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Song S, Zhi Y, Tian G, Sun X, Chen Y, Qiu W, Jiao W, Huang H, Yu Y, Li M, Lv G. Immature and activated phenotype of blood NK cells is associated with acute rejection in adult liver transplant. Liver Transpl 2023; 29:836-848. [PMID: 37002601 DOI: 10.1097/lvt.0000000000000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 05/10/2023]
Abstract
Natural killer (NK) cells contribute to liver transplant (LTx) rejection. However, the blood-circulating NK-cell dynamics of patients who experience acute rejection (AR) are unclear. Herein, we longitudinally profiled the total NK cells and their subsets, along with the expression of activating and inhibitory receptors in sequential peripheral blood mononuclear cell samples, spanning from before LTx to the first year after LTx of 32 patients with AR and 30 patients under a steady immune status. Before transplantation, patients with AR (rejectors) contained a significantly higher proportion of the immature CD56 bright CD16 - subset and a lower cytolytic CD56 dim CD16 + in the total blood-circulating NK cells than patients with steady immunity. Both subsets contained a high NKp30-positive population, and CD56 dim CD16 + additionally exhibited a high NKp46-positive ratio. The NKp30-positive ratio in CD56 dim CD16 + subset showed the most prominent AR predictive ability before LTx and was an independent risk factor of LTx AR. After transplantation, the blood-circulating NK cells in rejectors maintained a higher CD56 bright CD16 - and lower CD56 dim CD16 + composition than the controls throughout the first year after LTx. Moreover, both subsets maintained a high NKp30-positive ratio, and CD56 dim CD16 + retained a high NKp46-positive ratio. The blood-circulating NK cell subset composition was consistent during AR, while the expressions of NKp30 and NKp46 were augmented. Collectively, a more immature CD56 bright CD16 - subset composition and an activated phenotype of high NKp30 expression were the general properties of blood-circulating NK cells in rejected LTx recipients, and the NKp30-positive ratio in CD56 dim CD16 + NK subset before LTx possessed AR predictive potential.
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Affiliation(s)
- Shifei Song
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Lee CS, Wang YC, Wu TH, Lee WC. Impact of waiting time for liver transplantation on acute hepatitis B flare-up in non-cirrhotic patients. Asian J Surg 2022; 45:1041-1042. [PMID: 35183416 DOI: 10.1016/j.asjsur.2022.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 01/20/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Ching-Song Lee
- Department of Hepatology, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chao Wang
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Tsung-Han Wu
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Wei-Chen Lee
- Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taoyuan, Taiwan.
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Choi HJ, Na GH, Seo CH, Park SE, Ahn J, Hong TH, You YK. Clinical Analysis of Factors Affecting Hospital Mortality After Liver Transplant in Patients With High Model for End-Stage Liver Disease Score. Transplant Proc 2022; 54:424-429. [PMID: 35039160 DOI: 10.1016/j.transproceed.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND This study was undertaken to identify poor prognostic factors in patients with high Model for End-Stage Liver Disease (MELD) scores. METHODS From September 2001 to December 2017, living donor liver transplant and deceased donor liver transplant were performed in 851 (84.4%) and 157 patients (15.6%), respectively, in our center. Eighty-one patients (8.0%) with MELD scores ≥ 35 were classified as patients with high MELD scores. RESULTS The overall survival rates in patients with high MELD scores were significantly worse than those in patients with low MELD scores (P = .005). However, no significant difference in survival was found between the 2 groups when in-hospital mortality was excluded. In-hospital mortality occurred in 18 patients (22.2%), and the main cause of death was sepsis (n = 14, 77.8%). On univariate analysis, the risk factors for in-hospital mortality were mean age (P = .028), mean MELD score (P = .045), intubation status (P < .001), culture positivity (P = .042), and encephalopathy grade 3 or 4 (P = .014). On multivariate analysis, age (P = .006), intubation status (P = .042), and culture positivity (P = .036) were significant. CONCLUSIONS The main cause of in-hospital mortality was sepsis, and the risk factors for in-hospital mortality of patients with high MELD score were older age, preoperative intubation, and culture positivity. Special attention should be paid to the prevention and treatment of infection in the liver transplant of patient with high MELD scores.
