Continued Influence of Preoperative Renal Function on Outcome of Orthotopic Liver Transplant (OLTX) in the US: Where Will MELD Lead Us?
Article first published online: 29 AUG 2006
American Journal of Transplantation
Volume 6, Issue 11, pages 2651–2659, November 2006
How to Cite
Gonwa, T. A., McBride, M. A., Anderson, K., Mai, M. L., Wadei, H. and Ahsan, N. (2006), Continued Influence of Preoperative Renal Function on Outcome of Orthotopic Liver Transplant (OLTX) in the US: Where Will MELD Lead Us?. American Journal of Transplantation, 6: 2651–2659. doi: 10.1111/j.1600-6143.2006.01526.x
- Issue published online: 29 AUG 2006
- Article first published online: 29 AUG 2006
- Received 18 November 2005, revised 11 June 2006 and 11 July 2006 and accepted for publication 13 July 2006
- Combined kidney liver transplant;
- liver transplant;
- renal function
Renal function is a component of the Model for End Stage Liver Disease (MELD), We queried the 1999–2004 OPTN/UNOS database to determine whether preoperative renal function remained an important determinant of survival in primary deceased donor liver transplant alone patients (DDLTA) or primary combined kidney liver transplant patients (KLTX). We examined preoperative creatinine, renal replacement therapy (RRT), incidence of KLTX, and patient survival in the 34 months before and after introduction of MELD and performed a multivariate Cox regression analysis of time to death.
Preoperative renal function is an independent predictor of survival in DDLTA but not in KLTX. When compared to DDLTA with a preoperative serum creatinine of 0–0.99 mg/dL, patients with serum creatinine from 1–1.99 mg/dL, >2.0 mg/dL, those requiring RRT, and those receiving KLTX had a relative risk of death following transplant of 1.11, 1.58, 1.77, and 1.44 respectively. KLTX requiring RRT had better survival than DDLTA requiring RRT. Since introduction of MELD, KLTX, preoperative creatinine, and number of patients requiring preoperative RRT have increased. Despite this, patient survival following orthotopic liver transplant (OLTX) in the 34 months after introduction of MELD is not different than prior to introduction of MELD.