scholarly journals Liver Transplantation in Patients with Acute-onChronic Liver Failure: Challenging the Limits

2021 ◽  
pp. 61-69
Author(s):  
Juan Manuel Diaz ◽  
Ezequiel Mauro ◽  
Maria Nelly Gutierrez-Acevedo ◽  
Adrian Gadano ◽  
Sebastian Marciano
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Causes Of Death ◽  
Meld Score ◽  
Organ Allocation ◽  
Short Term ◽  
Before And After ◽  
Short Term Mortality ◽  
End Stage

Acute-on-chronic liver failure (ACLF) is one of the main causes of death on the waiting list. Liver transplantation (LT) is the only curative treatment for patients with ACLF and therefore it should be considered in all cases. However, the applicability of LT in patients with ACLF is challenging, given the scarcity of donors and the high short-term mortality of these patients. Organ allocation has traditionally been prioritised according to the model for end-stage liver disease (MELD) system. However, the accuracy of MELD score is limited in patients with ACLF. In this article, the authors review the outcomes of patients with ACLF before and after LT, highlighting its clinical course, the feasibility of LT in the sickest patients, the role of the organ allocation system, and possible indicators of futility.

scholarly journals Investigation of Bacteremia due toAeromonasSpecies and Comparison with That due to Enterobacteria in Patients with Liver Cirrhosis

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Toru Shizuma ◽  
Chiharu Tanaka ◽  
Hidezo Mori ◽  
Naoto Fukuyama
Keyword(s):  
Liver Cirrhosis ◽  
Japanese Patients ◽  
Meld Score ◽  
Short Term ◽  
E Coli ◽  
End Stage Liver Disease ◽  
Short Term Mortality ◽  
Clinical Background ◽  
End Stage

Background. The role ofAeromonasspecies (sp.) in bacteremia in Japanese patients with liver cirrhosis is poorly understood.Aim. To establish the importance ofAeromonassp. as a cause of bacteremia in patients with liver cirrhosis.Methods. Clinical and serological features and short-term prognosis were retrospectively investigated and compared in Japanese patients with bacteremia due toAeromonassp. () and due to enterobacteria (E. coli, Klebsiellasp., andEnterobactersp.) ().Results. There were no significant differences in patients’ clinical background, renal dysfunction, or short-term mortality rate between the two groups. However, in theAeromonasgroup, the model for end-stage liver disease (MELD) score and Child-Pugh score were significantly higher than in the enterobacteria group.Conclusion. These results indicate that the severity of liver dysfunction inAeromonas-induced bacteremia is greater than that in enterobacteria-induced bacteremia in Japanese patients with liver cirrhosis.

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

2019 ◽  
Vol 39 (04) ◽  
pp. 403-413 ◽  
Author(s):  
Sophie-Caroline Sacleux ◽  
Didier Samuel
Keyword(s):  
United States ◽  
Serum Creatinine ◽  
International Normalized Ratio ◽  
The United States ◽  
Meld Score ◽  
Waiting List ◽  
Organ Shortage ◽  
Short Term ◽  
Short Term Mortality ◽  
End Stage

AbstractIn a context of global organ shortage, the Model for End-Stage Liver Disease (MELD) score seems to be a fair prioritization tool, with a paradigm: “sickest first.” Since its introduction in the United States in 2002, it has been rapidly adopted by transplant centers and organ sharing agencies around the world. The MELD score showed its effectiveness with a 12% reduction in waiting list mortality in the United States. Its success is linked to its simplicity, the use of basic variables (serum creatinine, serum bilirubin, and international normalized ratio [INR]), and its ability to predict short-term mortality, particularly on the transplant waiting list. However, this score is not perfect: its variables may have disadvantages for some patients, especially women, with serum creatinine and interlaboratory variability of the INR. The MELD score does not take into account some variables associated with poor short-term prognosis in cirrhotic patients. In addition, it is currently capped at 40, which results in the exclusion of sicker patients who could greatly benefit from transplantation. Finally, the MELD score does not accurately reflect the prognosis of several conditions, requiring a MELD exception system. Some solutions have been suggested such as MELD-Na or MELD uncapping, but it has not yet been fully accepted by all transplant centers.

