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Acute kidney injury and chronic kidney disease after liver transplant: A retrospective observational study / Lesión renal aguda y enfermedad renal crónica después de trasplante hepático. Un estudio observacional retrospectivo
Fabrizi, Fabrizio; Donato, Maria F; Cerutti, Roberta; Invernizzi, Federica; Porata, Giulia; Frontini, Giulia; Raffiotta, Francesca; De Feo, Tullia; Alfieri, Carlo M; Lampertico, Pietro; Rossi, Giorgio; Messa, Piergiorgio.
Affiliation
  • Fabrizi, Fabrizio; Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation. Division of Nephrology, Dialysis and Renal Transplantation. Milano. Italy
  • Donato, Maria F; Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation. Division of Gastroenterology and Hepatology. Milano. Italy
  • Cerutti, Roberta; Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation. Division of Nephrology, Dialysis and Renal Transplantation. Milano. Italy
  • Invernizzi, Federica; Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation. Division of Gastroenterology and Hepatology. Milano. Italy
  • Porata, Giulia; Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation. Division of Nephrology, Dialysis and Renal Transplantation. Milano. Italy
  • Frontini, Giulia; Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation. Division of Nephrology, Dialysis and Renal Transplantation. Milano. Italy
  • Raffiotta, Francesca; Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation. Division of Nephrology, Dialysis and Renal Transplantation. Milano. Italy
  • De Feo, Tullia; Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation. North Italy Transplant Program, Organ and Tissue Transplantation Immunology. Milano. Italy
  • Alfieri, Carlo M; Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation. University School of Medicine. Milano. Italy
  • Lampertico, Pietro; Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation. University School of Medicine. Milano. Italy
  • Rossi, Giorgio; Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation. University School of Medicine. Milano. Italy
  • Messa, Piergiorgio; Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation. University School of Medicine. Milano. Italy
Nefrología (Madrid) ; 42(1): 1-9, Ene-Feb., 2022. tab, graf
Article in English | IBECS | ID: ibc-204266
Responsible library: ES1.1
Localization: ES15.1 - BNCS
ABSTRACT
Background and rationale Chronic kidney disease remains an important risk factor for morbidity and mortality among LT recipients, but its exact incidence and risk factors are still unclear.Material and methodsWe carried out a retrospective cohort study of consecutive adults who underwent liver transplant (January 2009–December 2018) and were followed (at least 6 months) at our institution. CKD was defined following the Kidney Disease Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guidelines. Long-term kidney function was classified into 4 groups no CKD (eGFR, ≥60mL/min/1.73m2), mild CKD (eGFR, 30–59mL/min/1.73m2), severe CKD (eGFR, 15–29mL/min/1.73m2), and end-stage renal disease (ESRD).ResultsWe enrolled 410 patients followed for 53.2±32.6 months. 39 had CKD at baseline, and 95 developed de novo CKD over the observation period. There were 184 (44.9%) anti-HCV positive, 47 (11.5%) HBsAg positive, and 33 (8.1%) HBV/HDV positive recipients. Recipient risk factors for baseline CKD were advanced age (P=0.044), raised levels of serum uric acid (P<0.0001), and insulin dependent DM (P=0.0034). Early post-transplant AKI was common (n=95); logistic regression analysis found that baseline serum creatinine was an independent predictor of early post-LT AKI (P=0.0154). According to our Cox proportional hazards model, recipient risk factors for de novo CKD included aging (P<0.0001), early post-transplant AKI (P=0.007), and baseline serum creatinine (P=0.0002). At the end of follow-up, there were 116 LT recipients with CKD – 109 (93.9%) and 7 (6.1%) had stage 3 and advanced CKD, respectively. Only two of them are undergoing long-term dialysis.ConclusionThe incidence of CKD was high in our cohort of LT recipients, but only a slight decline in kidney function over time was recorded. Prevention of post-transplant AKI will improve kidney function in the long run. ... (AU)
RESUMEN
Antecedentes y

justificación:

La enfermedad renal crónica (ERC) sigue siendo un importante factor de riesgo de morbimortalidad entre los receptores de un trasplante hepático (TH), su incidencia exacta y sus factores de riesgo aún no están claros.Materiales y métodosLlevamos a cabo un estudio de cohortes retrospectivo de adultos incluidos de forma consecutiva que habían recibido un TH (de enero de 2009 a diciembre de 2018) e hicimos el seguimiento (mínimo 6 meses) en nuestra institución. La ERC se definió siguiendo las guías de práctica clínica Kidney Disease Improving Global Outcomes (KDIGO) de 2012. La función renal a largo plazo se clasificó en 4 grupos sin ERC (filtración glomerular estimada [FGe]>60ml/min/1,73m2), ERC leve (FGe 30-59ml/min/1,73m2), ERC grave (FGe 15-29ml/min/1,73m2) y enfermedad renal terminal (ERT).ResultadosIncluimos a 410 pacientes a los que se hizo un seguimiento durante 53,2±32,6 meses 39 tenían ERC al inicio y 95 desarrollaron ERC de novo durante el periodo de observación. Había 184 (44,9%) receptores con anticuerpos contra el VHC, 47 (11,5%) con positividad para el HBsAg y 33 (8,1%) portadores del virus de la hepatitis B (VHB) o el virus de la hepatitis D (VHD). Los factores de riesgo de los receptores para presentar ERC al inicio fueron la edad avanzada (p=0,044), unos niveles elevados de ácido úrico en suero (p<0,0001) y la presencia de diabetes mellitus (DM) insulinodependiente (p=0,0034). La aparición temprana de lesión renal aguda (LRA) postrasplante fue frecuente (n=95); un análisis de regresión logística reveló que la creatinina sérica al inicio era un factor predictivo independiente de LRA temprana después del TH (p=0,0154). Según nuestro modelo de riesgos proporcionales de Cox, los factores de riesgo de los receptores para presentar ERC de novo incluyeron la edad avanzada (p<0,0001), una LRA temprana postrasplante (p=0,007) y la creatinina sérica al inicio (p=0,0002). ...
Subject(s)


Full text: Available Collection: National databases / Spain Database: IBECS Main subject: Liver Transplantation / Renal Insufficiency, Chronic / Acute Kidney Injury / Nephrology Limits: Humans Language: English Journal: Nefrología (Madrid) Year: 2022 Document type: Article Institution/Affiliation country: Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation/Italy / Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation/Italy

Full text: Available Collection: National databases / Spain Database: IBECS Main subject: Liver Transplantation / Renal Insufficiency, Chronic / Acute Kidney Injury / Nephrology Limits: Humans Language: English Journal: Nefrología (Madrid) Year: 2022 Document type: Article Institution/Affiliation country: Maggiore Policlinico Hospital and Ca’ Granda IRCCS Foundation/Italy / Maggiore Policlinico Hospital and Cà Granda IRCCS Foundation/Italy
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