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. 2022 Aug 23;23(1):294.
doi: 10.1186/s12882-022-02912-6.

Modelling kidney outcomes based on MELD eras - impact of MELD score in renal endpoints after liver transplantation

Paulo Ricardo Gessolo Lins  1   2 , Roberto Camargo Narciso  3 , Leonardo Rolim Ferraz  3 , Virgilio Gonçalves Pereira  3 , Ben-Hur Ferraz-Neto  3 , Marcio Dias De Almeida  3 , Bento Fortunato Cardoso Dos Santos  3 , Oscar Fernando Pavão Dos Santos  3 , Júlio Cesar Martins Monte  3 , Marcelino Souza Durão Júnior  3   4 , Marcelo Costa Batista  3   4   5
Affiliations

Modelling kidney outcomes based on MELD eras - impact of MELD score in renal endpoints after liver transplantation

Paulo Ricardo Gessolo Lins et al. BMC Nephrol. .

Abstract

Background: Acute kidney injury is a common complication in solid organ transplants, notably liver transplantation. The MELD is a score validated to predict mortality of cirrhotic patients, which is also used for organ allocation, however the influence of this allocation criteria on AKI incidence and mortality after liver transplantation is still uncertain.

Methods: This is a retrospective single center study of a cohort of patients submitted to liver transplant in a tertiary Brazilian hospital: Jan/2002 to Dec/2013, divided in two groups, before and after MELD implementation (pre-MELD and post MELD). We evaluate the differences in AKI based on KDIGO stages and mortality rates between the two groups.

Results: Eight hundred seventy-four patients were included, 408 in pre-MELD and 466 in the post MELD era. The proportion of patients that developed AKI was lower in the post MELD era (p 0.04), although renal replacement therapy requirement was more frequent in this group (p < 0.01). Overall mortality rate at 28, 90 and 365 days was respectively 7%, 11% and 15%. The 1-year mortality rate was lower in the post MELD era (20% vs. 11%, p < 0.01). AKI incidence was 50% lower in the post MELD era even when adjusted for clinically relevant covariates (p < 0.01).

Conclusion: Liver transplants performed in the post MELD era had a lower incidence of AKI, although there were more cases requiring dialysis. 1-year mortality was lower in the post MELD era, suggesting that patient care was improved during this period.

Keywords: Acute Kidney Injury; Liver Cirrhosis; Liver Transplantation; MELD.

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Conflict of interest statement

The authors declare that there are no conflicts of interests regarding the publication of this paper.

Figures

Fig. 1
Fig. 1
Overview of the study cohort. Flow chart shows patients screened, included, and excluded from analysis. ESDR: End-stage renal disease
Fig. 2
Fig. 2
AKI risk prediction using 2 periods of time (Pre-MELD and Post MELD) and grouped by KDIGO AKI classification. AKI: Acute Kidney Injury, MELD: Model of End-Stage Liver Disease, KDIGO: Kidney disease improving global outcomes
Fig. 3
Fig. 3
Cox proportional hazard analysis for 1-year mortality. SAPS3: Simplified Acute Physiology Score III, BMI: Body mass index, KDIGO: Kidney disease – Improving Global Outcomes, AKI: Acute Kidney Injury
See this image and copyright information in PMC

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