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Torterolli F, Watanabe RK, Tabushi FI, Peixoto IL, Nassif PAN, Tefilli NL, Rocha SL, Malafaia O. BAR, SOFT AND DRI POST-HEPATIC TRANSPLANTATION: WHAT IS THE BEST FOR SURVIVAL ANALYSIS? ACTA ACUST UNITED AC 2021; 34:e1576. [PMID: 34133523 PMCID: PMC8195467 DOI: 10.1590/0102-672020210001e1576] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/29/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Liver transplantation is the treatment of choice for patients with terminal liver disease. The Balance of Risk Score (BAR), Survival Outcomes Following Liver Transplantation (SOFT) and Donor Risk Index (DRI) scores are predictive systems for post-transplant survival. AIM To evaluate the most accurate score and the best cutoff point for each predictor in the brazilian population. METHOD Retrospective cross-sectional study of 177 patients. Data on the recipient, donor and transplant were analyzed and the prognostic scores BAR, SOFT and DRI were calculated for each transplant. To determine the BAR and SOFT cutoff points associated with death in three months, ROC curves were adjusted. Results : The best cutoff point for BAR was 9 points with an area under the ROC curve=0.69 and for SOFT it was 12 points with an area under the ROC curve=0.73. The DRI score did not discriminate survival (p = 0.139). CONCLUSION The SOFT score proved to be better than BAR for survival analysis post-hepatic transplantation and the DRI was not effective.
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Affiliation(s)
| | | | - Fernando Issamu Tabushi
- Postgraduete Course in Principles of Surgery, Mackenzie Evangelical College of Paraná.,Mackenzie Evangelical College of Paraná, Curitiba, PR, Brazil
| | | | - Paulo Afonso Nunes Nassif
- Postgraduete Course in Principles of Surgery, Mackenzie Evangelical College of Paraná.,Mackenzie Evangelical College of Paraná, Curitiba, PR, Brazil
| | | | | | - Osvaldo Malafaia
- Postgraduete Course in Principles of Surgery, Mackenzie Evangelical College of Paraná.,Mackenzie Evangelical College of Paraná, Curitiba, PR, Brazil
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İdin K, Dereli S, Kaya A, Yenerçağ M, Yılmaz AS, Tayfur K, Gülcü O. Modified model for end-stage liver disease score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units. SCAND CARDIOVASC J 2021; 55:237-244. [PMID: 33491501 DOI: 10.1080/14017431.2021.1876912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The Model for End-stage Liver Disease excluding the international normalised ratio that is derived from prothrombin time which is calculated as a ratio of the patient's prothrombin time to a control prothrombin time standardized (MELD-XI) and modified MELD, which uses albumin in place of the international normalised ratio (MELD-Albumin) scores reflect liver and renal function and are predictors of mortality. However, their prognostic value in acute pulmonary embolism (APE) has not been studied. DESIGN We assessed the predictive value of the MELD scores in patients diagnosed with high-risk APE admitted to the intensive care unit. The primary outcome was 30-day mortality. RESULTS Of the 273 patients included in the study, 231 were survivors and 42 were non-survivors. The mortality rate was 15.3%. The mean MELD-XI and MELD-Albumin scores were significantly higher in the non-survivors than in the survivors (MELD XI, 11.8 ± 1.8 and 10.6 ± 1.43, respectively; p = .002; MELD-Albumin, 10.5 ± 1.6 and 8.7 ± 1.1, respectively; p = .001). The multiple logistic regression analysis identified the MELD-XI (hazard ratio: 3.029, confidence interval: 1.06-1.21, p = .007) and MELD-Albumin (hazard ratio: 1.13, confidence interval: 1.06-1.21, p = .002) scores as independent predictors of mortality. Receiver operating characteristic analysis revealed that the predictive power of the MELD-Albumin score (0.871 ± 0.014; p < .001) was higher than those of the MELD-XI (0.726 ± 0.022, p < .001), APACHE III (0.682 ± 0.024, p < .001), and PESI (0.624 ± 0.023, p < .001) scores. CONCLUSIONS The MELD-Albumin score is an easily calculable, reliable, and practical risk assessment tool and independent predictor of 30-day mortality in patients with high-risk APE.
