Article

Continued Influence of Preoperative Renal Function on Outcome of Orthotopic Liver Transplant (OLTX) in the US: Where Will MELD Lead Us?

Department of Transplantation, Mayo Clinic Jacksonville, Jacksonville, Florida, USA.
American Journal of Transplantation (Impact Factor: 6.19). 12/2006; 6(11):2651-9. DOI: 10.1111/j.1600-6143.2006.01526.x
Source: PubMed

ABSTRACT Renal function is a component of the Model for End Stage Liver Disease (MELD), We queried the 1999-2004 OPTN/UNOS database to determine whether preoperative renal function remained an important determinant of survival in primary deceased donor liver transplant alone patients (DDLTA) or primary combined kidney liver transplant patients (KLTX). We examined preoperative creatinine, renal replacement therapy (RRT), incidence of KLTX, and patient survival in the 34 months before and after introduction of MELD and performed a multivariate Cox regression analysis of time to death. Preoperative renal function is an independent predictor of survival in DDLTA but not in KLTX. When compared to DDLTA with a preoperative serum creatinine of 0-0.99 mg/dL, patients with serum creatinine from 1-1.99 mg/dL, >2.0 mg/dL, those requiring RRT, and those receiving KLTX had a relative risk of death following transplant of 1.11, 1.58, 1.77, and 1.44 respectively. KLTX requiring RRT had better survival than DDLTA requiring RRT. Since introduction of MELD, KLTX, preoperative creatinine, and number of patients requiring preoperative RRT have increased. Despite this, patient survival following orthotopic liver transplant (OLTX) in the 34 months after introduction of MELD is not different than prior to introduction of MELD.

Download full-text

Full-text

Available from: Martin L Mai, Sep 18, 2014
0 Followers
 · 
114 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The continuing demand towards high-density and low profile integrated circuit packaging has accelerated the development of flip chip structures as used in direct chip attach (DCA) technology and chip size packages (CSP). The advantages in density, cost and electrical performance are obvious. Solder joints, the most widely used flip chip interconnects, have a relatively low structural compliance due to the large thermal expansion mismatch between silicon die and the organic substrate. This causes high thermally induced creep strain on the interconnects during temperature cycling and leads to early failure of the solder connections. The reliability of flip chip structures can be enhanced by applying an epoxy-based underfill between the chip and the substrate, encapsulating the solder joints. However, over ranges of design, process, and material parameters, different failure modes are observed with significant dependence on material properties and geometry. Nonlinear finite element analysis for flip chip structures is carried out to investigate the reliability impact due to a number of selected design and material parameters. Especially two fundamental issues are addressed, namely, the optimization of thermomechanical properties of underfill materials and manufacturing process-induced defects
    Advanced Packaging Materials, 1998. Proceedings. 1998 4th International Symposium on; 04/1998
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Thermal Management Group of the Packaging Research Center at the Georgia Institute of Technology is developing radically new and highly efficient cooling technologies suitable for on-the-spot and on-demand use on individual chips, MCMs and electronic packages. Our research efforts focus on the development of thermal management hardware that will target these heat flux levels in a low-profile, compact, reliable and inexpensive package. The cooling technologies are based manipulation of miniature single-phase jets using impulse actuators. The group is also developing two-phase versions for high heat flux applications. The technology can be applied as an open system (e.g. as a clip-on device for existing chips) or as a self-contained, integrated heat transfer module. The scalability, connectivity, and stackability of such modules could potentially provide significant improvements over current air-cooled thermal management schemes
    Advanced Packaging Materials, 1998. Proceedings. 1998 4th International Symposium on; 04/1998
  • Source
    Clinical Journal of the American Society of Nephrology 10/2006; 1(5):1066-79. DOI:10.2215/CJN.01340406 · 5.25 Impact Factor

Similar Publications