Simultaneous liver and kidney transplantation in the case of preexisting renal disease meets specific criteria to select the good patients ( 7- 10). Post-liver transplantation renal insufficiency is influenced by renal function, particularly acute kidney injury occurring before liver transplantation ( 6). Renal insufficiency is also a major problem after liver transplantation, particularly in case of previous renal disease, with an overall incidence of 15% to 25% of stage ≥4 CKD (chronic kidney disease), 5 years after liver transplantation it is predictive of mortality and increases health care costs ( 5). The MELD score is probably the most accurate for graft selection in the majority of countries.
Therefore, serum creatinine must be regularly measured in this population in clinical practice ( 3).Ĭreatinine is included in multiple cirrhosis prognostic criteria: it has a significant weighting in specific liver transplantation scores such as the MELD score (Mayo model for end-stage liver disease) ( 4). An increase of serum creatinine in cirrhosis may be the consequence of multiple causes: alteration of kidney perfusion due to splanchnic vasodilation associated to portal hypertension which leads to hepatorenal syndrome (HRS), specific kidney damages associated to cirrhosis specific etiologies ( 2), but also all nonspecific etiologies encountered in other populations (sepsis, medications, hypovolemia…). However, in the absence of other simple tool, creatinine still remains essential for the diagnosis of impaired renal function in this population. Serum creatinine, as well as creatinine-based equations (MDRD4 and MDRD6 formulas) which are supposed to reflect the glomerular filtration rate (GFR), are clearly insufficient. This paper leads to key reflections on creatinine role in cirrhosis management. If these results confirm the crucial prognosis impact of an impaired renal function in cirrhotic patients, they also encourage us to stay alert to changes in creatinine values within the normal range. In this retrospective single center study involving 385 patients, they showed thanks to a competing risk analysis, that each 1mg/dL increase of basal serum creatinine was associated with a 62% higher risk of mortality. highlighted, in a population of cirrhotic patients listed for liver transplant, the association between patient’ s basal serum creatinine level, including “normal range values” and the occurrence of acute kidney injury (AKI), the persistent kidney injury after AKI, and the death/delisting risk ( 1). In a recent issue of Hepatology, Cullaro et al. Received: 16 October 2018 Accepted: 25 October 2018 Published: 15 November 2018.
"Normal" Creatinine Levels Predict Persistent Kidney Injury and Waitlist Mortality in Outpatients With Cirrhosis. Fédération d’Hépatologie, Service d’Hépato-Gastroentérologie, Centre Hospitalier Universitaire Dupuytren Limoges, Avenue Martin Luther King, Limoges, France.
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