Minimum Pre-Liver Transplant Creatinine as a Predictor of Post-Transplant Renal Insufficiency
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
Transplant Center, Vanderbilt University Medical Center, Nashville, TN
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
Meeting: 2013 American Transplant Congress
Abstract number: D1680
Introduction: The Model for End-Stage Liver Disease score results in patients with often reversible renal insufficiency (RI) undergoing liver transplant and it is difficult to predict who would be best served with a combined liver-kidney transplant. We hypothesized that the minimum pre-transplant serum Cr is superior to the maximum as a predictor of post-transplant RI.
Methods: We performed a single center retrospective review of a de-identified research database. Information wase extracted for patients having Cr data within 8 weeks prior to and for at least 3 months after liver transplant. Kaplan-Meier and Cox regression models tested whether minimum pre-transplant Cr strata (<1.6, 1.6-2.0, >2.0 mg/dl) and minimum or maximum pre-transplant Cr were associated with post-transplant RI (Cr≥2.5 mg/dl).
Results: The sample included 533 adults (50±10y, 31% diabetes, 34% hypertension, follow-up time=62±44m). Higher pre-transplant minimum Cr was associated with increased risk of RI (p=0.004).
After controlling for age, diabetes and hypertension, minimum pre-transplant Cr was a stronger predictor of RI than maximum pre-transplant Cr (HR: 1.78 vs 1.23).
| Model 1 | B (p-value) | HR | 95% CI |
| Minimum pre-transplant Cr (mg/dl) | 0.578 (<0.001) | 1.783 | 1.411-2.253 |
| Age at transplant (yrs) | -0.003 (0.723) | 0.997 | 0.979-1.015 |
| Diabetes (ref=no) | 0.331 (0.062) | 1.392 | 0.983-1.969 |
| Hypertension (ref=no) | 0.055 (0.757) | 1.057 | 0.744-1.501 |
| Model 2 | |||
| Maximum pre-transplant Cr (mg/dl) | 0.210 (<0.001) | 1.234 | 1.109-1.373 |
| Age at transplant (yrs) | 0.000 (0.976) | 1.000 | 0.983-1.018 |
| Diabetes (ref=no) | 0.261 (0.139) | 1.298 | 0.919-1.832 |
| Hypertension (ref=no) | 0.030 (0.867) | 1.030 | 0.728-1.457 |
Conclusions: Contrary to current practice, the minimum pre-liver transplant Cr provides a robust predictor of post-transplant RI and may identify patients likely to recover renal function without combined liver-kidney transplant.
To cite this abstract in AMA style:
Grayson B, Dageforde L, Feurer I, Wright A, Shao C, Karp S. Minimum Pre-Liver Transplant Creatinine as a Predictor of Post-Transplant Renal Insufficiency [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/minimum-pre-liver-transplant-creatinine-as-a-predictor-of-post-transplant-renal-insufficiency/. Accessed November 26, 2024.« Back to 2013 American Transplant Congress