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International Journal of Nephrology
Volume 2014, Article ID 679605, 6 pages
Clinical Study

Nephrogenic Systemic Fibrosis Risk and Liver Disease

1Department of Radiology, Columbia University, New York Presbyterian Hospital, 622 West 168th Street, PB-1-301, New York, NY 10032, USA
2Division of Liver Diseases, Department of Pathology, Columbia University, 622 West 168th Street, New York, NY, USA

Received 8 November 2013; Revised 2 February 2014; Accepted 17 February 2014; Published 23 March 2014

Academic Editor: Anil K. Agarwal

Copyright © 2014 Robert F. Hanna et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. Evaluate the incidence of nephrogenic systemic fibrosis (NSF) in patients with liver disease in the peritransplant period. Materials and Methods. This IRB approved study retrospectively reviewed patients requiring transplantation for cirrhosis, hepatocellular carcinoma (HCC), or both from 2003 to 2013. Records were reviewed identifying those having gadolinium enhanced MRI within 1 year of posttransplantation to document degree of liver disease, renal disease, and evidence for NSF. Results. Gadolinium-enhanced MRI was performed on 312 of 837 patients, including 23 with severe renal failure (GFR < 30 mL/min/1.73 cm2) and 289 with GFR > 30. Two of 23 patients with renal failure developed NSF compared to zero NSF cases in 289 patients with GFR > 30 (0/289; ). High dose gadodiamide was used in the two NSF cases. There was no increased incidence of NSF with severe liver disease (1/71) compared to nonsevere liver disease (1/241; ). Conclusion. Renal disease is a risk factor for NSF, but in our small sample our evidence suggests liver disease is not an additional risk factor, especially if a low-risk gadolinium agent is used. Noting that not all patients received high-risk gadolinium, a larger study focusing on patients receiving high-risk gadolinium is needed to further evaluate NSF risk in liver disease in the peritransplant period.