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Affiliation(s)
- Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Gun Hyung Na
- Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Bucheon, Republic of Korea.
| | - Chang Ho Seo
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Joshep Ahn
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Ho Hong
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Young Kyoung You
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
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Almario Alvarez JA, Okoye O, Tulla K, Spaggiari M, Di Cocco P, Benedetti E, Tzvetanov I. Tracheostomy Following Liver Transplantation. Transplant Proc 2020; 52:932-937. [PMID: 32139274 DOI: 10.1016/j.transproceed.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/08/2019] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND With increased demand for liver transplantation, sicker patients are being transplanted frequently. These patients are at a higher risk of significant postoperative morbidity, including respiratory failure. This study evaluated the phenotype that characterizes liver transplant candidates who may benefit from early tracheostomy. METHODS A single center retrospective review of all liver transplant candidates between January 2012 and December 2017. Patients who eventually required tracheostomies were identified and compared to their counterparts. RESULTS Of the 130 liver transplants performed during the study period, 11 patients required tracheostomy. Although patients in the tracheostomized population (TP) did not have significantly worse preoperative functional status (<4 metabolic equivalents; 64% vs 42%, P = .21), they had a higher native model for end-stage liver disease (MELD) score (37 vs 30, P < .05) at the time of transplantation. Patients who eventually succumbed to respiratory failure had lower arterial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratios at the start of surgery and remained unchanged for the duration of surgery compared with the nontracheostomy group (P < .05). TP patients required more net fluid intraoperatively (7.3 vs 5.0 L, P < .05), increased length of time to attempted extubation (3.5 vs 1 day, P < .05), longer ventilation days (15 vs 1 day, P < .05), increased length of stay (37 vs 9 days, P < .05), and higher 1-year mortality (36% vs 8%, P < .05). CONCLUSIONS Based on our findings, patients with a high MELD score (>30), net postoperative fluid balance >6 L, and PaO2/FiO2 ratio ≤300 who fail to wean off mechanical ventilation after 72 hours may benefit from tracheostomy during the postoperative period.
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Affiliation(s)
| | - Obi Okoye
- Department of General Surgery, University of Illinois at Chicago, Chicago, IL
| | - Kiara Tulla
- Department of General Surgery, University of Illinois at Chicago, Chicago, IL
| | - Mario Spaggiari
- Department of General Surgery, University of Illinois at Chicago, Chicago, IL
| | - Pierpaolo Di Cocco
- Department of General Surgery, University of Illinois at Chicago, Chicago, IL
| | - Enrico Benedetti
- Department of General Surgery, University of Illinois at Chicago, Chicago, IL
| | - Ivo Tzvetanov
- Department of General Surgery, University of Illinois at Chicago, Chicago, IL
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Swanson A, Geller J, DeMartini K, Fernandez A, Fehon D. Active Coping and Perceived Social Support Mediate the Relationship Between Physical Health and Resilience in Liver Transplant Candidates. J Clin Psychol Med Settings 2019; 25:485-496. [PMID: 29546621 DOI: 10.1007/s10880-018-9559-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Without a transplant, end-stage liver disease is associated with significant morbidity and mortality. Transplant candidates endure physical and psychological stress while awaiting surgery, yet little is known about the relationship between physical health and psychological resilience during the wait-list period. This study examined predictors of psychological resilience and mediators of the relationship between physical health and psychological resilience in liver transplant candidates. Wait-listed candidates (N = 120) from a single Northeast transplant center completed assessments of physical functioning, coping, perceived social support, and resilience. Findings revealed that physical functioning, active coping, and perceived social support were positively associated with resilience; maladaptive coping was negatively associated with resilience. Perceived social support and active coping partially mediated the relationship between physical functioning and resilience. Transplant center care providers should promote active coping skills and reinforce the importance of effective social support networks. These interventions could increase psychological resilience among liver transplant candidates.
