24 May 2022 : Review article
A Systematic Review of the Literature on Chronic Kidney Disease Following Liver Transplantation
Hitomi Miyata1ADE*, Yoshiaki Morita2ADE, Anil Kumar3DEDOI: 10.12659/AOT.935170
Ann Transplant 2022; 27:e935170
Background
Protocol and Registration
Eligibility Criteria and Study Selection Process
Information Sources and Search Strategy
Data Collection Process and Summary Measures
Data Items and Outcomes
Risk of Bias in Individual Studies
Grading of Included Studies
Study Selection
Baseline Characteristics
Immunosuppressive Treatment
Renal Function
CKD Incidence/Prevalence and Stage
Patient and Graft Survival
Graft Rejection
Diabetes
Risk of Bias Across Studies
Discussion
Conclusions
References
Table 4 Patient demographics and baseline characteristics for the included studies.
Author, year [ref] | Study arm | n | Male sex, n (%) | Mean±SD age, years | Caucasian race, n (%) | Mean ±SD BMI, kg/m2 | Graft from living donor, n (%) | Primary disease (including pre-existing renal disease), n (%) | Mean±SD baseline creatinine level, mg/dL |
---|---|---|---|---|---|---|---|---|---|
Lin KH et al, 2017 []18 | 18 | 16 (88.9) | 55.2±7.5 | – | – | 18 (100) | – | 1.45±1.6 | |
23 | 19 (82.6) | 51.2±8.3 | – | – | 23 (100) | – | 1.15±0.3 | ||
Chen WY et al, 2017 []23 | 14 | 13 (92.9) | 50.3±5.6 | – | – | 9 (64.3) | Alcoholism, 10 (71.4)HBV, 2 (14.3)HCV, 1 (7.1)HBV/HCV coinfection, 1 (7.1) | 1.2±0.3 | |
28 | 26 (92.9) | 53.1±8.4 | – | – | 17 (60.7) | Alcoholism, 13 (46.4)HBV, 12 (42.9)HBV + HCV, 3 (10.7) | 1.1±0.3 | ||
Gojowy D et al, 2020 []24 | 130 | 78 (60.0) | 49.3±11.9 | – | – | 0 (0) | HCV, 36 (27.7)Ethanol abuse, 30 (23.1)HBV, 12 (9.2)Primary sclerosing cholangitis, 12 (9.2)Autoimmune hepatitis, 10 (7.7)Primary biliary cirrhosis, 6 (4.6)Autoimmune hepatitis/primary sclerosing cholangitis or autoimmune hepatitis/primary biliary cirrhosis overlapping syndrome, 4 (3.1)HCC without cirrhosis, 3 (2.3)Budd-Chiari syndrome, 2 (1.5)Wilson’s disease, 2 (1.5)Acute hepatitis A, 1 (0.8)Hemochromatosis, 1 (0.8)Unknown, 11 (8.5) | 0.96±0.61 | |
Levitsky J et al, 2020 []25 | 28 | 17 (60.7) | 52.5±12.2 | 22 (78.6) | – | – | HCV, 4 (14.3) | – | |
32 | 25 (78.1) | 54.1±8.7 | 25 (78.1) | – | – | HCV, 11 (34.4) | – | ||
Lladó L et al, 2019 []26 | 69 | 51 (73.9) | 55±9.9 | – | – | – | HCV negative, 69 (100)History of acute kidney failure, 29 (42.0)Refractory ascites, 18 (26.1)CKD, 6 (8.7)HRS I, 5 (7.2)HRS II, 5 (7.2) | 1.02±0.49 | |
Hong S et al, 2017 []27 | 48 | 41 (85.4) | 53.4±8.1 | – | – | Living related, 38 (79.2)Living unrelated, 8 (16.7) | HBV-related cirrhosis, (70.8)HCC, 30 (62.5)Alcoholic cirrhosis, (14.6) | 0.8±0.3 | |
