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Perioperative risk factors of progressive chronic kidney disease following liver transplantation: analyses of a 10-year follow-up single-center cohort

Annals of Surgical Treatment and Research 2020년 99권 1호 p.52 ~ 62
이경호, 전준석, 김종만, 김갑수, 김경아, 장혜련, 이정은, 조재원, 이석구, 허우성,
소속 상세정보
이경호 ( Lee Kyung-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
전준석 ( Jeon Jun-Seok ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
김종만 ( Kim Jong-Man ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
김갑수 ( Kim Gaab-Soo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Anesthesiology and Pain Medicine
김경아 ( Kim Kyung-A ) - Samsung Medical Center Research Institute for Future Medicine Statistics and Data Center
장혜련 ( Jang Hye-Ryoun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
이정은 ( Lee Jung-Eun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
조재원 ( Joh Jae-Won ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
이석구 ( Lee Suk-Koo ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery
허우성 ( Huh Woo-Seong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

Abstract


Purpose: The incidence of chronic kidney disease (CKD) has been increasing due to improved survival after liver transplantation (LT). Risk factors of kidney injury after LT, especially perioperative management factors, are potentially modifiable. We investigated the risk factors associated with progressive CKD for 10 years after LT.

Methods: This retrospective cohort study included 292 adult patients who underwent LT at a tertiary referral hospital between 2000 and 2008. Renal function was assessed by the e stimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula. The area under the curve of serial eGFR (AUCeGFR) was calculated for each patient to assess the trajectory of eGFR over the 10 years. Low AUCeGFR was considered progressive CKD. Linear regression analyses were performed to examine the associations between the variables and AUCeGFR.

Results: Multivariable analysis showed that older age (regression coefficient = ?0.53, P < 0.001), diabetes mellitus (DM) (regression coefficient = ?6.93, P = 0.007), preoperative proteinuria (regression coefficient = ?16.11, P < 0.001), preoperative acute kidney injury (AKI) (regression coefficient = ?14.35, P < 0.001), postoperative AKI (regression coefficient = ?3.86, P = 0.007), and postoperative mean vasopressor score (regression coefficient = ?0.45, P = 0.034) were independently associated with progressive CKD.

Conclusion: More careful renoprotective management is required in elderly LT patients with DM or preexisting proteinuria. Postoperative AKI and vasopressor dose may be potentially modifiable risk factors for progressive CKD.

키워드

Renal insufficiency; Kidney failure; Liver transplantation; Risk factors

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