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Brennan PN, MacMillan M, Manship T, Moroni F, Glover A, Graham C, Semple S, Morris DM, Fraser AR, Pass C, McGowan NWA, Turner ML, Lachlan N, Dillon JF, Campbell JDM, Fallowfield JA, Forbes SJ. Study protocol: a multicentre, open-label, parallel-group, phase 2, randomised controlled trial of autologous macrophage therapy for liver cirrhosis (MATCH). BMJ Open 2021; 11:e053190. [PMID: 34750149 PMCID: PMC8576470 DOI: 10.1136/bmjopen-2021-053190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Liver cirrhosis is a growing global healthcare challenge. Cirrhosis is characterised by severe liver fibrosis, organ dysfunction and complications related to portal hypertension. There are no licensed antifibrotic or proregenerative medicines and liver transplantation is a scarce resource. Hepatic macrophages can promote both liver fibrogenesis and fibrosis regression. The safety and feasibility of peripheral infusion of ex vivo matured autologous monocyte-derived macrophages in patients with compensated cirrhosis has been demonstrated. METHODS AND ANALYSIS The efficacy of autologous macrophage therapy, compared with standard medical care, will be investigated in a cohort of adult patients with compensated cirrhosis in a multicentre, open-label, parallel-group, phase 2, randomised controlled trial. The primary outcome is the change in Model for End-Stage Liver Disease score at 90 days. The trial will provide the first high-quality examination of the efficacy of autologous macrophage therapy in improving liver function, non-invasive fibrosis markers and other clinical outcomes in patients with compensated cirrhosis. ETHICS AND DISSEMINATION The trial will be conducted according to the ethical principles of the Declaration of Helsinki 2013 and has been approved by Scotland A Research Ethics Committee (reference 15/SS/0121), National Health Service Lothian Research and Development department and the Medicine and Health Care Regulatory Agency-UK. Final results will be presented in peer-reviewed journals and at relevant conferences. TRIAL REGISTRATION NUMBERS ISRCTN10368050 and EudraCT; reference 2015-000963-15.
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Affiliation(s)
- Paul Noel Brennan
- Centre for Regenerative Medicine, The University of Edinburgh Medical School, Edinburgh, UK
| | - Mark MacMillan
- Centre for Regenerative Medicine, The University of Edinburgh Medical School, Edinburgh, UK
| | | | | | - Alison Glover
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | - Catriona Graham
- Deanery of Clinical Sciences, The University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
| | - David M Morris
- Centre for Cardiovascular Science, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
| | | | - Chloe Pass
- Tissues, Cells and Advanced Therapeutics, SNBTS, Edinburgh, UK
| | | | - Marc L Turner
- Tissues, Cells and Advanced Therapeutics, SNBTS, Edinburgh, UK
| | - Neil Lachlan
- Department of Gastroenterology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John F Dillon
- Liver Group, University of Dundee Division of Cardiovascular and Diabetes Medicine, Dundee, UK
| | | | - Jonathan Andrew Fallowfield
- Queen's Medical Research Institute, University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | - Stuart J Forbes
- Centre for Regenerative Medicine, The University of Edinburgh Deanery of Clinical Sciences, Edinburgh, UK
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Benzing C, Krezdorn N, Förster J, Hinz A, Krenzien F, Atanasov G, Schmelzle M, Hau HM, Bartels M. Health-related quality of life and affective status in liver transplant recipients and patients on the waiting list with low MELD scores. HPB (Oxford) 2016; 18:449-55. [PMID: 27154809 PMCID: PMC4857066 DOI: 10.1016/j.hpb.2016.01.546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study seeks to examine the impact of orthotopic liver transplantation (OLT) on Health-Related Quality of Life (HRQoL) and mental health in patients with different MELD scores. METHODS Patients who has undergone orthotopic liver transplant (OLT) or were on the waiting list for OLT were submitted to HRQoL and depression/anxiety assessment by questionnaire: Short-Form 36 (SF-36), Questions on Life Satisfaction (FLZ-M), Patient Health Questionnaire-4 (PHQ-4). Data were analysed following division of patients into three groups: pretransplant patients with a MELD score <10, ≥10, and OLT recipients. RESULTS The surveys were sent to 940 consecutive patients within one week in June 2013. Of these 940 patients, 869 (92.4%) met the inclusion criteria. In total, 291 (33.5%) eligible questionnaires (OLT group: 235, MELD <10: 25; MELD _10: 31) were suitable for analysis. General health (GH), vitality (VIT), and mental health (MH) were lower in both pretransplant groups compared to the OLT group (all p < 0.05). Anxiety and depression were higher in the MELD <10 group than in the OLT group (anxiety: p < 0.05; depression: p < 0.01). DISCUSSION Patients with low MELD scores seem to benefit from OLT with regards to HRQoL and mental health.
