Revista Colombiana de Gastroenterologia
Print version ISSN 0120-9957
PINTO, Renzo et al. Incidence of chronic kidney disease and risk factors for patients who underwent liver transplantation at Fundación Santa Fe University Hospital from 2004 to 2008. Rev Col Gastroenterol [online]. 2011, vol.26, n.3, pp. 178-185. ISSN 0120-9957.
Background: Chronic Renal Failure (CRF) frequently develops in patients who undergo transplantation of solid organs such as livers, hearts, lungs, and small intestines. CRF increases morbidity and mortality rates, increases costs and results in deterioration in the quality of patients' lives. The development of CRF is a common complication in post-liver transplant patients. It is defined as a glomerular filtration rate between 29 and 60 ml/min/1.73 m2 of body surface area during post-surgical procedures. Multiple factors contribute to the risk of developing CRF in this group of patients. The most important among these factors are renal function prior to transplantation as measured by MDRD formula (Modification of Diet in Renal Disease), acute perioperative renal failure, and immune-suppressors such as calcineurin inhibitors. During the first six months after transplantation renal function deteriorates rapidly, but declines slowly thereafter. It is important to determine our incidence of chronic renal failure, the degree of severity according to the classification and the risk factors in patients who underwent liver transplantation. The aim of this study is to determine the incidence of chronic renal disease and the risk factors affecting post-liver transplant patients in the Fundación Santa Fe de Bogota University Hospital from January 2004 to November 2008. Materials and methods: This was a descriptive and retrospective study of a population of patients who had undergone liver transplantation in the Fundación Santa Fe de Bogota University Hospital between January 1, 2004 and November 11, 2008. These patients presented normal renal functions as measured by the MDRD formula. We excluded patients with previous renal insufficiency and combined liver-kidney transplantation patients. Results: 79 patients were included in the study. 27 (34.2% CI 95% 23.9 - 45.7) had developed Stage 2 MDRD renal failure by the 6th month of surveillance. 6 of the 27 patients (22.2%) presented cirrhosis resulting from NASH. 5 of the 27 (18.5%) presented hepatitis C. The 27 patients who developed chronic renal failure by the 6th month of surveillance presented an average MDRD score of 89.4 ml/min/m2/SC prior to transplantation. Chronic renal failure following transplantation is an increasingly common complication, associated with risk factors prior to and following transplantation. These factors include arterial hypertension, diabetes mellitus, hepatitis C and immunosuppression. Conclusions: Patients with pre-transplantation diagnoses of cirrhosis resulting from NASH or of hepatitis have a tendency to develop chronic renal failure. Immunosuppression immediately after transplantation influences the development of chronic renal failure. In our study we observed high percentages of cyclosporine A in patients who developed chronic renal failure. New studies are needed to determine the association between these risk factors and the development of chronic renal failure.
Keywords : Chronic kidney disease (CKD); MDRD; calcineurin inhibitors.