Proteinuria and baseline renal function predict mortality and renal outcomes after sirolimus therapy in liver transplantation recipients

BMC Gastroenterology

Research Article

Yu-Fan Cheng¹  Chien-Ning Hsu²  Tsung-Hui Hu³  Chih-Hsiung Lee⁴  Lung-Chih Li⁴  Toshiaki Nakano⁵  Chao-Long Chen⁵  Chih-Che Lin⁵  Ding-Wei Chen⁶ 

[1] Department of Diagnostic Radiology, Kaohsiung, Taiwan;Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, 123, Ta Pei Road, Niao Sung District, 833, Kaohsiung, Taiwan;School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan;Division of Gastroenterology, Department of Internal Medicine, Kaohsiung, Taiwan;Division of Nephrology, Department of Internal Medicine, Kaohsiung, Taiwan;Liver Transplant Center, Department of Surgery, Kaohsiung, Taiwan;Liver Transplant Center, Department of Surgery, Kaohsiung, Taiwan;Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan;

关键词: Liver transplant;    Sirolimus;    Acute kidney injury;    Chronic kidney disease;    Proteinuria;    Renal insufficiency;    Immunosuppression;   

DOI  :  10.1186/s12876-017-0611-z

 received in 2016-12-09, accepted in 2017-04-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundChronic kidney disease is a significant complication after liver transplantation (LT), but the role of pre-existing renal insufficiency and proteinuria remains unclear among LT recipients receiving sirolimus.MethodsWe assessed the effects of proteinuria and baseline renal function on long-term renal and survival outcomes among 576 LT recipients who received SRL in a medical center between 2005 and 2014. Renal outcomes were the incidences of >50% reduction in their baseline estimated glomerular filtration rate and end stage kidney disease requiring renal replacement therapy. Proteinuria was identified using morning dipstick results (≥30 mg/dL) at baseline and within the first year after the initiation of SRL therapy. A Kaplan-Meier analysis was performed to estimate time to event. Factors associated with the outcomes were determined using the Cox proportional hazards model with a significance level set at P <0.05.ResultsDuring the study period, renal function deteriorated in 135 (25.3%) patients and 68 (11.8%) patients died. Persistent and new onset proteinuria contributed to a high rate of mortality and the deterioration of renal function (both log-rank tests, P <0.0001). After adjustments, new onset proteinuria within the first year after the initiation of SRL therapy increased the risk of deteriorating renal function, regardless of baseline estimated glomerular filtration rate. Moreover, pre-existing (hazard ratio = 1.91; P <0.001) and new onset diabetes (hazard ratio = 2.34; P <0.0001) were significantly associated with new onset proteinuria among SRL users.ConclusionsThese findings support the effective monitoring and early management of the predictable risks for proteinuria among new SRL users in order to delay the progression of renal disease.

【 授权许可】

CC BY   
© The Author(s). 2017