Korean J Transplant.  2021 Oct;35(Supple 1):S43. 10.4285/ATW2021.OR-1130.

Pre- and post-transplant risk factors for renal dysfunction in the patients with preserved renal function at 1 month after liver transplantation: a national cohort study using Korean Organ Transplantation Registry (KOTRY)

Affiliations
  • 1Department of Surgery-Transplantation, Wonju Severance Christian Hospital, Wonju, Korea
  • 2Department of Surgery-Transplantation, Yonsei University College of Medicine, Seoul, Korea

Abstract

Background
Renal dysfunction (RD) is an important long-term complication after liver transplantation (LT) which is associated with patient survival. This study investigated pre- and post-transplant risk factors for RD in patient with preserved renal function at 1 month after LT using the Korean Organ Transplantation Registry (KOTRY) data.
Methods
We performed retrospective cohort study using data of recipients who underwent LT between April 2014 and December 2018 and were registered in KOTRY. We defined RD as 40% decline of eGFR from the value at 1 month and at least below 60 mL/min/1.73 m 2 . We performed multivariable Cox regression analyses for pre-transplant and within-one-month risk factors for RD. For post-transplant risk factors, we performed matched analyses according to 8 factors: biopsy-proven acute rejection, infection, bile duct complication, recurrence of HCC, new-onset diabetes mellitus (DM) after transplantation, type of immunosuppressants, steroid withdraw, and type of anti-HBV prophylaxis.
Results
Among 2,274 eligible patients, 251 (11.3%) developed RD during 36.6±14.4 of mean follow-up period. From multivariable Cox regression analyses, age, female sex, lower body mass index, pre-transplant DM, alcoholic liver disease, above Milan hepatocellular carcinoma (HCC), low Karnofsky performance status score at 1 month, bile duct complication within 1 month and lower estimated glomerular filtration rate at LT were identified as independent risk factors for RD after LT. Among post-transplant factors after 1 month, patients with recurrence of HCC (P=0.013), infection (P=0.003), and tacrolimus-mono treatment (vs. tacrolimus-based dual treatment, P=0.022) showed higher RD than control patients without those factors.
Conclusions
This study comprehensively indicates pre- and post-transplant risk factors for RD after LT among patients with preserved renal function at 1 month. Clinicians should consider these risk factors for managing patients during long-term follow-up.

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