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 Mortality and its Determinants in Adult Patients with End-stage Liver Disease on Waiting List for Liver Transplantation: A Preliminary Report on Baseline Data

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Kamran Bagheri Lankarani ◽  
Behnam Honarvar ◽  
Mohammad Reza Rouhezamin ◽  
Hadi Raeisi Shahraki ◽  
Vahid Seifi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Weight Loss ◽  
Liver Disease ◽  
Gallbladder Wall ◽  
Meld Score ◽  
Organ Allocation ◽  
Ca 125 ◽  
End Stage Liver Disease ◽  
History Of ◽  
End Stage

Background: Prevention of death in patients on the waiting list for liver transplantation (LT) is a major concern to prioritize organ allocation. Since the model for the end-stage liver disease (MELD) and its modifications have many shortages, there is a need for further refinement of the allocation strategy. Objectives: The current study aimed at assessing the predictors of mortality in LT candidates in a more comprehensive manner with the possible implications to improve the care of such patients and assist in developing better strategies for organ allocation. Methods: In the current cohort study, 544 adult LT candidates with end-stage liver disease were followed up for a mean of 12 months in three-month intervals. Data analysis was performed in Nutritionist, SPSS, and R software, using Kaplan-Meier, Cox proportional hazard (HRC), and LASSO Cox regression hazard (HRL) tests. Results: The mean age of the patients was 46.7 ± 13.7 years; the majority were male (n = 336, 61.7%). At the end of the study, 414 (76.1%) subjects were still alive and 130 (23.9%) dead. The cumulative percentages of death were 33.1%, 57.7%, and 79.2% after 3, 6, and 12 months of waiting for a donor, respectively. Although there was a strong association between having hepatopulmonary syndrome (HPS) (HRC = 4.7, HRL = 1.8), a history of myocardial infarction (MI) (HRC = 3.3, HRL = 1.6), low-carbohydrate (CHO) diet (HRC = 2.7, HRL = 1.5), and mortality, it was weak for MELD score. Moreover, a serum level of CA 125, high polymorphonuclear (PMN) count, weight loss, a high level of alanine aminotransferase (ALT), positive hepatitis B virus (HBV) markers, high mean corpuscular volume (MCV) of red blood cells, ascites, and edema of gallbladder wall had association with mortality in LT patients. Conclusions: In addition to MELD score, HPS, a history of MI, low CHO intake, weight loss, ascites, PMN, CA 125, ALT, hepatitis B surface antigen, MCV, blood urea nitrogen, and gallbladder wall thickness are predictors of mortality in LT candidates and need to be considered in the LT allocation system.

Potential predictive value of the meld score for short-term mortality after liver transplantation

2004 ◽  
Vol 36 (3) ◽  
pp. 533-534 ◽  
Author(s):  
G. Santori ◽  
E. Andorno ◽  
A. Antonucci ◽  
N. Morelli ◽  
G. Bottino ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Predictive Value ◽  
Meld Score ◽  
Short Term ◽  
Short Term Mortality

Copeptin – a biomarker of short-term mortality risk (7 days) in patients with end-stage liver disease

2019 ◽  
Vol 57 (12) ◽  
pp. 1897-1905
Author(s):  
Christoph Schneider ◽  
Johannes Remmler ◽  
Jeffrey Netto ◽  
Daniel Seehofer ◽  
Cornelius Engelmann ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Mortality Risk ◽  
Predictive Value ◽  
Evaluation Process ◽  
Short Term ◽  
Curative Therapy ◽  
End Stage Liver Disease ◽  
Short Term Mortality ◽  
End Stage

Abstract Background For many patients with end-stage liver disease, liver transplantation represents the only curative therapy. Transplant recipients are scored and ranked using the model for end-stage liver disease (MELD/MELD-Na). Circulatory impairment is known to deteriorate outcomes; however, it is not incorporated into the current allocation system’s score. The aim of our study is to analyze the predictive value of copeptin as a biomarker of circulatory impairment and increased short-term mortality risk in patients with end-stage liver disease. Methods We conducted a retrospective observational study of 615 patients with end-stage liver disease. Patients were recruited using assessments performed during the evaluation process for liver transplantation. Copeptin values were analyzed in comparison to MELD-Na, interleukin 6 (IL-6), and C-reactive protein (CRP). Results Elevated levels of copeptin, IL-6 and CRP, as well as high MELD-Na scores, were significantly correlated with mortality. In a comparison of copeptin-tertiles, patients in group T3 (16.3 pmol/L or more) showed a significantly higher mortality risk (hazard ratio 11.2, p < 0.001). After adjusting for MELD-Na, copeptin remains an independent predictor of mortality. It shows its greatest prognostic strength in short-term mortality, where it performs comparable to MELD-Na (AUROC for 7 day-mortality, 0.941/0.939; p = 0.981) and shows an additional predictive value to MELD-Na for short-term mortality (7 days, p: 0.046; 30 days, p: 0.006). Conclusions Copeptin presents a valuable individual biomarker in detecting patients at risk for short-term mortality. Further studies should be performed to confirm our findings.

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