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Matoba D, Noda T, Kobayashi S, Sasaki K, Iwagami Y, Yamada D, Tomimaru Y, Takahashi H, Doki Y, Eguchi H. Analysis of Short-Term and Long-Term Outcomes of Living Donor Liver Transplantation for Patients with a High Model for End-Stage Liver Disease Score. Transplant Proc 2023:S0041-1345(23)00149-5. [PMID: 37120341 DOI: 10.1016/j.transproceed.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/13/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND The Model of End-Stage Liver Disease (MELD) scoring system can predict short-term survival among patients awaiting liver transplantation and is used to allocate organs prioritizing liver transplantation. Patients with high MELD scores have been reported to have worse early graft dysfunction and survival. However, recent studies have shown that patients with high MELD scores had satisfactory graft survival, although they showed more postoperative complications. In this study, we examined the effect of the MELD score on the short-term and long-term prognosis of living donor liver transplantation (LDLT). METHODS This study included 102 patients who underwent LDLT in our institution between 2005 and 2020. The patients were divided into 3 groups according to MELD score (low MELD group: ≤20, moderate MELD group: 21-30, and high MELD group: ≥31). Perioperative factors were compared among the 3 groups, and cumulative overall survival rates were calculated using the Kaplan-Meier method. RESULTS The patients' characteristics were comparable, and the median age was 54 years. Hepatitis C virus cirrhosis was the most common primary disease (n = 40), followed by hepatitis B virus (n = 11). The low MELD group consisted of 68 patients (median score: 16, 10-20); the moderate MELD group, 24 patients (median score: 24, 21-30); and the high MELD group, 10 patients (median score: 35, 31-40). The mean operative time (1241 min versus 1278 min versus 1158 min, P = .19) and mean blood loss (7517 mL vs 11162 mL vs 8808 mL, P = .71) were not significantly different among the 3 groups. The vascular and biliary complication rates were similar. The periods of intensive care unit and hospital stay tended to be longer in the high MELD group, but the difference was insignificant. The 1-year postoperative survival rate (85.3 % vs 87.5 % vs 90.0 %, P = .90) and overall survival rate were also not significantly different among the 3 groups. CONCLUSIONS Our study showed that LDLT patients with high MELD scores do not have a worse prognosis than those with low scores.
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Affiliation(s)
- Daijiro Matoba
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Kazuki Sasaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Amiri M, Toosi MN, Moazzami B, Jafarian A, Shahsavari H, Javaherian M, Dashti H, Fakhar N, Karimi M, Khani F. Factors Associated With Length of Hospital Stay Following Liver Transplant Surgery. EXP CLIN TRANSPLANT 2020; 18:313-319. [PMID: 32133943 DOI: 10.6002/ect.2019.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Length of stay is considered an important surrogate for transplant survival rate and resource utilization. Therefore, in the present study, our aim was to determine factors affecting length of hospital stay. MATERIALS AND METHODS We retrospectively analyzed records of patients who underwent liver transplant at the Tehran University of Medical Sciences Liver Transplantation Center from March 2014 to March 2016. RESULTS For our final analyses, there were 161 adult recipients, including 106 males (65.8%) and 55 females (34.1%). Univariate analyses showed that body mass index, Modelfor End-Stage Liver Disease score, duration of surgery, number of administered packed red blood cells and fibrinogen during surgery, reoperation, retransplant, bacterial infection, pleural effusion, ascites, renal failure that required dialysis, and wound infection were risk factors for length of hospital stay. After multivariate linear regression analysis, only body mass index (β = 0.016; P = .028), Model for End-Stage Liver Disease score (β = 0.017; P = .002), surgical duration (β = 0.002; P = .001), reoperation (β = 0.016; P < .001), presence of pleural effusion (β = 0.212; P = .042), and management of bacterial infection (β = 0.21; P = .03) and psychiatric problems after liver transplant (β = 0.213; P = .025) were independent risk factors for length of hospital stay. CONCLUSIONS The present study showed that multiple preoperative, intraoperative, and postoperative variables could have an impact on length of hospitalization. Therefore, methods for assessing these factors could improve patient outcomes and resource savings in liver transplant centers.
