Early Management of Renal Insufficiency Following Liver Transplantation Using Everolimus Supports Tolerance and Efficacy of Therapy

Nonalcoholic Steatohepatitis (NASH) Cirrhosis is on the trajectory to become the leading indication for liver transplantation (LT) in the United States.The development of chronic renal insufficiency is a well-known complication following LT and has been associated with increased mortality.The aim of the current study was to determine the incidence, risk factors and outcomes for the development of moderate to severe chronic renal insufficiency (CRI) in NASH patients undergoing LT.We utilized a prospectively collected database of a retrospective cohort of well categorized NASH patients undergoing LT at a large tertiary center from 2000-2015.Demographic variables and outcomes were noted.Moderate to severe CRI was defined as a GFR of ≤ 44 mL/min per 1.73 m2 (G3b per 'Kidney Disease Improving Global Outcomes'; KDIGO) for 3 months or greater, or those patients who became dependent on hemodialysis.A total of 188 patients who underwent LT for NASH cirrhosis were available for analysis.Mean follow up was ~7 years post LT.Greater than 80% of all patients were on FK based immunosuppression.Ninety-nine patients (53%) of patient's developed a GFR ≤ 44 mL/min per 1.73 m2 at least 3 months post LT with 17 of these patients becoming dialysis dependent.Pre LT renal insufficiency (creatinine > 1.5) was significantly associated with the development of moderate to severe CRI post LT.Higher BMI at the time of LT and older donor age were significant risk factors for the development of moderate to severe CRI post LT.There was a trend towards female sex, older age at LT and longer cold ischemic time (CIT) being risk factors as well, but they did not reach statistical significance.There was no difference in survival at five year follow amongst the two groups.Fifty percent of patients with NASH cirrhosis developed moderate to severe CRI post LT.Pre LT renal insufficiency, higher BMI and older donor age were risk factors.Female patients may also be at higher risk.