Impact of dialysis and older age on survival after liver transplantation.
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 pre- and 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.
Dellon
E S
ES
Department of Medicine, Division of Gastroenterology and Hepatology, Center for Gastrointestinal Disease and Biology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Galanko
J A
JA
Medapalli
R K
RK
Russo
M W
MW
D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D006435:Renal Dialysis; D015996:Survival Rate; D016896:Treatment Outcome