OUTCOMES OF LIVER TRANSPLANTATION I

H. Patel¹, A. Patel², G. Divine³, D. Moonka^4
1Division Of Gastroenterology, Henry Ford Health System, Detroit/MI/UNITED STATES OF AMERICA, ²Transplant Nephrology, Henry Ford Hospital, Detroit/UNITED STATES OF AMERICA, ³Department Of Research Epidemiology, Henry Ford Health System, Detroit/UNITED STATES OF AMERICA, ⁴Division Of Gastroenterology, Henry Ford Health System, Detroit/UNITED STATES OF AMERICA

Body: Introduction: Few studies have looked at survival after liver transplantation (OLT) in patients once they have developed renal insufficiency or end-stage renal disease (ESRD). The current study looksat survival after patients have developed moderate or severe renal insufficiency or end-stage renal disease after OLT. Methods: We evaluated 716 patients who underwent OLT between 1993 and 2007 atour center. We excluded patients undergoing a second transplant, kidney-liver transplant or those who died within one year leaving 527 patients. Baseline demographic data were obtained for allpatients including age, sex donor age, race, hepatitis C infection, HCC, creatinine at transplant and pre-OLT diabetes and hypertension. GFR was calculated at three month intervals in the first yearand then at six month intervals using the MDRD4 formula. Patients were determined to have moderate renal insufficiency if the GFR was less than 60 ml/min/1,73m2, on three consecutive occasions.Severe renal insufficiency was defined by a GFR less than 30 on three consecutive occasions and end-stage renal disease was defined by need for dialysis or renal transplant. Once patients developedrenal insufficiency survival was determined from that point forward. A separate analysis was done to determine factors associated with survival from the time renal insufficiency ensued. Survival wascensored for patients undergoing renal transplant. Results: Of 527 patients, 331 developed moderate renal insufficiency (63%), 80 (15%) developed severe renal insufficiency and 40 (7.6%) developedESRD. Of the 40 with ESRD, 8 received kidney transplants without dialysis. The incidence of moderate, severe and end-stage renal disease at five years was 49%, 11% and 5%. Once renal insufficiencyensued, 1, 3 and 5 year survival for patients with moderate renal insufficiency was 92%, 84.6% and 76.1%. For severe renal insufficiency, survival was 87.4%, 75.4% and 63.4%. For patients ondialysis, 1, 3 and 5 year survival was 93.4%, 70% and 45%. Using a univariate Cox regression log rank test the only variables associated with time to death for patients with moderate renalinsufficiency were increased age at transplant (P=0.038), hepatitis C (0.033), pre-transplant diabetes (0.013) and being transplanted in the pre-MELD era (P=0.002). For time to death from the onsetof severe renal insufficiency, the only associated variable was serum creatinine at the time of transplant (P=0.003). Conclusion: Development of increasing degrees of renal insufficiency correlatedwith diminishing survival. Our incidence of renal insufficiency after OLT is similar to previously published reports but our five year survival on dialysis is somewhat higher. The only pre-transplantvariable that correlated with poor survival once severe renal insufficiency ensued was serum creatinine at the time of transplant with a hazard ratio of 1.35 (1.1-1.65) per 1 mg/dl of creatinine.

Disclosure: All authors have declared no conflicts of interest.