Late-onset renal failure after liver transplantation: Role of posttransplant alcohol use

Background. Late-onset renal failure is being increasingly recognized as a complication in patients undergoing liver transplantation for hepatitis C v irus (HCV). However, its precise incidence, predisposing risk factors, and impact on outcome after liver transplantation, have not been defined. Methods. The development of late-onset renal failure (defined as serum crea tinine persistently >2.0 mg/dl, occurring more than 6 months posttransplant ) was assessed in 120 consecutive liver transplant recipients who survived at least 6 months after transplantation. Fifty-seven percent (68/120) of th e patients had undergone transplantation for liver disease due to HCV, The median follow-up was 5 years. Results. Late-onset renal failure developed in 28% (33/120) of the patients . Posttransplant alcohol use (P = 0.0001), posttransplant diabetes (P = 0.0 042), and recurrent HCV hepatitis (P = 0.019) were significantly associated with late onset renal failure. In multivariate analysis, alcohol use (O.R. 10.7, 95%; CI 2.4-35.9, P = 0.001) and diabetes (O.R. 2.1, 95%; CI 1.1-9.9 , P = .03) were independently significant predictors of late onset renal fa ilure. When only patients transplanted for MCV were analyzed, posttransplan t alcohol use (P = 0.004) was the only significant independent predictor of late-onset renal failure, HCV genotype Ib, as compared with other HCV geno types, was associated with a higher rate of late-onset renal failure in pat ients with HCV; 70% of the patients with genotype Ib versus 32% of those wi th la and 33% of those with 2b, developed late onset renal failure (P = 0.0 3), At a median follow up of 5 years, mortality in patients with HCV with l ate-onset renal failure was 52% as compared with 2% in those without renal failure (P = .0001). Conclusion. Late-onset renal failure in patients with MCV portended a grave outcome. Alcohol use was an independent predictor of late-onset renal fail ure in patients with HCV and represents a potentially modifiable risk facto r for late-onset renal failure in these patients.