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

Paulo Ricardo Gessolo Lins1,2, Roberto Camargo Narciso3, Leonardo Rolim Ferraz3

  • 1Hospital Israelita Albert Einstein, São Paulo, Brazil. pr.lins@uol.com.br.

BMC Nephrology
|August 23, 2022
PubMed
Abstract

Insights

The Model for End-Stage Liver Disease (MELD) score implementation in liver transplantation reduced acute kidney injury (AKI) incidence. However, post-MELD liver transplants saw increased dialysis needs but lower overall mortality rates.

Area of Science:

  • Nephrology
  • Hepatology
  • Transplantation Medicine

Background:

  • Acute kidney injury (AKI) is a frequent complication following solid organ transplantation, particularly in liver transplant recipients.
  • The Model for End-Stage Liver Disease (MELD) score, used for cirrhotic patient mortality prediction and organ allocation, has an uncertain impact on AKI and mortality post-liver transplant.

Purpose of the Study:

  • To evaluate the influence of MELD score implementation on the incidence of AKI and mortality rates in liver transplant patients.
  • To compare AKI rates based on KDIGO stages and mortality between pre-MELD and post-MELD eras.

Main Methods:

  • Retrospective single-center study of liver transplant patients from January 2002 to December 2013.
  • Patients were divided into two groups: pre-MELD implementation and post-MELD implementation.
  • AKI incidence (KDIGO stages) and mortality rates were assessed and compared between the two groups.

Main Results:

  • A lower proportion of patients developed AKI in the post-MELD era (p=0.04), with a 50% reduction even after covariate adjustment (p<0.01).
  • Renal replacement therapy (dialysis) was more frequent in the post-MELD group (p<0.01).
  • The 1-year mortality rate was significantly lower in the post-MELD era (11% vs. 20%, p<0.01).

Conclusions:

  • Liver transplants performed after MELD implementation showed a reduced incidence of AKI.
  • Despite an increased need for dialysis post-MELD, the overall 1-year mortality decreased, suggesting improved patient management and outcomes.
Keywords:
Acute Kidney InjuryLiver CirrhosisLiver TransplantationMELD

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