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Affiliation(s)
- Mahmoud Amiri
- >From the Department of Medical-Surgical Nursing, School of Nursing and Midwifery, University of Medical Sciences, Tehran, Iran
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Danforth D, Gabriel RA, Clark AI, Newhouse B, Khoche S, Vig S, Sanchez R, Schmidt UH. Preoperative risk factors for massive transfusion, prolonged ventilation requirements, and mortality in patients undergoing liver transplantation. Korean J Anesthesiol 2019; 73:30-35. [PMID: 31378055 PMCID: PMC7000286 DOI: 10.4097/kja.19108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/30/2019] [Indexed: 01/21/2023] Open
Abstract
Background Despite improvements in techniques and management of liver transplant patients, numerous perioperative complications that contribute to perioperative mortality remain. Models to predict intraoperative massive blood transfusion, prolonged mechanical ventilation, or in-hospital mortality in liver transplant recipients have not been identified. In this study we aim to identify preoperative factors associated with the above mentioned complications. Methods A retrospective observational analysis was conducted on data collected from 124 orthotopic liver transplants performed at a single institution between 2014 and 2017. A multivariable logistic regression using backwards elimination was performed for three defined outcomes (massive transfusion ≥ 10 units packed red blood cells (PRBC), prolonged mechanical ventilation > 24 h, and in-hospital mortality) to identify associations with preoperative characteristics. Results Statistically significant (P < 0.05) associations with massive transfusion ≥ 10 units PRBC were hepatocellular carcinoma and preoperative transfusion of PRBC. Significant associations with prolonged mechanical ventilation > 24 h were hepatitis C, alcoholic hepatitis, elevated preoperative alanine aminotransferase, and hepatorenal syndrome. Male gender was protective for requiring prolonged mechanical ventilation. End-stage renal disease and hepatitis B were significantly associated with increased in-hospital mortality. Conclusions This study identified risk factors associated with common perioperative complications of liver transplantation. These factors may assist practitioners in risk stratification and may form the basis for further investigations of potential interventions to mitigate these risks.
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Affiliation(s)
- Dennis Danforth
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.,Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, USA
| | - Anthony I Clark
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Beverly Newhouse
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Swapnil Khoche
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Sanjana Vig
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Ramon Sanchez
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
| | - Ulrich H Schmidt
- Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA
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Sobotka L, Hinton A, Conteh L. Women receive more inpatient resections and ablations for hepatocellular carcinoma than men. World J Hepatol 2017; 9:1346-1351. [PMID: 29359018 PMCID: PMC5756724 DOI: 10.4254/wjh.v9.i36.1346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 11/14/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate disparities in the treatment of hepatocellular carcinoma (HCC) based on gender.
METHODS A retrospective database analysis using the Nationwide Inpatient Sample (NIS) was performed between 2010 and 2013. Adult patients with a primary diagnosis of hepatocellular carcinoma determined by International Classification of Disease 9 (ICD-9) codes were included. Univariate analysis and multivariate logistic regressions were performed to analyze differences in treatment, mortality, features of decompensation, and metastatic disease based on the patient’s gender.
RESULTS The analysis included 62582 patients with 45908 men and 16674 women. Women were less likely to present with decompensated liver disease (OR = 0.84, P < 0.001) and had less risk of inpatient mortality when compared to men (OR = 0.75, P < 0.001). Women were more likely to receive inpatient resection (OR = 1.31, P < 0.001) or an ablation (OR = 1.22, P = 0.028) than men. There was no significant difference between men and women in regard to liver transplantation and transcatheter arterial chemoembolization (TACE).
CONCLUSION Gender impacts treatment for hepatocellular carcinoma. Women are more likely to undergo an ablation or resection then men. Gender disparities in transplantation have resolved.
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Affiliation(s)
- Lindsay Sobotka
- Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, the Ohio State University, Columbus, OH 43210, United States
| | - Lanla Conteh
- Section of Hepatology, Division of Gastroenterology, Hepatology and Nutrition, the Hepatocellular Carcinoma Multidisciplinary Clinic, the James Comprehensive Cancer Center, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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Annunziata TB, Paulino K, Fernandes R, Bento G, Stoduto G, Vasconcelos R, Demetrio L, Moreira LFP. Impact of Model for End-stage Liver Disease Score in Post-Liver Transplantation Prognosis. Transplant Proc 2017; 48:2348-2351. [PMID: 27742295 DOI: 10.1016/j.transproceed.2016.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
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. The sample was divided in two groups according to their MELD scores: group 1, with MELD <25 (n = 134), and group 2, with MELD ≥25 (n = 38). The groups were compared with regard to 1-, 3-, and 12-month postoperative survival; total length of stay and in intensive care unit; and perioperative blood transfusion. The global 30-day post-liver transplantation survival rate was 87.2% (89.55% for group 1 and 78.99% for group 2 (P = .090). The evaluation of 3- and 12-month survival showed that in group 2 the mortality was higher (P = .01). Our data suggests a positive relationship between the higher MELD group and longer length of stay in intensive care unit (P = .0345), but not for total time of hospital admission (P = .524). Perioperative blood product transfusion was needed in 35.82% of patients in group 1 and 71.05% in group 2; this correlated with a higher 30- day postoperative mortality (P < .001).
