Incident ESRD after liver transplantation (LT) is associated with high post-transplant

Incident ESRD after liver transplantation (LT) is associated with high post-transplant mortality. 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 CS-088 5-year cumulative incidence of ESRD and post-transplant mortality. In conclusion the RRI constructed in this CS-088 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. Chronic renal failure (CRF) and ESRD are major public health problems.1 They also represent a major form of morbidity after nonrenal solid organ transplant and are associated with high post-transplant mortality increased resource utilization and high cost.2-5 Candidates with end stage liver disease on the waiting list are prioritized for deceased donor liver transplantation (LT) based on the Model for End-Stage Liver Disease (MELD) score.6 The MELD score is highly associated with the risk of death in the absence of an LT. It has served as the basis for liver allocation in the United States since February of 2002 in accordance with federal regulations emanating from an Institute of Medicine recommendation that deceased donor livers should be allocated based on ?皁bjective and measurable criteria of urgency.” The MELD score is computed using serum creatinine serum bilirubin and the international normalized ratio (INR) of the prothrombin time as follows7 Mouse monoclonal to MAPK10 8 Recipients of deceased donor LT in the pre-MELD era had an 18% cumulative incidence of post-LT CRF at 5 years.2 In examining the MELD equation serum creatinine has the greatest impact on the overall score reflecting the influence of renal dysfunction on waitlist mortality in end stage liver disease candidates.9 However MELD score is unable to differentiate between candidates with severe synthetic dysfunction of liver and well preserved renal function and candidates with preexisting renal disease in the setting of well preserved liver function. An unintended consequence of MELD-based policy was a 15% higher relative risk of post-LT ESRD among LT recipients compared with the pre-MELD era.5 Consequently the post-LT ESRD incidence rate has risen significantly since the implementation of MELD-based allocation policy.5 Our aim was to construct a risk score based on recipients’ risk factors to identify the LT recipients at elevated risk for post-LT ESRD among recipients of LT alone. Results Patient Characteristics A total of 43 514 candidates met the inclusion criteria and received deceased donor LT during the study period (Figure 1). Table 1 shows the recipient characteristics at LT. Figure 1. Description of cohort. Adult deceased donor LT recipients CS-088 transplanted between February 28 2002 and December 31 2010 LT liver transplant; SLK simultaneous liver and kidney transplant. Table 1. Recipient characteristics of the cohort (n=43 514 The median donor age was 43 years (interquartile range [IQR]=25-55) 60 were men median cold ischemia time was 7 hours (IQR=5.2-9.0) and 4% were donation after cardiac death (DCD) donors. Incidence and Predictors of Post-LT ESRD There were 1812 ESRD events. The post-LT ESRD incidence rate among recipients was 15.0 per 1000 patient-years. Table 2 shows the recipient risk factors independently associated with the post-LT ESRD. Table 2. Multivariable model of LT CS-088 recipient factors significantly associated with post-LT ESRD Donor risk factors significantly associated with post-LT ESRD included age 50-59 years versus reference age 18-39 years (hazard ratio [HR] 1.17 95 confidence interval [CI] 1.03 to 1 1.34; P=0.02) age 60-69 years (HR 1.29 95 CI 1.1 to 1 1.51; P=0.002) age≥70 years (HR 1.31 95 CI 1.06 to 1 1.62; P=0.01) and DCD (HR 1.45 95 CI 1.17 to 1 1.80; P<0.001). Each additional 1 hour of cold ischemia time (HR 1.02 95 CI 1.01 to 1 1.06; P<0.001) was also significantly associated with a higher CS-088 risk of post-LT ESRD. The type of calcineurin inhibitor (CNI) and use of antibody induction after LT were not associated with the post-LT ESRD. Renal Risk Index The Cox model for new onset post-LT ESRD onset included 14 recipient factors.