scholarly journals Pre-Liver Transplant ROTEM™ Clot Lysis Index Is Associated with 30-Day Mortality, But Is Not a Measure for Fibrinolysis

2020 ◽  
Vol 9 (10) ◽  
pp. 3298
Author(s):  
Matthias Hartmann ◽  
Bogdan Craciun ◽  
Andreas Paul ◽  
Thorsten Brenner ◽  
Fuat H. Saner
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Blood Product ◽  
Meld Score ◽  
Coagulation System ◽  
Clot Lysis ◽  
End Stage Liver Disease ◽  
Product Use ◽  
Increased Risk ◽  
End Stage

Complex alterations of the coagulation system in end stage liver disease lead to an increased risk of bleeding and mortality. In the present study, we investigated; 1. the association of pre-liver transplant rotational thrombelastometry (ROTEM™) variables with bleeding as well as 30-day-mortality and 2. the underlying pathophysiology. After approval from the local ethics committee, rotational thrombelastometry variables, conventional laboratory coagulation values, MELD score (model of end-stage liver disease), red blood cell loss, blood product use, coagulation factors, underlying disease, and demographic data were retrospectively analysed. Pre-transplant thrombelastometry clot lysis index (CLI) and MELD were the only variables associated with mortality, bleeding and blood product use, respectively. Mortality was 4.2%, when CLI was <85%, and increased to 25.7% when the CLI was >95%. Multivariate analysis including CLI and MELD score identified the CLI as an independent and the best predictor of 30-day-mortality. Interestingly, the inhibition of fibrinolysis did neither affect CLI nor the association of the variable with mortality. Thus, fibrinolysis can be excluded as the reason for low CLI values. In conclusion, low CLI values measured before the beginning of liver transplantation are associated with reduced bleeding and mortality, but do not indicate fibrinolysis.

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 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

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.

scholarly journals Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns

2017 ◽  
Vol 2 ◽  
pp. 168-168
Author(s):  
Florencia I. Aiello ◽  
Magdalena Bajo ◽  
Fernanda Marti ◽  
Adrian Gadano ◽  
Carlos G. Musso
Keyword(s):  
Liver Disease ◽  
Liver Transplant ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
End Stage
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