CHRONIC-RENAL-FAILURE FOLLOWING LIVER-TRANSPLANTATION - A RETROSPECTIVE ANALYSIS

Background Liver transplant recipients are at risk of chronic renal di sease, principally as a result of nephrotoxicity of the commonly used immunosuppressive agents cyclosporine and tacrolimus. We have investig ated the incidence of chronic renal failure and its risk factors in ou r transplant population, which was treated predominantly with cyclospo rine. Methods. A single-center retrospective study was done of 883 con secutive adult patients receiving a first liver transplant between 198 2 and 1996, Potential risk factors for the development of chronic rena l failure were recorded, including serial measurements of cyclosporine therapy and renal function. Results. Severe chronic renal failure (se rum creatinine level >250 mu M/L for at least 6 months) developed in 2 5 patients, representing 4% of patients surviving 1 year or more. Twel ve of these patients developed endstage renal failure and mortality wa s 44%, The predominant cause of renal failure was cyclosporine nephrot oxicity, Serum creatinine as early as 3 months after surgery was stron gly associated with the eventual development of severe chronic renal f ailure (P=0.001), and this group could be further subdivided into two groups with differing risk factors, The first group had early (<1 year ) renal dysfunction, with older age (P=0.03), cytomegalovirus infectio n (P=0,03), need for perioperative renal replacement therapy (P=0.06), and regrafting (P=0.06) as risk factors for eventual renal failure; t he second group had late-onset (>1 year) renal dysfunction, with cyclo sporine levels at 1 month after surgery (P=0.007) and daily and cumula tive cyclosporine dosage at 5 years (P=0.01 for both) as risk factors, Conclusions. With improved survival of liver trans plant recipients, chronic renal failure has become an important cause of morbidity and i s associated with a high mortality. Many patients at risk of severe ch ronic renal failure may be identified at an early stage, Treatment reg imens that avoid or prevent cyclosporine-induced nephrotoxicity are ur gently required for this population.