Rising Rates of Renal Failure After Liver Transplantation: Presented at AASLD

By Maria Bishop

November 3, 2006

BOSTON, MA -- Since the 2002 inception of the Model for End-stage Liver Disease (MELD) disease severity scoring system for organ allocation in liver transplantion, there has been a dramatic increase in the number of patients experiencing renal failure after orthotopic liver transplant, according to research presented here at the 57^th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

Investigator D. Scott Batty, Jr., MD, FACS, director, global medical affairs, Pharmaceuticals Research Institute, Bristol-Myers Squibb, Princeton, New Jersey, presented the findings on October 29^th.

In an analysis of 22,796 liver-transplant patients (white, 74%) from the United Network for Organ Sharing database 1998-2006, Dr. Batty and colleagues classified 14,903 into a pre-MELD cohort and 7,893 into a post-MELD cohort.

Rates of renal failure at 6, 12 and 18 months post-transplant for the pre-MELD group were 3.4%, 3.7% and 3.9%, respectively, while post-MELD patients experienced rates of 12.8%, 13.6% and 14%, respectively. At 6 months, this comparison represents a nearly 4-fold increase in renal failure from the pre-MELD to the post-MELD era.

The increase in renal failure was primarily driven by a dramatic increase in the number of concomitant kidney/liver transplants performed, noted Dr. Batty.

In a recent analysis, researchers showed a positive survival benefit for recipients of concomitant kidney/liver transplant patients requiring preoperative renal-replacement therapy over liver-transplant recipients requiring the same therapy (Gonwa et al. Am J Transplant. 2006 Nov;6(11):2651-9. Epub 2006 Aug 25). This could result in increased competition between patients awaiting liver transplants and kidney transplants for a constrained number of available donor kidneys, and may result in a significant increase in waiting time for patients already listed for kidney transplant, Dr. Batty hypothesized in his presentation on October 29^th.

Strategies to address renal failure in liver-transplant patients are needed to reduce the incidence of post-liver-transplant renal failure, Dr. Batty concluded. Concerns over the use of nephrotoxic immunosuppression in liver-transplant recipients should address the default to kidney/liver transplant in these at-risk patients.

Also, an analysis of pre-operative factors predicting the likelihood of end-stage renal disease is needed to better guide the selection of candidates for kidney/liver transplant.

All of this study's authors are employees of Bristol-Myers-Squibb.

Presentation title: Impact of MELD Allocation on Post-OLT Renal Failure: Analysis of the UNOS Database. Abstract 581.

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This article posted November 25, 2006.