SURF registry was designed to investigate the evolution of renal function in Italian adult liver transplant (LT) recipients by: exploring the prevalence of chronic kidney disease (CKD, defined as eGFR <60 mL/min/1.73m²) from 6 to 60 months (M) after LT (cross-sectional phase, T0); assessing the velocity (=slope) of renal function (RF) deterioration from LT to study entry; and prospectively reassessing the RF slope 12 M after inclusion and introduction of recommendations for CKD (longitudinal phase, T12).

SURF multicenter, observational study enrolled a total of 1002 patients, of which 738 (73.6%) were followed up for 12 M. The SURF board's recommendations stratified patients in 6 alert categories for renal dysfunction (from very low to very high) based on eGFR (≥90; 89-60; 59-30; <30 mL/min/1.73m²), proteinuria (0.5 g/day), and slope of eGFR deterioration (-4 mL/min/1.73m²/year). Immunosuppressive therapy was administered according to clinical practice.

Prevalence of CKD was 15.6% at transplant (N=874), 25.2% at study inclusion (N=1002), and 27.9% after 12M from inclusion (N=738). The mean change in eGFR (±standard deviation) from LT to T0 was -18.1±35.7 mL/min (p<0.0001) and -1.6±16.0 from T0 to T12 (p=0.0061). The median change in eGFR slope (25thp;75thp) was -13.8 (-36.4;3.5) mL/min/year in the first year (Y) after LT (N=665); -0.7 (-10.6;7.7) in the second Y (N=561); -0.3 (-9.1;8.9) in the third Y (N=366); -0.3 (-6.7;6.6) in the fourth Y (N=253); -0.2 (-6.5;8.7), in the fifth Y (N=129 patients); -0.3 (-8.2;6.8) in the sixth y (N=34). Patients with eGFR >90 mL/min were 53% at LT, 29% 6M after LT and similar proportion from 1 to 6Y from LT, when it was 25%. Calcineurin inhibitor (CNI) monotherapy was the most frequent therapy ongoing at study entry (50.8%), followed by mycophenolate with CNI (31.2%), everolimus with CNI (7.6%) and everolimus monotherapy (5.6%).

A RF decline rapidly progressive in the first year from transplant was observed. It appeared to be the result of nephrotoxic agents, as therapeutic approach in clinical practice was mainly focused on CNI. RF protection with introduction of kidney sparing immunosuppressive strategies is highly needed, focusing on early period after LT.

CITATION INFORMATION: Giacomoni A, Cescon M, Magini G, Picciotto F, Cillo U, Senzolo M, Vennarecci G, De Simone P. Renal Function Decline Is Higher in the First Year After Liver Transplantation: Final Results from the Italian Observational Study SURF. Am J Transplant. 2016;16 (suppl 3).

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