-Analysis of Observational Studies

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Abstract

Background

Chronic kidney disease is a common problem in long-term survivors after liver transplantation. Several studies to clarify the risk factors for incidence of chronic kidney disease among liver transplant recipients, including preoperative kidney function, have yielded conflicting results.

Aim

The aim of this study was to conduct a systematic review of the published medical literature on the impact of pre-transplant kidney function on the occurrence of chronic kidney disease after liver transplantation.

Methods

Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effects pooled estimates for incidence of chronic kidney disease across the published studies. The relative risk of chronic kidney disease after liver transplantation according to pre-transplant glomerular filtration rate was regarded as the most reliable outcome end-point.

Results

We identified seven studies (38,036 unique liver transplant recipients). A stratified analysis including only studies provided with glomerular filtration rate at transplant reported that the summary estimate of relative risk and 95% confidence intervals (CIs) for developing chronic renal failure among liver transplant recipients with diminished renal function at transplant was 2.12 (95% CI, 1.01; 4.46) (random-effects model). The p value for study heterogeneity was significant (p = 0.0001). Post-transplant chronic kidney disease shows impact on survival; the summary estimate for the adjusted relative risk of all-cause mortality with chronic kidney disease after liver transplant was 4.35 (95% confidence Intervals, 3.34; 5.66), p = 0.0001 (random-effects model).

Conclusions

An increased risk of chronic kidney disease frequently exists among liver transplant recipients with reduced renal function at transplant. The occurrence of chronic kidney disease after liver transplantation has a major impact on mortality. Additional studies are needed to understand better the natural history of chronic kidney disease among liver transplant recipients.

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Abbreviations

OLT:

Orthotopic liver transplantation

CKD:

Chronic kidney disease

LT:

Liver transplantation

DM:

Diabetes mellitus

aRR:

Adjusted relative risk

CAD:

Coronary artery disease

CIs:

Confidence intervals

MELD:

Model for end-stage liver disease

GFR:

Glomerular filtration rate

ESRD:

End-stage renal disease

TIPS:

Transjugular intra-hepatic porto-systemic shunt

MDRD:

Modification of diet in renal disease

MOOSE:

Standard guidelines for meta-analyses of observational studies

ESLD:

End-stage liver disease

HCV:

Hepatitis C virus

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Acknowledgments

The authors’ work is supported in part by the grant ‘Project Glomerulonephritis’; in memory of Pippo Neglia. The authors of this manuscript have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Pad. Croff, Via Commenda 15, 20122, Milan, Italy

    Fabrizio Fabrizi & Piergiorgio Messa

  2. Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA

    Vivek Dixit

  3. Division of Hepatology, School of Medicine, University of Miami, Miami, FL, USA

    Paul Martin

Authors
  1. Fabrizio Fabrizi
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  2. Vivek Dixit
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  3. Paul Martin
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  4. Piergiorgio Messa
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Correspondence to Fabrizio Fabrizi.

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Fabrizi, F., Dixit, V., Martin, P. et al. Pre-transplant Kidney Function Predicts Chronic Kidney Disease After Liver Transplant: Meta-Analysis of Observational Studies. Dig Dis Sci 56, 1282–1289 (2011). https://doi.org/10.1007/s10620-010-1529-2

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