HCC Liver Transplantation Wait List Dropout Rates Before and After the Mandated 6-Month Wait Time

Background Studies have shown significant improvement in hepatocellular carcinoma (HCC) recurrence rates after liver transplantation since the united network of organ sharing (UNOS) implementation of a 6-month wait period prior to accrued exception model for end-stage liver disease (MELD) points enacted on October 8, 2015. However, few have examined the impact on HCC dropout rates for patients awaiting liver transplant. Our objective is to evaluate the outcomes of HCC dropout rates before and after the mandatory 6-month wait policy enacted. Methods We conducted a retrospective cohort study on adult patients added to the liver transplant wait list between January 1, 2012, and March 8, 2019 (n = 767). Information was obtained through electronic medical records and organ procurement and transplant network (OPTN) publicly available national data reports. Results In response to the 2015 UNOS-mandated 6-month wait time, dropout rates in the HCC patient population at our center increased from 12% pre-mandate to 20.8% post-mandate This increase was similarly reflected in the national dropout rate, which also increased from 26.3% pre-mandate to 29.0% post-mandate. Discussion From these changes, it is evident that the UNOS mandate achieved its goal of increasing equity of liver organ allocation, but HCC patients are nonetheless dropping off of the wait list at an increased rate and are therefore disadvantaged.

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The Impact of Cirrhosis and Prescription Medications on QTc Interval Before and After Liver Transplantation

Journal of Pharmacy Practice ◽

10.1177/0897190017737896 ◽

2017 ◽

Vol 32 (1) ◽

pp. 48-53 ◽

Cited By ~ 1

Author(s):

Andrew D. Santeusanio ◽

Kevin G. Dunsky ◽

Stephanie Pan ◽

Thomas D. Schiano

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Qtc Interval ◽

Prescription Medications ◽

Qtc Prolongation ◽

Before And After ◽

Group 2 ◽

Transplant Candidates ◽

The Impact ◽

Group 1

Background: Higher rates of corrected QT (QTc) prolongation have been reported in patients with cirrhosis. The impact of liver transplantation and prescription medications on the natural history of QTc prolongation has yet to be well characterized. Methods: This was a single-center review of patients receiving (group 1) or listed for (group 2) a liver transplant during 2014. Patients in group 1 were followed prospectively from the date of transplantation to assess rates of QTc normalization posttransplant. In group 2, patients were evaluated from the date of listing up until December 2015 to assess the prevalence of QTc prolongation among liver transplant candidates. Results: In group 1, 22 (75.9%) patients with QTc intervals >460 milliseconds at the time of transplant established normal baseline QTc intervals following transplantation. The median time to this QTc normalization was 17 days. In group 2, 30 (16.9%) patients had at least 1 documented QTc interval >500 milliseconds with prevalence rates of 42.9%, 19.0%, and 10.2% in patients with natural model of end-stage liver disease scores of >30, 16 to 30, and <16, respectively ( P < .01). Overall, 49.4% of patients in group 1 and 47.5% of patients in group 2 were prescribed QTc prolonging medications. Conclusion: QTc prolongation will resolve following transplantation in the majority of patients and generally occurs within the first several weeks. Among the listed liver transplant candidates, higher rates of clinically significant QTc prolongation may be observed in patients with more severe underlying cirrhosis. QTc prolonging medications are commonly prescribed in this population and warrant monitoring following initiation.

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SPECIALIST SERVICE IN LIVER TRANSPLANT IN A UNIVERSITY HOSPITAL: A CASE STUDY

Texto & Contexto - Enfermagem ◽

10.1590/0104-07072017002630015 ◽

2017 ◽

Vol 26 (2) ◽

Cited By ~ 1

Author(s):

Sílvia Ferrazzo ◽

Mara Ambrosina de Oliveira Vargas ◽

Diana Coelho Gomes ◽

Francine Lima Gelbcke ◽

Karina Silveira de Almeida Hammerschimidt ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Care Service ◽

