A Novel Equation, GRAIL (GfR Assessment in Liver Disease) Correctly Classifies Patients with Reduced GFR and Predicts Development of ESRD.

S. Asrani,¹ L. Jennings,¹ M. Nadim,² J. Levitsky,³ J. Trotter,¹ G. Klintmalm.¹

¹BUMC, Dallas, TX
²USC, LA, CA
³NW, Chicago, IL

Meeting: 2017 American Transplant Congress

Abstract number: 571

Keywords: Kidney/liver transplantation, Liver cirrhosis, Post-operative complications, Renal dysfunction

Session Information

Session Name: Concurrent Session: Late Breaking

Session Type: Concurrent Session

Date: Tuesday, May 2, 2017

Session Time: 4:30pm-6:00pm

Presentation Time: 5:30pm-5:42pm

Location: E353C

Estimating glomerular filtration rate(CKD-EPI, MDRD-4, MDRD-6) is poor in liver patients with renal dysfunction(GFR<30ml/min). We developed a model for GFR Assessment In Liver disease(GRAIL) before and after LT.

Measured GFR(iothalamate, mGFR) in 13,021 samples (30 yrs) at protocol time points before/after LT was used as reference(derivation 70% validation 30%). GRAIL was derived using objective variables (creatinine, BUN, age, gender, race, albumin) to estimate GFR based on timing of measurement relative to LT and degree of renal dysfunction. Equation characteristics were compared in cross sectional analyses. In cohort analysis (n=473), development of renal outcomes(mGFR<20ml/min, chronic dialysis, renal transplantation) within 5 years after LT was compared.

GRAIL was more accurate and precise as compared to CKD-EPI, MDRD-4 and MDRD-6. For mGFR<30ml/min, the median difference (ml/min) was GRAIL: 5.2[IQR 9.6] vs. CKD-EPI: 13.6[21.9], MDRD-4: 9.4[17.4] and MDRD-6: 6.8[15.3]. Median difference (eGFR-mGFR) was lowest for GRAIL at almost all points before/after LT.(Fig1) GRAIL eGFR correctly classified a higher percentage of mGFR<30ml/min.(Fig2a) On the waitlist, GRAIL correctly classified 75% as having mGFR<30ml/min vs. 25%(CKD-EPI), 36%(MDRD-4), and 50%(MDRD-6). In cohort analysis, GRAIL eGFR<30ml/min predicted highest percentage of patients developing renal outcomes.(Fig2b) At 1 month after LT, GRAIL eGFR <30mlmin predicted 84.8% vs. 25.4%(CKD-EPI), 28.4%(MDRD-4), and 40.3%(MDRD-6) of renal outcomes within 5 years after LT.

GRAIL eGFR correctly classifies low mGFR and predicts development of renal related outcomes after LT. GRAIL may improve estimation of GFR before/after LT for crucial decisions regarding SLKT as well as CNI minimization.

CITATION INFORMATION: Asrani S, Jennings L, Nadim M, Levitsky J, Trotter J, Klintmalm G. A Novel Equation, GRAIL (GfR Assessment in Liver Disease) Correctly Classifies Patients with Reduced GFR and Predicts Development of ESRD. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Asrani S, Jennings L, Nadim M, Levitsky J, Trotter J, Klintmalm G. A Novel Equation, GRAIL (GfR Assessment in Liver Disease) Correctly Classifies Patients with Reduced GFR and Predicts Development of ESRD. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/a-novel-equation-grail-gfr-assessment-in-liver-disease-correctly-classifies-patients-with-reduced-gfr-and-predicts-development-of-esrd/. Accessed May 25, 2025.

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