Instead, this allocation policy can reduce the time on the waiting list for LT and mortality from all causes of the patient with end-stage liver disease. Other studies call attention to the increasing prevalence of hepatocellular carcinoma that could lead patients without this condition to receive a liver transplant late – because hepatocellular carcinoma diagnosis supplements MELD scores irrespective to laboratorial data. MELD score-based liver allocation policy continues under discussion, especially because some authors criticize that patient with remarkably high scores are too sicky to undergoing liver transplantation. From the past 10 years, this score has been used by the UNOS, Euro transplant for prioritizing allocation of liver transplants and Brazilian liver allocation policy instead of the previous CPT score. Disparities among grafts distribution and patient selection force transplant polices to draw a specific liver allocation criterion that include MELD score. Liver transplantation (LT) is preferred therapy for individuals with advanced chronic liver disease and those with acute liver failure. 1-year mortality was lower in the post MELD era, suggesting that patient care was improved during this period. Liver transplants performed in the post MELD era had a lower incidence of AKI, although there were more cases requiring dialysis. AKI incidence was 50% lower in the post MELD era even when adjusted for clinically relevant covariates ( p < 0.01). The 1-year mortality rate was lower in the post MELD era (20% vs. Overall mortality rate at 28, 90 and 365 days was respectively 7%, 11% and 15%. 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). ResultsĮight hundred seventy-four patients were included, 408 in pre-MELD and 466 in the post MELD era. We evaluate the differences in AKI based on KDIGO stages and mortality rates between the two groups. 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). 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. Marcelo Costa Batista ORCID: /0000-0002-1399-0969 1, 2, 3īMC Nephrology volume 23, Article number: 294 ( 2022)Īcute kidney injury is a common complication in solid organ transplants, notably liver transplantation.Modelling kidney outcomes based on MELD eras - impact of MELD score in renal endpoints after liver transplantation
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