Impact of MELD‐Based Allocation on End‐Stage Renal Disease After Liver Transplantation

• Published in: American journal of transplantation Vol. 11; no. 11; pp. 2372 - 2378
• Main Authors: Sharma, P., Schaubel, D. E., Guidinger, M. K., Goodrich, N. P., Ojo, A. O., Merion, R. M.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.11.2011; Wiley
• Subjects: 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; United States; End-stage renal disease; Prognosis; Chronic renal failure; Liver; model for end-stage renal disease; Hepatic disease; Homotransplantation; Epidemiology; Liver failure; Allocation; Surgery; Graft; liver transplant; Scientific Registry of Transplant Recipients; Kidney disease; Human; Urinary system disease; Digestive system; Mortality; Attribution; Treatment; Register; Renal failure; Digestive diseases; Models; Organ; Liver transplantation
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/j.1600-6143.2011.03703.x

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.