IMPACT OF PRETRANSPLANT RENAL-FUNCTION ON SURVIVAL AFTER LIVER-TRANSPLANTATION

To determine the effect of pretransplant liver function on survival fo llowing orthotopic liver transplantation and to quantify the effects o f cyclosporine administration on long-term renal function in patients undergoing liver transplant, we performed an analysis of a prospective ly maintained database. Data from 569 consecutive patients undergoing liver transplantation alone who were treated with CsA for immunosuppre ssion were used for this study. Actuarial graft and patient survival r ates were calculated using Kaplan-Meier statistics. Glomerular filtrat ion rates, serum creatinine, and the use of various immunosuppressives were analyzed for this study. The initial analysis demonstrated that patients presenting for liver transplant with hepatorenal syndrome hav e a significantly decreased actuarial patient survival after liver tra nsplant at 5 years compared with patients without hepatorenal syndrome (60% vs. 68%, P<0.03), Patients with hepatorenal syndrome recovered t heir renal function after liver transplant. Patients who had hepatoren al syndrome were sicker and required longer stays in the intensive car e unit, longer hospitalizations, and more dialysis treatments after tr ansplantation compared with patients who did not have hepatorenal synd rome. The incidence of end-stage renal disease after liver transplanta tion in patients who had hepatorenal syndrome was 7%, compared with 2% in patients who did not have hepatorenal syndrome, To more fully exam ine the effect of pretransplant renal function on posttransplant survi val, the non-hepatorenal syndrome patients were divided into quartiles depending upon their pretransplant renal function. The patients with the lowest pretransplant renal function had the same survival as the p atients with the highest pretransplant renal function. In addition, th ere was no increased incidence of acute or chronic rejection in any of the groups. The patients with the lower pretransplant renal function were treated with more azathioprine to maintain renal function and had a negligible decrease in glomerular filtration rate following transpl ant. Conversely, patients with the highest level of renal function pre transplant had a 40% decline in renal function in the first year, but maintained stable renal function up to 4 years after transplant. We co nclude that pretransplant renal function other than hepatorenal syndro me has no effect on patient survival after orthotopic liver transplant . Renal function after liver transplant is stable after an initial dec line, despite continued administration of CsA. Use of a CsA-sparing pr otocol utilizing high doses of azathioprine and lower doses of CsA can maintain renal function in those patients who present with poor renal function before transplantation.