Review Article

How to prevent chronic kidney disease after liver transplantation?

Jae Geun Lee

Ann Liver Transplant 2024; 4(1): 1-9

Abstract  

Full Text PDF Cite Share

Abstract : Risk factors contributing to chronic kidney disease (CKD) after liver transplantation (LT) are multifaceted, involving episodes of acute kidney injury (AKI), donor-related factors, and immunosuppressive medication, notably calcineurin inhibitors (CNIs). AKI is a common complication post-LT, affecting nearly half of all patients, with approximately 15% requiring kidney replacement therapy. Recipient factors such as metabolic syndrome, diabetes, obesity, age, ethnicity, hepatitis C infection, and prior malignancy contribute to post-transplant CKD. Maintenance immunosuppressive regimens, particularly early CNI administration, may exacerbate CKD progression by inducing chronic vasoconstriction of kidney arterioles. Early detection of risk factors, addressing modifiable ones, and minimizing perioperative AKI are essential focuses for high-risk individuals. Prioritizing strategies targeting CKD management, diabetes, and hypertension, along with the utilization of Kidney Disease Improving Global Outcomes (KDIGO) recommendations, is crucial for effective management. Blood pressure targets, pharmacological interventions, and timely referral to nephrologists for access creation are integral components of CKD management. Additionally, optimization of immunosuppressive protocols, primarily through CNI minimization or withdrawal, and considering alternative agents like mammalian target of rapamycin (mTOR) inhibitors or antimetabolites, play pivotal roles in preserving renal function. Adjusting the immunosuppressive regimen, particularly by minimizing CNIs in the first post-transplant year, can slow kidney dysfunction progression. Identifying and addressing risk factors for renal dysfunction, optimizing perioperative care, and tailoring immunosuppressive regimens are essential steps to enhance long-term outcomes following LT.

Original Article

Carbapenem-resistant gram-negative rod bacteremia in the early postoperative period following liver transplantation

Eun-Ki Min , Deok-Gie Kim , Minyu Kang , Hwa-Hee Koh , Jae Geun Lee , Dong Jin Joo , Myoung Soo Kim

Ann Liver Transplant 2024; 4(1): 16-22

Abstract  

Full Text PDF Cite Share

Abstract : Background: Carbapenem-resistant gram-negative rod bacteremia (CRGNR-B) is emerging as a formidable challenge, complicating patient management and outcomes in liver transplantation (LT). This study aimed to investigate the incidence, mortality, and risk factors associated with CRGNR-B within 90 days following LT. Methods: A retrospective nested case-control study was conducted using single centric LT data (n=1,379). CRGNR-B cases were matched 1:5 with control patients for analyzing survival and risk factors for CRGNR-B. Results: The incidence of CRGNR-B within 90 days post-LT was 6.5% (n=87). The CRGNR-B group showed significantly lower 1-year post-LT survival compared to the control group (37.9% vs. 90.0%, p

Original Article

Clinical impact and risk factors for cytomegalovirus infection in deceased donor liver transplantation without prophylaxis: Single center experience

Deok-Gie Kim , Eun-Ki Min , Jae Geun Lee , Dong Jin Joo , Myoung Soo Kim

Ann Liver Transplant 2024; 4(1): 23-29

Abstract  

Full Text PDF Cite Share

Abstract : Background: The study aims to elucidate the relationship between cytomegalovirus (CMV) infection and graft survival, as well as to identify risk factors for CMV infection in deceased donor liver transplantation (DDLT) recipients without prophylaxis. Methods: A retrospective study was conducted on 465 DDLT recipients at Severance Hospital, South Korea, employing a nested case-control design to explore CMV infection risk factors. Results: All study population showed CMV antibody seropositivity and did not received CMV prophylaxis. CMV infection was observed in 38.6% of DDLT recipients within the first year. Patients with CMV infection showed reduced graft survival rates within 5 years after matched time points compared to those without infection (57.9% vs. 67.5%, p=0.039), which confirmed in multivariable analysis (hazard ratio 1.44, p=0.047). Risk factor analysis revealed that Child-Pugh class C, donor liver macrovesicular steatosis ≥20%, and elevated pretransplant neutrophil levels were independently associated with an increased risk of CMV infection. Conclusion: This study confirms that CMV infection post-DDLT is a significant predictor of reduced graft survival. Addressing risk factors of CMV infection through targeted interventions could potentially improve patient management and post-transplant outcomes after DDLT.

Original Article

Outcomes of living donor liver transplantation using graft with multiple hepatic arteries on the graft: Propensity score-matched analysis

Minyu Kang , Hwa-Hee Koh , Deok-Gie Kim , Seung Hyuk Yim , Mun Chae Choi , Eun-Ki Min , Jae Geun Lee , Dong Jin Joo , Myoung Soo Kim

Ann Liver Transplant 2024; 4(1): 30-36

Abstract  

Full Text PDF Cite Share

Abstract : Background: This study aims to analyze the outcomes of living donor liver transplantation (LDLT) using grafts with multiple hepatic arteries (HAs), compared to those with a single HA. Methods: A retrospective analysis was conducted on 1,059 LDLT patients from July 2005 to December 2022 at Severance Hospital, South Korea. Patients were categorized into multiple-HA and single-HA groups. Propensity score matching was employed to balance baseline characteristics, with primary outcomes being graft survival and secondary outcomes including HA, biliary, and total vascular complications. Results: The study included 27 patients in the multiple-HA group and 925 in the single-HA group before matching. After propensity score matching, no significant difference in 5-year graft survival rates was observed between the groups (60.4% for multiple-HA vs. 72.8% for single-HA, p=0.172). However, the multiple-HA group exhibited a higher incidence of bile duct complications (80.0% vs. 48.3%, p=0.038). Multivariable Cox regression analysis did not find multiple HAs to be a significant predictor of graft loss but confirmed their association with increased bile duct complications. Conclusion: LDLT using grafts with multiple HAs does not adversely affect overall graft survival compared to single-HA grafts. Nevertheless, the increased risk of bile duct complications associated with multiple HAs necessitates careful surgical planning and postoperative management to mitigate this risk.