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Affiliation(s)
- Kadir İdin
- Intensive Care Unit, Anesthesiology Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Seçkin Dereli
- Deparment of Cardiology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Ahmet Kaya
- Deparment of Cardiology, Faculty of Medicine, Ordu University, Ordu, Turkey
| | - Mustafa Yenerçağ
- Department of Cardiology, Samsun Training and Research Hospital, University of Health Sciences, Samsun, Turkey
| | - Ahmet Seyda Yılmaz
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Kaptanıderya Tayfur
- Deparment of Cardiovascular Surgery, Ordu University Faculty of Medicine, Ordu, Turkey
| | - Oktay Gülcü
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
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Arruda S, Chedid MF, Jacinto MM, Álvares-DA-Silva MR. MELD EXCEPTION POINTS PROVIDE AN ENOURMOUS ADVANTAGE FOR RECEIVING A LIVER TRANSPLANT IN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:254-261. [PMID: 32935744 DOI: 10.1590/s0004-2803.202000000-48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Current policy for listing to liver transplant (LT) may place cirrhotic patients without MELD exception points (CIR) in a disadvantageous position if compared to patients enlisted with appealed MELD scores - patients with hepatocellular carcinoma (HCC) or special conditions other than hepatocellular carcinoma (SPE). Transplant rates, delisting, and waitlist mortality of CIR, HCC, and SPE candidates were compared. OBJECTIVE The aim of this study is to counterweight the listing rate and speed of listing of HCC, SPE, and CIR patients. To the best of our knowledge, this is the first study comparing the outcomes of patients enlisted for SPE to those of HCC and CIR. In several countries worldwide, SPE patients also receive appealed MELD scores in a similar way of HCC patients. METHODS Two cohorts of patients listed for LT in a single institution were evaluated. The first cohort (C1, n=180) included all patients enlisted on August 1st, 2008, and all additional patients listed from this date until July 31st, 2009. The second cohort (C2, n=109) included all patients present on the LT list on October 1st, 2012, and all additional patients listed from this date until May 2014. RESULTS In both cohorts, HCC patients had a higher chance of receiving a LT than CIR patients (C1HR =2.05, 95%CI=1.54-2.72, P<0.0001; C2HR =3.17, 95%CI =1.83-5.52, P<0.0001). For C1, 1-year waiting list mortality was 21.6% (30.0% for CIR vs 9.5% for HCC vs 7.1% for SPE) (P<0.001). For C2, 1-year waiting list mortality was 13.3% (25.7% for CIR, 8.3% for HCC, and 4.0% for SPE) (P<0.001). Post-transplant survival was similar among the three groups. CONCLUSION Compared to CIR, SPE and HCC patients had lower wait list mortality. CIR patients had the highest waitlist mortality and the lowest odd of LT. Current LT allocation system does not allow equitable organ allocation.
