title: Impact of MELD-based allocation on end-stage renal disease after liver transplantation.
abstract: The proportion of patients undergoing liver transplantation (LT), with concomitant renal dysfunction, markedly increased after allocation by the model for end-stage liver disease (MELD) score was introduced. We examined the incidence of subsequent post-LT end-stage renal disease (ESRD) before and after the policy was implemented. Data on all adult deceased donor LT recipients between April 27, 1995 and December 31, 2008 (n = 59 242), from the Scientific Registry of Transplant Recipients, were linked with Centers for Medicare & Medicaid Services' ESRD data. Cox regression was used to (i) compare pre-MELD and MELD eras with respect to post-LT ESRD incidence, (ii) determine the risk factors for post-LT ESRD and (iii) quantify the association between ESRD incidence and mortality. Crude rates of post-LT ESRD were 12.8 and 14.5 per 1000 patient-years in the pre-MELD and MELD eras, respectively. Covariate-adjusted post-LT ESRD risk was higher in the MELD era (hazard ratio [HR]= 1.15; p = 0.0049). African American race, hepatitis C, pre-LT diabetes, higher creatinine, lower albumin, lower bilirubin and sodium >141 mmol/L at LT were also significant predictors of post-LT ESRD. Post-LT ESRD was associated with higher post-LT mortality (HR = 3.32; p < 0.0001). The risk of post-LT ESRD, a strong predictor of post-LT mortality, is 15% higher in the MELD era. This study identified potentially modifiable risk factors of post-LT ESRD. Early intervention and modification of these risk factors may reduce the burden of post-LT ESRD.
authors: Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. pratimas@med.umich.edu
authors: P
authors: P
authors: Sharma
authors: D E
authors: DE
authors: Schaubel
authors: M K
authors: MK
authors: Guidinger
authors: N P
authors: NP
authors: Goodrich
authors: A O
authors: AO
authors: Ojo
authors: R M
authors: RM
authors: Merion
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000145:classification / Q000601:surgery*; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology