Role of MELD Score and Serum Creatinine as Prognostic Tools for the Development of Acute Kidney Injury after Liver Transplantation

Abstract

BackgroundThe role of the Model for End-Stage Liver Disease (MELD) score in predicting complications, such as Acute Kidney Injury (AKI), after orthotopic liver transplantation (OLT) has yet to be evaluated and serum creatinine may be too heavily weighted in the existing MELD formula, since it has many pitfalls in cirrhotic patients.MethodsRetrospective data of the perioperative period from consecutive adult OLTs performed from January to December 2009 were recorded. Univariate and multivariate analysis were performed to analyze the risk factors for AKI and mortality after OLT.ResultsThere were 114 OLTs performed in the study period, 22 (19,2%) were submitted to dialysis prior OLT and were excluded from the analysis for AKI. The median age was 52 years and 66% were male. Median creatinine value was 0.85mg/dL and MELD was 19. Fifty-two of the 92 patients (56,5%) developed AKI in the first 72 hours after OLT. The only independent risk factor for AKI was calculated MELD and when the components of the MELD score were analyzed, INR had a much stronger impact in predicting AKI then serum creatinine. Overall mortality rate was 32,5% and anesthesia duration was the only variable associated with higher mortality rate.ConclusionsAlthough MELD score seems to have a good performance in predicting AKI after OLT, serum creatinine had no impact on its prediction despite its importance on MELD calculation. Modifying the MELD score, which could include novel AKI biomarkers, may improve its prognostic accuracy and provide a better tool for public health planning.

Effect of Early Everolimus-Facilitated Reduction of Tacrolimus on Efficacy and Renal Function in De Novo Liver Transplant Recipients

“…8 These factors are known to be associated with an increased risk of chronic kidney disease or acute kidney injury. 11,12 Regional variation in patient characteristics after liver transplantation have also previously been reported in the literature. 13 Because geographical disparities in risk factors for posttransplant renal insufficiency could have an impact on study outcomes, it is important to analyze data for specific subpopulations to assess results in comparison to the overall study population.…”

Perioperative Acute Kidney Injury

“…(Table 1). The Model for End-Stage Liver Disease (MELD) score, but not pre-transplantation creatinine values, was predictive of AKI among patients undergoing liver transplantation 44 . Creating a risk score for AKI applicable to all patients has proven to be challenging.…”

Organ protection in allograft recipients

“…Twenty studies reporting on anesthetic strategies aiming at reducing postoperative morbidity and mortality were eventually included (Table 1) [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. We retrieved 14 studies reporting on postoperative complications in patients undergoing liver transplantation [22][23][24]28,29,[31][32][33][35][36][37][39][40][41], five studies conducted in kidney recipients [26,27,30,34,38] and one reporting on lung recipients [25].…”

“…Our search retrieved five articles: one casecontrol analysis evaluated the association between postoperative AKI and perioperative factors [36], whereas four were RCTs comparing different vasoactive drugs. AKI was the primary outcome in two [23,37], whereas the other trials reported a variety of data, including markers of the renal function [28,29].…”