scholarly journals Changes in the allocation policy for deceased donor livers in Korea: perspectives from anesthesiologists

2021 ◽  
Vol 16 (1) ◽  
pp. 68-74
Author(s):  
Seung Yeon Yoo ◽  
Gaab Soo Kim
Keyword(s):  
Scoring System ◽  
Deceased Donor ◽  
Meld Score ◽  
Red Blood Cell Transfusion ◽  
Objective Condition ◽  
Intraoperative Bleeding ◽  
Allocation Policy ◽  
Donor Liver Transplantation ◽  
Before And After ◽  
End Stage

Background: The allocation policy for deceased donor livers in Korea was changed in June 2016 from Child-Turcotte-Pugh (CTP) scoring system-based to Model for End-stage Liver Disease (MELD) scoring system-based. Thus, it is necessary to review the effect of allocation policy changes on anesthetic management.Methods: Medical records of deceased donor liver transplantation (DDLT) from December 2014 to May 2017 were reviewed. We compared the perioperative parameters before and after the change in allocation policy.Results: Thirty-seven patients underwent DDLT from December 2014 to May 2016 (CTP group), and 42 patients underwent DDLT from June 2016 to May 2017 (MELD group). The MELD score was significantly higher in the MELD group than in the CTP group (36.5 ± 4.6 vs. 26.5 ± 9.4, P < 0.001). The incidence of hepatorenal syndrome (HRS) was higher in the MELD group than in the CTP group (26 vs. 7, P < 0.001). Packed red blood cell transfusion occurred more frequently in the MELD group than in the CTP group (5.0 ± 3.6 units vs. 3.4 ± 2.2 units, P = 0.025). However, intraoperative bleeding, vasopressor support, and postoperative outcomes were not different between the two groups.Conclusions: Even though the patient’s objective condition deteriorated, perioperative parameters did not change significantly.

scholarly journals HEPATOCELLULAR CARCINOMA PATIENTS ARE ADVANTAGED IN THE CURRENT BRAZILIAN LIVER TRANSPLANT ALLOCATION SYSTEM. A COMPETING RISK ANALYSIS

2020 ◽  
Vol 57 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Santiago RODRÍGUEZ ◽  
Alfeu de Medeiros FLECK JR ◽  
Marcos MUCENIC ◽  
Cláudio MARRONI ◽  
Ajacio BRANDÃO
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplant ◽  
Risk Model ◽  
Rio Grande ◽  
Deceased Donor ◽  
Meld Score ◽  
Waiting List ◽  
Competing Risk ◽  
Rio Grande Do Sul ◽  
Donor Liver Transplantation

ABSTRACT BACKGROUND: In Brazil, the Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for deceased donor liver transplantation (DDLT). Patients with hepatocellular carcinoma (HCC) receive standardized MELD exception points to account for their cancer risk of mortality, which is not reflected by their MELD score. OBJECTIVE: To compare DDLT rates between patients with and without HCC in Rio Grande do Sul, the Southernmost state of Brazil. METHODS - We retrospectively studied 825 patients on the liver-transplant waiting list from January 1, 2007, to December 31, 2016, in a transplant center located in Porto Alegre, the capital of Rio Grande do Sul, to compare DDLT rates between those with and without HCC. The time-varying hazard of waiting list/DDLT was estimated, reporting the subhazard ratio (SHR) of waiting list/DDLT/dropout with 95% confidence intervals (CI). The final competing risk model was adjusted for age, MELD score, exception points, and ABO group. RESULTS: Patients with HCC underwent a transplant almost three times faster than patients with a calculated MELD score (SHR 2.64; 95% CI 2.10-3.31; P<0.001). The DDLT rate per 100 person-months was 11.86 for HCC patients vs 3.38 for non-HCC patients. The median time on the waiting list was 5.6 months for patients with HCC and 25 months for patients without HCC. CONCLUSION: Our results demonstrated that, in our center, patients on the waiting list with HCC have a clear advantage over candidates listed with a calculated MELD score.

scholarly journals Hospitalization Rates Before and After Adult-to-Adult Living Donor or Deceased Donor Liver Transplantation

2010 ◽  
Vol 251 (3) ◽  
pp. 542-549 ◽  
Author(s):  
Robert M. Merion ◽  
Tempie H. Shearon ◽  
Carl L. Berg ◽  
James E. Everhart ◽  
Michael M. Abecassis ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Deceased Donor ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Hospitalization Rates ◽  
Deceased Donor Liver Transplantation ◽  
Before And After

scholarly journals Adoption of MELD score increases the number of liver transplant