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Affiliation(s)
- Soraia Arruda
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Gastroenterologia, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil.,HCPA, Programa de Transplante Hepático, Porto Alegre, RS, Brasil
| | - Marcio F Chedid
- HCPA, Programa de Transplante Hepático, Porto Alegre, RS, Brasil.,UFRGS, Faculdade de Medicina, Programa de Pós-Graduação em Cirurgia, Porto Alegre, RS, Brasil
| | | | - Mario R Álvares-DA-Silva
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Gastroenterologia, Porto Alegre, RS, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Porto Alegre, RS, Brasil.,HCPA, Programa de Transplante Hepático, Porto Alegre, RS, Brasil.,UFRGS, Faculdade de Medicina, Porto Alegre, RS, Brasil
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Vasconcellos M, Zamith LM. Impact of the MELD score on the survival of hepatocellular carcinoma transplantation patients in Brazil: a systematic review. Rev Col Bras Cir 2020; 46:e20192392. [PMID: 32022116 DOI: 10.1590/0100-6991e-20192392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022] Open
Abstract
This study aimed to analyse the predictive value of Model For End-Stage Liver Disease (MELD) score on medium- and long-term survival in transplanted hepatocellular carcinoma (HCC) patients in Brazil. The study was registered with International Prospective Register of Systematic Reviews (PROSPERO) under N# 152,363. Inclusion criteria were based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. The search was performed on the indexed databases of Lilacs, SciELO, PubMed, and Cochrane Library, and used as search strategy the following Medical Subject Headings (MeSH) terms: ((("MELD Score") OR "Model For End-Stage Liver Disease") AND "Hepatocellular Carcinoma") AND ("Brazil"). We included full-text articles published from January 2006 to October 2019. The initial search found 162 articles. After reading the available abstracts and full texts, 156 articles were excluded, totaling six articles for qualitative analysis. Although the small number of eligible articles was a limiting factor of the study, our results partially corroborated those found in the United States, United Kingdom, and Ireland. In these countries, unlike Brazil, MELD prognostic model has shown a strong association with post-liver transplant (LT) survival. However, the low predictive capacity of the model in medium- and long-term has been similar to the one of our study. The urgency of the development and validation of a post-transplant survival model for patients with HCC is set, improving the organ allocation system in Brazil.
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Affiliation(s)
- Marcel Vasconcellos
- Centro Universitário Serra dos Órgãos (UNIFESO), Faculdade de Medicina, Teresópolis, RJ, Brasil
| | - Luíza Magalhães Zamith
- Centro Universitário Serra dos Órgãos (UNIFESO), Faculdade de Medicina, Teresópolis, RJ, Brasil
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Zamper RPC, Amorim TC, Queiroz VNF, Lira JDO, Costa LGV, Takaoka F, Juffermans NP, Neto AS. Association between viscoelastic tests-guided therapy with synthetic factor concentrates and allogenic blood transfusion in liver transplantation: a before-after study. BMC Anesthesiol 2018; 18:198. [PMID: 30579327 PMCID: PMC6303918 DOI: 10.1186/s12871-018-0664-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/03/2018] [Indexed: 02/06/2023] Open
Abstract
Background Perioperative bleeding and transfusion are important causes of morbidity and mortality in patients undergoing liver transplantation. The aim of this study is to assess whether viscoelastic tests-guided therapy with the use of synthetic factor concentrates impact transfusion rates of hemocomponents in adult patients undergoing liver transplantation. Methods This is an interventional before-after comparative study. Patients undergoing liver transplantation before the implementation of a protocol using thromboelastometry and synthetic factor concentrates were compared to patients after the implementation. Primary outcome was transfusion of any hemocomponents. Secondary outcomes included: transfusion of red blood cells (RBC), fresh frozen plasma (FFP), cryoprecipitate or platelets, clinical complications, length of stay and in-hospital mortality. Results A total of 183 patients were included in the control and 54 in the intervention phase. After propensity score matching, the proportion of patients receiving any transfusion of hemocomponents was lower in the intervention phase (37.0 vs 58.4%; OR, 0.42; 95% CI, 0.20–0.87; p = 0.019). Patients in the intervention phase received less RBC (30.2 vs 52.5%; OR, 0.21; 95% CI, 0.08–0.56; p = 0.002) and FFP (5.7 vs 27.3%; OR, 0.11; 95% CI, 0.03–0.43; p = 0.002). There was no difference regarding transfusion of cryoprecipitate and platelets, complications related to the procedure, hospital length of stay and mortality. Conclusions Use of a viscoelastic test-guided transfusion algorithm with the use of synthetic factor concentrates reduces the transfusion rates of allogenic blood in patients submitted to liver transplantation. Trial registration This trial was registered retrospectively on November 15th, 2018 – clinicaltrials.gov – Identifier: NCT03756948. Electronic supplementary material The online version of this article (10.1186/s12871-018-0664-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raffael P C Zamper
- Department of Transplant Anesthesia, Hospital Israelita Albert Einstein, Rua Galeno de Almeida 107 ap 172-A, Pinheiros, SP, 05410-030, Brazil.