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Affiliation(s)
- T B Annunziata
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil.
| | - K Paulino
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil
| | - R Fernandes
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil
| | - G Bento
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil
| | - G Stoduto
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil
| | - R Vasconcelos
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil
| | - L Demetrio
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil
| | - L F P Moreira
- State Transplantation Center, Hospital São Francisco de Assis, Rio de Janeiro, Brazil
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Chen HP, Tsai YF, Lin JR, Liu FC, Yu HP. Recipient Age and Mortality Risk after Liver Transplantation: A Population-Based Cohort Study. PLoS One 2016; 11:e0152324. [PMID: 27019189 PMCID: PMC4809564 DOI: 10.1371/journal.pone.0152324] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/11/2016] [Indexed: 12/31/2022] Open
Abstract
The aim of the present large population-based cohort study is to explore the risk factors of age-related mortality in liver transplant recipients in Taiwan. Basic information and data on medical comorbidities for 2938 patients who received liver transplants between July 1, 1998, and December 31, 2012, were extracted from the National Health Insurance Research Database on the basis of ICD-9-codes. Mortality risks were analyzed after adjusting for preoperative comorbidities and compared among age cohorts. All patients were followed up until the study endpoint or death. This study finally included 2588 adults and 350 children [2068 (70.4%) male and 870 (29.6%) female patients]. The median age at transplantation was 52 (interquartile range, 43–58) years. Recipients were categorized into the following age cohorts: <20 (n = 350, 11.9%), 20–39 (n = 254, 8.6%), 40–59 (n = 1860, 63.3%), and ≥60 (n = 474, 16.1%) years. In the total population, 428 deaths occurred after liver transplantation, and the median follow-up period was 2.85 years (interquartile range, 1.2–5.5 years). Dialysis patients showed the highest risk of mortality irrespective of age. Further, the risk of death increased with an increase in the age at transplantation. Older liver transplant recipients (≥60 years), especially dialysis patients, have a higher mortality rate, possibly because they have more medical comorbidities. Our findings should make clinicians aware of the need for better risk stratification among elderly liver transplantation candidates.
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Affiliation(s)
- Hsiu-Pin Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yung-Fong Tsai
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- * E-mail:
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Liu C, Vachharajani N, Song S, Cooke R, Kangrga I, Chapman WC, Grossman BJ. A quantitative model to predict blood use in adult orthotopic liver transplantation. Transfus Apher Sci 2015; 53:386-92. [DOI: 10.1016/j.transci.2015.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 12/12/2022]
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Chen HP, Tsai YF, Lin JR, Liu FC, Yu HP. Incidence and Outcomes of Acute Renal Failure Following Liver Transplantation: A Population-Based Cohort Study. Medicine (Baltimore) 2015; 94:e2320. [PMID: 26717368 PMCID: PMC5291609 DOI: 10.1097/md.0000000000002320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of our large, population-based, cohort study was to explore the risk factors of acute renal failure (ARF) after liver transplant (LT) in Taiwan.From the Taiwanese National Health Insurance Research Database, 2862 patients who had undergone LT without pretransplant dialysis between July 1, 1998, and December 31, 2012, were identified. Preoperative, operative, and perioperative risks factors were considered and analyzed using logistic regression analysis, after adjusting for age and sex. All patients were followed up until the study endpoint or death.The final dataset included 214 patients with ARF and 2648 without ARF post-LT. Preoperative cerebrovascular diseases were the most important identifiable risk factor for ARF post-LT. Comparison of outcomes for patients "with" and "without" ARF indicated higher incidence rates of bacteremia, pneumonia, and postoperative bleeding, as well as longer stays in both intensive care unit and hospital. Kaplan-Meier mortality curves identified higher rates of mortality for patients' developing ARF at 1-year post-LT and overall at 14.5 years postsurgery.We provide evidence of a high incidence of ARF post-LT in Taiwan, with documented association of ARF with higher incidence rates of morbidity and mortality in this clinical population. The most important identifiable risk factor for ARF in our study was cerebrovascular diseases.
