Effect of pretransplant serum creatinine on the survival benefit of liver transplantation

Authors

  • Pratima Sharma,

    Corresponding author
    1. Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
    • Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109
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    • Telephone: 734-936-4780; FAX: 734-936-7392

  • Douglas E. Schaubel,

    1. Department of Biostatistics, University of Michigan, Ann Arbor, MI
    2. Scientific Registry of Transplant Recipients, Ann Arbor, MI
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  • Mary K. Guidinger,

    1. Scientific Registry of Transplant Recipients, Ann Arbor, MI
    2. Arbor Research Collaborative for Health, Ann Arbor, MI
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  • Robert M. Merion

    1. Department of Surgery, University of Michigan, Ann Arbor, MI
    2. Scientific Registry of Transplant Recipients, Ann Arbor, MI
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  • This research was presented in part as a free communication at the 2008 American Transplant Congress in Toronto, Canada.

  • The views expressed herein are those of the authors and not necessarily those of the US Government. This study was approved by the Scientific Registry of Transplant Recipients project officer of the Health Resources and Services Administration. The Health Resources and Services Administration has determined that this study satisfies the criteria for the institutional review board exemption described in the “Public Benefit and Service Program” provisions of 45 CFR 46.101(b)(5) and Health Resources and Services Administration Circular 03.

Abstract

More candidates with creatinine levels ≥ 2 mg/dL have undergone liver transplantation (LT) since the implementation of Model for End-Stage Liver Disease (MELD)–based allocation. These candidates have higher posttransplant mortality. This study examined the effect of serum creatinine on survival benefit among candidates undergoing LT. Scientific Registry of Transplant Recipients data were analyzed for adult LT candidates listed between September 2001 and December 2006 (n = 38,899). The effect of serum creatinine on survival benefit (contrast between waitlist and post-LT mortality rates) was assessed by sequential stratification, an extension of Cox regression. At the same MELD score, serum creatinine was inversely associated with survival benefit within certain defined MELD categories. The survival benefit significantly decreased as creatinine increased for candidates with MELD scores of 15 to 17 or 24 to 40 at LT (MELD scores of 15-17, P < 0.0001; MELD scores of 24-40, P = 0.04). Renal replacement therapy at LT was also associated with significantly decreased LT benefit for patients with MELD scores of 21 to 23 (P = 0.04) or 24 to 26 (P = 0.01). In conclusion, serum creatinine at LT significantly affects survival benefit for patients with MELD scores of 15 to 17 or 24 to 40. Given the same MELD score, patients with higher creatinine levels receive less benefit on average, and the relative ranking of a large number of wait-listed candidates with MELD scores of 15 to 17 or 24 to 40 would be markedly affected if these findings were incorporated into the allocation policy. Liver Transpl 15:1808–1813, 2009. © 2009 AASLD.

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