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Affiliation(s)
- Christian Benzing
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany,Correspondence Christian Benzing, Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Tel: +49 (0) 30 450 652 359. Fax: +49 (0) 30 450 552 900.
| | - Nicco Krezdorn
- Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neubergstr. 1, 30625 Hannover, Germany
| | - Julia Förster
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Philipp-Rosenthal-Str. 55, 04103 Leipzig, Germany
| | - Felix Krenzien
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Georgi Atanasov
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of General, Visceral and Transplantation Surgery, Campus Virchow, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of General, Visceral, Thoracic and Vascular Surgery, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Michael Bartels
- Department of Visceral, Transplantation, Thoracic, and Vascular Surgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Vidal-Trécan G, Kone V, Pilette C, Nousbaum JB, Doll J, Buffet C, Eugene C, Podevin P, Boutet O, Puyeo J, Conti F, Calmus Y. Subjective parameters markedly limit the referral of transplantation candidates to liver transplant centres. Liver Int 2016; 36:555-62. [PMID: 26604165 DOI: 10.1111/liv.13030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/12/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Equality of access to organ transplantation is a mandatory public health requirement. Referral from a local to a university hospital and then registration on the national waiting list are the two key steps enabling access to liver transplantation (LT). Although the latter procedure is well defined using the Model for End-stage Liver Disease score that improves equality of access, the former is mostly reliant on the practices of referring physicians. The aim of this study was to clarify the factors determining this initial step. METHODS This observational study included consecutive inpatients with cirrhosis of whatever origin in a cohort constituted between 2003 and 2008, using medical records and structured questionnaires concerning patient characteristics and the opinions of hospital clinicians. Candidates for LT were defined in line with these opinions. RESULTS Four hundred and thirty-three patients, mostly affected by alcoholic cirrhosis, were included, 21.0% of whom were considered to be candidates for LT. Factors independently associated with their candidature were: physician empathy [odds ratio (OR) = 10.8; 95% CI: 4.0-29.5], adherence to treatment (OR = 16.6; 95% CI: 3.7-75.2), geographical area (OR = 6.8; 95% CI: 2.2-21.3) and the patient's physiological age (OR = 2.3; 95% CI: 1.1-4.7). CONCLUSIONS Several subjective markers restrict the referral of patients from local hospitals to liver transplant centres. Their advancement to this second step is thus markedly weakened by initial subjectivity. The development of objective guidelines for local hospital physicians to assist them with their initial decision-making on LT is now necessary.
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Affiliation(s)
- Gwenaëlle Vidal-Trécan
- Public Health Unit: Risk Management and Quality of Care, Paris Centre University Hospital Group, AP-HP, Paris, France.,Department of Public Health, Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Research Unit (INSERM U1153) Methods Team, Methods of Therapeutic Evaluation of Chronic Diseases, Research Center Epidemiology and Biostatistics, Sorbonne Paris Cité, Paris, France
| | - Victoria Kone
- Public Health Unit: Risk Management and Quality of Care, Paris Centre University Hospital Group, AP-HP, Paris, France
| | | | | | - Jacques Doll
- Hepatogastroenterology Department, CHG de Versailles, Versailles, France
| | - Catherine Buffet
- Hepatogastroenterology Department, CHU Kremlin Bicètre, Kremlin Bicètre, France
| | - Claude Eugene
- Hepatogastroenterology Department, CHG de Poissy, Poissy, France
| | - Philippe Podevin
- Centre de Reference en Addictologie, Pitie-Salpetriere Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Olivier Boutet
- Hepatogastroenterology Department, CHG de Bagnoles sur Cèze, Bagnoles sur Cèze, France
| | - Jacques Puyeo
- Hepatogastroenterology Department, CHG de Carcassonne, Carcassonne, France
| | - Filomena Conti
- Centre de Transplantation Hepatique, Pitie-Salpetriere Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Yvon Calmus
- Centre de Transplantation Hepatique, Pitie-Salpetriere Hospital, AP-HP, Paris Descartes University, Paris, France
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Stepanova M, Wai H, Saab S, Mishra A, Venkatesan C, Younossi ZM. The outcomes of adult liver transplants in the United States from 1987 to 2013. Liver Int 2015; 35:2036-41. [PMID: 25559873 DOI: 10.1111/liv.12779] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS In the past three decades, there have been major advances in the procedure and candidate selection for liver transplantation. The aim of this study was to assess the changes in outcomes of liver transplantations in the Unites States. METHODS This observational study uses the Scientific Registry of Transplant Recipients (SRTR) that includes all liver transplants from 1987 to 2013 (N = 108 707 adults). RESULTS Four study cycles were introduced: 1987-1993, 1994-2000, 2001-2006, 2007-2013. The length of inpatient stay for receiving liver transplant substantially shortened (42-20 days), and so did the rate of acute post-transplant rejections (33-4%). The use of high risk donors and donors with chronic diseases increased significantly. Of transplant outcomes, despite recently reported unfavourable changes in clinico-demographic profile of liver transplant recipients (older age, substantial increases in all major comorbidities), the proportion of patients discharged alive increased from 78.2 to 91.8%. On the other hand, post-discharge 1-, 3- and 5-year mortality varied between 6.7 and 8.0%, 15.2 to 17.2% and 22.5 to 24.5%, respectively, and no consistent trend was found. Despite this, the rates of graft failure decreased: an approximately two-fold decrease in 1 year graft loss, and a 1.6-fold decrease in 5 year graft loss were observed. CONCLUSION Despite all improvements in liver transplant technique and patient management, the changes in post-transplant outcomes vary. While inpatient mortality, graft losses and post-transplant infect-ion rates improved substantially, post-discharge mortality remains stable because of increasing losses to competing risks in patients with non-liver comorbidities.
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Affiliation(s)
- Maria Stepanova
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Homan Wai
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Sammy Saab
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA
| | - Alita Mishra
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Chapy Venkatesan
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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Chaib E, Figueira ERR, Brunheroto A, Gatti AP, Fernandes DV, D'Albuquerque LAC. Does the patient selection with MELD score improve short-term survival in liver transplantation? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:324-7. [PMID: 24510043 DOI: 10.1590/s0102-67202013000400014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/11/2013] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The Model for End-Stage Liver Disease (MELD) score introduced in 2002 has come to improve selection of patients dying in the liver transplantation waiting list. OBJECTIVE To evaluate the short-term survival in liver transplantation around the world when MELD score was applied as selection criteria. METHODS - A review has been done at the online database PubMed/ Medline/Scielo. The expressions applied for the search were "liver transplantation and/or MELD and/or survival analysis" from 2002 to 2009. Among the 124 analyzed articles, 94 were excluded due to irrelevance of the subject and lack of information. Were considered L1, L2A and MELD>20 the sickest patient; L2B, L3 and MELD< 20 the healthiest. Was compiled the data of transplanted patients, their one-year survival rate related to MELD score and compare it with pre-MELD era. RESULTS MELD score has been applied, mainly in America and Europe patients, range from 8.4 to 30. One-year survival ranged from 66.5 to 92%. Analysis of patient survival rate significance between the pre-MELD and post-MELD era showed: Group I (L1 and L2A) x Group III (MELD>20), significant (p<0,0001); Group II (L2B and L3) x Group IV(MELD<20), not significant. Also, comparative one-year survival by country in the MELD era was search. CONCLUSION The MELD score have significantly improved short-term survival for the sickest patient on the waiting list for liver transplantation; additionally, it does not have any significant impact in survival for the healthiest patient.
