Variables in the study were evaluated by the Shapiro-Wilk W test and distribution plots to test normality of distribution. The diagnosis of AKI in our study was based on only one of the components of the Acute Kidney Injury Network (AKIN) since data on urinary output was not available. Reference creatinine was defined as the last creatinine available before the transplantation procedure, measured by the colorimetric kinetic method. We also noted the days of in-hospital stay before transplant, donor age and height, as well as in-hospital mortality rates.ĪKI was defined as an increase equal or greater than 0.3 mg/dL in serum creatinine in the first 72 hours after procedure. Post operative factors recorded included: maximum lactate levels during the first 24 hours after ICU admission, noradrenaline dose of admission in ICU and need for re-transplantation. Preoperative laboratory values were also recorded: reference creatinine, INR, bilirubin, infection prior surgery, MELD value of indications of OLT (taking into account the presence of factors such as hepatocellular carcinoma, hepatopulmonary hypertension and neuroendocrine metastatic tumor, as described in the Brazilian National Transplant System legislation) and calculated MELD.įrom the intraoperative period, we recorded use of terlipressin, volume of blood components transfused, fluid balance, duration of anesthesia, maximum pulmonary artery pressure and maximum cardiac index. Information recorded from patients’ charts included demographic characteristics: age, gender, previous history of hypertension (HTN) and diabetes mellitus (DM). We retrospectively reviewed the medical records of consecutive adult OLTs performed from January to December of 2009. The Ethical Committe stated that written consent was not needed since data collected did not identify patients, and there was no intervention propsed by the researchers. The Ethical Committee of Hospital das Clinicas of Sao Paulo Medical School approved this study. In this study, we aim to evaluate the role of the MELD score and pre-procedure serum creatinine in predicting AKI after OLT. Still, there remains a lack of understanding about the risk factors leading to AKI after OLT. In the last decade, there have been many efforts to improve perioperative management and to enhance the use of intervention drugs with less nephrotoxicity. Deterioration in renal function in this setting is also associated with increased 30-day mortality rate, graft dysfunction and 1-year mortality. Despite the inaccuracy of creatinine as a marker for renal dysfunction in cirrhotic patients, it is still used as a gold standard for the diagnosis of AKI after OLT.ĪKI after OLT is a common complication, with incidences ranging from 12–95% –. However, although pre-procedure serum creatinine is a well recognized risk factor for Acute Kidney Injury (AKI) in many surgical scenarios, some studies do not confirm this correlation in liver transplanted patients. Renal dysfunction, measured by the pre-procedure serum creatinine, is a key component of that score. The MELD score for prioritizing organs for liver transplantation is calculated based on serum creatinine, the international normalized ratio (INR) and serum bilirubin. However, the role of the score in predicting complications after OLT has yet to be evaluated. MELD has been a useful tool to predict mortality for patients awaiting OLT. Understanding the prognosis of the cirrhotic patients awaiting orthotopic liver transplantation (OLT) and assessing morbid-mortality risk factors are critical points in the development of strategies to improve long-term outcomes and assist in planning public health strategies.įor over a decade, the Model for End-Stage Liver Disease (MELD) has been used worldwide as the criteria for organ allocation in patients with chronic liver disease.
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