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Affiliation(s)
- Hsiu-Pin Chen
- From the Department of Anesthesiology, Chang Gung Memorial Hospital (H-PC, Y-FT, F-CL, H-PY); College of Medicine, Chang Gung University (H-PC, Y-FT, J-RL, F-CL, H-PY); and Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan (J-RL)
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Intensivbehandlung nach Transplantation solider Organe. DIE INTENSIVMEDIZIN 2015. [PMCID: PMC7124053 DOI: 10.1007/978-3-642-54953-3_90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Klinzing S, Brandi G, Stehberger PA, Raptis DA, Béchir M. The combination of MELD score and ICG liver testing predicts length of stay in the ICU and hospital mortality in liver transplant recipients. BMC Anesthesiol 2014; 14:103. [PMID: 25844060 PMCID: PMC4384315 DOI: 10.1186/1471-2253-14-103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/27/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Early prediction of outcome would be useful for an optimal intensive care management of liver transplant recipients. Indocyanine green clearance can be measured non-invasively by pulse spectrophometry and is closely related to liver function. METHODS This study was undertaken to assess the predictive value of a combination of the model of end stage liver disease (MELD) score and early indocyanine plasma disappearance rates (ICG-PDR) for length of stay in the intensive care unit (ICU), length of stay in the hospital and hospital mortality in liver transplant recipients. RESULTS Fifty consecutive liver transplant recipients were included in this post Hoc single-center study. ICG-PDR was determined within 6 hours after ICU admission. Endpoints were length of stay in the ICU, length of hospital stay and hospital mortality. The combination of a high MELD score (MELD >25) and a low ICG-PDR clearance (ICG-PDR < 20%/minute) predicts a significant longer stay in the ICU (p = 0.004), a significant longer stay in the hospital (p < 0.001) and a hospital mortality of 40% vs. 0% (p = 0.003). CONCLUSION The combination of MELD scores and a singular ICG-PDR measurement in the early postoperative phase is an accurate predictor for outcome in liver transplant recipients. This easy-to-assess tool might be valuable for an optimal intensive care management of those patients.
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Affiliation(s)
- Stephanie Klinzing
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Giovanna Brandi
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Paul A Stehberger
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Dimitri A Raptis
- Department of Visceral- and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Markus Béchir
- Surgical Intensive Care Medicine, University Hospital of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Karapanagiotou A, Kydona C, Dimitriadis C, Papadopoulos S, Theodoridou T, Tholioti T, Fouzas G, Imvrios G, Gritsi-Gerogianni N. Impact of the Model for End-Stage Liver Disease (MELD) Score on Liver Transplantation in Greece. Transplant Proc 2014; 46:3212-5. [DOI: 10.1016/j.transproceed.2014.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Hummel R, Irmscher S, Schleicher C, Senninger N, Brockmann JG, Wolters HH. Aorto-hepatic bypass in liver transplantation in the MELD-era: outcomes after supraceliac and infrarenal bypasses. Surg Today 2013; 44:626-32. [DOI: 10.1007/s00595-013-0513-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
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Hong SH, Kwak JA, Jeon JY, Park CS. Prediction of early allograft dysfunction using serum phosphorus level in living donor liver transplantation. Transpl Int 2013; 26:402-10. [DOI: 10.1111/tri.12058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/26/2012] [Accepted: 12/23/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Sang Hyun Hong
- Department of Anaesthesiology and Pain Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
| | - Jung Ah Kwak
- Department of Anaesthesiology and Pain Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
| | - Jin Yeong Jeon
- Department of Anaesthesiology and Pain Medicine; Yeouido St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
| | - Chul Soo Park
- Department of Anaesthesiology and Pain Medicine; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul; Korea
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Lichtenstern C, Hochreiter M, Zehnter VD, Brenner T, Hofer S, Mieth M, Büchler MW, Martin E, Weigand MA, Schemmer P, Busch CJ. Pretransplant model for end stage liver disease score predicts posttransplant incidence of fungal infections after liver transplantation. Mycoses 2013; 56:350-7. [DOI: 10.1111/myc.12041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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15
