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Kidney Woes Seldom Progress After Liver Transplant

Study suggests pre-existing dysfunction rarely warrants combined liver/kidney transplantation

THURSDAY, May 1 (HealthDay News) -- In patients undergoing orthotopic liver transplantation alone, pre-existing kidney dysfunction -- especially of less than 12 weeks' duration -- seldom progresses to advanced stage 4 or 5 chronic kidney disease, suggesting that combined liver/kidney transplantation is usually not warranted in such patients, researchers report in the May issue of Liver Transplantation.

Ranjeeta Bahirwani, M.D., of the University of Pennsylvania in Philadelphia, and colleagues conducted a retrospective study of 60 patients who received an orthotopic liver transplantation alone between 2000 and 2005.

After a median follow-up of 36 months, the researchers found that only eight patients (13 percent) achieved estimated glomerular filtration rates of less than 20 mL/minute. They also found that patients with pre-transplant kidney dysfunction for more than 12 weeks had an increased risk for an estimated glomerular filtration rate of less than 20 mL/min (hazard ratio 5.3) and an even higher risk after adjustment for age and serum creatinine at transplant (HR, 8.9).

"Studies on the potential predictive factors for non-recovery of renal function or progressive chronic kidney disease following orthotopic liver transplantation alone have yielded variable and conflicting results," state the authors of an accompanying editorial. "Discrepancies among studies may have resulted from different study designs, underlying etiologies of renal dysfunction, and the inaccurate measurements of renal function with serum creatinine values, among others. Nonetheless, possible risk factors may be similar to those observed in the non-transplant setting and include the presence of pre-transplant comorbid conditions such as diabetes mellitus, hypertension and coronary artery disease."

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