| | - Thiago C Amorim
- Resident of the Anesthesiology Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Veronica N F Queiroz
- Resident of the Anesthesiology Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jordana D O Lira
- Resident of the Anesthesiology Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luiz Guilherme V Costa
- Department of Transplant Anesthesia, Hospital Israelita Albert Einstein, Rua Galeno de Almeida 107 ap 172-A, Pinheiros, SP, 05410-030, Brazil
| | - Flavio Takaoka
- Department of Transplant Anesthesia, Hospital Israelita Albert Einstein, Rua Galeno de Almeida 107 ap 172-A, Pinheiros, SP, 05410-030, Brazil
| | - Nicole P Juffermans
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ary S Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Moraes ACOD, Fonseca-Neto OCLD. THE USE OF MELD SCORE (MODEL FOR END-STAGE LIVER DISEASE) AND DERIVATIVES IN CARDIAC TRANSPLANTATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 31:e1370. [PMID: 29972398 PMCID: PMC6044199 DOI: 10.1590/0102-672020180001e1370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022]
Abstract
Introduction: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. Objective: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. Method: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors “heart transplantation”, “liver disease” and “prognosis”. From the total of 111 articles found, six were selected and composed the sample. Results: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. Conclusion: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.
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Coelho JCU, Leite LDO, Molena A, Freitas ACTD, Matias JEF. BILIARY COMPLICATIONS AFTER LIVER TRANSPLANTATION. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:127-131. [PMID: 29257849 PMCID: PMC5543792 DOI: 10.1590/0102-6720201700020011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary reconstitution has been considered the Achilles's heel of liver transplantations due to its high rate of postoperative complications. AIM To evaluate the risk factors for occurrence of biliary strictures and leakages, and the most efficient methods for their treatment. METHOD Of 310 patients who underwent liver transplantation between 2001 and 2015, 182 medical records were retrospectively analyzed. Evaluated factors included demographic profile, type of transplantation and biliary reconstitution, presence of vascular and biliary complications, their treatment and results. RESULTS 153 (84.07%) deceased donor and 29 (15.93%) living donor transplantations were performed. Biliary complications occurred in 49 patients (26.92%): 28 strictures (15.38%), 14 leakages (7.7%) and seven leakages followed by strictures (3.85%). Hepatic artery thrombosis was present in 10 patients with biliary complications (20.4%; p=0,003). Percutaneous and endoscopic interventional procedures (including balloon dilation and stent insertion) were the treatment of choice for biliary complications. In case of radiological or endoscopic treatment failure, surgical intervention was performed (biliodigestive derivation or retransplantation (32.65%). Complications occurred in 25% of patients treated with endoscopic or percutaneous procedures and in 42.86% of patients reoperated. Success was achieved in 45% of patients who underwent endoscopic or percutaneous procedures and in 61.9% of those who underwent surgery. CONCLUSION Biliary complications are frequent events after liver transplantation. They often require new interventions: endoscopic and percutaneous procedures at first and surgical treatment when needed. Hepatic artery thrombosis increases the number of biliary complications.
