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Model for end stage liver disease

Louise Barbier, Manuela Cesaretti, Federica Dondero, François Cauchy, Linda Khoy-Ear, Takeshi Aoyagi, Emmanuel Weiss, Olivier Roux, Safi Dokmak, Claire Francoz, Catherine Paugam-Burtz, Ailton Sepulveda, Jacques Belghiti, François Durand, Olivier Soubrane
BACKGROUND: Older liver grafts have been considered in the past decade due to organ shortage. The aim was to compare outcomes after liver transplantation with either younger or older donors. METHODS: Patients transplanted in our center between 2004 and 2014 with younger donors (younger than 60 years; n = 253) were compared with older donors (older than 75 years; n = 157). Multiorgan transplantations, split grafts, or non-heart-beating donors were not included. RESULTS: Donors in the older group were mostly women deceased from stroke, and only 3 patients had experienced cardiac arrest...
November 2016: Transplantation
Brett E Fortune, Guadalupe Garcia-Tsao, Maria Ciarleglio, Yanhong Deng, Michael B Fallon, Samuel Sigal, Naga P Chalasani, Joseph K Lim, Adrian Reuben, Hugo E Vargas, Gary Abrams, Michele D Lewis, Tarek Hassanein, James F Trotter, Arun J Sanyal, Kimberly L Beavers, Daniel Ganger, Paul J Thuluvath, Norman D Grace, Roberto J Groszmann
GOALS/BACKGROUND: Data on acute variceal hemorrhage (AVH) in the United States is limited and the best method to stratify risk is not clear. Taking advantage of a prospective US cohort study, we aimed to (1) describe clinical outcomes of AVH and their predictors; (2) compare predictors of 6-week mortality. STUDY: Prospective 15-center US cohort of patients with cirrhosis presenting with endoscopically proven AVH, all of whom received antibiotics, vapreotide (a somatostain analog) infusion and endoscopic band ligation...
October 24, 2016: Journal of Clinical Gastroenterology
ShaoMing Zhu, Yulituzi Waili, XiaoTing Qi, YueMei Chen, YuFeng Lou
BACKGROUND: The lymphocyte-monocyte ratio (LMR) in the peripheral blood is suggested to be a potential biomarker for predicting the clinical outcomes of several diseases. We aimed to evaluate the relative efficiency of LMR for predicting 3-month mortality in patients with acute-on-chronic liver failure (AoCLF). PATIENTS AND METHODS: In this study, 74 chronic hepatitis B patients, 90 AoCLF patients, and 70 healthy controls were followed up for 4 months. The primary endpoint was 3-month in-hospital mortality...
October 24, 2016: European Journal of Gastroenterology & Hepatology
Ryan B Perumpail, Eric R Yoo, George Cholankeril, Lupe Hogan, Melodie Deis, Waldo C Concepcion, C Andrew Bonham, Zobair M Younossi, Robert J Wong, Aijaz Ahmed
Background and Aims: Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.). We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT. Methods: All U.S. adult LDLT recipients with MELD < 25 were evaluated using the 1995-2012 United Network for Organ Sharing registry. Survival following LDLT was stratified into three MELD categories (MELD < 15 vs...
September 28, 2016: Journal of Clinical and Translational Hepatology
Younghwan Kim, Yo-Han Park, Shin Hwang, Ki-Hun Kim, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Sung-Gyu Lee
BACKGROUND The aim of this study was to investigate the diagnostic role of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) in predicting hepatocellular carcinoma (HCC) in patients with advanced liver cirrhosis (LC) awaiting liver transplantation (LT). MATERIAL AND METHODS During a study period of 10 years, 2074 adult LT recipients were identified. They were divided into 2 groups: HCC (n=970; 46.8%) and non-HCC (n=1104; 53.2%). They were stratified into 5 categories according to model for end-stage liver disease (MELD) scores: <10 (n=464), ≥10 and <15 (n=632), ≥15 and <20 (n=355), ≥20 and <30 (n=340), and ≥30 (n=283)...
October 25, 2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Puneeta Tandon, K Rajender Reddy, Jacqueline G O'Leary, Guadalupe Garcia-Tsao, Juan G Abraldes, Florence Wong, Scott W Biggins, Benedict Maliakkal, Michael B Fallon, Ram M Subramanian, Paul Thuluvath, Patrick S Kamath, Leroy R Thacker, Jasmohan S Bajaj
BACKGROUND AND AIMS: Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize post-discharge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). METHODS: NACSELD consists of 16 tertiary-care hepatology centers that prospectively enroll non-electively admitted cirrhotic patients. Patients enrolled had KPS assessed one week post-discharge...
