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Open Access 01-12-2017 | Research article

Proteinuria and baseline renal function predict mortality and renal outcomes after sirolimus therapy in liver transplantation recipients

Authors: Lung-Chih Li, Chien-Ning Hsu, Chih-Che Lin, Yu-Fan Cheng, Tsung-Hui Hu, Ding-Wei Chen, Chih-Hsiung Lee, Toshiaki Nakano, Chao-Long Chen

Published in: BMC Gastroenterology | Issue 1/2017

Abstract

Background

Chronic kidney disease is a significant complication after liver transplantation (LT), but the role of pre-existing renal insufficiency and proteinuria remains unclear among LT recipients receiving sirolimus.

Methods

We assessed the effects of proteinuria and baseline renal function on long-term renal and survival outcomes among 576 LT recipients who received SRL in a medical center between 2005 and 2014. Renal outcomes were the incidences of >50% reduction in their baseline estimated glomerular filtration rate and end stage kidney disease requiring renal replacement therapy. Proteinuria was identified using morning dipstick results (≥30 mg/dL) at baseline and within the first year after the initiation of SRL therapy. A Kaplan-Meier analysis was performed to estimate time to event. Factors associated with the outcomes were determined using the Cox proportional hazards model with a significance level set at P <0.05.

Results

During the study period, renal function deteriorated in 135 (25.3%) patients and 68 (11.8%) patients died. Persistent and new onset proteinuria contributed to a high rate of mortality and the deterioration of renal function (both log-rank tests, P <0.0001). After adjustments, new onset proteinuria within the first year after the initiation of SRL therapy increased the risk of deteriorating renal function, regardless of baseline estimated glomerular filtration rate. Moreover, pre-existing (hazard ratio = 1.91; P <0.001) and new onset diabetes (hazard ratio = 2.34; P <0.0001) were significantly associated with new onset proteinuria among SRL users.

Conclusions

These findings support the effective monitoring and early management of the predictable risks for proteinuria among new SRL users in order to delay the progression of renal disease.

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Title: Proteinuria and baseline renal function predict mortality and renal outcomes after sirolimus therapy in liver transplantation recipients
Authors: Lung-Chih Li
Chien-Ning Hsu
Chih-Che Lin
Yu-Fan Cheng
Tsung-Hui Hu
Ding-Wei Chen
Chih-Hsiung Lee
Toshiaki Nakano
Chao-Long Chen
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Gastroenterology / Issue 1/2017
Electronic ISSN: 1471-230X
DOI: https://doi.org/10.1186/s12876-017-0611-z

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Conclusions

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