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Younossi ZM, Stepanova M, Saab S, Kalwaney S, Clement S, Henry L, Frost S, Hunt S. The impact of type 2 diabetes and obesity on the long-term outcomes of more than 85 000 liver transplant recipients in the US. Aliment Pharmacol Ther 2014; 40:686-94. [PMID: 25040315 DOI: 10.1111/apt.12881] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type 2 diabetes is known to negatively impact the outcome of chronic liver disease. AIM To evaluate the impact of diabetes on the outcomes of liver transplants (LT). METHODS Study cohort included adults (>18 years) who received LT in the US between 1994 and 2013 (The Scientific Registry of Transplant Recipients). Pre- and post-transplant diabetes was recorded in patients with mortality follow-up. RESULTS We included 85 194 liver transplant recipients. Of those, 11.2% had history of pre-transplant diabetes. The most common indications for liver transplant were hepatitis C (36.4%), alcohol-related liver disease (20.6%), primary liver malignancy of unspecified aetiology (14.7%), cryptogenic cirrhosis (8.0%), hepatitis B (4.6%) and non-alcoholic steatohepatitis (3.9%). A total of 96.5% transplants were from deceased donors, and 7.9% donors had history of diabetes. During an average 6.5 years of follow-up, 31.3% recipients died and 8.8% had a graft failure. In multivariate survival analysis [at least 5 years of cohort follow-up (N = 35 870)], after adjustment for age, ethnicity, insurance type, history of chronic diseases, HCV infection and noncompliance, independent predictors of recipient mortality included the presence of pre-transplant diabetes [adjusted hazard ratio (95%CI) = 1.21 (1.12-1.30)] and developing diabetes post-transplant [1.06 (1.02-1.11)]. Donor's history of diabetes was also independently associated with higher mortality [1.10 (1.02-1.19)]. Furthermore, donor's history of diabetes was also associated with an increased the risk of liver graft failure [1.35 (1.24-1.47)]. CONCLUSIONS Presence of type 2 diabetes pre- and post-transplant, as well as presence of type 2 diabetes in the donors, are all associated with an increased risk of adverse post-transplant outcomes.
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Affiliation(s)
- Z M Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
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Wu FL, Shi KQ, Chen YP, Braddock M, Zou H, Zheng MH. Scoring systems predict the prognosis of acute-on-chronic hepatitis B liver failure: an evidence-based review. Expert Rev Gastroenterol Hepatol 2014; 8:623-32. [PMID: 24762209 DOI: 10.1586/17474124.2014.906899] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute-on-chronic hepatitis B liver failure is a devastating condition that is associated with mortality rates of over 50% and is consequent to acute exacerbation of chronic hepatitis B in patients with previously diagnosed or undiagnosed chronic liver disease. Liver transplantation is the definitive treatment to lower mortality rate, but there is a great imbalance between donation and potential recipients. An early and accurate prognostic system based on the integration of laboratory indicators, clinical events and some mathematic logistic equations is needed to optimize treatment for patients. As parts of the scoring systems, the MELD was the most common and the donor-MELD was the most innovative for patients on the waiting list for liver transplantation. This review aims to highlight the various features and prognostic capabilities of these scoring systems.
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Affiliation(s)
- Fa-Ling Wu
- Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Clinical significance of a scoring formula of liver injury for the preoperative evaluation of patients with liver cirrhosis. Eur J Gastroenterol Hepatol 2014; 26:95-100. [PMID: 24284370 DOI: 10.1097/meg.0b013e3283632189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to establish a clinical scoring formula of liver injury (SFLI) using the matter element analysis method, in order to provide the necessary information for the preoperative assessment and treatment of liver cirrhosis in clinical practice. MATERIALS AND METHODS We collected preoperative information for 12 serum biochemical markers (ALB, PA, TBil, SCr, INR, ALT, AST, γ-GT, ALP, PT, APTT, and TT) from patients with liver cirrhosis, statistically analyzed the relationship between the serum biochemical markers and the extent of liver injury, and obtained the liver injury scoring formula using the matter element analysis method. RESULTS In our formula, the serum biochemical markers of patients with different degrees of liver cirrhosis damage led to different R-values, which represented the severity of the disease and the liver functional reserve. R=1 indicates that the liver tissue is normal; 0.770≤R<1 indicates that the liver is in the early stage of cirrhosis (SFLI I stage); 0.712≤R<0.770 indicates that the liver is in the intermediate state of compensated cirrhosis and decompensated cirrhosis (SFLI I+ stage); 0.629≤R<0.712 indicates that the liver is in the decompensated cirrhosis stage with ascites (SFLI II stage); 0.401≤R<0.629 indicates that the liver is in the stage of severely decompensated cirrhosis with ascites, and patients present with varying degrees of hepatic encephalopathy, hepatic coma, and other complications. CONCLUSION The SFLI that we constructed can sensitively and accurately reflect the conditions of liver cirrhosis damage and liver functional reserve.
