The Case of the Criminal Liver

2011 ◽  
Vol 20 (1) ◽  
pp. 143-143 ◽  
Author(s):  
RUCHIKA MISHRA
Keyword(s):  
Liver Disease ◽  
Hepatitis C ◽  
Liver Transplant ◽  
Chinese American ◽  
Chronic Fatigue ◽  
Meld Score ◽  
Waiting List ◽  
End Stage Liver Disease ◽  
Speed Up ◽  
End Stage

Mr. C was a 62-year-old Chinese-American man suffering from end stage liver disease secondary to Hepatitis C. While on the waiting list for a liver, he was told that his current condition and MELD score were not advanced enough to expect a liver transplant for several years. Because of his chronic fatigue, he asked if there was any way to speed up the process but was told that was not possible.

scholarly journals Impact of Integrating Insulin-Like Growth Factor 1 Levels into Model for End-Stage Liver Disease Score for Survival Prediction in Hepatocellular Carcinoma Patients

Oncology ◽  
2020 ◽  
Vol 98 (12) ◽  
pp. 836-846
Author(s):  
Reham Abdel-Wahab ◽  
Manal M. Hassan ◽  
Bhawana George ◽  
Roberto Carmagnani Pestana ◽  
Lianchun Xiao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Growth Factor ◽  
Meld Score ◽  
Waiting List ◽  
Survival Prediction ◽  
Insulin Like Growth Factor ◽  
Priority Assignment ◽  
End Stage Liver Disease ◽  
End Stage

<b><i>Background:</i></b> Liver reserve affects survival in hepatocellular carcinoma (HCC). Model for End-Stage Liver Disease (MELD) score is used to predict overall survival (OS) and to prioritize HCC patients on the transplantation waiting list, but more accurate models are needed. We hypothesized that integrating insulin-like growth factor 1 (IGF-1) levels into MELD score (MELD-IGF-1) improves OS prediction as compared to MELD. <b><i>Methods:</i></b> We measured plasma IGF-1 levels in training (<i>n</i> = 310) and validation (<i>n</i> = 155) HCC cohorts and created MELD-IGF-1 score. Cox models were used to determine the association of MELD and MELD-IGF-1 with OS. Harrell’s c-index was used to compare the predictive capacity. <b><i>Results:</i></b> IGF-1 was significantly associated with OS in both cohorts. Patients with an IGF-1 level of ≤26 ng/mL in the training cohort and in the validation cohorts had significantly higher hazard ratios than patients with the same MELD but IGF-1 &#x3e;26 ng/mL. In both cohorts, MELD-IGF-1 scores had higher c-indices (0.60 and 0.66) than MELD scores (0.58 and 0.60) (<i>p</i> &#x3c; 0.001 in both cohorts). Overall, 26% of training and 52.9% of validation cohort patients were reclassified into different risk groups by MELD-IGF-1 (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> After independent validation, the MELD-IGF-1 could be used to risk-stratify patients in clinical trials and for priority assignment for patients on liver transplantation waiting list.

Tu1055 High Model for End-Stage Liver Disease (MELD) Score Disproportionately Worsens Liver Transplant Outcomes for Older Recipients

2013 ◽  
Vol 144 (5) ◽  
pp. S-1042
Author(s):  
Suzanne R. Sharpton ◽  
Sandy Feng ◽  
Eric Vittinghoff ◽  
Bilal Hameed ◽  
Francis Yao ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Meld Score ◽  
Transplant Outcomes ◽  
End Stage Liver Disease ◽  
End Stage ◽  
Older Recipients

Preoperative Trapped Lung Is Associated With Increased Mortality After Orthotopic Liver Transplantation

2020 ◽  
pp. 152692482097860
Author(s):  
Kathryn H. Melamed ◽  
David Dai ◽  
Natasha Cuk ◽  
Daniela Markovic ◽  
Robert Follett ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Liver Transplant ◽  
Orthotopic Liver Transplantation ◽  
Meld Score ◽  
Transplant Recipients ◽  
End Stage Liver Disease ◽  
Trapped Lung ◽  
End Stage ◽  
Liver Transplant Recipients

