TY - JOUR
T1 - Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US
T2 - Where will MELD lead us?
AU - Gonwa, T. A.
AU - McBride, M. A.
AU - Anderson, K.
AU - Mai, M. L.
AU - Wadei, H.
AU - Ahsan, N.
PY - 2006/11
Y1 - 2006/11
N2 - 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.
AB - 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.
KW - Combined kidney liver transplant
KW - Liver transplant
KW - MELD
KW - Renal function
UR - http://www.scopus.com/inward/record.url?scp=33750020257&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33750020257&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2006.01526.x
DO - 10.1111/j.1600-6143.2006.01526.x
M3 - Article
C2 - 16939515
AN - SCOPUS:33750020257
SN - 1600-6135
VL - 6
SP - 2651
EP - 2659
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 11
ER -