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Abstract
The decision to perform liver transplantation for a particular patient is never the decision of one single individual, although a single individual could preclude transplant as an option if the opportunity for referral is missed. Every physician treating patients with cirrhosis, including primary care physicians and primary gastroenterologists, should watch for the essential turning points at which a patient may become eligible for a transplant referral. Timing of referral could be assessed according to either the type of liver disease or non–disease-specific measures of disease severity. Although the MELD score is an easily accessible and convenient tool it is not as well known as CTP classification, and many cirrhotic patients under long-term management may not be being allocated a MELD score regularly calculated by their primary physicians. Because a slow progression in MELD score may occur without a change in symptoms, reaching the MELD score acceptable for transplant referral may go unrecognized. As generalists face the rising prevalence of NAFLD and the rising prevalence of cirrhosis and HCC from HCV, there will be an increasing need for education in the management of liver disease. It will be necessary for specialists and health care systems to better inform primary care physicians about the recommendations on criteria for transplant referral and the critical windows of opportunity within which they can act. Although there is a recognized knowledge gap that needs to be addressed, once a patient is in medical care, inadequate physician knowledge should never be the cause for late timing or missing the opportunity for referral.
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Affiliation(s)
- Rena K Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, 1545 Divisadero Street, Suite 307, San Francisco, CA 94143-0320, USA.
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Abolghasemi J, Eshraghian MR, Nasiri Toosi M, Mahmoodi M, Rahimi Foroushani A. Introducing an optimal liver allocation system for liver cirrhosis patients. HEPATITIS MONTHLY 2013; 13:e10479. [PMID: 24098306 PMCID: PMC3787686 DOI: 10.5812/hepatmon.10479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/08/2013] [Accepted: 02/20/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver transplantation (LT) is the only treatment option for patients with advanced liver disease. Currently, liver donation to these patients, considering priorities, is based on the Model for End-Stage Liver Disease (MELD). MELD score is a tool for predicting the risk of mortality in patients with advanced liver disease. However, few studies have so far been conducted in Iran on the efficacy of MELD score of these patients. OBJECTIVES This study reviews the present status of the MELD score and introduces a new model for optimal prediction of the risk of mortality in Iranian patients with advanced liver disease. PATIENTS AND METHODS Data required were collected from 305 patients with advanced liver disease who enrolled in a waiting list (WL) in Imam Khomeini Hospital from May 2008 to May 2009. All of the patients were followed up for at least 3 years until they died or underwent LT. Cox regression analysis was applied to select the factors affecting their mortality. Survival curves were plotted. Wilcoxson test and receiver operating characteristics curves for survival predictive model were used to compare the scores. All calculations were performed with the SPSS (version 13.0) and R softwares. RESULTS During the study, 71 (23.3%) patients died due to liver cirrhosis and 43 (14.1%) underwent LT. Viral Hepatitis (43.7%) is the most common cause of end-stage liver disease among Iranian patients. A new model (NMELD) was proposed with the use of the natural logarithms of two blood serum variables (total bilirubin and albumin) and the patients' age (year) by applying the Cox model: NMELD = 10 × (0.736 × ln (bilirubin) - 1.312 × ln (albumin) + 0.025 × age + 1.776). CONCLUSIONS The results of the Wilcoxon test showed that there is a significant difference between the usual MELD and our proposed NMELD scores (P < 0.001). Receiver operating characteristics curve for survival predictive model indicated that the NMELD score is more efficient compared with the MELD score in predicting the risk of mortality. Since serum creatinine was not significant in NMELD score, further studies to clarify this issue are suggested.