October 24, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
H L Cole, S Pennycook, P C Hayes
BACKGROUND: Proton pump inhibitor (PPI) therapy has been reported to be an independent mortality risk factor in patients with cirrhosis. AIMS: To identify the prevalence of PPI prescription, the appropriateness of this therapy and to investigate the relationship between PPI therapy and overall survival in patients with liver disease. METHODS: This retrospective cohort study used patient data for 2012 to 2014 collected from the Scottish Liver Transplant Unit and the Hepatology Ward at the New Royal Infirmary of Edinburgh...
October 23, 2016: Alimentary Pharmacology & Therapeutics
Brian J McMahon, Dana Bruden, Lisa Townshend-Bulson, Brenna Simons, Phillip Spradling, Stephen Livingston, James Gove, Annette Hewitt, Julia Plotnik, Chriss Homan, Hannah Espera, Susan Negus, Mary Snowball, Youssef Barbour, Michael Bruce, Prabhu Gounder
BACKGROUND & AIMS: Few studies have examined factors associated with disease progression in hepatitis C virus (HCV) infection. We examined the association of 11 risk factors with adverse outcomes in a population-based prospective cohort observational study of Alaska Native/American Indian persons with chronic HCV infection. METHODS: We collected data from a population-based cohort study of liver-related adverse outcomes of infection in American Indian/Alaska Native persons with chronic HCV living in Alaska, recruited from 1995 through 2012...
October 17, 2016: Clinical Gastroenterology and Hepatology
Lívia C Lionço, Angelo A de Mattos, Alex F Horbe, Ane M Costabeber, Ângelo Z de Mattos, Dorvaldo P Tarasconi
OBJECTIVE: The main aim of this study was to evaluate the real-life survival rates of patients with intermediate-stage hepatocellular carcinoma treated with transarterial chemoembolization. METHODS: A retrospective cohort study involving 95 patients was conducted and the studied variables were analysed according to survival. Treatment response was determined using the Modified Response Evaluation Criteria in Solid Tumors assessment. The Kaplan-Meier method and Cox regression were used to analyse survival...
October 18, 2016: European Journal of Gastroenterology & Hepatology
Martin I Montenovo, Ryan N Hansen, André A S Dick, Jorge Reyes
OBJECTIVES: Individuals older than 60 years represent a large proportion of the organs available for orthotopic liver transplant. However, the use of organs from older donors remains controversial. We hypothesized that the use of older donors would not affect patient and graft survival due to significant improvements in donor-recipient management. MATERIALS AND METHODS: We conducted a retrospective cohort analysis using the United Network for Organ Sharing database from February 2002 through December 2012, including non-HCV-infected adults (18 and older) who underwent primary orthotopic liver transplant...
October 14, 2016: Experimental and Clinical Transplantation
Ricardo U Macías-Rodríguez, Astrid Ruiz-Margáin, Jose L Rodriguez-Garcia, Sergio Zepeda-Gómez, Aldo Torre
OBJECTIVE: Endoscopic retrograde cholangio-pancreatography (ERCP) is useful for the management of biliary tract diseases; in patients with cirrhosis, portal hypertension may increase the risk for complications from ERCP. We evaluated the outcome and risk factors related to ERCP in patients with cirrhosis and portal hypertension. PATIENTS AND METHODS: In this case-control study, 37 patients (71 procedures) with cirrhosis and portal hypertension (group 1) and 37 controls (group 2) undergoing ERCP were included...
October 14, 2016: European Journal of Gastroenterology & Hepatology
Barbara J Turner, Yuanyuan Liang, Amit Singal
OBJECTIVES: Noninvasive measures are widely used to assess fibrosis and may be used to prioritize hepatitis C virus (HCV) treatment. We examined risks for likely fibrosis in patients with chronic HCV infection using fibrosis-4 (FIB-4) and imaging. PATIENTS AND METHODS: A HCV screening program diagnosed chronic HCV in patients born from 1945 to 1965 admitted in a safety net hospital. Likely fibrosis was based on FIB-4 (≥1.45) alone or combined with imaging interpreted as fibrosis or cirrhosis...
October 17, 2016: European Journal of Gastroenterology & Hepatology
Mamatha Bhat, Peter Ghali, Benoît Dupont, Roy Hilzenrat, Mahmood Tazari, André Roy, Prosanto Chaudhury, Fernando Alvarez, Michel Carrier, Marc Bilodeau
BACKGROUND & AIMS: Patients listed with exception points for Hepatocellular carcinoma (HCC) have been more likely to be transplanted than those listed for chronic liver failure (LF) based on the Model for End-Stage Liver Disease (MELD) score. The aim of this study was to determine outcomes in the 5-year experience of a scoring system designed to reflect heterogeneity of tumor load of patients listed for HCC. METHODS: A novel MELD exception point system based on size and number of HCC was implemented in July 2009...
