Impact of MELD‐Based Allocation on End‐Stage Renal Disease After Liver Transplantation
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 af...
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| Published in | American journal of transplantation Vol. 11; no. 11; pp. 2372 - 2378 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Malden, USA
Blackwell Publishing Inc
01.11.2011
Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1600-6135 1600-6143 1600-6143 |
| DOI | 10.1111/j.1600-6143.2011.03703.x |
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| 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.
This study finds that the risk of new onset post–liver transplant end‐stage renal disease, a strong predictor of posttransplant mortality, is significantly higher in the MELD era, and identifies potentially modifiable risk factors of post–liver transplant end‐stage renal disease. |
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| AbstractList | 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.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. 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 4/27/95 and 12/31/08 (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 (iii) quantify the association between ESRD incidence and mortality. Crude rates of post-LT ESRD were 12.8 and 14.5 per 1,000 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. 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. This study finds that the risk of new onset post-liver transplant end-stage renal disease, a strong predictor of posttransplant mortality, is significantly higher in the MELD era, and identifies potentially modifiable risk factors of post-liver transplant end-stage renal disease. 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. This study finds that the risk of new onset post–liver transplant end‐stage renal disease, a strong predictor of posttransplant mortality, is significantly higher in the MELD era, and identifies potentially modifiable risk factors of post–liver transplant end‐stage renal disease. 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. |
| Author | Ojo, A. O. Merion, R. M. Schaubel, D. E. Sharma, P. Guidinger, M. K. Goodrich, N. P. |
| AuthorAffiliation | 2 Department of Biostatistics, University of Michigan, Ann Arbor, MI 4 Arbor Research Collaborative for Health, Ann Arbor, MI 3 Department of Surgery, University of Michigan, Ann Arbor, MI 1 Department of Internal Medicine, University of Michigan, Ann Arbor, MI |
| AuthorAffiliation_xml | – name: 3 Department of Surgery, University of Michigan, Ann Arbor, MI – name: 1 Department of Internal Medicine, University of Michigan, Ann Arbor, MI – name: 4 Arbor Research Collaborative for Health, Ann Arbor, MI – name: 2 Department of Biostatistics, University of Michigan, Ann Arbor, MI |
| Author_xml | – sequence: 1 givenname: P. surname: Sharma fullname: Sharma, P. – sequence: 2 givenname: D. E. surname: Schaubel fullname: Schaubel, D. E. – sequence: 3 givenname: M. K. surname: Guidinger fullname: Guidinger, M. K. – sequence: 4 givenname: N. P. surname: Goodrich fullname: Goodrich, N. P. – sequence: 5 givenname: A. O. surname: Ojo fullname: Ojo, A. O. – sequence: 6 givenname: R. M. surname: Merion fullname: Merion, R. M. |
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| SubjectTerms | Adult Aged Biological and medical sciences End Stage Liver Disease - classification End Stage Liver Disease - surgery End‐stage renal disease Female Gastroenterology. Liver. Pancreas. Abdomen Health Care Rationing Hepatitis C virus Humans Kidney Failure, Chronic - etiology liver transplant Liver Transplantation - adverse effects Liver Transplantation - mortality Liver, biliary tract, pancreas, portal circulation, spleen Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged model for end‐stage renal disease mortality Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Other diseases. Semiology Patient Selection Proportional Hazards Models Renal failure Risk Factors Scientific Registry of Transplant Recipients Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system United States - epidemiology |
| Title | Impact of MELD‐Based Allocation on End‐Stage Renal Disease After Liver Transplantation |
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