University Hospital ◽

Structured Interviews ◽

Specialist Service ◽

Immunosuppressed Patients ◽

Structures Of Care ◽

The Impact

ABSTRACT Objective: was to describe the flow of a specialist service in the care of liver transplant in a university hospital. Method: a qualitative research in the form of a case study, performed in a transplant service in southern Brazil. Data collection occurred from November 2013 to February 2014 through the triangulation of data, document analysis, structured interviews with 11 professional and semi direct observations interviews. Data analysis was performed by analysis of thematic content. Results: describes the flow of service and revealed the involvement of a multidisciplinary team in a cohesive manner, with competence recognized by patients and other sectors of the institution and structural deficiencies in care service for immunosuppressed patients. Conclusion: it was found that there is a need for studies that address the structures of care in liver transplantation services and to evaluate the impact of the quality of the life expectancy and proper recovery of persons undergoing liver transplantation.

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The Real Impact of Bridging or Downstaging on Survival Outcomes after Liver Transplantation for Hepatocellular Carcinoma

Liver Cancer ◽

10.1159/000507887 ◽

2020 ◽

Vol 9 (6) ◽

pp. 721-733

Author(s):

Sunyoung Lee ◽

Kyoung Won Kim ◽

Gi-Won Song ◽

Jae Hyun Kwon ◽

Shin Hwang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Early Stage ◽

Organ Procurement ◽

Survival Outcomes ◽

Full Cohort ◽

Donor Liver Transplantation ◽

Positron Emission ◽

The Impact

Introduction: There is no consensus regarding selection criteria on liver transplantation (LT) for hepatocellular carcinoma (HCC), especially for living donor liver transplantation, although emerging evidence has been found for the effectiveness of bridging or downstaging. Objective: We evaluated the long-term outcomes of patients who underwent LT with or without bridging or downstaging for HCC. Methods: This retrospective study included 896 LT recipients with HCC between June 2005 and May 2015. Recurrence-free survival (RFS), overall survival (OS), and their associated factors were evaluated. Results: The 5-year RFS in the full cohort of 896 patients was 82.4%, and the OS was 85.3%. In patients with initial Organ Procurement and Transplantation Network (OPTN) T1 and T2, the 5-year RFS and OS did not significantly differ between LT groups with and without bridging (all p ≥ 0.05). The 5-year RFS and OS of OPTN T3 patients with successful downstaging were not significantly different from those of patients with OPTN T2 with primary LT (p = 0.070 and p = 0.185), but were significantly higher than in patients with OPTN T3 with downstaging failure and initial OPTN T1 or T2 with progression (all p < 0.001). In the multivariate analysis, last alpha-fetoprotein before LT ≥70 ng/mL (hazard ratio [HR]: 1.77, p = 0.001; HR: 1.72, p = 0.004), pretransplant HCC status exceeding the Milan criteria (HR: 5.12, p < 0.001; HR: 3.31, p < 0.001), and positron emission tomography positivity (HR: 2.57, p < 0.001; HR: 2.57, p < 0.001) were independent predictors for worse RFS and OS. Conclusions: The impact of bridging therapy on survival outcomes is limited in patients with early-stage HCC, whereas OPTN T1 or T2 with progression provides worse prognosis. OPTN T3 should undergo LT after successful downstaging, and OPTN T3 with successful downstaging allows for acceptable long-term posttransplant outcomes.

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Effects of Enhancing Coach-Athlete Relationships on Youth Sport Attrition

The Sport Psychologist ◽

10.1123/tsp.6.2.111 ◽

1992 ◽

Vol 6 (2) ◽

pp. 111-127 ◽

Cited By ~ 90

Author(s):

Nancy P. Barnett ◽

Frank L. Smoll ◽

Ronald E. Smith

Keyword(s):

Dropout Rate ◽

Control Group ◽

Little League ◽

Team Success ◽

Before And After ◽

Group 5 ◽

The Impact ◽

Baseball Coaches ◽

Treatment Control Group ◽

Experimental Group

A field experiment was conducted to examine the impact of the Coach Effectiveness Training program on athlete attrition. Eight Little League Baseball coaches attended a preseason sport psychology workshop designed to facilitate desirable coach-athlete interactions. A no-treatment control group consisted of 10 coaches. Children who played for both groups of coaches were interviewed before and after the season and were contacted again the following year. At the end of the initial season, children in the experimental group evaluated their coaches, teammates, and the sport of baseball more positively than children who played for the control-group coaches. Player attrition was assessed at the beginning of the next baseball season, with control-group youngsters withdrawing at a significantly higher rate (26%) than those in the experimental group (5% dropout rate). There was no difference in mean team won-lost percentages between dropouts and returning players, which indicates that the attrition was not due to lack of team success.