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Affiliation(s)
- Amelia Swanson
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Jessica Geller
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Department of Veterans Affairs, Denver-Seattle Center of Innovation, Aurora, CO, USA
| | - Kelly DeMartini
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Smilow Cancer Hospital at Yale-New Haven, New Haven, CT, USA.,Yale-New Haven Transplantation Center, New Haven, CT, USA
| | - Anne Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Dwain Fehon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Smilow Cancer Hospital at Yale-New Haven, New Haven, CT, USA.,Yale-New Haven Transplantation Center, New Haven, CT, USA
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Do Social Determinants Define "Too Sick" to Transplant in Patients With End-stage Liver Disease? Transplantation 2019; 104:280-284. [PMID: 31335769 DOI: 10.1097/tp.0000000000002858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delisting for being "too sick" to be transplanted is subjective. Previous work has demonstrated that the mortality of patients delisted for "too sick" is unexpectedly low. Transplant centers use their best clinical judgment for determining "too sick," but it is unclear how social determinants influence decisions to delist for "too sick." We hypothesized that social determinants and Donor Service Area (DSA) characteristics may be associated with determination of "too sick" to transplant. METHODS Data were obtained from the Scientific Registry of Transplant Recipients for adults listed and removed from the liver transplant waitlist from 2002 to 2017. Patients were included if delisted for "too sick." Our primary outcome was Model for End-Stage Liver Disease (MELD) score at waitlist removal for "too sick." Regression assessed the association between social determinants and MELD at removal for "too sick." RESULTS We included 5250 delisted for "too sick" at 127 centers, in 53 DSAs, over 16 years. The mean MELD at delisting for "too sick" was 25.8 (SD ± 11.2). On adjusted analysis, social determinants including age, race, sex, and education predicted the MELD at delisting for "too sick" (P < 0.05). CONCLUSIONS There is variation in delisting MELD for "too sick" score across DSA and time. While social determinants at the patient and system level are associated with delisting practices, the interplay of these variables warrants additional research. In addition, center outcome reports should include waitlist removal rate for "too sick" and waitlist death ratios, so waitlist management practice at individual centers can be monitored.
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Wang SJ, Yin S, Gu WY, Zhang Y, Li H. Acute-on-chronic liver failure exists in patients with hepatitis B virus-related decompensated cirrhosis. J Dig Dis 2018; 19:614-625. [PMID: 30226019 DOI: 10.1111/1751-2980.12671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/30/2018] [Accepted: 09/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This research sought to verify whether acute-on-chronic liver failure (ACLF) develops in hepatitis B virus (HBV)-related cirrhotic patients with previous decompensation and to identify the similarity between assumed ACLF patients and those with ACLF that developed from compensated cirrhosis. METHODS Patients with HBV-related cirrhosis were retrospectively screened and divided into the cirrhotic patients with first acute decompensation (AD) group and those with previous decompensation. Patients' characteristics, changes in laboratory results during hospitalization such as serum levels of total bilirubin (TB), creatinine (Cr) and white blood cell (WBC) counts, the Model for End-Stage Liver Disease (MELD) score and the 28-day and 1-year mortality rates were compared. RESULTS Altogether 890 patients were enrolled and divided into the compensated cirrhotic group with first AD (n = 400; 157 of whom diagnosed as ACLF within 28 days after admission according to the European Association for the Study of the Liver-Chronic Liver Failure [EASL-CLIF] criteria) and those with previous decompensation (n = 490; of whom 143 met the ACLF criteria [assumed ACLF]). There was no significant difference in 28-day mortality between the assumed ACLF group with previous decompensation and ACLF group with first AD. The WBC count, TB and Cr levels, international normalized ratio and MELD score exhibited similar variations in both groups at days 1, 7 and 28; however, these values in both ACLF groups significantly differed from the non-ACLF group. CONCLUSION HBV-related cirrhotic patients with previous decompensation who met the ACLF criteria had similar characteristic to ACLF patients with first AD.
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Affiliation(s)
- Shi Jin Wang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shan Yin
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Yi Gu
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hai Li
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Liver Transplantation in Recipients With High Model for End-stage Liver Disease Score. Transplant Proc 2018; 50:595-597. [PMID: 29579862 DOI: 10.1016/j.transproceed.2017.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The score in the Model of End-stage Liver Disease, or MELD, is a good indicator of the survival in patients on the liver transplant waiting list. In this study, an analysis is performed on the benefits of liver transplant on those patients with a very high MELD score and who thus start from a very severe baseline state that could affect the surgical outcome. MATERIALS AND METHODS A prospective study was conducted on a cohort of 331 patients that received a liver transplant between 2002 and 2014. The patients were divided into 2 groups according to the MELD score (<28 vs ≥28), and differences in age, postoperative complications, stay in the intensive care unit (ICU), hospital stay, and survival were compared. RESULTS Of the total of 331 patients, 21 (6.3%) had a MELD score ≥ 28. The mean age of the group with MELD score ≥ 28 was lower than the age in the group with MEDL score < 28 (42.5 vs 53.7 years; P < .0001). No significant increase was observed in postoperative complications. Although there were also no differences in survival, the group with MELD score ≥ 28 did have a longer stay in ICU and a longer hospital stay (with a mean of 6.7 days in ICU and 41.5 days admission vs 4.1 and 26.9, respectively). CONCLUSIONS A very high MELD score is associated with a longer stay in ICU and more days of hospital admission, although no differences were observed in postoperative complications or survival. Therefore, there does not seem to be any contraindication in transplantation in this group of patients.
