Risk of End-Stage Renal Disease Among Liver Transplant Recipients With Pretransplant Renal Dysfunction

Ruebner, Rebecca L.; Goldberg, David S.; Abt, Peter L.; Bahirwani, Ranjeeta; Levine, Matthew H.; Sawinski, Deirdre; Bloom, Roy D.; Reese, Peter P.

doi:10.1111/j.1600-6143.2012.04177.x

Cited by 88 publications

(69 citation statements)

References 22 publications

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“…5,15,18 Studies have shown that patients on the waiting list with a high MELD score can develop pretransplant renal dysfunction, which increases the risk of renal failure after transplant. [19][20][21] In addition, a correlation was noted between high PELD/MELD score and increased length of posttransplant hospitalization. 18,[22][23][24][25] Our experience was similar to the results reported in the literature.…”

Section: Discussionmentioning

confidence: 96%

Untitled

Yankol

Mecit²,

Kanmaz³

et al. 2016

Exp Clin Transplant

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Objectives: We present here the outcomes of our first 500 liver transplants and discuss the lessons learned during this time. The main cause of chronic liver failure was biliary atresia in pediatric patients (30.4%) and chronic hepatitis B infection in adults (35.6%). The complication rate for primary nonfunction was 3.8%, overall biliary complications 24.0% (significantly higher after adult living-donor liver transplant, 30.3%), hepatic artery thrombosis 1.6%, portal vein thrombosis 3.0%, retransplant 3.8%, acute cellular rejection 29.6%, and bacterial infection 39.4%. Overall 1-, 3-, and 5-year patient survival rates in the first 500 consecutive transplants performed on recipients within United Network for Organ Sharing listing criteria were 87.8%, 85.0%, and 78.6%; for hepatocellular carcinoma patients beyond the Milan criteria, survival rates were 71.9%, 52.5%, and 38.2%. Conclusions:In regions without a sufficient number of deceased donors, living-donor liver transplant, with its associated problems, is the only alternative to deceased-donor liver transplant. Liver transplant requires teamwork, with all players working well together for a successful outcome. The important keys to success in liver transplant include decision-making, timing, surgical skills, experience, and close follow-up.

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Section: Discussionmentioning

confidence: 96%

Untitled

Yankol

Mecit²,

Kanmaz³

et al. 2016

Exp Clin Transplant

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“…Those covariates with P#0.05 were included in the final model. The following baseline covariates determined at the time of LTwere included in model selection based on these data and previous studies: 2,5,18,19 recipient age, sex, race, diagnosis, BMI, status-1 (acute liver failure), pre-LT hypertension, diabetes mellitus, hospitalization status at LT, on life support at LT, on RRT at LT, previous LT, history of TIPSS, serum bilirubin, serum creatinine, slope of creatinine, acute dialysis, INR, serum sodium, and serum albumin.…”

Section: Model Buildingmentioning

confidence: 99%

Patient-Specific Prediction of ESRD after Liver Transplantation

Sharma¹,

Goodrich

Schaubel³

et al. 2013

Journal of the American Society of Nephrology

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Incident ESRD after liver transplantation (LT) is associated with high post-transplant mortality. We constructed and validated a continuous renal risk index (RRI) to predict post-LT ESRD. Data for 43,514 adult recipients of deceased donor LT alone (February 28, 2002 to December 31, 2010 were linked from the Scientific Registry of Transplant Recipients and the Centers for Medicare and Medicaid Services ESRD Program. An adjusted Cox regression model of time to post-LT ESRD was fitted, and the resulting equation was used to calculate an RRI for each LT recipient. The RRI included 14 recipient factors: age, AfricanAmerican race, hepatitis C, cholestatic disease, body mass index$35, pre-LT diabetes, ln creatinine for recipients not on dialysis, ln albumin, ln bilirubin, serum sodium,134 mEq/L, status-1, previous LT, transjugular intrahepatic portosystemic shunt, and acute dialysis at LT. This RRI was validated and had a C statistic of 0.76 (95% confidence interval, 0.75 to 0.78). Higher RRI associated significantly with higher 5-year cumulative incidence of ESRD and post-transplant mortality. In conclusion, the RRI constructed in this study quantifies the risk of post-LT ESRD and is applicable to all LT alone recipients. This new validated measure may serve as an important prognostic tool in ameliorating post-LT ESRD risk and improve survival by informing post-LT patient management strategies.

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“…Serum creatinine is a poor marker for renal dysfunction in the liver disease population and tends to overestimate renal function (12). The existing literature (6) suggests that patients with CKD and low GFR require combined liver-kidney transplantation. The definition of CKD chosen was formulated by incorporating the current published literature with the observed characteristic of SLK patients discussed above.…”

Section: Medical Eligibility Criteriamentioning

confidence: 99%

Simultaneous Liver–Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources

Formica

Aeder

Boyle³

et al. 2016

American Journal of Transplantation

159

194

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The introduction of the Mayo End-Stage Liver Disease score into the Organ Procurement and Transplantation Network (OPTN) deceased donor liver allocation policy in 2002 has led to a significant increase in the number of simultaneous liver-kidney transplants in the United States. Despite multiple attempts, clinical science has not been able to reliably predict which liver candidates with renal insufficiency will recover renal function or need a concurrent kidney transplant. The problem facing the transplant community is that currently there are almost no medical criteria for candidacy for simultaneous liver-kidney allocation in the United States, and this lack of standardized rules and medical eligibility criteria for kidney allocation with a liver is counter to OPTN's Final Rule. Moreover, almost 50% of simultaneous liver-kidney organs come from a donor with a kidney donor profile index of ≤0.35. The kidneys from these donors could otherwise be allocated to pediatric recipients, young adults or prior organ donors. This paper presents the new OPTN and United Network of Organ Sharing simultaneous liver-kidney allocation policy, provides the supporting evidence and explains the rationale on which the policy was based.

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Risk of End-Stage Renal Disease Among Liver Transplant Recipients With Pretransplant Renal Dysfunction

Cited by 88 publications

References 22 publications

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Untitled

Patient-Specific Prediction of ESRD after Liver Transplantation

Simultaneous Liver–Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources

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