Abstract: PO2144
Renal Outcomes After Liver Transplantation in the MELD-Na Score Era in Patients with Pre-Transplant Renal Impairment
Session Information
- Transplantation: Clinical - Underrecognized Risk Factors, Traditional Considerations, and Outcomes
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1902 Transplantation: Clinical
Authors
- Lin, Roger, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Varghese, Nevin, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Choi, Sung, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Haririan, Abdolreza, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Xie, Wen Yan, University of Maryland School of Medicine, Baltimore, Maryland, United States
- Maluf, Daniel G., University of Maryland School of Medicine, Baltimore, Maryland, United States
- Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
Background
Post-liver transplant (LT) renal insufficiency is an established predictor of morbidity and mortality for liver transplant recipients. Current reports on renal outcomes after LT have exclusively focused on patients from the MELD era. There is little information on the progression of kidney disease since the implementation of the MELDNa scoring system. We sought to characterize the prevalence of kidney disease after LT and its risk factors during the MELDNa era.
Methods
This is a retrospective cohort study of 107 adult, single-organ, primary liver transplants performed at the University of Maryland Medical Center between January 2016 and January 2017, after implementation of the MELDNa scoring system. We determined the pre-transplant chronic kidney disease (CKD) status (defined as eGFR <60ml/min or dependence on renal replacement therapy) by using the CKD-EPI Creatinine equation, available lab values, and the renal replacement therapy (RRT) status within the 90 days prior to transplant. The primary outcome was persistent CKD or mortality at 12 months. Recipients of MELDNa exception scores as well as Status 1 liver transplants were excluded.
Results
The mean patient age was 54.2 ± 11 years, 74 male, 85 Caucasian, 30 had diabetes, 55 were hypertensive, and 27 had HCV. 32 patients had pre-LT renal insufficiency and 25 patients were on RRT at the time of LT. The overall 1-year mortality rate post-LT was 11.2%. 36 patients had CKD at 12 months. Among the patients with pre-LT renal insufficiency, 13 demonstrated improved renal function, 13 remained with CKD, 2 ended up on long-term RRT, and 4 died by 12 months. Renal insufficiency equivalent to CKD stage 4 prior to LT (OR 8.75, CI 0.97-78.7, p=0.053) and RRT at time of LT (OR 3.68, CI 1.42-9.55, P=0.007) were associated with increased risk of recipient death or CKD at 12 months. Other variables including age, sex, HCV, DM, HTN, CKD Stage 3, MELDNa score, BMI, and organ rejection were not predictive of the outcome.
Conclusion
Our study in the MELDNa era patients suggests that 40% of the patients with impaired renal function pre-LT recover renal function by 12 months post-LT. RRT at the time of LT, and moderate to severe renal impairment prior to LT are risk factors for recipient mortality or persistent CKD at 1 year post-LT.