title: Can pre-liver transplantation renal insufficiency using a creatinine clearance calculator predict long-term survival?
abstract: BACKGROUND
  Renal insufficiency can be associated with poor long-term survival of liver transplant recipients.
  
  
  OBJECTIVE
  The objective of this study was to study renal insufficiency observed pretransplantation and its long-term impact after liver transplantation.
  
  
  METHODS
  We analyzed retrospectively an electronic database collected prospectively including transplant records from June 1994 to October 2010 using piggyback venous reconstruction. The exclusion criteria were chronic kidney disease, acute hepatic failure, children up to 12 years of age, and retransplantations. Renal insufficiency was defined by the creatinine clearance (CCr) calculated using the Cockcroft-Gault method. Patients were distributed into 3 groups: CCr >90, between 90 and 60, and >60 mL/min/1.73 m(2). The survival rate was calculated using the Kaplan-Meier method and proportional hazards Cox regression analysis using death and CCr as stratifying variables evaluated predictive factors for survival. The groups were compared using the Kruskal-Wallis test with significant differences at P < .05.
  
  
  RESULTS
  Among the 305 patients those who showed preoperative and postoperative CCR of >90 were 187/59.9% and 82/26.3%, 60 to 90 were 77/24.7% and 74/23.7%, or <60 mL/min/1.73 m(2) were (41/13.1% and 149 (47.7%). Patients with preoperative CCr <60 mL/min/1.73 m(2) showed worse short- and long-term survivals as well as the longest intensive care unit and hospital stays (P = .034). The only predictive donor factor was age older than 40 years namely, the greatest hemotransfusion needs and postoperative liver and renal dysfunction (Chi square = 100.6064; P = .00001). The area under the curve (AUC) obtained using an receiver operating characteristic (ROC) analysis was 0.563 (95% CI 0.498-0.627) with a cut off of 30.25.
  
  
  CONCLUSIONS
  Pre-liver transplantation renal insufficiency seemed to be a predictive factor for long-term survival.
authors.affiliation: Unit of Liver Transplantation, State University of Campinas, SP, Brazil. ilkaboin@yahoo.com
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
authors.forename: E C
authors.initials: EC
authors.lastname: de Ataide
authors.forename: E P O
authors.initials: EP
authors.lastname: Dias
authors.forename: R S B
authors.initials: RS
authors.lastname: Stucchi
authors.forename: T
authors.initials: T
authors.lastname: Seva-Pereira
authors.forename: G
authors.initials: G
authors.lastname: Calomeni
authors.forename: C C
authors.initials: CC
authors.lastname: Capel Junior
authors.forename: M
authors.initials: M
authors.lastname: Mazzali
mesh_terms: D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D008107:Liver Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012372:ROC Curve; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D003404:Creatinine