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MELD Era Increases the Number of Combined Liver and Kidney Transplantations

Lucas Souto Nacif, Wellington Andraus, Luciana Bertocco de Paiva Haddad, Rafael Soares Pinheiro and Luiz Augusto Carneiro D'Albuquerque

Introduction: Combined Liver and Kidney Transplantation (CKLT) procedure is performed in large transplant centers worldwide as a therapeutic option for patients with disease in both organs and is currently the procedure of choice in many centers. The objective of this study was the evaluation of the number of combined transplantations before and after adoption of the MELD score in the Liver and Gastrointestinal Transplant Division of the University of São Paulo (Brazil) and comparison with the State of São Paulo.

Method: Clinical data from 705 transplantations performed from January 2002 to July 2012 were studied. Overall patient survival was analyzed by the Kaplan-Meier method for patients who underwent either combined liver and kidney transplantation or liver transplantation alone. Evaluation of the number of combined transplantations before and after adoption of the MELD score. The mean values and standard deviations were used to examine normally distributed variables. Comparison the incidence results with the CLKT and LT on State of São Paulo.

Results: There was a high prevalence of male patients referred to both modalities of transplantation. The mean age of patients was also similar in both groups, with a predominance of middle-aged males. The predominant reason for transplantation was hepatitis C cirrhosis (25.8%) in the CLKT group. The mean and median survival rates and survival over 10 years were similar between the groups (p= 0.620). The MELD score increases over the course of the period analyzed for patients who underwent both modalities of transplantation (p=0.46). There was an increase in the number of CLKTs after adoption of the MELD score in our institution and in State of São Paulo (p<0.001).

Conclusion: The adoption of the MELD score increase the number of combined transplants performed. The survival rate for Combined Liver and Kidney Transplantation is similar to that of Liver Transplantation alone.