Jochmans I et al, 2017 []28 | 21 | 10 (47.6) | Median (IQR), 59 (47–69) | – | – | 21 (100) | HCC, 11 (52.4)Acute liver failure, 4 (19.0)Non-alcoholic steatohepatitis cirrhosis, 4 (19.0)Post ethyl cirrhosis, 4 (19.0)HCV, 3 (14.3)HBV, 2 (9.5)Polycystic liver disease, 1 (4.8)Retransplantation, 1 (4.8)Other, 6 (28.6) | Median (range) 0.77 (0.62–0.98) | |
59 | 38 (64.4) | 60 (51–67) | – | – | 59 (100) | HCC, 21 (35.6)Cholestatic disease, 14 (23.7)Post ethyl cirrhosis, 13 (22.0)HCV, 6 (10.2)Non-alcoholic steatohepatitis cirrhosis, 5 (8.5)Acute liver failure, 4 (6.8)Retransplantation, 4 (6.8)HBV, 3 (5.1)Polycystic liver disease, 1 (1.7)Other, 5 (8.5) | Median (range) 0.86 (0.74–1.04) | ||
Dopazo C et al, 2018 []29 | 20 | 18 (90.0) | 60±6 | – | – | 0 (0) | Pre-liver transplant renal dysfunction (eGFR <60 mL/min/1.73 m), 20 (100)Alcoholism, 11 (55.0)HCV, 4 (20.0)HCC, 3 (15.0)HBV, 1 (5.0)Non-alcoholic steatohepatitis, 1 (5.0) | – | |
Pascher A et al, 2015 []30 | 49 | 37 (75.5) | 56.4±8.44 | 45 (91.8) | 49 (100) | Alcoholic cirrhosis, 21 (42.9)HCC, 11 (22.4)Sclerosing cholangitis, 7 (14.3)HBV, 5 (10.2) | – | ||
51 | 39 (76.5) | 53.8±11.34 | 45 (88.2) | 51 (100) | Alcoholic cirrhosis, 16 (31.4)HCC, 14 (27.5)HBV, 4 (7.8)Sclerosing cholangitis, 3 (5.9) Cryptogenic cirrhosis, 1 (2.0)HCV, 1 (2.0)Primary biliary cirrhosis, 1 (2.0) | – | |||
49 | 33 (67.3) | 55.1±8.86 | 48 (98.0) | – | 49 (100) | Alcoholic cirrhosis, 20 (40.8)HCC, 9 (18.4)Primary biliary cirrhosis, 4 (8.2)Cryptogenic cirrhosis, 3 (6.1)Metabolic disease, 2 (4.1)Sclerosing cholangitis, 2 (4.1)HBV, 1 (2.0)HCV, 1 (2.0) | – | ||
51 | 27 (52.9) | 53.3±10.2 | 45 (88.2) | – | 51 (100) | Alcoholic cirrhosis, 18 (35.3)HCC, 8 (15.7)Primary biliary cirrhosis, 5 (9.8)Sclerosing cholangitis, 3 (5.9)Cryptogenic cirrhosis, 2 (3.9)HBV, 1 (2.0)Metabolic disease, 1 (2.0) | – | ||
Sharma P et al, 2019 []7 | 93 | 66 (71.0) | Median (IQR) 56 (49–62) | 81 (87.1) | Median (IQR) 27 (23–32) | 0 (0) | HCV, 33 (35.5)HCC, 30 (32.3)Non-alcoholic steatohepatitis,15 (16.1)Alcoholic liver disease, 6 (6.5)Cryptogenic, 6 (6.5)Other, 33 (35.5) | Median (IQR) 0.8 (0.6–1.0) | |
Lim Y-T et al, 2020 []19 | 78 | 47 (60.0) | Median (range) 54 (21–71) | – | – | – | Alcoholic liver disease, 24 (30.8)HCC, 18 (23.1)NAFLD, 10 (12.8)Autoimmune hepatitis, 8 (10.3)HCV, 7 (9.0)Primary sclerosing cholangitis, 7 (9.0)HBV±HDV, 4 (5.1)Primary biliary cholangitis, 4 (5.1)Acute liver failure, 2 (2.6)Cryptogenic, 1 (1.3)Other, 11 (14.1) | – | |
Saliba F et al, 2017 []22 | 93 | 79 (84.9) | 56.5±8.6 | 88 (94.6) | 25.6±4.2 | 0 (0) | Alcoholic cirrhosis, 49 (52.7)HCC, 19 (20.4)HCV, 7 (7.5)HBV, 3 (3.2)Other, 15 (16.1) | – | |
