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Minimal Improvement in Glomerular Filtration Rate in the First Year After Liver Transplantation

Background Renal function is an important predictor of liver transplantation (LT) outcome. This study examines the change in glomerular filtration rate (GFR, mL/min per m2) in the first year after LT, with subgroup analysis by baseline GFR, model for end-stage liver disease (MELD), age, sex, race, and diabetes/hypertension. Methods The records of 1275 consecutive deceased donor, liver, and liver/kidney transplants were reviewed retrospectively, with the liver/kidney data analyzed separately. Glomerular filtration rate was calculated using the modification of diet in renal disease equation. Results Among liver only patients, 25% had GFR less than 60 (mL/min per 1.73 m2) at LT, and this increased to 39% at 1 year. There were 42% of patients with normal renal function (GFR > 90) at baseline, and this decreased to 18% at 1 year. Only patient subgroups with MELD > 25 experienced any 1-year improvement in GFR, whereas all lower MELD groups experienced a significant decline in GFR. At 1 year after transplantation, there were 42% of recipients that had an absolute GFR decrease greater than 20 mL/min per 1.73 m2, and 39% that decreased greater than 25% from their transplant baseline. Only 22% had an absolute improvement in GFR greater than 5 mL/min per 1.73 m2. Conclusions Sixty-four percent of liver transplant recipients overall experience a decrease in GFR 1 year after transplantation. Recipients with severe kidney disease at transplant (GFR < 30) are the group most likely to experience improvement in GFR after transplantation. However, at 1 year, as a group, they remain at GFR less than 60 (stage III chronic kidney disease). These results suggest that severe renal dysfunction may be marginally reversible after LT, but only 22% of the recipients in this cohort experienced any post-LT improvement in renal function.