Predicting End-Stage Renal Disease After Liver Transplant

Abstract

Few equations have been developed to predict endstage renal disease (ESRD) after deceased donor liver transplant. This retrospective observational cohort study analyzed all adult deceased donor liver transplant recipients in the Scientific Registry of Transplant Recipients (SRTR) database, 1995-2010. The prediction equation for ESRD was developed using candidate predictor variables available in SRTR after implementation of the allocation policy based on the model for end-stage liver disease. ESRD was defined as initiation of maintenance dialysis therapy, kidney transplant or registration on the kidney transplant waiting list. We used Cox proportional hazard models to develop separate equations for assessing risk of ESRD by 6 months posttransplant and between 6 months and 5 years posttransplant. Variables in the 6-month equation included recipient age, history of diabetes, history of dialysis before liver transplant, history of malignancy, body mass index, serum creatinine and liver donor risk index. Variables in the 6-month to 5-year equation included recipient race, history of diabetes, hepatitis C status, serum albumin, serum bilirubin and serum creatinine. The prediction equations have good calibration and discrimination (C statistics 0.74-0.78). We have produced risk prediction equations that can be used to aid in understanding the risk of ESRD after liver transplant.

Revisiting Multi-Organ Transplantation in the Setting of Scarcity

“…The lack of minimal listing criteria for MOT enables physicians to list some patients for MOT whose outcome may only be improved incrementally by the nonprimary organ-and diverts that nonprimary organ from other candidates who may die waiting (11)(12)(13). For example, it is common for MOT candidates to receive a kidney transplant even before receiving chronic dialysis, because of the concern that complications of transplant surgery may cause the patient's chronic kidney disease to proceed to ESRD.…”

“…No randomized controlled trials of singleorgan transplant versus MOT have been conducted. Most studies have been retrospective and commonly based on data from the Organ Procurement and Transplantation Network (OPTN), with the prominent limitation of unmeasured confounding, because MOT candidates differ in meaningful ways from single-organ recipients (13)(14)(15)(16). The other valuable data source has been single-center studies with the problem of limited generalizability (17,18).…”

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

“…Moreover, data suggest that even in the highest risk patients, the development of end-stage renal disease in the first 6 mo after liver transplantation is a relatively rare occurrence (7). This is counterbalanced by the available evidence suggesting that renal disease requiring dialysis during the first year after liver transplantation results in an 5% decrease in 1-year patient survival compared with a liver transplant recipient without renal disease (8).…”

Simultaneous Liver-Kidney Transplant: Too Many or Just Enough?

“…7 Both degree and duration of CKD before liver transplant contribute to future ESRD. A database analysis of 4997 liver transplant recipients from 2002 to 2008 with serial eGFR data available in the 3 months before liver transplant were stratified into 4 groups: (1) those with eGFR always more than 30 mL/min, (2) those with eGFR fluctuating more and less than 30 mL/min, (3) those with eGFR always less than 30 mL/min, and (4) those on short-term dialysis.…”