Continued Influence of Preoperative Renal Function on Outcome of Orthotopic Liver Transplant (OLTX) in the US: Where Will MELD Lead Us?

TLDR

Renal function is a component of the MELD score, and we queried the 1999‑2004 OPTN/UNOS database to assess its role in liver transplant outcomes. The study aimed to determine whether pre‑operative renal function remains a key determinant of survival in primary deceased‑donor liver transplant alone and combined kidney‑liver transplant recipients. We analyzed pre‑operative creatinine, renal replacement therapy, incidence of combined transplants, and patient survival before and after MELD implementation, using multivariate Cox regression. Pre‑operative renal function independently predicted survival in deceased‑donor liver transplant alone but not in combined kidney‑liver transplants; higher creatinine and RRT increased mortality risk, yet overall survival after MELD introduction remained unchanged.

Abstract

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.