Impact of Dialysis and Older Age on Survival after Liver Transplantation

Abstract

Because creatinine is heavily weighed in the MELD (model for end-stage liver disease) score, we sought to determine the impact of MELD-based organ allocation on outcomes after transplantation in the preand post-MELD eras, focusing on recipients over age 65 on dialysis prior to transplant. A total of 20 196 patients from the UNOS database were analyzed. Comparing the pre-MELD to MELD era, there was a 41% increase in patients on dialysis (p < 0.0001), and a 117% increase in combined liver/kidney transplants (p < 0.0001). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who received liver transplant alone was 56.8% and 76.4%, respectively (p = 0.13). In the MELD era these rates were 50.7% and 77.8% (p = 0.04). In the pre-MELD era, 1-year patient survival in recipients greater and less than age 65 on dialysis who underwent combined liver/kidney transplantation was 25.0% and 83.2%, respectively (p = 0.0002). In the MELD era, these rates were 67.0% and 82.5% (p = 0.18). In conclusion, a greater proportion of patients in the MELD era are on dialysis prior to transplant, and more receive combined liver/kidney transplants compared with the pre-MELD era. Candidates over age 65 who are on dialysis at the time of transplant have decreased survival after isolated liver transplantation.

Persistent disparities in liver transplantation for patients with hepatocellular carcinoma in the United States, 1998 through 2007

“…Although data regarding insurance status collected in the NCDB has not been independently validated, it is highly complete and is abstracted from hospital records, in which billing data are likely to be accurately recorded. In addition, there were important patient characteristics that we were unable to consider, such as HCV serostatus, 19 HBV antigen positivity, 20 a-fetoprotein level, 21 diabetes status, 22 or dialysis requirement before LT. 23 We also had no available data concerning whether individual patients were referred to an LT program. It has been suggested that racial/ethnic differences in referral to a LT center may be one of the most important factors underlying the disparity in access to LT for minority patients.…”

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“…12 Previous investigations have suggested that renal dysfunction is associated with a prolonged hospital and intensive care unit stay, more postoperative infections, and poor survival rates. 13,14 Dellon and associates 15 have suggested that combined liver and kidney transplant may be the best treatment for older patients who need preoperative renal replacement therapy. The liver transplant procedure is difficult and is associated with major hemodynamic changes.…”

Lebertransplantation

“…Abb. 6; [8]). SALT und ähnliche Modelle müssen daher weiter entwickelt und prospektiv evaluiert werden.…”