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|
|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 October 30, 2020.
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