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Affiliation(s)
| | | | - Antonio Molena
- Department of Surgery, Clinics Hospital, Federal University of Paraná, Curitiba, PR, Brazil
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Freitas ACTD, Shiguihara RS, Monteiro RT, Pazeto TL, Coelho JCU. COMPARATIVE STUDY ON LIVER TRANSPLANTATION WITH AND WITHOUT HEPATOCELLULAR CARCINOMA WITH CIRRHOSIS: ANALYSIS OF MELD, WAITING TIME AND SURVIVAL. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:21-5. [PMID: 27120734 PMCID: PMC4851145 DOI: 10.1590/0102-6720201600010006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/15/2015] [Indexed: 12/19/2022]
Abstract
Background : Liver transplantation is the usual treatment for hepatocellular carcinoma. Aim: To analyze the MELD score, waiting time and three month and one year survival for
liver transplantation in cirrhotic patients affected by hepatocellular carcinoma
or not. Methods : This was a retrospective, observational and analytical study of 93 patients
submitted to liver transplantation. Results : There were 28 hepatocellular carcinoma and 65 non-hepatocellular carcinoma
patients with no differences related to age and sex distribution. The main causes
of cirrhosis on hepatocellular carcinoma were hepatitis C virus (57.1%) and
hepatitis B virus (28.5%), more frequent than non-hepatocellular carcinoma
patients, which presented 27.7% and 4.6% respectively. The physiological and
exception MELD score on hepatocellular carcinoma were 11.9 and 22.3 points. On
non-hepatocellular carcinoma, it was 19.4 points, higher than the physiological
MELD and lower than the exception MELD on hepatocellular carcinoma. The waiting
time for transplantation was 96.2 days for neoplasia, shorter than the waiting
time for non-neoplasia patients, which was 165.6 days. Three month and one year
survival were 85.7% and 78.6% for neoplasia patients, similar to non-neoplasia,
which were 77% and 75.4%. Conclusion: Hepatocellular carcinoma patients presented lower physiological MELD score, higher
exception MELD score and shorter waiting time for transplantation when compared to
non-hepatocellular carcinoma patients. Three month and one year survival were the
same between the groups.
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Affiliation(s)
| | | | - Ruan Teles Monteiro
- Hospital de Clínicas, Federal Universtiy of Paraná, Curitiba, Paraná, Brazil
| | - Thiago Linck Pazeto
- Hospital de Clínicas, Federal Universtiy of Paraná, Curitiba, Paraná, Brazil
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Moraes ACOD, Oliveira PCD, Fonseca-Neto OCLD. THE IMPACT OF THE MELD SCORE ON LIVER TRANSPLANT ALLOCATION AND RESULTS: AN INTEGRATIVE REVIEW. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:65-68. [PMID: 28489174 PMCID: PMC5424692 DOI: 10.1590/0102-6720201700010018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/06/2016] [Indexed: 11/21/2022]
Abstract
Introduction Liver transplantation is intended to increase the survival of patients with chronic liver disease in terminal phase, as well as improved quality of life. Since the first transplant until today many changes have occurred in the organ allocation system. Objective To review the literature on the Model for End-stage Liver Disease (MELD) and analyze its correlation with survival after liver transplantation. Method An integrative literature review in Lilacs, SciELO, and Pubmed in October 2015, was realized. Were included eight studies related to the MELD score and its impact on liver transplant. Results There was predominance of transplants in male between 45-55 y. The main indications were hepatitis C, hepatocellular carcinoma and alcoholic cirrhosis. The most important factors post-surgery were related to the MELD score, the recipient age, expanded donor criteria and hemotransfusion. Conclusion The MELD system reduced the death rate in patients waiting for a liver transplant. However, this score by itself is not a good predictor of survival after liver transplantation.
