Abstract: Objective To investigate the risk factors for chronic renal dysfunction (CRD) after liver transplantation.
Methods The clinical data of 101 patients who survived more than 3 years after liver transplantation at the General Hospital of Armed Police Forces from January 2007 to January 2008 were retrospectively analyzed. The glomeruar filtration rate (GFR) before operation and at postoperative year 1 and 3 were calculated by the modification of diet in renal disease (MDRD) formula. All the patients were divided into the CRD group (16 patients) and the control group (85 patients) according to whether the GFR was under 60 ml/min. Risk factors (gender, age, diabetes mellitus, creatinine, urea nitrogen, tacrolimus level, preoperative GFR, warm ischemia time, cold ischemia time, international normalized ratio, total protein, total bilirubin, alanine transaminase, aspartate transaminase, alkaline phosphatase) for CRD after liver transplantation were analyzed using chisquare test or t test, and multivariate analysis was done using Logistic regression models.
Results The mean preoperative level of GFR of the 101 patients was (103±22)ml/min, and the preoperative levels of GFR of 3 patients were under 60 ml/min. The mean levels of GFR of the 101 patients at postoperative year 1 and 3 were (91±22)ml/min and (83±21)ml/min, and the levels of GFR at postoperative year 1 of 7 patients were under 60 ml/min, and the levels of GFR at postoperative year 3 of 16 patients were under 60 ml/min. The results of univariate analysis showed that hypertension, diabetes mellitus, creatinine, blood urea nitrogen, tacrolimus level and preoperative GFR were risk factors for CRD after liver transplantation (χ2=9.400, 21.917, t=51.024, 91.620, 41.381, 99.000, P<0.05). The results of multivariate analysis showed that hypertension, diabetes mellitus and preoperative GFR were independent risk factors for CRD after liver transplantation (OR=65.438, 17.903, 0.911, P<0.05).
Conclusion Decrease of GFR, higher blood pressure and diabetes mellitus are risk factors that contributing to the development of CRD.