2014 ◽  
Vol 27 (3) ◽  
pp. 201-203 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Wellington ANDRAUS ◽  
Rodrigo Bronze MARTINO ◽  
Vinicius Rocha SANTOS ◽  
Rafael Soares PINHEIRO ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Sao Paulo ◽  
Meld Score ◽  
The State ◽  
São Paulo ◽  
Liver Transplants ◽  
Mean Values ◽  
Before And After ◽  
End Stage

BACKGROUND: Liver transplantation is performed at large transplant centers worldwide as a therapeutic intervention for patients with end-stage liver diseases. AIM: To analyze the outcomes and incidence of liver transplantation performed at the University of São Paulo and to compare those with the State of São Paulo before and after adoption of the Model for End-Stage Liver Disease (MELD) score. METHOD: Evaluation of the number of liver transplantations before and after adoption of the MELD score. Mean values and standard deviations were used to analyze normally distributed variables. The incidence results were compared with those of the State of São Paulo. RESULTS: There was a high prevalence of male patients, with a predominance of middle-aged. The main indication for liver transplantation was hepatitis C cirrhosis. The mean and median survival rates and overall survival over ten and five years were similar between the groups (p>0.05). The MELD score increased over the course of the study period for patients who underwent liver transplantation (p>0.05). There were an increased number of liver transplants after adoption of the MELD score at this institution and in the State of São Paulo (p<0.001). CONCLUSION: The adoption of the MELD score led to increase the number of liver transplants performed in São Paulo.

scholarly journals Model of End-Stage Liver Disease (MELD) Score as a Predictor of In-Hospital Mortality in Patients with COVID-19: A Novel Approach to a Classic Scoring System

Cureus ◽  
2021 ◽  
Author(s):  
Peter M Stawinski ◽  
Karolina N Dziadkowiec ◽  
Baher Al-Abbasi ◽  
Laura Suarez ◽  
Larnelle Simms ◽  
...  
Keyword(s):  
Liver Disease ◽  
Hospital Mortality ◽  
Scoring System ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Novel Approach ◽  
End Stage

Low Preoperative Antithrombin III level is Associated with Postoperative Acute Kidney Injury after Liver Transplantation

2021 ◽  
Author(s):  
Kyoung-Sun Kim ◽  
Young-Jin Moon ◽  
Sung-Hoon Kim ◽  
In-Gu Jun ◽  
Hye-Mee Kwon ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Animal Studies ◽  
Antithrombin Iii ◽  
Kidney Injury ◽  
High Body Mass Index ◽  
Deceased Donor ◽  
Meld Score ◽  
Red Blood Cell Transfusion ◽  
Duration Of Surgery

Abstract Background: The reno-protective effect of Antithrombin III (ATIII) has been well-studied in various animal studies; however, little is known about the effect of ATIII on kidney function in patients undergoing liver transplantation (LT). This study aimed to determine the association between preoperative ATIII level and postoperative acute kidney injury (AKI) after LT (post-LT AKI).Methods: We retrospectively evaluated 2,395 LT recipients between 2010 and 2018 whose data of perioperative ATIII levels were available. Patients were divided into two groups based on the preoperative level of ATIII (ATIII<50% vs. ATIII≥50%). Multivariable regression analysis was performed to assess the risk factors for post-LT AKI. In addition, subgroup analysis for the Model for End-stage liver disease (MELD) score (<20, ≥20) and donor types (deceased vs. living) were performed to identify the predictive value of ATIII.Results: The mean preoperative ATIII levels were 30.2±11.8% in the ATIII<50% group and 67.2±13.2% in the ATIII≥50% group. The incidence of post-LT AKI was significantly lower in ATIII≥50% group compared to that in the ATIII<50% group (54.7% vs. 75.5%, P<0.001; odds ratio [OR, per 10% increase of ATIII level] 0.86, 95% confidence interval [CI] 0.81–0.92; P<0.001). The prognostic value of ATIII was found to be statistically significant in the low-MELD group (<20, OR 0.82, 95% CI 0.77–0.87, P<0.001) and living donor LT (OR 0.89, CI 0.85–0.94, P<0.001) group. After a backward stepwise regression model, female sex, high body mass index, low albumin, deceased donor LT, longer duration of surgery, and high red blood cell transfusion remained significantly associated with post-LT AKI.Conclusion: Low preoperative ATIII level is associated with post-LT AKI, suggesting that preoperative ATIII might be a prognostic factor for predicting post-LT AKI.

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