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The impact of computerized provider order entry on emergency department flow

CJEM ◽

10.1017/cem.2016.11 ◽

2016 ◽

Vol 18 (4) ◽

pp. 264-269 ◽

Cited By ~ 4

Author(s):

Andrew Gray ◽

Christopher M.B. Fernandes ◽

Kristine Van Aarsen ◽

Melanie Columbus

Keyword(s):

Emergency Department ◽

Patient Safety ◽

Improve Patient Safety ◽

Patient Flow ◽

Wait Time ◽

Order Entry ◽

Computerized Provider Order Entry ◽

Left Without Being Seen ◽

Before And After ◽

The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

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Importance of daptomycin dosage on the clinical outcomes in early post-liver transplant recipients with vancomycin-resistant enterococci infection

10.21203/rs.3.rs-284680/v1 ◽

2021 ◽

Author(s):

Ing-Kit Lee ◽

Yi-Ping Sng ◽

Wei-Feng Li ◽

Chao-Long Chen ◽

Chih-Chi Wang ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Transplant Recipients ◽

Donor Liver ◽

Level Of Evidence ◽

Donor Liver Transplantation ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Liver Transplant Recipients ◽

The Impact

Abstract Background: The prevalence of vancomycin-resistant enterococci (VRE) is increasing among liver transplant recipients. This study aimed to explore the clinical features of liver transplant recipients with VRE infection/colonization and to determine the impact of daptomycin dosage on the outcomes. Methods: We retrospectively enrolled pre-transplant and post-transplant patients with VRE colonization/infection from 2016 to 2019. Results: Altogether, 428 patients underwent liver transplantation. Among these, 22 (5.1%) patients developed VRE colonization/infection. All VRE isolates were Enterococcus faecium. Two (9%) patients acquired VRE in the pre-transplant period, 16 (3 colonizations and 13 infections) (72.7%) in the early post-liver transplant period (≤60-day after transplantation), and 4 (2 colonization and 2 infections) (18.1%) in the late post-liver transplant period (>6-month after transplantation). Among 13 patients with early post-liver transplant VRE infection, 12 (92.3%) underwent living-donor liver transplantation and 1 underwent deceased donor liver transplantation. Among these 13 patients, the median time from transplant to emergence of VRE infection was 12 days. The median interval from VRE infection to death was 27 days and the 30-day mortality was 67%. Of these 13 patients, eleven patients (8 survived; 3 died) received daptomycin therapy for VRE. Among them, 4 (36.3%) received daptomycin doses <8 mg/kg. Non-survivors (n=3) received significantly lower daptomycin dose than survivors (n=8) (P=0.040). Daptomycin doses <8mg/kg were more frequently associated with non-survivors (n=3) than with survivors (n=8) (P=0.024). Conclusions: In summary, the suboptimal dosage of daptomycin may have contributed to a higher rate of in-hospital mortality. Doses ≥8 mg/kg may be needed to adequately treat VRE infection in early post-liver transplant recipients.Level of evidence: Level III

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P-L16 The Impact of Covid-19 on the Management of Primary and Metastatic Liver Cancers; A Single Centre Experience

British Journal of Surgery ◽

10.1093/bjs/znab430.109 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Adam Tweedie ◽

Stephen McCain ◽

James Mooney ◽

Claire Jones

Keyword(s):

