P3466Cardiac output in end-stage liver disease increases with the severity of liver dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A N Koshy ◽  
B Cailes ◽  
P Gow ◽  
A Testro ◽  
J K Sajeev ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Liver Disease ◽  
Cardiac Function ◽  
Liver Transplant ◽  
Liver Dysfunction ◽  
Meld Score ◽  
Left Ventricular ◽  
Cirrhotic Cardiomyopathy ◽  
End Stage Liver Disease ◽  
End Stage

Abstract Background End-stage liver disease is associated with significant systemic and haemodynamic alterations that affect cardiac function. Cirrhotic cardiomyopathy remains an ill-defined entity among cardiologists. Understanding the complex interplay between liver dysfunction and cardiac function can lead to a better understanding of the compensatory mechanisms of the heart in liver failure. Purpose To investigate whether severity of liver disease affects baseline cardiac output in a large contemporary cohort of patients undergoing liver transplant work-up. Methods Consecutive patients that underwent pre-liver transplant (LT) workup between 2010–2017 were included. All patients underwent a resting echocardiogram. Cardiac output (CO) was prospectively recorded at baseline by pulsed-wave Doppler examination of the left ventricular outflow tract from the apical window and systemic vascular resistance (SVR) was calculated as 80 x (mean arterial pressure (MAP)/CO). Severity of liver disease was characterized by the model of end-stage liver disease (MELD) and Child-Pugh scores. Results 560 patients were included (mean age 57.5±7.7, 74.8% male). Mean MELD score was 19±7 and Child-Pugh Score was 9±3. There was an inverse linear relationship between the severity of liver disease by the MELD score and baseline SVR (rho 0.40, P<0.001). As SVR reduced, there was also a significant rise in baseline CO with a strong inverse correlation between the two variables (rho 0.86, p<0.001). There was a significant linear correlation between the severity of liver disease and baseline CO with both the scores (MELD Score rho 0.42, p<0.001; Child Pugh rho 0.44, p<0.001) (Figure). Baseline CO in LT Patients by Severity Conclusions Baseline CO increased with the severity of liver dysfunction due to a reduced afterload. A higher resting CO may lead to patients encroaching on their cardiac reserve at rest. This provides a pathophysiological insight suggesting a limited role for beta-blockers, particularly in patients with advanced liver cirrhosis.

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.

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.

scholarly journals ALBI and Child-Pugh score in predicting mortality in chronic liver disease patients secondary to alcohol - A retrospective comparative study

2019 ◽  
Vol 10 (5) ◽  
pp. 33-36
Author(s):  
B S Nagaraja ◽  
R Madhumathi ◽  
S B Sanjeet ◽  
K J Umesh ◽  
S Kumar Nandish
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Liver Dysfunction ◽  
Age Distribution ◽  
Roc Curves ◽  
Meld Score ◽  
Chronic Liver ◽  
End Stage Liver Disease ◽  
Retrospective Comparative Study ◽  
End Stage

Background: The severity of liver dysfunction in chronic liver disease is often estimated with Child-Pugh (CTP) classification or model for end-stage liver disease (MELD) score. The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction, which is simple and more objective. Aims and Objective: The present study was aimed to retrospectively compare the performance of ALBI score with Child-Pugh score for predicting the mortality in patients with chronic liver disease. Materials and Methods: Data of patients with chronic Liver disease irrespective of etiology were retrospectively reviewed. Child Pugh score and ALBI score were calculated for the patients and results from ROC curves were analysed. Results: Study conducted on 299 patients of chronic liver disease, age distribution was between 20-85 years with mean age of patients being 45.7+/-10.94 years, sex ratio male: female is 265:34 with mortality rate of 19.73%.The area under curves of ROC of ALBI and Child pugh are 0.586 and 0.549 respectively. Conclusion: Ability of ALBI score for predicting mortality was comparable with that of Child Pugh score but Child pugh score of more than 10 has got better performance of predicting mortality as compared to ALBI score.

scholarly journals Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients

Critical Care ◽  
2010 ◽  
Vol 14 (3) ◽  
pp. R117 ◽  
Author(s):  
Christian E Oberkofler ◽  
Philipp Dutkowski ◽  
Reto Stocker ◽  
Reto A Schuepbach ◽  
John F Stover ◽  
...  
Keyword(s):  
Liver Disease ◽  
Length Of Stay ◽  
Liver Transplant ◽  
Meld Score ◽  
Transplant Recipients ◽  
End Stage Liver Disease ◽  
End Stage ◽  
Liver Transplant Recipients

Cardiac Output in End-Stage Liver Disease Increases Proportional to the Degree of Liver Dysfunction

2019 ◽  
Vol 28 ◽  
pp. S289
Author(s):  
A. Koshy ◽  
B. Cailes ◽  
P. Gow ◽  
A. Testro ◽  
H. Han ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Liver Disease ◽  
Liver Dysfunction ◽  
End Stage Liver Disease ◽  
End Stage
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