95 | 81 (85.3) | 55.5±8.2 | 90 (94.7) | 26.5±3.8 | 0 (0) | Alcoholic cirrhosis, 50 (52.6)HCC, 25 (26.3)HCV, 7 (7.4)HBV, 3 (3.2)Other, 10 (10.5) | – | ||
Chauhan KC et al, 2018 []20 | 290 | 187 (64.5) | Median (IQR) 59.0 (52.0–64.0) | 110 (37.9) | Median (IQR) 26.4 (23.0–30.5) | – | HCV, 106 (36.6)HCC, 51 (17.6)HBV, 30 (10.3)Alcoholic liver disease, 22 (7.6)NAFLD, 13 (4.5)Primary biliary cirrhosis, 12 (4.1)Primary sclerosing cirrhosis, 11 (3.8)Acute liver failure, 9 (3.1)Other liver disease, 36 (12.4) | – | |
223 | 139 (62.3) | Median (IQR) 58.0 (49.0–62.0) | 81 (36.3) | Median (IQR) 26.0 (23.0–30.0) | – | HCV, 78 (35.0)HCC, 39 (17.5)HBV, 24 (10.8)Alcoholic liver disease, 15 (6.7)Primary biliary cirrhosis, 12 (5.4)Acute liver failure, 9 (4.0)NAFLD, 9 (4.0)Primary sclerosing cirrhosis, 7 (3.1)Other liver disease, 30 (13.5) | – | ||
67 | 48 (71.6) | Median (IQR) 63.0 (56.0–68.0) | 29 (43.3) | Median (IQR) 27.2 (24.0–31.8) | – | HCV, 28 (41.8)HCC, 12 (17.9)Alcoholic liver disease, 7 (10.5)HBV, 6 (9.0)NAFLD, 4 (6.0)Primary sclerosing cirrhosis, 4 (6.0)Other liver disease, 6 (9.0) | – | ||
149 | 92 (61.7) | Median (IQR) 59.0 (52.0–64.0) | 58 (38.9) | Median (IQR) 26.0 (23.0–30.0) | – | HCV, 48 (32.2)HCC, 36 (24.2)HBV, 18 (12.1)Alcoholic liver disease, 9 (6.0)Primary biliary cirrhosis, 9 (6.0)Acute liver failure, 5 (3.4)Primary sclerosing cirrhosis, 4 (2.7)Other liver disease, 20 (13.4) | – | ||
141 | 95 (67.4) | Median (IQR) 59.0 (52.0–64.0) | 52 (36.9) | Median (IQR) 27.0 (23.1–31.0) | – | HCV, 58 (41.1)HCC, 15 (10.6)Alcoholic liver disease, 13 (9.2)NAFLD, 13 (9.2)HBV, 12 (8.5)Primary sclerosing cirrhosis, 7 (5.0)Acute liver failure, 4 (2.8)Primary biliary cirrhosis, 3 (2.1)Other liver disease, 16 (11.4) | – | ||
Yoon K et al, 2018 []21 | 11 | 6 (54.5) | 48.5±10.0 | – | – | 9 (81.8) | HBV, 9 (81.8)HCC, 7 (63.6)Other, 2 (18.2) | – | |
30 | 23 (76.7) | 58.8±7.5 | – | – | 22 (73.3) | HBV, 19 (63.3)HCC, 19 (63.3)Other, 11 (36.7) | – | ||
10 | 10 (100) | 61.5±6.9 | – | – | 6 (60.0) | HCC, 6 (60.0)HBV, 5 (50.0)Other, 5 (50.0) | – | ||
AKI – acute kidney injury; ATG – anti-human T-lymphocyte globulin; BID – twice daily; BMI – body mass index; CKD – chronic kidney disease; CsA – ciclosporin A; EC-MPS – enteric-coated mycophenolate sodium; eGFR – estimated glomerular filtration rate; GFR – glomerular filtration rate; HBV – hepatitis B virus; HCC – hepatocellular carcinoma; HCV – hepatitis C virus; HDV – hepatitis D virus; HRS – hepatorenal syndrome; IQR – interquartile range; MMF – mycophenolate mofetil; NAFLD – non-alcoholic fatty liver disease; OLT – orthotopic liver transplantation; QD – once daily; SD – standard deviation; TAC – tacrolimus. |