Clinical progression and predictors of renal outcomes following liver transplantation: long-term follow-up results from a Taiwanese center.

Renal dysfunction post-liver transplant (LT) can escalate healthcare costs and mortality, yet remains under-studied. We retrospectively reviewed 393 consecutive adult liver recipients from 2004 to 2018 at one center, with longitudinal recording of estimated glomerular filtration rate (eGFR) pre- and post-LT. The outcomes encompassed post-LT mortality, new onset chronic kidney disease (CKD) stage 3 or higher, and progression of end stage renal disease (ESRD) among patients with pre-existing CKD. Cox regression analysis identified predictors of mortality and new-onset CKD stage 3 or higher. The multivariate analysis identified that post-LT eGFR < 60 mL/minute in the 1st year (HR = 1.94, 95% CI 1.164-3.233), P = 0.01), post-LT proteinuria in the 1st year (HR = 1.817, 95% CI 1.16-2.846, P < 0.01), hepatocellular carcinoma as LT cause (HR = 2.284, 95% CI 1.323-3.942, P < 0.01) and living donor graft (HR = 2.563, 95% CI 1.222-5.372, P = 0.01) were predictors for mortality. Cumulative incidences of new onset CKD stage 3 or higher at 1, 3, 5, 10, 15 years post-LT were 23.8%, 30.8%, 34.7%, 45.9%, 52.9%, respectively, and were associated with older age (HR = 1.035, 95% CI 1.012-1.059, P < 0.01), male sex (HR = 1.506, 95% CI 1.006-2.253, P = 0.047), pre-existing diabetes (HR = 1.533, 95% CI 1.092-2.207, P = 0.014), and pre-LT proteinuria (HR = 1.574, 95% CI 1.013-2.446, P = 0.044). The ESRD progression rates in pre-existing CKD recipients at 1, 3, 5, 7, 10 years post-LT were 8.7%, 18.8%, 28.8%, 33.9%, 51.9%, respectively. Significant cumulative incidences of new CKD stage 3 or higher and ESRD progression exists in LT recipients during long-term follow-up. Several mortality and renal dysfunction predictors were identified, emphasizing the need for early renal protection for liver recipients.