Secular Trends in Development of End-Stage Renal Disease Following Liver Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-05-12 DOI:10.1111/ctr.70141

Jessica M. Ruck, Maria A. Parra, Laura B. Zeiser, Goutham Nair, Sam Kant, Benjamin Philosophe, Shane E. Ottmann, Andrew M. Cameron, Russell N. Wesson, Allan B. Massie, Dorry L. Segev, Elizabeth A. King

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引用次数: 0

Abstract

Background

Renal dysfunction is common among liver transplant candidates and can resolve, persist, or develop de novo following liver transplantation (LT). In light of the 2017 policy changes to simultaneous liver-kidney transplant and the post-LT kidney transplant safety net eligibility, we evaluated risk factors for and change in the incidence of post-LT renal dysfunction.

Methods

Using SRTR data for adult deceased-donor liver-only transplant recipients 2010–2022, we evaluated secular trends in and risk factors for the development of post-LT ESRD at 1 year and overall using multivariable logistic and Cox regression. We compared observed versus expected incidence of ESRD at 1-year post-LT using weighting by odds.

Results

Among 77 565 LT recipients, 6032 (7.8%) developed ESRD during the study period, of whom 2354 (39.0%) developed ESRD within the first year after LT. In a multivariable model, diabetes (aOR 1.63, 95% CI 1.48–1.79, p < 0.001), pre-LT eGFR (aOR 0.97 per unit, 95% CI 0.97–0.97, p < 0.001), and MELD category remained independently associated with ESRD within 1-year post-LT. Odds of ESRD by 1 year post-LT were 47% higher than expected post-2017 after accounting for changes in donor and recipient characteristics.

Conclusions

The rising 1-year post-LT ESRD risk highlights the need to reassess safety net eligibility beyond 1 year and prioritize counseling on risk minimization, including post-transplant diabetes management and potential adjustments to immunosuppression protocols to improve outcomes.

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肝移植后终末期肾病发展的长期趋势

背景：肾功能障碍在肝移植候选者中很常见，并且可以在肝移植（LT）后消退、持续或重新发展。鉴于2017年同步肝肾移植和肝移植后肾移植安全网资格的政策变化，我们评估了肝移植后肾功能不全发生率的危险因素和变化。方法：使用2010-2022年成人死亡仅肝移植受者的SRTR数据，我们使用多变量logistic和Cox回归评估了1年和总体的肝移植后ESRD发展的长期趋势和危险因素。我们比较了肝移植后1年观察到的和预期的ESRD发生率，采用加权比值法。结果在77565例接受肝移植的患者中，6032例（7.8%）在研究期间发生了ESRD，其中2354例（39.0%）在肝移植后的一年内发生了ESRD。0.001)， lt前eGFR (aOR 0.97 /单位，95% CI 0.97 - 0.97, p <；0.001)， MELD类别在lt后1年内仍与ESRD独立相关。考虑到供体和受体特征的变化，移植后1年发生ESRD的几率比2017年后的预期高出47%。结论：肝移植后1年ESRD风险的上升表明，需要重新评估1年以上的安全网资格，并优先考虑风险最小化咨询，包括移植后糖尿病管理和对免疫抑制方案的潜在调整，以改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.