Chronic kidney disease at one year after liver transplantation: Role of changes in immunosuppression over three decades

Abstract

Background: Kidney disease is a common complication in liver transplant (LT) recipients, contributing to substantial morbidity and mortality. Calcineurin inhibitors are associated with short- and long-term decline in kidney function.

Aim: To assess how changes in immunosuppression over three decades have impacted the evolution of renal function in the first year post-LT.

Methods: This single-center, observational, retrospective study was conducted in a tertiary hospital in Madrid. Adult patients who received a first LT in our center from 1987 to 2019 were included. Patients with simultaneous or prior transplantation of another organ and patients who required re-transplantation, or were lost to follow-up or died during the first year after transplantation were excluded. The development of chronic kidney disease (CKD) pre-transplant or at the first year after LT was analyzed.

Results: A total of 594 patients (median age: 52.9 years, 25th-75th percentiles = 45-59.08 years; 29.3% female) were included. At 1 year post-transplant, 290 (48.82%) patients had developed CKD. Older age [odds ratio (OR) = 1.03, 95%CI: 1.01-1.05], female sex (OR = 1.88, 95%CI: 1.23-2.89), pre-transplant renal dysfunction (RD) (OR = 2.69, 95%CI: 1.58-4.58), and treatment with cyclosporine A (CsA) (OR = 3.77, 95%CI: 2.45-5.78) were independent risk factors for CKD at 1 year after LT. In patients treated with tacrolimus (Tac) (n = 375), the combination of basiliximab and mycophenolic acid (MPA) resulted in decreased Tac blood levels (P < 0.001); additionally, MPA was associated with a lower incidence of RD in the first year (P = 0.016).