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David AI, Coelho MPV, Paes AT, Leite AK, Della Guardia B, de Almeida MD, Meira SP, de Rezende MB, Afonso RC, Ferraz-Neto BH. Liver transplant outcome: a comparison between high and low MELD score recipients. EINSTEIN-SAO PAULO 2012; 10:57-61. [PMID: 23045827 DOI: 10.1590/s1679-45082012000100012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To compare low and high MELD scores and investigate whether existing renal dysfunction has an effect on transplant outcome. METHODS Data was prospectively collected among 237 liver transplants (216 patients) between March 2003 and March 2009. Patients with cirrhotic disease submitted to transplantation were divided into three groups: MELD > or = 30, MELD < 30, and hepatocellular carcinoma. Renal failure was defined as a +/- 25% decline in estimated glomerular filtration rate as observed 1 week after the transplant. Median MELD scores were 35, 21, and 13 for groups MELD > or = 30, MELD < 30, and hepatocellular carcinoma, respectively. RESULTS Recipients with MELD > or = 30 had more days in Intensive Care Unit, longer hospital stay, and received more blood product transfusions. Moreover, their renal function improved after liver transplant. All other groups presented with impairment of renal function. Mortality was similar in all groups, but renal function was the most important variable associated with morbidity and length of hospital stay. CONCLUSION High MELD score recipients had an improvement in the glomerular filtration rate after 1 week of liver transplantation.
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Experience Since MELD Implementation: How Does the New System Deliver? Int J Hepatol 2012; 2012:264015. [PMID: 23091734 PMCID: PMC3467768 DOI: 10.1155/2012/264015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 09/03/2012] [Accepted: 09/03/2012] [Indexed: 12/12/2022] Open
Abstract
Because of increasing waiting-list mortality, the MELD (Model for End-Stage Liver Disease) allocation system was implemented within most countries of the Eurotransplant area on December 16, 2006. Five years have now passed, and we review in this paper the effects of the MELD-based allocation upon the waiting list for liver transplantation, on peri-operative management and on postoperative outcome. Giving priority to sicker patients on the waiting list has resulted in a significant increase in mean MELD score at the time of organ allocation. Consequently, there has also been a significant reduction in waiting-list mortality. However, in Germany a worsening in postoperative outcome, mainly in the group of high-MELD recipients (≥30 points), has been reported. This paper presents comprehensive results following liver transplantation within the MELD era. Especially for the group of high-risk recipients, risk factors for impaired survival are presented and discussed.
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Dutkowski P, Oberkofler CE, Béchir M, Müllhaupt B, Geier A, Raptis DA, Clavien PA. The model for end-stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: a prospective outcome analysis. Liver Transpl 2011; 17:674-84. [PMID: 21618688 DOI: 10.1002/lt.22228] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We analyzed the first 100 patients who underwent liver transplantation by Model for End-Stage Liver Disease (MELD) allocation, and compared the outcome of patients on the waiting list and after orthotopic liver transplantation with the last 100 patients who underwent transplantation prior to the introduction of the MELD system in July 2007. MELD allocation resulted in decreased waiting list mortality (386 versus 242 deaths per 1000 patient-years, P < 0.0001) and the transplantation of sicker recipients (uncorrected median MELD score 13.5 versus 20, P = 0.003). Recipient posttransplant morbidity was significantly higher, mainly caused by increased percentage of renal failure requiring renal replacement therapy (13 versus 46%, P < 0.0001). However, kidney function recovered in most cases within 6 months after OLT. Hospital mortality remained similar in both groups (6% versus 9%). Patient 1-year survival was 91% versus 83% (pre-MELD versus MELD era, P = 0.2154), graft 1-year survival was 88% versus 78% (P = 0.1013), respectively. Costs accumulated were significantly higher after introduction of the MELD policy (US $81,967 versus US $127,453, a 55% increase, P = 0.02) with a strong correlation with the individual MELD score (P < 0.0001). The MELD system addresses the goal of fairness well. However, the postoperative course appears more difficult in the MELD era with increased financial burden, but reasonable patient and graft survival. This is the inevitable price to balance justice and utility in liver graft allocation.
