Muñoz-Serrano A, Citores MJ, Gutiérrez-Villanueva A, Moreno-Torres V, López-Ibor JV, Vicente N, Cuervas-Mons V. Chronic kidney disease at one year after liver transplantation: Role of changes in immunosuppression over three decades. World J Transplant 2025; 15(4): 108791 [DOI: 10.5500/wjt.v15.i4.108791]
Corresponding Author of This Article
María Jesús Citores, Laboratorio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Joaquin Rodrigo 2, Majadahonda 28222, Madrid, Spain. mariajesus.citores@salud.madrid.org
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Transplantation
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 18, 2025 (publication date) through Nov 18, 2025
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World Journal of Transplantation
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2220-3230
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Muñoz-Serrano A, Citores MJ, Gutiérrez-Villanueva A, Moreno-Torres V, López-Ibor JV, Vicente N, Cuervas-Mons V. Chronic kidney disease at one year after liver transplantation: Role of changes in immunosuppression over three decades. World J Transplant 2025; 15(4): 108791 [DOI: 10.5500/wjt.v15.i4.108791]
World J Transplant. Dec 18, 2025; 15(4): 108791 Published online Dec 18, 2025. doi: 10.5500/wjt.v15.i4.108791
Chronic kidney disease at one year after liver transplantation: Role of changes in immunosuppression over three decades
Alejandro Muñoz-Serrano, María Jesús Citores, Andrea Gutiérrez-Villanueva, Víctor Moreno-Torres, Jorge V López-Ibor, Natalia Vicente, Valentín Cuervas-Mons
Alejandro Muñoz-Serrano, Andrea Gutiérrez-Villanueva, Víctor Moreno-Torres, Natalia Vicente, Valentín Cuervas-Mons, Department of Internal Medicine, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda 28222, Madrid, Spain
María Jesús Citores, Laboratorio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda 28222, Madrid, Spain
Víctor Moreno-Torres, Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Pozuelo de Alarcón 28224, Madrid, Spain
Jorge V López-Ibor, Department of Cardiology, Hospital Universitario La Princesa, Madrid 28006, Madrid, Spain
Valentín Cuervas-Mons, Department of Medicine, Universidad Autónoma de Madrid, Madrid 28029, Madrid, Spain
Co-first authors: Alejandro Muñoz-Serrano and María Jesús Citores.
Author contributions: Muñoz-Serrano A, Citores MJ, and Cuervas-Mons V participated in the conception and design of the study; Muñoz-Serrano A, Gutiérrez-Villanueva A, Moreno-Torres V were involved in the acquisition, analysis, and interpretation of the data; Citores MJ conducted the statistical analyses, verified the study data; Muñoz-Serrano A and Citores MJ contributed equally in the design of the study, interpretation of the data, and writing of the manuscript, underlying their merit as co-first authors; all authors critically reviewed and provided final approval of the manuscript and were responsible for the decision to submit the manuscript for publication.
Institutional review board statement: Ethical approval for this study (Ethical Committee No. 20/16) was provided by the Ethical Committee of our hospital on 19 December 2016. All research was conducted in accordance with the Declarations of both Helsinki and Istanbul.
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: María Jesús Citores, Laboratorio de Medicina Interna, Hospital Universitario Puerta de Hierro Majadahonda, Joaquin Rodrigo 2, Majadahonda 28222, Madrid, Spain. mariajesus.citores@salud.madrid.org
Received: May 12, 2025 Revised: June 17, 2025 Accepted: September 18, 2025 Published online: December 18, 2025 Processing time: 191 Days and 21 Hours
Abstract
BACKGROUND
Kidney disease is a common complication in liver transplant (LT) recipients, contributing to substantial morbidity and mortality. Calcineurin inhibitors are associated with short- and long-term decline in kidney function.
AIM
To assess how changes in immunosuppression over three decades have impacted the evolution of renal function in the first year post-LT.
METHODS
This single-center, observational, retrospective study was conducted in a tertiary hospital in Madrid. Adult patients who received a first LT in our center from 1987 to 2019 were included. Patients with simultaneous or prior transplantation of another organ and patients who required re-transplantation, or were lost to follow-up or died during the first year after transplantation were excluded. The development of chronic kidney disease (CKD) pre-transplant or at the first year after LT was analyzed.
RESULTS
A total of 594 patients (median age: 52.9 years, 25th-75th percentiles = 45-59.08 years; 29.3% female) were included. At 1 year post-transplant, 290 (48.82%) patients had developed CKD. Older age [odds ratio (OR) = 1.03, 95%CI: 1.01-1.05], female sex (OR = 1.88, 95%CI: 1.23-2.89), pre-transplant renal dysfunction (RD) (OR = 2.69, 95%CI: 1.58-4.58), and treatment with cyclosporine A (CsA) (OR = 3.77, 95%CI: 2.45-5.78) were independent risk factors for CKD at 1 year after LT. In patients treated with tacrolimus (Tac) (n = 375), the combination of basiliximab and mycophenolic acid (MPA) resulted in decreased Tac blood levels (P < 0.001); additionally, MPA was associated with a lower incidence of RD in the first year (P = 0.016).
CONCLUSION
Age, female sex, pre-transplant RD, and CsA are associated with increased risk of CKD within 1 year after LT. Addition of MPA to Tac is associated with lower RD incidence.
Core Tip: This retrospective study evaluated how changes in initial immunosuppression patterns over three decades have affected the evolution of kidney function in the first year after liver transplantation. The risk of chronic kidney disease (CKD) was higher among patients treated with cyclosporine than those treated with tacrolimus (Tac). Addition of basiliximab and mycophenolic acid to the treatment regimen reduced the incidence of CKD in the first year. Elevated Tac blood levels led to acute renal dysfunction at 1 month post-transplant; however, its role in the development of CKD at 1 year post-transplant is less clear, and other non-dose-dependent mechanisms may be involved.
