A Meta-Analysis on the Prevalence of Chronic Kidney Disease in Liver Transplant Candidates and its Associated Risk Factors and Outcomes.

BACKGROUND AND AIMS Pre-liver transplant (LT) chronic kidney disease (CKD) has emerged as a leading cause of postoperative morbidity. We aimed to report the prevalence, associated risk factors and clinical outcomes in patients with pre-LT CKD. METHODS Meta-analysis and systematic review were conducted for included cohort and cross-sectional studies. Studies comparing healthy and CKD patients pre-LT were included. Outcomes were assessed with pooled hazard ratios. RESULTS 15 studies were included, consisting of 82,432 LT patients and 26,754 with pre-LT CKD. Pooled prevalence of pre-LT CKD was 22.35% (CI: 15.30% - 32.71%). Diabetes mellitus, hypertension, viral hepatitis and non-alcoholic fatty liver disease, and older age were associated with increased risk of pre-LT CKD: (OR 1.72 CI: 1.15- 2.56, p = 0.01), (OR 2.23 CI: 1.76 - 2.83, p<0.01), (OR 1.09; CI: 1.05 - 1.13, p <0.01), (OR 1.73; CI: 1.10 - 2.71 p = 0.03), and (MD: 2.92 years; CI: 1.29 - 4.55years; p<0.01) respectively. Pre-LT CKD was significantly associated with increased mortality (HR 1.38; CI: 1.2-1.59; p<0.01), post-LT end-stage renal disease and post-LT CKD. CONCLUSION Almost a quarter of pre-LT patients have CKD and it is significantly associated with post-operative morbidity and mortality. However, long-term outcomes remain unclear due to a lack of studies reporting such outcomes.