scholarly journals Making an equal system equitable: Proposing a sex-adjusted MELDNa score for liver transplantation allocation

2021 ◽  
Author(s):  
Julia M Sealock ◽  
Ioannis Ziogas ◽  
Zhiguo Zhao ◽  
Fei Ye ◽  
Sophoclis Alexopoulos ◽  
...  
Keyword(s):  
Sex Differences ◽  
Liver Disease ◽  
Liver Transplant ◽  
Medical Center ◽  
International Normalized Ratio ◽  
Liver Allocation ◽  
Sex Disparities ◽  
Adjusted Scores ◽  
End Stage ◽  
Liver Transplant Recipients

Background & Aims: Liver allocation is determined by the model for end-stage liver disease (MELD), a scoring system based on four laboratory measurements. During the MELD era, sex disparities in liver transplant have increased and there are no modifications to MELD based on sex. We use data from electronic health records (EHRs) to describe sex differences in MELD labs and propose a sex adjustment. Methods: We extracted lab values for creatinine, International Normalized Ratio of prothrombin rate, bilirubin, and sodium from EHRs at Vanderbilt University Medical Center (VUMC) and the All of Us Research Project to determine sex differences in lab traits. We calculated MELDNa scores within liver transplant recipients, non-transplanted liver disease cases, and non-liver disease controls separately. To account for sex differences in lab traits in MELDNa scoring, we created a sex-adjusted MELDNa map which outputs adjusted female scores mapped to male scores of equal liver disease severity. Using waitlist data from the Liver Simulated Allocation Modeling, we conducted simulations to determine if the sex-adjusted scores reduced sex disparities. Results: All component MELDNa lab values and calculated MELDNa scores yielded significant sex differences within VUMC (n=623,931) and All of Us (n=56,715) resulting in MELDNa scoring that disadvantaged females who, despite greater decompensation traits, had lower MELDNa scores. In simulations, the sex-adjusted MELDNa score modestly increased female transplantation rate and decreased overall death. Conclusions: Our results demonstrate pervasive sex differences in all labs used in MELDNa scoring and highlight the need and utility of a sex-adjustment to the MELDNa protocol.

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 Survival outcomes in liver transplant recipients with Model for End‐stage Liver Disease scores of 40 or higher: a decade‐long experience

HPB ◽  
2015 ◽  
Vol 17 (12) ◽  
pp. 1074-1084 ◽  
Author(s):  
Hina J. Panchal ◽  
Joel B. Durinka ◽  
Jeromy Patterson ◽  
Farah Karipineni ◽  
Sarah Ashburn ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Survival Outcomes ◽  
Transplant Recipients ◽  
End Stage Liver Disease ◽  
End Stage ◽  
Liver Transplant Recipients

Survival Outcomes After Intracranial Hemorrhage in Liver Disease

2018 ◽  
Vol 16 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Carlito Lagman ◽  
Daniel T Nagasawa ◽  
Daniel Azzam ◽  
John P Sheppard ◽  
Cheng Hao Jacky Chen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Liver Disease ◽  
Liver Transplant ◽  
Intracranial Hemorrhage ◽  
Medical Center ◽  
Academic Medical Center ◽  
Admission Diagnosis ◽  
Survival Outcomes ◽  
Significant Difference ◽  
End Stage

Abstract BACKGROUND Survival outcomes for patients with liver disease who suffer an intracranial hemorrhage (ICH) have not been thoroughly investigated. OBJECTIVE To understand survival outcomes for 3 groups: (1) patients with an admission diagnosis of liver disease (end-stage liver disease [ESLD] or non-ESLD) who developed an ICH in the hospital, (2) patients with ESLD who undergo either operative vs nonoperative management, and (3) patients with ESLD on the liver transplant waitlist who developed an ICH in the hospital. METHODS We retrospectively reviewed hospital charts from March 2006 through February 2017 of patients with liver disease and an ICH evaluated by the neurosurgery service at a single academic medical center. The primary outcome was survival. RESULTS We included a total of 53 patients in this study. The overall survival for patients with an admission diagnosis of liver disease who developed an ICH (n = 29, 55%) in the hospital was 22%. Of those patients with an admission diagnosis of liver disease, 27 patients also had ESLD. Kaplan–Meier analysis found no significant difference in survival for ESLD patients (n = 33, 62%) according to operative status. There were 11 ESLD patients on the liver transplant waitlist. The overall survival for patients with ESLD on the liver transplant waitlist who suffered an in-hospital ICH (n = 7, 13%) was 14%. CONCLUSION ICH in the setting of liver disease carries a grave prognosis. Also, a survival advantage for surgical hematoma evacuation in ESLD patients is not clear.

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
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