A pocket guide to identify patients at risk for chronic kidney disease after liver transplantation.

Chronic kidney disease (CKD) after liver transplantation (LT) has a strong impact on transplant and patient survival. After LT, a significant proportion of patients develop renal dysfunction with a high risk to progress to end-stage renal disease (ESRD). Because of the multifactorial nature of CKD in the post-transplant period, the ability to accurately identify patients at risk and the development of preventative strategies remain unsolved issues. In some patients, the pretransplant kidney function significantly declines within the first year post-LT. Until now, no user-friendly and reliable prediction scores exist to identify these patients early on. Data from 328 consecutive adult patients receiving their first LT between 2004 and 2008 at Hannover Medical School were analyzed to develop a prediction model using ordinal logistic regression. We developed a concise risk score identifying the five most important predictors and performed a temporal validation using a prospectively monitored patient cohort of 120 patients from our transplant center. Based on those five parameters, we developed a pocket guide card for clinical use that could be a useful tool for instant identification of patients at high risk as well as patients more suitable for combined liver and kidney transplantation (CLKT).