Long-Term Renal Outcomes and Survival After Liver Transplant: A 10-Year Cohort Study.

OBJECTIVES: Liver transplant markedly improves survival and quality of life in patients with chronic liver disease; however, chronic kidney disease remains a frequent long -term complication that adversely affects outcomes. In this study, we evaluated the effects of preoperative, perioperative, and postoperative factors on long -term renal outcomes, including chronic kidney disease and end -stage renal disease, as well as patient survival after liver transplant.

MATERIALS AND METHODS: We conducted a retrospective, single-center cohort study of adult liver transplant recipients with 10 -year follow -up. Renal function was assessed using serum creatinine levels and estimated glomerular filtration rate, and chronic kidney disease was defined as estimated glomerular filtration rate of <60 mL /min /1.73 m ² persisting for at least 3 months. We analyzed clinical, perioperative, and postoperative variables to identify predictors of chronic kidney disease, end-stage renal disease, and 10-year mortality.

RESULTS: Postoperative chronic kidney disease developed in 24% of recipients, with 6.7% progressing to end -stage renal disease. Advanced age, recurrent postoperative acute kidney injury, hepatitis B virus infection, alcohol use, cyclosporine -based immunosuppression, nephrotoxic antibiotics, and postoperative hypertension were independent predictors of chronic kidney disease, whereas hypertension and intensive nephrotoxic antibiotic exposure predicted progression to end -stage renal disease. Graft rejection rates were lower in patients with chronic kidney disease or end -stage renal disease (P < .05 ). Hepatitis C virus positivity, hepatocellular carcinoma, and frequent postoperative infections predicted mortality, whereas renal dysfunction was not independently associated with 10 -year survival.

CONCLUSIONS: Long -term renal dysfunction remains a major source of morbidity after liver transplant. Identification of high -risk patients, minimization of nephrotoxic exposures, optimization of blood pressure control, and renal -protective immunosuppressive strategies may help preserve kidney function. The lower rejection rates observed in patients with chronic kidney disease suggest a complex interaction between immune modulation and renal injury.