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Mattos ÂZD, Mattos AAD, Sacco FKF, Hoppe L, Oliveira DMSD. Analysis of the survival of cirrhotic patients enlisted for liver transplantation in the pre- and post-MELD era in southern Brazil. ARQUIVOS DE GASTROENTEROLOGIA 2014; 51:46-52. [PMID: 24760064 DOI: 10.1590/s0004-28032014000100010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 11/04/2013] [Indexed: 12/13/2022]
Abstract
CONTEXT Transplantation is the only cure for decompensated cirrhosis. Model for End-Stage Liver Disease (MELD) is used in liver allocation. OBJECTIVES Comparing survival of enlisted populations in pre- and post-MELD eras and estimating their long-term survival. METHODS This is a retrospective study of cirrhotics enlisted for transplantation during pre- and post-MELD eras. Survival curves were generated using Kaplan-Meier's model. Cox's model was used to determine risk factors for mortality. Exponential, Weibull's, normal-log and Gompertz's models were used to estimate long-term survival. RESULTS The study included 162 patients enlisted in pre-MELD era and 184 in post-MELD period. Kaplan-Meier's survival curve of patients enlisted in post-MELD era was better than that of pre-MELD period (P = 0.009). This difference remained for long-term estimates, with a survival of 53.54% in 5 years and 44.64% in 10 years for patients enlisted in post-MELD era and of 43.17% and 41.75% for pre-MELD period. Era in which patients had been enlisted (P = 0.010) and MELD score at enlistment (P<0.001) were independently associated to survival with hazard ratios of 0.664 (95% CI-confidence interval = 0.487-0.906) and 1.069 (95% CI = 1.043-1.095). CONCLUSIONS MELD-based transplantation policy is superior to chronology-based one, promoting better survival for enlisted patients, even in long-term.
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Affiliation(s)
| | | | | | - Lísia Hoppe
- Hospital São Vicente de Paulo, Passo Fundo, RS, Brasil
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Kikuchi L, Chagas AL, Alencar RS, Paranaguá-Vezozzo DC, Carrilho FJ. Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil. Antivir Ther 2013; 18:445-9. [PMID: 23793796 DOI: 10.3851/imp2602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2012] [Indexed: 10/26/2022]
Abstract
The global hepatocellular carcinoma (HCC) incidence is widely variable, depending on geographic region and the prevalence of major risk factors. In Brazil, two large multicentre retrospective studies were performed to investigate clinical and epidemiological aspects of HCC. In the first study, performed in 1997, HCC was found in cirrhotic livers in 71% of cases. Chronic alcoholism was present in 36% of cases, chronic hepatitis B in 35% and hepatitis C in 25%. In a 2010 survey, cirrhosis was present in 98% of cases and HCV was the main aetiology (54%). Differences in HBV prevalence were found among regions. Selection of HCC treatment depends on tumour burden, liver function and performance status. Liver transplantation (LT) is the best available curative treatment for HCC in its early stage and with compromised liver function. After modifications in priority policy, the number of patients with early HCC submitted for LT has increased in the past 5 years in Brazil. Chemoembolization is the most common initial HCC therapy in early and intermediate stages of HCC in Brazil.
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Affiliation(s)
- Luciana Kikuchi
- São Paulo Clínicas Liver Cancer Group, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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Alves RCP, Fonseca EAD, Mattos CALD, Abdalla S, Gonçalves JE, Waisberg J. Predictive factors of early graft loss in living donor liver transplantation. ARQUIVOS DE GASTROENTEROLOGIA 2012; 49:157-61. [PMID: 22767004 DOI: 10.1590/s0004-28032012000200011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 03/16/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Living donor liver transplantation has become an alternative to reduce the lack of organ donation. OBJECTIVE To identify factors predictive of early graft loss in the first 3 months after living donor liver transplantation. METHODS Seventy-eight adults submitted to living donor liver transplantation were divided into group I with 62 (79.5%) patients with graft survival longer than 3 months, and group II with 16 (20.5%) patients who died and/or showed graft failure within 3 months after liver transplantation. The variables analyzed were gender, age, etiology of liver disease, Child-Pugh classification, model of end-stage liver disease (MELD score), pretransplantation serum sodium level, and graft weight-to-recipient body weight (GRBW) ratio. The GRBW ratio was categorized into < 0.8 and MELD score into >18. The chi-square test, Student t-test and uni- and multivariate analysis were used for the evaluation of risk factors for early graft loss. RESULTS MELD score <18 (P<0.001) and serum sodium level > 135 mEq/L (P = 0.03) were higher in group II than in group I. In the multivariate analysis MELD scores > 18 (P<0.001) and GRBW ratios < 0.8 (P<0.04) were significant. CONCLUSIONS MELD scores >18 and GRBW < 0.8 ratios are associated with higher probability of graft failure after living donor liver transplantation.
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