Hepatocellular carcinoma may be a surrogate risk factor for deterioration of kidney function after liver transplant: results from a retrospective observational cohort study

Background: Kidney disease is frequent among recipients of liver allografts. However, data on non-renal risk factors for change of kidney function after transplant are limited. We aimed to identify clinical non-renal parameters at transplant predicting deterioration or improvement of kidney function stage after transplant. Methods: All adult patients undergoing liver transplant at our centre over a ten-year period were retrospectively analysed for non-renal risk factors for change of kidney function after transplant. Kidney function was categorized by estimated glomerular filtration rate. Improvement or deterioration of kidney function was defined as change of at least one category compared to time of transplant. Statistical analysis was done by chi-squared test, Mann-Whitney U test and conditional forward binary regression analysis. Results: Six months after transplant, kidney function had stabilised in most patients, which was therefore chosen as timepoint for comparison. 33/165 (20%) of patients showed decreased kidney function, while 31/165 patients (19%) displayed improved kidney function by at least one stage. Presence of hepatocellular carcinoma (HCC) was the only risk factor associated significantly with deterioration of kidney function in multivariate analysis (OR 4.1; p=0.004). Conversely, hepatorenal syndrome was the only predictive parameter for improvement of kidney disease in multivariate analysis (OR 4.4; p=0.03). Patients with HCC were characterized by an accumulation of risk factors for kidney disease such as older age and diabetes. Conclusion: If confirmed in larger multicentric studies, HCC patients, whose frequency among liver transplant recipients is rising, should receive more awareness concerning preserving kidney function after transplant.