Background:

Midodrine is an alpha-1 agonist which induces arterial and venous vasoconstriction. It prevents symptomatic hypotension and is used for treatment of refractory ascites and hepatorenal syndrome (HRS) in cirrhosis. A recent study showed that pre-kidney transplant Midodrine use resulted in increased post-transplant graft failure and death. The current study examines if Midodrine prior to liver transplantation is associated with increased pre- and post-transplant renal failure and pre-transplant mortality.

Methods:

A single center retrospective study was conducted by analyzing the hospital charts of 369 patients on the liver transplant waitlist between 2010-2016. A multivariate analysis was performed with the primary endpoint of pre-transplant renal failure (defined by the requirement of renal replacement therapy, RRT) and secondary endpoints of post-transplant renal failure and waitlist mortality. Confounders were well known risk factors for waitlist mortality such as: diagnosis of chronic kidney disease (CKD), diabetes, HRS, and MELD score (at time of listing and at time of transplant/current).

Results:

Thirty-eight percent of all patients received pre-transplant Midodrine (n=141). The mean age was 54 (range 18-76) which was not significant between the exposed and unexposed groups (p=0.34). Patients with HRS were more likely to receive Midodrine (p<0.001), while there was no association with CKD or diabetes (p=0.86 and p=0.64, respectively). There was no significant association between pre- or post-transplant renal failure and patients who received Midodrine (p=0.9 and p=0.82, respectively). The median MELD at time of listing was 20.5 and at time of transplant/current was 33.5 in the Midodrine group which were both significantly higher than the no Midodrine group (p<0.001). Patients receiving Midodrine had a significantly increased risk of mortality on the waitlist (OR 2.37, 95% CI: 1.18 – 4.8, p=0.02), independent of MELD at listing, MELD at transplant/current, and HRS.

Conclusion:

Patients who take Midodrine while on the liver transplant waitlist do not have increased pre- or post-transplant renal failure. Midodrine use is associated with increased mortality on the waitlist, independent of well-established risk factors for waitlist mortality. The use of this drug in waitlisted patients should be further explored.

CITATION INFORMATION: Kalil J., Hertl M., Schadde E., Poirier J., Alvey N., Chan E. Midodrine Associated with Increased Mortality on Liver Transplant Waitlist Am J Transplant. 2017;17 (suppl 3).

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