Evaluation of Factors Influencing Renal Dysfunction Following Living Donor Liver Transplantation

Deterioration of kidney function is the most worrisome long term complication following liver transplantation. This study was performed to identify the risk factors of renal dysfunction following living donor liver transplant and the effect of immunosuppressant dosage adjustment on the recovery of renal function. A retrospective observational study was conducted on 133 consecutive adult living donor liver transplant recipients over an 8 y period from 2006 onwards. An increase in serum creatinine of >1.4 mg/dl was taken as a marker for renal insufficiency. The incidence of post living donor liver transplant renal dysfunction was 35% and maximum incidence occurred at one year of liver transplantation. Male gender, pretransplant diabetes, hepatorenal syndrome, posttransplant hypertension, bilirubin >1.2 mg/dl, albumin <3.5 g/dl, pretransplant serum creatinine >1.4 mg/dl and tacrolimus trough level >7 mu g/l at 3rd month of liver transplantation were significant risk factors for the development of renal dysfunction. Reduction of tacrolimus dosage was the most effective intervention to restore renal function. This however resulted in abnormal liver function tests secondary to rejection and necessitated the addition of alternative non-nephrotoxic immunosuppressants. Two and four year survival rates were 98.9 and 96.6% for patients without renal dysfunction compared to 97.4 and 91.6% for those complicated by renal dysfunction after living donor liver transplant. Maintaining lower levels of tacrolimus along with addition of non-nephrotoxic immunosuppressants may be a worthwhile strategy to protect the kidneys and preserve long term graft function in patients at high risk of post living donor liver transplant renal dysfunction.