Renal function in patients transplanted for NASH cirrhosis: Time to reconsider immunosuppression regimens?

Rationale: Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for chronic kidney injury (CKI), yet the impact of liver transplantation (LT) on renal function in this at risk group is not known. We compare the post-LT renal function of non-alcoholic steatohepatitis (NASH) patients to a matched comparison group. Methods: 48 consecutive patients transplanted for NASH between 2000 to 2008 in a single UK centre were compared to non-NASH patients matched for age, gender, MELD and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) formula. Results: NASH patients had a significantly lower eGFR at 3 months post-LT compared to non-NASH patients (eGFR difference 8.85 ml/min/1.73m(2) ; 95% CI = 2.93 - 14.77). After adjusting for the effects of BMI, tacrolimus levels, diabetes mellitus, hypertension and hepatocellular carcinoma, the difference between the groups at 3 months post-LT remained significant (p=0.001). These data were then analysed at numerous time points (6, 12, 24 months) post-LT, and time did not significantly affect the difference between the groups (p=0.173). At 2 years, 31.3% (15/48) of NASH patients had developed stage IIIb chronic kidney injury as opposed to only 8.3% (4/48) in the non-NASH group (p=0.009). Conclusions: This study identifies NASH as an independent risk factor for renal dysfunction following LT. Renal sparing immunosuppression regimens should be considered at the time of LT to reduce the development of kidney injury in NASH patients. Optimisation of such regimens requires prospective study. Liver Transpl, 2011. © 2011 AASLD.