Acute and chronic renal failure in liver transplantation

Abstract

We have performed a retrospective review of the incidence and etiologies of acute renal failure (ARF) in 105 adult patients receiving liver transplants. The prevalence of chronic renal failure was also determined. ARF occurred in 94.2% of these patients. Acute tubular necrosis was the leading cause of ARF and was associated with the highest mortality. Factors associated with increased mortality included: (1) peak serum creatinine greater than 3 mg/dl, (2) multiple liver transplants and (3) the need for dialysis. Pretransplant renal failure did not increase mortality. Chronic renal failure developed in 83% of patients at latest follow-up (mean: 30.5 +/- 7.9 months).

Fig. 1

Pretransplant SCr values plotted versus percent survival in liver transplant recipients.

Fig. 2

Percent survival in patients with mild, moderate, and severe ARF. Patients are categorized to the level of their peak SCr values.

Fig. 3

Mean SCr values in the pretransplant period, at discharge, and at latest follow-up for patients categorized according to the etiology of their ARF. ISC = Ischemic ATN; AMI = aminoglycoside-induced ATN; VD = volume depletion-induced ATN; CYA = ciclosporin toxicity; PR = prerenal azotemia; NARF = no ARF; UNK = unknown; HPR = HRS; AIN = allergic interstitial nephritis.

Fig. 4

The proportion of patients with normal SCr plotted vs. increasing time postliver transplantation. The values 85, 41, and 5 indicate the number of patients remaining in the study at the times noted.