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Title: A meta-analysis of the cumulative incidence, risk factors, and clinical outcomes associated with chronic kidney disease after liver transplantation
Authors: Lim, Sze Yinn
Wang, Renaeta
Tan, Darren Jun Hao
Ng, Cheng Han
Lim, Wen Hui
Quek, Jingxuan
Syn, Nicholas
Nah, Benjamin Kai Yi
Wong, Emmett Tsz-Yeung
Huang, Daniel Q 
Vathsala, Anantharaman 
Siddiqui, Mohammad Shadab
Fung, James
Muthiah, Mark D 
Tan, Eunice Xiang-Xuan
Keywords: chronic kidney disease
liver transplantation
Issue Date: 15-Nov-2021
Citation: Lim, Sze Yinn, Wang, Renaeta, Tan, Darren Jun Hao, Ng, Cheng Han, Lim, Wen Hui, Quek, Jingxuan, Syn, Nicholas, Nah, Benjamin Kai Yi, Wong, Emmett Tsz-Yeung, Huang, Daniel Q, Vathsala, Anantharaman, Siddiqui, Mohammad Shadab, Fung, James, Muthiah, Mark D, Tan, Eunice Xiang-Xuan (2021-11-15). A meta-analysis of the cumulative incidence, risk factors, and clinical outcomes associated with chronic kidney disease after liver transplantation. TRANSPLANT INTERNATIONAL 34 (12) : 2524-2533. ScholarBank@NUS Repository.
Abstract: Chronic kidney disease (CKD) remains a relatively common complication after liver transplantation (LT), and significantly impacts overall survival. We sought to assess the cumulative incidence, risk factors and mortality associated with post-LT CKD. CKD was defined as eGFR <60 ml/min/1.73 m2 as estimated by the Modified Diet in Renal Disease (MDRD) formula. Single-arm meta-analysis was done to evaluate the cumulative incidence of CKD at 1-, 3-, and 5-year timepoints post-LT. Risk factors for CKD were evaluated using hazard ratios (HR). Twenty-one studies involving 44 383 patients were included. Cumulative incidence of stage 3–5 CKD was 31.44% (CI 0.182–0.447), 36.71% (CI 0.188–0.546), and 43.52% (CI 0.296–0.574) at 1, 3, and 5 years after LT, respectively. Stage 5 CKD cumulative incidence increased from 0.274% (CI 0.001–0.005) at 1 year to 2.06% (CI 0.009–0.045) at 5 years post-LT. Age, female sex, diabetes, and peri-operative acute kidney injury (AKI) were significant risk factors for CKD. Stage 4–5 CKD was associated with a decrease in overall survival (HR 3.23, 95% CI 1.74–5.98, P < 0.01). CKD after LT is relatively common, and is associated with significantly reduced overall survival. Identification of patients at high risk of developing CKD allows physicians to prophylactically use renal-sparing immunosuppression which may be crucial in achieving desirable clinical outcomes.
ISSN: 0934-0874
DOI: 10.1111/tri.14149
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