Liver Resection ◽

Length Of Stay ◽

Wait Time ◽

Colorectal Metastases ◽

Recurrence Rates ◽

Term Survival ◽

Admission Rates ◽

Liver Cancers ◽

Neo Adjuvant Chemotherapy ◽

The Impact

Abstract Background The Covid-19 pandemic has impacted on all aspects of health care. Surgical specialties have been affected by the impact on theatre time and space, staff re-deployments, reduced ICU capacity for non-Covid patients, and in some cases this has had a significant impact on wait time for surgery and overall surgical capacity. In our tertiary referral HPB unit, the service has been relocated to two different sites throughout the pandemic. We aimed to assess the impact of this on patients undergoing liver resection Methods We examined patient data for all patients undergoing liver resection in the 15 month period prior to the introduction of national lockdown, and compared this with all patients who have undergone liver resection since. We looked at total number of cases, ICU admission rates (planned vs unplanned), length of stay, case mix, histology, rates of laparoscopic vs open surgery, and length of time from completing neoadjuvant chemotherapy to surgery. Data were obtained from electronic care records and patient notes. Results The overall number of cases was similar (84 pre-covid vs 86 since) and basic patient demographics were unaffected. Median length of stay was the same for both groups (7 days). Colorectal metastases were the underlying pathology in the majority of cases (56/84 pre Covid, 56/86 post). Numbers of laparoscopic and laparoscopic converted to open cases were reduced in the post-Covid era, 12 prior versus four since. The median time from completion of neo-adjuvant chemotherapy to surgery was also affected, increasing from 46 to 62 days. Conclusions These data show some differences in patient care in the pre and post-Covid eras, in particular a lower rate of laparoscopic surgery and longer period of time between neo-adjuvant treatment and surgery. Longer follow up is required to see if these trends persist and their effect on long term survival and recurrence rates. However, despite the strains on the system there were similar numbers of patients pre and post Covid, indicating that patients are still presenting and being treated. This showed that staff responded well to the pressures of Covid, and trainee experience would have been similar

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Are there Geographical Disparities in Access to Liver Transplantation in Atlantic Canada?

Canadian Journal of Gastroenterology ◽

10.1155/2012/627239 ◽

2012 ◽

Vol 26 (10) ◽

pp. 705-710 ◽

Cited By ~ 2

Author(s):

Paul Douglas Renfrew ◽

Michele Molinari

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Liver Transplant ◽

New Brunswick ◽

Newfoundland And Labrador ◽

Prince Edward Island ◽

Assessment Process ◽

Wait List ◽

End Stage Liver Disease ◽

End Stage

OBJECTIVE: To characterize the patient population served by Atlantic Canada’s Multi-Organ Transplant Program liver transplant service over the first five years of activity in its current iteration.METHODS: Data from a prospective institutional database, supplemented by retrospective medical record review, were used to identify and characterize the cohort of patients assessed for consideration of first liver transplant between December 1, 2004 and December 1, 2009.RESULTS: In the five-year period after reactivation, the program assessed 337 patients for first liver transplant. The median age at referral for this group of 199 men (59.0%) and 138 women (41.0%) was 56.1 years (range 16.3 to 72.3 years). The leading three liver diseases indicating liver replacement were alcohol-related end-stage liver disease (20.5%), hepatocellular cancer (16.6%) and hepatitis C-related end-stage liver disease (14.0%). When evaluated according to provincial population-standardized incidence, significant differences in the incidence of liver transplant assessment among the four Atlantic Canadian provinces were found (per 100,000 inhabitants: Nova Scotia 19.8, New Brunswick 13.0, Newfoundland and Labrador 9.1 and Prince Edward Island 11.0; Fisher’s exact P<0.001). Of the 337 individuals who began the assessment process, 153 (45.4%) were assigned to the wait list. The probability of an individual being assigned to the wait list was not found to differ according to province of residence (Nova Scotia 45.3%, New Brunswick 40.0%, Newfoundland and Labrador 58.7% and Prince Edward Island 40.0%; Fisher’s exact P=0.206).CONCLUSIONS: The analysis suggests that there are geographical disparities in access to liver transplantation in Atlantic Canada. These disparities appear to be related to factors that precede the transplant assessment process.

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