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Affiliation(s)
- Philipp Dutkowski
- Swiss Hepato-Pancreatico-Biliary and Transplant Center, Department of Surgery, Zürich, Switzerland
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Lichtenstern C, Müller M, Schmidt J, Mayer K, Weigand MA. [Intensive therapy after solid organ transplantation]. Anaesthesist 2011; 59:1135-52; quiz 1153-4. [PMID: 21136032 PMCID: PMC7096098 DOI: 10.1007/s00101-010-1822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Transplantationsmedizin ist eine interdisziplinäre Aufgabe. Oberstes Ziel ist die schnelle Wiederherstellung der individuellen Eigenständigkeit des Patienten. Nach einer Nierentransplantation sind die Überwachung der Organperfusion, ein adäquater Volumenstatus und die Vermeidung einer nephrotoxischen Medikation entscheidend. Die Betreuung von Patienten mit einer weit fortgeschrittenden Leberinsuffizienz ist nach Einführung des „Model-of-end-stage-liver-disease“- (MELD-)Systems häufiger geworden; dies geht mit dem Anstieg des Anteils komplikationsträchtiger Verläufe einher. Die Überwachung der Transplantatfunktion, die Diagnose früher Perfusions- oder Gallengangskomplikationen, eine spezifische Gerinnungssubstitution und die hämodynamische Optimierung im Sinne der Vermeidung einer Leberstauung sind die Eckpunkte der intensivmedizinischen Betreuung. Viele Patienten zur Herztransplantation sind bereits präoperativ aufgrund der stark eingeschränkten Herzfunktion in intensivmedizinischer Behandlung. Eine differenzierte Unterstützung der Transplantatfunktion mithilfe pulmonalarterieller Dilatatoren und Inotropika ist postoperativ regelhaft notwendig. Die Lungentransplantation zielt besonders auf eine Verbesserung der Lebensqualität der Patienten. Postoperativ ist auf die Limitierung des pulmonalarteriellen Drucks, die Vermeidung einer Flüssigkeitsüberladung und die zügige Entwöhnung vom Respirator zu achten.
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Affiliation(s)
- C Lichtenstern
- Klinik für Anaesthesiologie und Operative Intensivmedizin, Universitätsklinikum Giessen und Marburg, Standort Giessen, Rudolf-Buchheim Str. 7, 35392, Giessen, Deutschland.
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Batista TP, Sabat BD, Melo PSV, Miranda LEC, Fonseca-Neto OCL, Amorim AG, Lacerda CM. Impact of MELD allocation policy on survival outcomes after liver transplantation: a single-center study in northeast Brazil. Clinics (Sao Paulo) 2011; 66:57-64. [PMID: 21437437 PMCID: PMC3044564 DOI: 10.1590/s1807-59322011000100011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 10/13/2010] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To analyze the impact of model for end-stage liver disease (MELD) allocation policy on survival outcomes after liver transplantation (LT). INTRODUCTION Considering that an ideal system of grafts allocation should also ensure improved survival after transplantation, changes in allocation policies need to be evaluated in different contexts as an evolutionary process. METHODS A retrospective cohort study was carried out among patients who underwent LT at the University of Pernambuco. Two groups of patients transplanted before and after the MELD allocation policy implementation were identified and compared using early postoperative mortality and post-LT survival as end-points. RESULTS Overall, early postoperative mortality did not significantly differ between cohorts (16.43% vs. 8.14%; p = 0.112). Although at 6 and 36-months the difference between pre-vs. post-MELD survival was only marginally significant (p = 0.066 and p = 0.063; respectively), better short, medium and long-term post-LT survival were observed in the post-MELD period. Subgroups analysis showed special benefits to patients categorized as nonhepatocellular carcinoma (non-HCC) and moderate risk, as determined by MELD score (15-20). DISCUSSION This study ensured a more robust estimate of how the MELD policy affected post-LT survival outcomes in Brazil and was the first to show significantly better survival after this new policy was implemented. Additionally, we explored some potential reasons for our divergent survival outcomes. CONCLUSION Better survival outcomes were observed in this study after implementation of the MELD criterion, particularly amongst patients categorized as non-HCC and moderate risk by MELD scoring. Governmental involvement in organ transplantation was possibly the main reason for improved survival.
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Affiliation(s)
- Thales Paulo Batista
- Department of Surgery and Liver Transplantation, Oswaldo Cruz University Hospital, University of Pernambuco, Recife, PE, Brazil.
