Arun Kumar Narayanan1, Satish Balan2, Sandeep Patil3, Praveen Murlidharan4, Venugopal Bhaskaran Pillai5, Shabeerali Thadakkun Usman6
BACKGROUND
Postoperative Acute Renal Injury (ARI) is a serious clinical problem
in Orthotopic Liver Transplantation (OLT). There are currently
no standard criteria for the evaluation of patients with AKI or Chronic Kidney Disease (CKD) requiring Liver Transplantation (LT).
The present study is taken up to fill up the lacunae. What is the use of MELD in predicting the outcome of OLT and renal
function?.
The aim of our study is to determine the association of various pretransplant risk factors, especially creatinine including t
he
MELD score on patient renal function after OLT.
MATERIALS
AND METHODS
A prospective, observational study of 35 consecutive liver transplantation patients including all patients who have been work
ed
up for OLT and who underwent liver transplantation have been included. Patients who are previously diagnosed with C KD have
been excluded. Preoperative AKI is defined as S. creatinine >1.2 mg/dL, postoperative AKI is defined as a persistent rise of 50%
increase or more of the S. creatinine (S. Cr).
RESULTS
Total number of patients in the present study were (n=35), mean
creatinine before liver transplantation was 1.0 ± 0.6 mg/dL.
Serum creatinine 1 month, 3 rd month and 6 th month post transplantation was 0.8 ± 0.4 mg/dL, 0.9 ± 0.4 mg/dL and 1.03 ± 0.5
mg/dL, respectively. Males in the study were 34 (97.1%), total number o f females were 1 (2.9%). Cadaver transplantation was
done in 21 patients (60%). Living donor transplantation was done in 14 patients (40%). Median MELD score was 25. There was
no significant change in the serum creatinine range at follow up in patients who had preop creatinine of 1. Those with creatinine
of >1.2 mg/dL and labelled as having HRS were found to have follow up creatinine varying between 1.3 4.5 mg/dL. The overall
post LT patient survival was 88% at 1 year, total of 4.1% underwent CVVHDF and 2 p atients died in the group. Remaining 2
patients are not dialysis dependent.
CONCLUSION
In this preliminary observation, there is a progressive rise in creatinine among patients who had a baseline creatinine of ar
ound
1 mg/dL and a higher MELD score in the pretransplant situation. Even without TAC toxicity, sepsis or underlying comorbidities.
The group with low MELD and low creatinine seems to be related to better health on one side, but the other group with high
creatinine and higher MELD have abnormal val ues are possibly related to preoperative conditions, also the donor and also the
duration of the transplant surgery.
