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KMID : 0361120090230010058
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Korean Journal of Transplantation
2009 Volume.23 No. 1 p.58 ~ p.64
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Clinical Outcome of Pretransplant Renal Dysfunction in Adult Living Donor Liver Transplantation
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Kim Ho-Youn
Lee Kyung-Keun
Park Jung-Hyun
Kim Ji-Il
Moon In-Sung
Lee Myung-Duk
You Young-Kyoung
Kim Dong-Goo
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Abstract
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Background: The aim of this study is to analyze the clinical significance of preoperative renal dysfunction in patients with living donor liver transplant (LDLT).
Methods: We analyzed data collected retrospectively from 327 consecutive LDLT performed at Department of Surgery, Catholic University of Korea from Jan. 2000 to Dec. 2007. Based on creatinine clearance rate (CCR) calculated before LDLT, the patients were classified in three groups: normal renal function(CCR ≥70 ml/min, 273 patients, 83.5%), mild renal dysfunction (CCR ＜70 ml/min and CCR ≥40 ml/min, 38 patients, 11.6%) and severe renal dysfunction (CCR ＜40 ml/min, 16 patients, 4.9%). The mean follow up period was 47.5 months.
Results: The patient with severe renal dysfunction had higher incidence of postoperative dialysis and longer hospital stay (P＜0.001). During the 3 months follow up period, the mean serum creatinine level in patients with severe renal dysfunction were not normalized and the incidence of renal dysfunction (serum creatinine, ＞1.5 mg/dl) was up to 46.2%. Even in patient with normal renal function, the incidence of postoperative hemodialysis and renal dysfunction 3 months postoperatively was about 5%. Multivariate analysis showed that preoperative serum creatinine, MELD score and postoperative diabetes predicted postoperative renal dysfunction. There was no statistical difference in survival curve between normal and mild renal dysfunction group but the patient with severe renal dysfunction showed worse survival compare with other groups (P＜0.001).
Conslusions: Our data suggested that the patient with preoperative severe renal dysfunction have had poor recovery of renal dysfunction and high incidence of hemodialysis postoperatively and showed worse survival rate after transplantation.
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KEYWORD
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Preoperative renal dysfunction, Creatinine clearance rate, Living donor liver transplantation
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