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Abstract
Acute-on-chronic liver failure (ACLF) is a distinct entity that differs from acute liver failure and decompensated cirrhosis in timing, presence of treatable acute precipitant, and course of disease, with a potential for self-recovery. The core concept is acute deterioration of existing liver function in a patient of chronic liver disease with or without cirrhosis in response to an acute insult. The insult should be a hepatic one and presentation in the form of liver failure (jaundice, encephalopathy, coagulopathy, ascites) with or without extrahepatic organ failure in a defined time frame. ACLF is characterized by a state of deregulated inflammation. Initial cytokine burst presenting as SIRS, progression to CARS and associated immunoparalysis leads to sepsis and multi-organ failure. Early identification of the acute insult and mitigation of the same, use of nucleoside analogue in HBV-ACLF, steroid in severe alcoholic hepatitis, steroid in severe autoimmune hepatitis and/or bridging therapy lead to recovery, with a 90-day transplant-free survival rate of up to 50 %. First-week presentation is crucial concerning SIRS/sepsis, development, multiorgan failure and consideration of transplant. A protocol-based multi-disciplinary approach including critical care hepatology, early liver transplant before multi-organ involvement, or priority for organ allocation may improve the outcome. Presentation with extrahepatic organ involvement or inclusion of sepsis as an acute insult in definition restricts the therapy, i.e., liver transplant or bridging therapy, and needs serious consideration. Augmentation of regeneration, cell-based therapy, immunotherapy, and gut microbiota modulation are the emerging areas and need further research.
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Affiliation(s)
- Shiv Kumar Sarin
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India.
| | - Ashok Choudhury
- Department of Hepatology and Liver Transplant, Institute of Liver and Biliary Sciences, D-1, VasantKunj, New Delhi, 110070, India
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Nekrasov V, Matsuoka L, Rauf M, Kaur N, Cao S, Groshen S, Alexopoulos SP. National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35. Am J Transplant 2016; 16:2912-2924. [PMID: 27063579 DOI: 10.1111/ajt.13823] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 01/25/2023]
Abstract
In certain regions of the United States in which organ donor shortages are persistent and competition is high, recipients wait longer and are critically ill with Model for End-Stage Liver Disease (MELD) scores ≥40 when they undergo liver transplantation. Recent implementation of Share 35 has increased the percentage of recipients transplanted at these higher MELD scores. The purpose of our study was to examine national data of liver transplant recipients with MELD scores ≥40 and to identify risk factors that affect graft and recipient survival. During the 12-year study period, 5002 adult recipients underwent deceased donor whole-liver transplantation. The 1-, 3-, 5- and 10-year graft survival rates were 77%, 69%, 64% and 50%, respectively. The 1-, 3-, 5- and 10-year patient survival rates were 80%, 72%, 67% and 53%, respectively. Multivariable analysis identified previous transplant, ventilator dependence, diabetes, hepatitis C virus, age >60 years and prolonged hospitalization prior to transplant as recipient factors increasing the risk of graft failure and death. Donor age >30 years was associated with an incrementally increased risk of graft failure and death. Recipients after implementation of Share 35 had shorter waiting times and higher graft and patient survival compared with pre-Share 35 recipients, demonstrating that some risk factors can be mitigated by policy changes that increase organ accessibility.
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Affiliation(s)
- V Nekrasov
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - L Matsuoka
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - M Rauf
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - N Kaur
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - S Cao
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - S Groshen
- Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA
| | - S P Alexopoulos
- Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA
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Colmenero J, Navasa M. Delta-MELD and survival after liver transplantation: the slope matters. Liver Int 2016; 36:949-51. [PMID: 26970536 DOI: 10.1111/liv.13112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jordi Colmenero
- Liver Transplant Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Biomedical Research Networking Center Consortium - Digestive and Liver Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Miquel Navasa
- Liver Transplant Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Biomedical Research Networking Center Consortium - Digestive and Liver Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
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