A team from Baltimore, Maryland, USA, determined the impact of pretransplant renal function on graft and patient survival rates after orthotopic liver transplantation (OLT).
The United Network for Organ Sharing (UNOS) database was searched for adults who underwent OLT between 1988 and 1996.
Patients were classified arbitrarily based on calculated creatinine clearance (CCr) at the time of OLT.
They were grouped as those with normal renal function (> 70 ml/min), and mild (40-69.9 ml/min), moderate (20-39.9 ml/min), and severe (< 20 ml/min) renal insufficiency.
Of the 20,281 patients who underwent transplantation, complete data were available for 19,261 patients.
Of these, 67% had normal CCr (mean, 118 ml/min), and 22% had mild (56 ml/min), 8% had moderate (30 ml/min), and 3% had severe (14 ml/min) renal failure.
The researchers found that UNOS status 1 was more common in patients with moderate and severe renal failure.
| Survival rates lower in patients with moderate or severe renal failure.
| Hepatology |
Primary graft nonfunction and 30-day mortality rates were higher in patients with moderate or severe renal failure.
Furthermore, 1-, 2-, and 5-year graft and patient survival rates were lower in these individuals.
Multiple regression analysis showed that renal failure was an independent predictor of 30-day and 2-year mortality, after adjusting for confounding factors.
CCr less than 40 ml/min was associated with significantly lower short-term and long-term graft and patient survival rates.
Satheesh Nair, of the Johns Hopkins University School of Medicine, Baltimore, concluded on behalf of the group, "Our findings suggest that, when Mayo End-Stage Liver Disease (MELD) score is used to prioritize organ allocation, lower than expected graft and patient survival rates may be seen."