{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T01:47:38Z","timestamp":1782092858399,"version":"3.54.5"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","award":["ZR2024MH056"],"award-info":[{"award-number":["ZR2024MH056"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The temporal relationship between post\u2010operative bilirubin dynamics and chronic kidney disease (CKD) following liver transplantation (LT) remains unclear. Given the potential dual (injurious and protective) biological effects of bilirubin, this study aimed to investigate the phase\u2010dependent impact of bilirubin on CKD development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 552 adult LT recipients (2018\u20132023) with a 2\u2010year follow\u2010up. Mean total bilirubin (tBil) levels were measured at regular post\u2010operative intervals and stratified into two phases: early (0\u20133\u2009months) and late (3\u201324\u2009months). Fine\u2013Grey competing risk models with restricted cubic splines (RCS) evaluated nonlinear associations between tBil and CKD risk. CKD incidence was estimated using cumulative incidence functions. Longitudinal bilirubin trajectories were assessed using linear mixed\u2010effects models (LMM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Early post\u2010operative tBil &gt;\u200951.30\u2009\u03bcmol\/L was independently associated with increased CKD risk (adjusted SHR 1.666; 95% CI 1.158\u20132.397;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006), with a U\u2010shaped RCS curve. CKD incidence was significantly higher in patients with early tBil &gt;\u200951.30\u2009\u03bcmol\/L (44.6%) compared to 25.65\u201351.30\u2009\u03bcmol\/L (27.4%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). Late post\u2010operative tBil of 25.65\u201351.30\u2009\u03bcmol\/L was protective (adjusted SHR 0.321; 95% CI 0.173\u20130.594;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and RCS showed a gradual risk reduction with increasing tBil. The lowest CKD incidence (12.2%) occurred in patients with moderate tBil during the late phase (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). LMM demonstrated higher sustained tBil from 6\u2009months onward in non\u2010CKD patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Post\u2010LT bilirubin exhibits a Janus\u2010like, phase\u2010specific association with CKD: early elevations increase risk, while late moderate levels appear protective. These findings suggest a role for phase\u2010specific bilirubin monitoring and management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nep.70234","type":"journal-article","created":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T23:30:51Z","timestamp":1780270251000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Janus Effect of Bilirubin After Liver Transplantation: A Retrospective Study of Phase\u2010Dependent Risk and Protection Against Chronic Kidney Disease"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6709-7068","authenticated-orcid":false,"given":"Lin","family":"Lyu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology The Affiliated Hospital of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology The Affiliated Hospital of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenli","family":"Bi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology The Affiliated Hospital of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Lun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology The Affiliated Hospital of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengnan","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology The Affiliated Hospital of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology The Affiliated Hospital of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aijie","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology The Affiliated Hospital of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Wang","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center Affiliated Hospital of Qingdao University  Qingdao Shandong China"},{"name":"Institute of Organ Donation and Transplantation Medical College of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingguo","family":"Xu","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center Affiliated Hospital of Qingdao University  Qingdao Shandong China"},{"name":"Institute of Organ Donation and Transplantation Medical College of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5414-1050","authenticated-orcid":false,"given":"Jinzhen","family":"Cai","sequence":"additional","affiliation":[{"name":"Organ Transplantation Center Affiliated Hospital of Qingdao University  Qingdao Shandong China"},{"name":"Institute of Organ Donation and Transplantation Medical College of Qingdao University  Qingdao Shandong China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/tri.14154"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.25468"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2022.01.006"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.21345"},{"key":"e_1_2_14_6_1","first-page":"1541","article-title":"Etiology and Incidence of Unconjugated Hyperbilirubinemia After Orthotopic Liver Transplantation","volume":"89","author":"Gates L. 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