Kidney outcomes in patients with liver cirrhosis and chronic kidney disease receiving an orthotopic liver transplant alone |
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Authors: | Neeraj Singh Shahab Ahmadzadeh Hosein Shokouh‐Amiri Yasir A Qazi Adrian Sequeira Hrishikesh Samant Robert McMillan Gazi B Zibari |
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Institution: | 1. John C. McDonald Regional Transplant Center, Willis Knighton Medical Center, Shreveport, LA, USA;2. Division of Nephrology, Department of Medicine, LSUHSC‐S, Shreveport, LA, USA;3. Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA;4. Division of Gastroenterology, Department of Medicine, LSUHSC‐S, Shreveport, LA, USA |
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Abstract: | Kidney transplant in patients with liver cirrhosis and nondialysis chronic kidney disease (CKD) is controversial. We report 14 liver cirrhotic patients who had persistently low MDRD‐6 estimated glomerular filtration rate (e‐GFR) <40 mL/min/1.73 m2 for ≥3 months and underwent either liver transplant alone (LTA; n=9) or simultaneous liver‐kidney transplant (SLKT; n=5). Pretransplant, patients with LTA compared with SLKT had lower serum creatinine (2.5±0.73 vs 4.6±0.52 mg/dL, P=.001), higher MDRD‐6 e‐GFR (21.0±7.2 vs 10.3±2.0 mL/min/1.73 m2, P=.002), higher 24‐hour urine creatinine clearance (34.2±8.8 vs 18.0±2.2 mL/min, P=.002), lower proteinuria (133.2±117.7 vs 663±268.2 mg/24 h, P=.0002), and relatively normal kidney biopsy and ultrasound findings. Post‐LTA, the e‐GFR (mL/min/1.73 m2) increased in all nine patients, with mean e‐GFR at 1 month (49.8±8.4), 3 months (49.6±8.7), 6 months (49.8±8.1), 12 months (47.6±9.2), 24 months (47.9±9.1), and 36 months (45.1±7.3) significantly higher compared to pre‐LTA e‐GFR (P≤.005 at all time points). One patient developed end‐stage renal disease 9 years post‐LTA and another patient expired 7 years post‐LTA. The low e‐GFR alone in the absence of other markers or risk factors of CKD should not be an absolute criterion for SLKT in patients with liver cirrhosis. |
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Keywords: | clinical decision‐making hepatorenal syndrome kidney (native) function/dysfunction |
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