Researchers create tool to calculate risk of ESRD after liver transplant

Researchers have created and validated a risk score, called renal risk index, that can predict the risk of end-stage renal disease after liver transplant. Investigators at the University of Michigan and Arbor Research Collaborative for Health created the Renal Risk Index using national data of 43,514 liver transplant recipients. The results were published in the Journal of the American Society of Nephrology.

ESRD is one of the major public health problems among solid organ transplant recipients that is associated with death after transplant and high cost of care.

“Our goal was to create a risk score based on the liver transplant recipient’s factors to identify those who were at a higher risk of developing post-liver transplant end-stage renal disease,” said Pratima Sharma, MD, MS, lead author of the study and assistant professor of Internal Medicine in the University of Michigan Medical School.

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The renal risk index calculates a score by evaluating several recipient characteristics like age, race/ethnicity, history of hepatitis C, diabetes, body mass index, serum creatinine levels and other factors. The renal risk index calculator is available at: https://rri.med.umich.edu.

Patients with BMI over 35 had a 28% increased risk of post-LT end stage renal disease compared to those with lower BMI. Diagnosis of hepatitis C was associated with a 31% higher risk of post-transplant ESRD compared to non-hepatitis C diagnoses. The study also showed that other factors, like serum sodium over 134 mEq/L at transplant were associated with a lower risk of post-transplant end-stage renal disease.

Sharma said the renal risk index is an objective score based upon readily available clinical and laboratory data that can help clinicians stratify liver transplant recipients into mild, moderate or high risk of post-liver transplant end-stage renal disease at the time of transplant.

“In the long run, risk stratification using renal risk index and risk modification among highest risk group can help prevent or delay the progression of kidney disease to end-stage renal disease and improve overall patient survival,” Sharma said

Sharma says future research should focus on using the renal risk index to personalize immunosuppression strategies and risk modification to improve patient outcomes.