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Intensivtherapie nach Transplantation solider Organe. DIE INTENSIVMEDIZIN 2011. [PMCID: PMC7123926 DOI: 10.1007/978-3-642-16929-8_80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Der Intensivmedizin kommt eine zentrale Bedeutung in Rahmen der Transplantationsmedizin zu. Aufgrund ihrer marginalen Organfunktion benötigen die Patienten nicht selten bereits im Vorfeld der Transplantation eine intensivmedizinische Versorgung, zu der dann auch die Evaluation und Listung sowie die Koordination des zeitkritischen Transplantationsablaufs gehören können. Die direkte postoperative Betreuung nach komplexen Organtransplantationen bedarf fast ausschließlich der Versorgung im Rahmen von Überwachungsstationen, in denen sowohl direkt transplantationsassoziierte Komplikationen als auch Nebenerkrankungen eine intensivmedizinische Behandlungen notwendig machen. Sie zielt auf die Stabilisierung der Organfunktion, Behandlung begleitender Organdysfunktionen, adäquate Induktion der Immunsuppression und die möglichst frühe Wiedererlangung der Eigenständigkeit des Transplantierten ab.
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Oberkofler CE, Stocker R, Raptis DA, Stover JF, Schuepbach RA, Müllhaupt B, Dutkowski P, Clavien PA, Béchir M. Same quality - higher price? The paradox of allocation: the first national single center analysis after the implementation of the new Swiss transplantation law: the ICU view. Clin Transplant 2010; 25:921-8. [DOI: 10.1111/j.1399-0012.2010.01364.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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An increase in deceased donor incidence alleviated the need for urgent adult living donor liver transplantation in a Korean high-volume center. Transplant Proc 2010; 42:1497-501. [PMID: 20620462 DOI: 10.1016/j.transproceed.2009.12.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 12/29/2009] [Indexed: 02/08/2023]
Abstract
PURPOSE This study analyzed the effects of a recent increase in deceased donors on the pattern of adult liver transplantation (OLT) in a high-volume center in Korea. METHODS OLT patterns relative to pretransplant recipient status were analyzed for 112 deceased donor LTs (DDLT) and 743 living donor OLT (LDLT) in a single center as compared to nationwide Korean data over 3 years from 2006 to 2008. RESULTS During the study period, the annual proportion of institutional urgent OLT was relatively invariable (20% to 25.2%), but the annual proportion of DDLTs to all OLT increased from 8.9% to 19.9%, as did the annual rate of DDLTs among those undergoing urgent OLT, from 18.6% to 65.8%, with a reciprocal decrease in the proportion of urgent LDLTs. Korean nationwide data also showed a noticeable increase in deceased liver graft allocation for urgency from 39.8% to 62.2% over the same time period. CONCLUSION An increase in deceased donors up to 5 per million enabled an increase in urgent adult DDLTs, alleviating the need for urgent adult LDLTs in Korea.
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Weismüller TJ, Fikatas P, Schmidt J, Barreiros AP, Otto G, Beckebaum S, Paul A, Scherer MN, Schmidt HH, Schlitt HJ, Neuhaus P, Klempnauer J, Pratschke J, Manns MP, Strassburg CP. Multicentric evaluation of model for end-stage liver disease-based allocation and survival after liver transplantation in Germany--limitations of the 'sickest first'-concept. Transpl Int 2010; 24:91-9. [PMID: 20819196 DOI: 10.1111/j.1432-2277.2010.01161.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Since the introduction of model for end-stage liver disease (MELD) in 2006, post-orthotopic liver transplantation (OLT) survival in Germany has declined. The aim of this study was to evaluate risk factors and prognostic scores for outcome. All adult OLT recipients in seven German transplant centers after MELD implementation (December 2006-December 2007) were included. Recipient data were analyzed for their influence on 1-year outcome. A total of 462 patients (mean calculated MELD = 20.5, follow-up: 1 year) were transplanted for alcoholic cirrhosis (33.1%), hepatocellular carcinoma (26.6%), Hepatitis-C (17.1%), Hepatitis-B (9.5%), primary sclerosing cholangitis (5.6%) and late graft-failure after first OLT before December 2006 (8.7%). 1-year patient survival was 75.8% (graft survival 71.2%) correlating with MELD parameters and serum choline esterase. MELD score >30 [odds ratio (OR) = 4.17, confidence interval: 2.57-6.78, 12-month survival = 52.6%, c-statistic = 0.669], hyponatremia (OR = 2.07), and pre-OLT hemodialysis (OR = 2.35) were the main death risk factors. In alcoholic cirrhosis (n = 153, mean MELD = 21.1) and hepatocellular carcinoma (n = 123, mean MELD = 13.5), serum bilirubin and the survival after liver transplantation score were independent outcome parameters, respectively. MELD >30 currently represents a major risk factor for outcome. Risk factors differ in individual patient subgroups. In the current German practice of organ allocation to sicker patients, outcome prediction should be considered to prevent results below acceptable standards.
