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Pre-transplant kidney function predicts chronic kidney disease after liver transplant: meta-analysis of observational studies.

Authors :
Fabrizi F
Dixit V
Martin P
Messa P
Source :
Digestive diseases and sciences [Dig Dis Sci] 2011 May; Vol. 56 (5), pp. 1282-9. Date of Electronic Publication: 2011 Jan 08.
Publication Year :
2011

Abstract

Background: Chronic kidney disease is a common problem in long-term survivors after liver transplantation. Several studies to clarify the risk factors for incidence of chronic kidney disease among liver transplant recipients, including preoperative kidney function, have yielded conflicting results.<br />Aim: The aim of this study was to conduct a systematic review of the published medical literature on the impact of pre-transplant kidney function on the occurrence of chronic kidney disease after liver transplantation.<br />Methods: Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effects pooled estimates for incidence of chronic kidney disease across the published studies. The relative risk of chronic kidney disease after liver transplantation according to pre-transplant glomerular filtration rate was regarded as the most reliable outcome end-point.<br />Results: We identified seven studies (38,036 unique liver transplant recipients). A stratified analysis including only studies provided with glomerular filtration rate at transplant reported that the summary estimate of relative risk and 95% confidence intervals (CIs) for developing chronic renal failure among liver transplant recipients with diminished renal function at transplant was 2.12 (95% CI, 1.01; 4.46) (random-effects model). The p value for study heterogeneity was significant (p = 0.0001). Post-transplant chronic kidney disease shows impact on survival; the summary estimate for the adjusted relative risk of all-cause mortality with chronic kidney disease after liver transplant was 4.35 (95% confidence Intervals, 3.34; 5.66), p = 0.0001 (random-effects model).<br />Conclusions: An increased risk of chronic kidney disease frequently exists among liver transplant recipients with reduced renal function at transplant. The occurrence of chronic kidney disease after liver transplantation has a major impact on mortality. Additional studies are needed to understand better the natural history of chronic kidney disease among liver transplant recipients.

Details

Language :
English
ISSN :
1573-2568
Volume :
56
Issue :
5
Database :
MEDLINE
Journal :
Digestive diseases and sciences
Publication Type :
Academic Journal
Accession number :
21221799
Full Text :
https://doi.org/10.1007/s10620-010-1529-2