October 14, 2016: Journal of Hepatology
Jem Ma Ahn, Chang Ha Kim, Soon Ho Um, Kyung Mee Kim, Tae Hyung Kim, Sun Young Yim, Hyuk Soon Choi, Eun Sun Kim, Bora Keum, Yeon Seok Seo, Hyung Joon Yim, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu
BACKGROUND AND AIM: In a recent study, microsatellite variations (GCA tandem repeats) in the promoter region of the (kidney-type) glutaminase gene were associated with the development of hepatic encephalopathy (HE) in Spanish patients with cirrhosis. The objective of this study was to validate the relation between microsatellite variations in the glutaminase promoter region and the development of overt HE in Korean patients with liver cirrhosis. METHODS: We performed a prospective cohort study of 154 cirrhotic patients who underwent a glutaminase microsatellite study without previous overt HE history at baseline...
October 17, 2016: Journal of Gastroenterology and Hepatology
Xiaoshu Li, Fangyuan Gao, Huimin Liu, Henghui Zhang, Yao Liu, Xieqiong Ye, Mingfan Geng, Le Sun, Rui Wang, Yuxin Li, Yuyong Jiang, Xiaojing Wang, Guiqin Zhou, Zhiyun Yang, Ang Li, Hui Zeng, Xianbo Wang
AIM: Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has significant morbidity and mortality. There is no standard approach for the management of HBV-related ACLF with nucleos(t)ide analogs. Our objective was to compare the short-term mortality between entecavir (ETV) and lamivudine (LAM) in patients with HBV-related ACLF. METHODS: We recruited 311 inpatients with HBV-related ACLF from December 2002 to January 2015. The patients were treated with ETV (n=143) or LAM (n=168)...
October 4, 2016: European Journal of Gastroenterology & Hepatology
Raquel Núñez-Ramos, Soledad Montoro, Marcello Bellusci, María Rosa Del Fresno-Valencia, Marta Germán-Díaz, Pedro Urruzuno, Enrique Medina, Javier Manzanares
PURPOSE: The aims of this study were to analyze the characteristics of patients with acute liver failure (ALF) in our center and evaluate the prognostic value of the Pediatric End-Stage Liver Disease (PELD) score calculated at admission. PATIENTS AND METHODS: A retrospective analysis of patients with ALF younger than 15 years between 2005 and 2013 was performed. Information collected included age, sex, etiology of ALF, laboratory tests, PELD score, stage of encephalopathy, and need for liver support devices such as MARS and/or liver transplant (LT) and survival...
September 30, 2016: Pediatric Emergency Care
Yi-Chan Chen, Ting-Shuo Huang, Yu-Chao Wang, Chih-Hsien Cheng, Chen-Fang Lee, Ting-Jun Wu, Hong-Shiue Chou, Kun-Ming Chan, Wei-Chen Lee, Ruey-Shyang Soong
Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009...
2016: BioMed Research International
P Taura, G Martinez-Palli, A Blasi, E Rivas, J Beltran, J Balust
Liver transplantation (LT) offers patients with liver disease a real chance for long-term survival. In the past decade, successful survival after LT along with the Model for End-Stage Liver Disease-based allocation policy have increased willingness to accept patients with a higher risk profile and marginal organs and to prioritize the sickest patients on the waiting list. Therefore, the anesthesiologist now deals with very challenging patients. In the present review, we aimed to highlight key aspects of intraoperative LT management in high-risk patients and to place these aspects in the perspective of their impact on perioperative outcomes...
September 2016: Transplantation Proceedings
M M C da Silva, R A Corcha, A M Oliveira da Silva, F J B Z Franco, J R de Souza Almeida, I F S F Boin
BACKGROUND: Patients in the immediate post-operative liver transplantation (LxT) period can develop respiratory and functional complications. In the postoperative months, these functions tend to improve. Nevertheless, there are few studies that evaluate precisely and specifically respiratory function in post-LxT long-term after surgery. The objective of the study was to describe the respiratory profile of patients 1 to 6 months after LxT, accompanied by LxT outpatients. METHODS: We included patients between 25 and 60 years old...
September 2016: Transplantation Proceedings
T B Annunziata, K Paulino, R Fernandes, G Bento, G Stoduto, R Vasconcelos, L Demetrio, L F P Moreira
Although the Model for End-Stage Liver Disease (MELD) score has been used to evaluate mortality of patients on the waiting list for liver transplantation, it has not established if it correlates with post-liver transplantation prognosis. The aim of this study is to assess if there is a relationship between pretransplantation MELD and post-transplantation results, especially regarding 30-day post-LT survival rates. We analyzed data from 172 patients who underwent deceased-donor liver transplantation between February 2013 and May 2015 in a single center...
September 2016: Transplantation Proceedings
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