The implementation of the model for end-stage liver disease (MELD) score decreased mortality of those awaiting liver transplantation.
However, the impact of the MELD allocation system on the risk of chronic renal disease after liver transplantation remains unknown.
Dr Manal Abdelmalek and colleagues from Florida conducted a single-center cohort study of 174 patients undergoing liver transplantation.
The researchers assessed patients who underwent liver transplantation 1 year prior to MELD implementation.
The investigators compared these results to those who underwent liver transplantation 1 year following MELD implementation.
All patients were followed for at least 2 years after liver transplantation.
Stage 3 chronic renal disease was defined by an estimated creatinine clearance creatinine clearance below 60 ml/min/1.73 m2.
Stage 4 chronic renal disease was defined by an estimated creatinine clearance below 30 mL/min/1.73 m2.
|Creatinine clearance at time of liver transplantat was lower in the MELD cohort|
Requirement of kidney transplantation and need for hemodialysis were also evaluated following liver transplantaion.
The reported that 97 patients were included in the pre-MELD cohort, and 77 in the MELD cohort.
The investigators noted that patients were comparable in baseline characteristics, prevalence of diabetes and hypertension, and immunosuppression.
Mean calculated MELD score in the pre-MELD cohort was significantly lower than in the MELD cohort .
The team observed that the estimated creatinine clearance at time of liver transplantation was lower in the MELD cohort compared with the pre-MELD cohort.
However, the incidence and prevalence of Stage 3 and 4 chronic renal disease at 6, 12, and 24 months after transplant were comparable between the 2 cohorts.
The investigators founds that the need for kidney transplantation or hemodialysis after transplant was comparable between the groups.
In multivariate analysis, serum creatinine at liver transplant was the only variable associated with the development of Stage 3 chronic renal disease in the first 2 years.
Dr Abdelmalek's team concludes, “The implementation of the MELD allocation system is not associated with increased mortality or occurrence of Stage 3 or 4 chronic renal disease in the first 2 years after liver transplant.”