Secular Trends in Development of End‐Stage Renal Disease Following Liver Transplantation
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Wiley
2025
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| author | Jessica M. Ruck Maria A. Parra Laura B. Zeiser Goutham Nair Sam Kant Benjamin Philosophe Shane E. Ottmann Andrew M. Cameron Russell N. Wesson Allan B. Massie Dorry L. Segev Elizabeth A. King |
| author_facet | Jessica M. Ruck Maria A. Parra Laura B. Zeiser Goutham Nair Sam Kant Benjamin Philosophe Shane E. Ottmann Andrew M. Cameron Russell N. Wesson Allan B. Massie Dorry L. Segev Elizabeth A. King Jessica M. Ruck Maria A. Parra Laura B. Zeiser Goutham Nair Sam Kant Benjamin Philosophe Shane E. Ottmann Andrew M. Cameron Russell N. Wesson Allan B. Massie Dorry L. Segev Elizabeth A. King |
| collection | Wiley Open Access |
| contents | Secular Trends in Development of End‐Stage Renal Disease Following Liver Transplantation Jessica M. Ruck Maria A. Parra Laura B. Zeiser Goutham Nair Sam Kant Benjamin Philosophe Shane E. Ottmann Andrew M. Cameron Russell N. Wesson Allan B. Massie Dorry L. Segev Elizabeth A. King Clinical Transplantation ABSTRACTBackgroundRenal dysfunction is common among liver transplant candidates and can resolve, persist, or develop de novo following liver transplantation (LT). In light of the 2017 policy changes to simultaneous liver‐kidney transplant and the post‐LT kidney transplant safety net eligibility, we evaluated risk factors for and change in the incidence of post‐LT renal dysfunction.MethodsUsing SRTR data for adult deceased‐donor liver‐only transplant recipients 2010–2022, we evaluated secular trends in and risk factors for the development of post‐LT ESRD at 1 year and overall using multivariable logistic and Cox regression. We compared observed versus expected incidence of ESRD at 1‐year post‐LT using weighting by odds.ResultsAmong 77 565 LT recipients, 6032 (7.8%) developed ESRD during the study period, of whom 2354 (39.0%) developed ESRD within the first year after LT. In a multivariable model, diabetes (aOR 1.63, 95% CI 1.48–1.79, p < 0.001), pre‐LT eGFR (aOR 0.97 per unit, 95% CI 0.97–0.97, p < 0.001), and MELD category remained independently associated with ESRD within 1‐year post‐LT. Odds of ESRD by 1 year post‐LT were 47% higher than expected post‐2017 after accounting for changes in donor and recipient characteristics.ConclusionsThe rising 1‐year post‐LT ESRD risk highlights the need to reassess safety net eligibility beyond 1 year and prioritize counseling on risk minimization, including post‐transplant diabetes management and potential adjustments to immunosuppression protocols to improve outcomes. 10.1111/ctr.70141 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70141 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70141 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Secular Trends in Development of End‐Stage Renal Disease Following Liver Transplantation Jessica M. Ruck Maria A. Parra Laura B. Zeiser Goutham Nair Sam Kant Benjamin Philosophe Shane E. Ottmann Andrew M. Cameron Russell N. Wesson Allan B. Massie Dorry L. Segev Elizabeth A. King Clinical Transplantation Secular Trends in Development of End‐Stage Renal Disease Following Liver Transplantation Jessica M. Ruck Maria A. Parra Laura B. Zeiser Goutham Nair Sam Kant Benjamin Philosophe Shane E. Ottmann Andrew M. Cameron Russell N. Wesson Allan B. Massie Dorry L. Segev Elizabeth A. King Clinical Transplantation ABSTRACTBackgroundRenal dysfunction is common among liver transplant candidates and can resolve, persist, or develop de novo following liver transplantation (LT). In light of the 2017 policy changes to simultaneous liver‐kidney transplant and the post‐LT kidney transplant safety net eligibility, we evaluated risk factors for and change in the incidence of post‐LT renal dysfunction.MethodsUsing SRTR data for adult deceased‐donor liver‐only transplant recipients 2010–2022, we evaluated secular trends in and risk factors for the development of post‐LT ESRD at 1 year and overall using multivariable logistic and Cox regression. We compared observed versus expected incidence of ESRD at 1‐year post‐LT using weighting by odds.ResultsAmong 77 565 LT recipients, 6032 (7.8%) developed ESRD during the study period, of whom 2354 (39.0%) developed ESRD within the first year after LT. In a multivariable model, diabetes (aOR 1.63, 95% CI 1.48–1.79, p < 0.001), pre‐LT eGFR (aOR 0.97 per unit, 95% CI 0.97–0.97, p < 0.001), and MELD category remained independently associated with ESRD within 1‐year post‐LT. Odds of ESRD by 1 year post‐LT were 47% higher than expected post‐2017 after accounting for changes in donor and recipient characteristics.ConclusionsThe rising 1‐year post‐LT ESRD risk highlights the need to reassess safety net eligibility beyond 1 year and prioritize counseling on risk minimization, including post‐transplant diabetes management and potential adjustments to immunosuppression protocols to improve outcomes. 10.1111/ctr.70141 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Secular Trends in Development of End‐Stage Renal Disease Following Liver Transplantation |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70141 |