Renal dysfunction following orthotopic liver transplantation

One-hundred-fifteen patients with no preexisting renal disease underwent orthotopic liver transplantation between December 1984 and February 1988. Immunosuppression was based on cyclosporine and steroids with azathioprine added after treatment for rejection. One and 2-year patient survival was 88 and 82%, respectively. Glomerular filtration rate averaged 98.4 ± 5.1 cc/min preoperatively and dropped to 54.8 ± 4.2 cc/min 1 month postoperatively. Renal function was stable at 1 and 2 yr postoperatively. A drop in average whole blood cyclosporine levels resulted in better preservation of renal function with no increase in rejection rate or decrease in patients survival. An investigation of factors responsible for the decrease in renal function found no difference in cyclosporine levels, nephrotoxic drugs or events in patient with large or small drops in glomerular filtration rate post-op. Patients who developed early renal dysfunction (serum creatinine > 2 mg/dl in the first 3 weeks posttransplant) had a significantly lower GFR 1 month and 1 yr post-op compared with those who did not. There is a predictable decrease in renal function post-liver transplant and the level of renal function post-operatively can be predicted by the level of renal function preoperatively. The renal dysfunction appears to be stable at 1 and 2 yr postoperatively.