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Affiliation(s)
- Jamileh Abolghasemi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Eshraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Reza Eshraghian, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188989127, Fax: +98-2188989127, E-mail:
| | - Mohsen Nasiri Toosi
- Department of Gastroenterology, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mahmood Mahmoodi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
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Shateri K, Mohammadi A, Moloudi F, Nosair E, Ghasemi-Rad M. Correlation Between Sonographic Portal Vein Diameter and Flow Velocity With the Clinical Scoring Systems MELD and CTP in Cirrhotic Patients: Is There a Relationship? Gastroenterology Res 2012; 5:112-119. [PMID: 38952407 PMCID: PMC11216000 DOI: 10.4021/gr369w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2012] [Indexed: 07/03/2024] Open
Abstract
Background Liver cirrhosis is defined as a chronic disease of the liver with destruction of the hepatic parenchymal cells. The aim of the current study was to investigate the correlation between sonographic portal vein diameter (PVD) as well as portal flow velocity (PFV) with the clinical scoring systems; CTP and MELD in cirrhotic patients. Methods In this cross sectional study, convenience sampling enrolled 108 patients, diagnosed with liver cirrhosis. Blood samples were taken and all patients subsequently underwent Doppler sonography to determine mean portal vein velocity and diameter. Results All 108 patients (66 males and 42 females) were enrolled in study. The mean age (± SD) was 50.9 ± 17.6 years (range 13 - 85). The results of the present work revealed weak +ve correlation between MELD and CHILD scores (r = 0.629; P = 0.01). Moreover, the mean PVD showed a little or no +ve correlation with both MELD and CHILD scores (r = 0.216, P = 0.05) and (r = 0.241, P = 0.05) respectively. However, the mean PFV showed no statistical significant relationship with MELD score (P = 0.41). Conclusion Sonographic portal vein parameters cannot be a substitute for clinical grading and staging of cirrhosis; and we cannot propose it as a single acceptable diagnostic indicator in grading liver cirrhosis with accuracy.
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Affiliation(s)
- Kamran Shateri
- Department of Gastroenterology, Urmia University of Medical Sciences, Urmia, Iran
| | - Afshin Mohammadi
- Department of Radiology, Urmia University of Medical Sciences, Urmia, Iran
| | - Farzad Moloudi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Emad Nosair
- Sharjah University, UAE; and Ain Shams University, Egypt
| | - Mohammad Ghasemi-Rad
- Genius and Talented Student Organization, Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
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Kong XJ, Jiang YJ, Zhao QX, Wu J, Liu SL, Tian ZB. Values of end-stage liver disease model in assessment of prognosis in patients with decompensated liver cirrhosis. Shijie Huaren Xiaohua Zazhi 2009; 17:1786-1790. [DOI: 10.11569/wcjd.v17.i17.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the prognostic values of for end-stage liver disease (MELD) model and Child-Turcotte-Pugh (CTP) for patients with decompensated liver cirrhosis.
METHODS: From a previously collected database, 203 patients with decompensated liver cirrhosis admitted to our hospital were studied and followed up at least for one year. MELD and CTP score and classification were calculated on entry. Receiver operating characteristics curves (ROC) and the area under ROC were used to determine the ability of the scores for predicting three, six and twelve month mortality. Kaplan-Meier survival analysis (K-M) was performed using the cut-offs to establish the predictive power of each score.
RESULTS: There were 23, 39 and 85 dead cases within 3, 6 and 12 mo respectively. There was a significant correlation between the MELD and CTP score in 3, 6 and 12 mo (r = 0.76, 0.69, 0.71, P < 0.01). The areas under the receiver operating characteristics curves of MELD and CTP for the occurrence of death in 3 mo were 0.886 and 0.775. There was a significant difference in the 3 mo between two scores (P < 0.01). The areas under the receiver operating characteristics curves for MELD was 0.892 compared with 0.876 for CTP at 6 mo (P > 0.05); the area was 0.873 and 0.886 respectively at 12 mo (P > 0.05). Both MELD and CTP scores predicted the death rate and survival rate within 3, 6 and 12 mo by survival analysis (P < 0.01).
CONCLUSION: MELD is a strong prognosis predictor for the decompensated liver cirrhosis. MELD was significantly better than CTP score for predicting in-hospital mortality in 3 mo. However, these are not superior to CTP score and CTP classification in 6 and 12 mo.
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Comparison of modes of prothrombin time reporting in patients with advanced liver disease associated with viral hepatitis. J Thromb Thrombolysis 2009; 29:81-6. [DOI: 10.1007/s11239-009-0330-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Accepted: 03/12/2009] [Indexed: 01/26/2023]
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