title: Renal insufficiency after liver transplantation in the MELD era compared to the pre-MELD era.
abstract: Because the model for end-stage liver disease (MELD) system for liver allocation gives priority to patients with a higher creatinine, and because pre-transplant renal function is one determinant of post-transplant renal function, this study compares the burden of renal insufficiency in the pre-MELD and MELD eras. Two hundred and eleven patients, at our institution, transplanted in the pre-MELD era, were compared to 143 in the MELD era. The GFR (mL/min/1.73 m2) was significantly higher in the MELD cohort than the pre-MELD cohort at time of transplant, discharge, and 12 months post-transplant (95.5 vs. 85.3, p = 0.039; 90.4 vs. 77.4, p = 0.002; 66.8 vs. 60.3, p = 0.026). There was no difference between the two groups in time to renal failure. There was a higher rate of sirolimus use in the MELD era (27% vs. 18%: p = 0.042) and a slightly higher use of kidney-liver transplant in the MELD era (p = 0.056). We did not identify greater renal insufficiency in the MELD era. There was greater renal function in the MELD era at time of transplant, discharge and month 12. Potential explanations include: absence of an increase in renal insufficiency prior to transplant in the MELD era, greater use of renal sparing immunotherapy and growing use of kidney-liver transplant.
authors: Division of Gastroenterology, Henry Ford Health Systems, Detroit, Michigan 48202, USA.
authors: Zhen-Zhou
authors: ZZ
authors: Feng
authors: Jeffrey
authors: J
authors: Tang
authors: Dean Y
authors: DY
authors: Kim
authors: Kimberly
authors: K
authors: Brown
authors: Marwan
authors: M
authors: Abouljoud
authors: Stuart
authors: S
authors: Gordon
authors: Atsushi
authors: A
authors: Yoshida
authors: Mary Ann
authors: MA
authors: Huang
authors: George
authors: G
authors: Divine
authors: Dilip Kumar
authors: DK
authors: Moonka
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D051437:Renal Insufficiency / Q000209:etiology*; D016896:Treatment Outcome