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Evaluation of Longitudinal Exposure to Tacrolimus as a Risk Factor of Chronic Kidney Disease Occurrence Within the First-year Post-Liver Transplantation. | LitMetric

AI Article Synopsis

  • Renal failure in the early period after liver transplantation can predict mortality, and the study examines the effects of tacrolimus exposure and other factors on the 1-year survival rate without chronic kidney disease (CKD).
  • Analysis of data from 180 patients revealed that CKD-free survival was 74.5%, with previous acute kidney injury (AKI) and low eGFR levels at 1 month post-transplant identified as significant predictors of CKD.
  • The study concluded that while tacrolimus exposure was not linked to CKD-free survival, the presence of hepatorenal syndrome-related AKI and low eGFR were essential risk factors for developing CKD post-liver transplant.

Article Abstract

Background: Renal failure is predictive of mortality in the early postliver-transplantation period and calcineurin inhibitors toxicity is a main challenge. Our aim is to assess the impact of longitudinal tacrolimus exposure (TLE) and other variables on chronic kidney disease (CKD)-free 1-year-survival.

Methods: Retrospective data of consecutive patients transplanted between 2011 and 2016 and treated with tacrolimus were collected. TLE and all relevant pre- and post-liver transplantation (LT) predictive factors of CKD were tested and included in a time-to-event model. CKD was defined by repeated estimated glomerular filtration rate (eGFR) values below 60 mL/min/1.73m2 at least for the last 3 months before M12 post-LT.

Results: Data from 180 patients were analyzed. CKD-free survival was 74.5% and was not associated with TLE. Pre-LT acute kidney injury (AKI) and eGFR at 1-month post-LT (eGFRM1) <60 mL/min/1.73m2 were significant predictors of CKD. By distinguishing 2 situations within AKI (ie, with or without hepatorenal syndrome [HRS]), only HRS-AKI remained associated to CKD. HRS-AKI and eGFRM1 <60 mL/min/1.73m2 increased the risk of CKD (hazard ratio, 2.5; 95% confidence interval, 1.2-4.9; hazard ratio, 4.8; 95% confidence interval, 2.6-8.8, respectively).

Conclusions: In our study, TLE, unlike HRS-AKI and eGFRM1, was not predictive of CKD-free survival at 1-year post-LT. Our results once again question the reversibility of HRS-AKI.

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Source
http://dx.doi.org/10.1097/TP.0000000000003384DOI Listing

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