Introduction: Trapped lung, characterized by atelectatic lung unable to reexpand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease complicated by hepatic hydrothorax. Limited data suggest that trapped lung prior to orthotopic liver transplantation may be associated with poor outcomes. Research Question: What is the clinical significance of trapped lung in patients receiving orthotopic liver transplantation? Design: We performed a retrospective analysis of patients who underwent liver transplantation over an 8-year period. Baseline clinical characteristics and postoperative outcomes of adult patients with trapped lung were analyzed and compared to the overall cohort of liver transplant recipients and controls matched 3:1 based on age, sex, Model for End-Stage Liver Disease (MELD) score, and presence of pleural effusion. Results: Of the 1193 patients who underwent liver transplantation, we identified 20 patients (1.68%) with trapped lung. The probability of 1 and 2-year survival were 75.0% and 57.1%, compared to 85.6% and 80.4% (p = 0.02) in all liver transplant recipients and 87.9% and 81.1% (p = 0.03) in matched controls respectively. Patients with trapped lung had a longer hospital length of stay compared to the total liver transplant population (geometric mean 54.9 ± 8.4 vs. 27.2 ± 0.7 days, p ≤ 0.001), when adjusted for age and MELD score. Discussion: Patients with trapped prior to orthotopic liver transplantation have increased probability of mortality as well as increased health care utilization. This is a small retrospective analysis, and further prospective investigation is warranted.

339 Outcomes of Patients With END-Stage Liver Disease on Dialysis for More Than 6 Weeks on the Liver Transplant Waiting List

2010 ◽  
Vol 138 (5) ◽  
pp. S-784
Author(s):  
Ayse L. Mindikoglu ◽  
Laurence S. Magder ◽  
Stephen L. Seliger ◽  
Jean-Pierre Raufman ◽  
Charles D. Howell
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Waiting List ◽  
End Stage Liver Disease ◽  
Liver Transplant Waiting List ◽  
End Stage

scholarly journals Postoperative Resource Utilization and Survival among Liver Transplant Recipients with Model for End-Stage Liver Disease Score ≥40: A Retrospective Cohort Study

2015 ◽  
Vol 29 (4) ◽  
pp. 185-191 ◽  
Author(s):  
Filipe S Cardoso ◽  
Constantine J Karvellas ◽  
Norman M Kneteman ◽  
Glenda Meeberg ◽  
Pedro Fidalgo ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Retrospective Cohort ◽  
Meld Score ◽  
Cumulative Survival ◽  
End Stage Liver Disease ◽  
Icu Stay ◽  
Significant Difference ◽  
Cirrhotic Patients ◽  
End Stage

BACKGROUND: Cirrhotic patients with Model for End-stage Liver Disease (MELD) score ≥40 have high risk for death without liver transplant (LT).OBJECTIVE: To evaluate these patients’ outcomes after LT.METHODS: The present study analyzed a retrospective cohort of 519 cirrhotic adult patients who underwent LT at a single Canadian centre between 2002 and 2012. Primary exposure was severity of liver disease measured by MELD score at LT (≥40 versus <40). Primary outcome was duration of first intensive care unit (ICU) stay after LT. Secondary outcomes were duration of first hospital stay after LT, rate of ICU readmission, re-LT and survival rates.RESULTS: On the day of LT, 5% (28 of 519) of patients had a MELD score ≥40. These patients had longer first ICU stays after LT (14 versus two days; P<0.001). MELD score ≥40 at LT was independently associated with first ICU stay after LT ≥10 days (OR 3.21). These patients had longer first hospital stays after LT (45 versus 18 days; P<0.001); however, there was no significant difference in the rate of ICU readmission (18% versus 22%; P=0.58) or re-LT rate (4% versus 4%; P=1.00). Cumulative survival at one month, three months, one year, three years and five years was 98%, 96%, 90%, 79% and 72%, respectively. There was no significant difference in cumulative survival stratified according to MELD score ≥40 versus <40 at LT (P=0.59).CONCLUSIONS: Cirrhotic patients with MELD score ≥40 at LT utilize greater postoperative health resources; however, they derive similar long-term survival benefit from LT.

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