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Affiliation(s)
- Tobias J Weismüller
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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Oberkofler CE, Dutkowski P, Stocker R, Schuepbach RA, Stover JF, Clavien PA, Béchir M. 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 : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:R117. [PMID: 20550662 PMCID: PMC2911764 DOI: 10.1186/cc9068] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/30/2010] [Accepted: 06/15/2010] [Indexed: 02/06/2023]
Abstract
Introduction The impact of model of end stage liver disease (MELD) score on postoperative morbidity and mortality is still elusive, especially for high MELD. There are reports of poorer patient outcome in transplant candidates with high MELD score, others though report no influence of MELD score on outcome and survival. Methods We retrospectively analyzed data of 144 consecutive liver transplant recipients over a 72-month period in our transplant unit, from January 2003 until December 2008 and performed uni- and multivariate analysis for morbidity and mortality, in particular to define the influence of MELD to these parameters. Results This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by intensive care unit (ICU) stay longer than 10 days (odds ratio 7.0) but in contrast had no negative impact on mortality. Furthermore, we identified transfusion of more than 7 units of red blood cells as independent risk factor for mortality (hazard ratio 7.6) and for prolonged ICU stay (odds ratio [OR] 7.8) together with transfusion of more than 10 units of fresh frozen plasma (OR 11.6). Postoperative renal failure is a strong predictor of morbidity (OR 7.9) and postoperative renal replacement therapy was highly associated with increased mortality (hazard ratio 6.8), as was hepato renal syndrome prior to transplantation (hazard ratio 13.2). Conclusions This study identified MELD score greater than 23 as an independent risk factor of morbidity represented by ICU stay longer than 10 days but in contrast had no negative impact on mortality. This finding supports the transplantation of patients with high MELD score but only with knowledge of increased morbidity.
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Affiliation(s)
- Christian E Oberkofler
- Department of Visceral- and Transplantation Surgery, University Hospital of Zurich, Raemistrasse 100, Zürich 8091, Switzerland.
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Weismüller TJ, Negm A, Becker T, Barg-Hock H, Klempnauer J, Manns MP, Strassburg CP. The introduction of MELD-based organ allocation impacts 3-month survival after liver transplantation by influencing pretransplant patient characteristics. Transpl Int 2009; 22:970-8. [DOI: 10.1111/j.1432-2277.2009.00915.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Neuberger J. The introduction of MELD-based organ allocation impacts 3-month survival after liver transplantation by influencing pretransplant patient characteristics. Transpl Int 2009; 22:979-81. [PMID: 19740245 DOI: 10.1111/j.1432-2277.2009.00929.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Suga K, Kawakami Y, Iwanaga H, Tokuda O, Matsunaga N. Findings of hepatopulmonary syndrome on breath-hold perfusion SPECT-CT fusion images. Ann Nucl Med 2009; 23:413-9. [PMID: 19396512 DOI: 10.1007/s12149-009-0250-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/27/2009] [Indexed: 01/29/2023]
Abstract
Pulmonary perfusion SPECT-CT fusion images were used to characterize CT manifestations of intrapulmonary arteriovenous communications (AVC) causing right-to-left shunt and hepatopulmonary syndrome (HPS). After scanning the whole body and obtaining multiple view images of the lung, deep-inspiratory breath-hold (DIBrH) SPECT was obtained in 2 patients with HPS, which was automatically and three-dimensionally co-registered with DIBrH CT. In both patients, the whole body scan depicted systemic organs and confirmed the existence of right-to-left shunt. DIBrH SPECT-CT fusion images showed that perfusion defects were predominantly located at subpleural reticulo-nodular opacities and/or dilated vessels in the lung base. Subpleural reticulo-nodular opacities and/or dilated vessels in the lung base appear to be characteristic CT manifestation of intrapulmonary AVC in HPS.
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Affiliation(s)
- Kazuyoshi Suga
- Department of Radiology, St. Hill Hospital, 1462-3 Nishikiwa, Ube, Yamaguchi, 755-0151, Japan.
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