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Abstract
End-stage liver disease (ESLD) is the culmination of progression of chronic liver disease to cirrhosis, decompensation, and chronic liver failure, featuring portal hypertension or hepatocellular failure-related complications. Liver transplantation offers improved long-term survival for these patients but is negatively influenced by donor availability, financial constraints in developing countries, active substance abuse, progression of disease or malignancy on wait-list, sepsis and extrahepatic organ involvement. In this context, palliative care (PC), an interdisciplinary medical practice that aim to prevent and relieve suffering, offers best possible quality of life and is not limited to end-of-life care. It also encompasses achievable goals such as symptom control and aggressive disease-modifying treatments or interventions that beneficially alter the natural course of the disease to offer curative intend. In this narrative review, we discuss the prognostic factors that define disease course in ESLD, various indications and challenges in PC for advanced cirrhosis and management options for major symptom burden in patients with ESLD based on evidence-based best practice.
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Key Words
- ACLF
- ACLF, acute-on-chronic liver failure
- CPT, Child–Pugh–Turcotte
- ESLD, end-stage liver disease
- HE, hepatic encephalopathy
- INR, international normalized ratio
- LSM, liver stiffness measurement
- LT, liver transplantation
- MELD, model for end stage liver disease
- PC, palliative care
- TE, transient elastography
- TIPS, transjugular intrahepatic portosystemic shunt
- ascites
- cirrhosis
- end of life care
- hepatic encephalopathy
- hyponatremia
- portal hypertension
- sepsis
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Affiliation(s)
- Cyriac A. Philips
- Department of Clinical and Translational Hepatology and the Monarch Liver Laboratory, Rajagiri Hospital, Aluva, Kerala, India
| | - Chandan K. Kedarisetty
- Department of Hepatology and Liver Transplantation, Gleneagles Global Hospital, Hyderabad, India
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Villeret F, Dharancy S, Erard D, Abergel A, Barbier L, Besch C, Boillot O, Boudjema K, Coilly A, Conti F, Corpechot C, Duvoux C, Faitot F, Faure S, Francoz C, Giostra E, Gugenheim J, Hardwigsen J, Hilleret MN, Hiriart JB, Houssel-Debry P, Kamar N, Lassailly G, Latournerie M, Pageaux GP, Samuel D, Vanlemmens C, Saliba F, Dumortier J. Inevitability of disease recurrence after liver transplantation for NAFLD cirrhosis. JHEP Rep 2023; 5:100668. [PMID: 36852108 PMCID: PMC9957774 DOI: 10.1016/j.jhepr.2022.100668] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background & Aims Liver transplantation (LT) is the only available treatment for end-stage non-alcoholic fatty liver disease (NAFLD) (related decompensated cirrhosis and/or hepatocellular carcinoma). The aim of our study was to evaluate the risk of disease recurrence after LT and the factors influencing it. Method This retrospective multicenter study included adults transplanted for NAFLD cirrhosis between 2000 and 2019 in 20 participating French-speaking centers. Disease recurrence (steatosis, steatohepatitis and fibrosis) was diagnosed from liver graft biopsies. Results We analyzed 150 patients with at least one graft liver biopsy available ≥6 months after transplantation, among 361 patients transplanted for NAFLD. The median (IQR) age at LT was 61.3 (54.4-64.6) years. The median follow-up after LT was 4.7 (2.8-8.1) years. The cumulative recurrence rates of steatosis and steatohepatitis at 5 years were 80.0% and 60.3%, respectively. Significant risk factors for steatohepatitis recurrence in multivariate analysis were recipient age at LT <65 years (odds ratio [OR] 4.214; p = 0.044), high-density lipoprotein-cholesterol <1.15 mmol/L after LT (OR 3.463; p = 0.013) and grade ≥2 steatosis on the graft at 1 year after LT (OR 10.196; p = 0.001). The cumulative incidence of advanced fibrosis (F3-F4) was 20.0% at 5 years after LT and significant risk factors from multivariate analysis were metabolic syndrome before LT (OR 8.550; p = 0.038), long-term use of cyclosporine (OR 11.388; p = 0.031) and grade ≥2 steatosis at 1 year after LT (OR 10.720; p = 0.049). No re-LT was performed for NAFLD cirrhosis recurrence. Conclusion Our results strongly suggest that recurrence of initial disease after LT for NAFLD is inevitable and progressive in a large proportion of patients; the means to prevent it remain to be further evaluated. Impact and implications Non-alcoholic fatty liver disease (NAFLD) is a growing indication for liver transplantation, but the analysis of disease recurrence, based on graft liver biopsies, has been poorly studied. Cumulative incidences of steatosis, steatohepatitis and NAFLD-related significant fibrosis recurrence at 5 years were 85.0%, 60.3% and 48.0%, respectively. Grade ≥2 steatosis on graft biopsy at 1 year (present in 25% of patients) is highly predictive of recurrence of steatohepatitis and advanced fibrosis: bariatric surgery should be discussed in these patients specifically.
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Key Words
- ABM, Agence de la Biomédecine
- BS, bariatric surgery
- Bariatric surgery
- CNI, calcineurin inhibitor
- CST, corticosteroid
- CV, cardiovascular
- CYA, cyclosporine
- ESLD, end-stage liver disease
- HCC, hepatocellular carcinoma
- LT, liver transplantation
- MS, metabolic syndrome
- NAFLD recurrence
- NAFLD, non-alcoholic fatty liver disease
- NASH
- NASH, non-alcoholic steatohepatitis
- liver transplantation
- mTOR-i, mTOR inhibitor
- metabolic syndrome
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Affiliation(s)
- François Villeret
- Service d’Hépatologie et de Transplantation Hépatique, Institut d’Hépatologie de Lyon, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France,Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Dharancy
- Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Domitille Erard
- Service d’Hépatologie et de Transplantation Hépatique, Institut d’Hépatologie de Lyon, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Armand Abergel
- Département de Médecine digestive, CHU Estaing, Clermont-Ferrand, France
| | - Louise Barbier
- Service de Chirurgie digestive, Oncologique et Transplantation Hépatique, Hôpital Trousseau, CHU Tours, Tours, France
| | - Camille Besch
- Service de Chirurgie Hépato-bilio-pancréatique et Transplantation Hépatique, CHRU Hautepierre, Strasbourg, France
| | - Olivier Boillot
- Fédération des Spécialités Digestives, Institut d’Hépatologie de Lyon, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Karim Boudjema
- Service de Chirurgie Hépatobiliaire et digestive, Hôpital Universitaire de Pontchaillou, Rennes, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Filomena Conti
- Sorbonne Université, CRSA, APHP, Unité Médicale de Transplantation Hépatique, Service d’Hépatogastroentérologie, Hôpital Pitié Salpêtrière, Paris, France
| | - Christophe Corpechot
- Service d'Hépatologie, Hôpital Saint-Antoine, CHU Saint-Antoine, APHP, Paris, France
| | | | - François Faitot
- Service de Chirurgie Hépato-bilio-pancréatique et Transplantation Hépatique, CHRU Hautepierre, Strasbourg, France
| | - Stéphanie Faure
- Service d’Hépato-gastroentérologie et Transplantation Hépatique, CHU Saint-Eloi, Université de Montpellier, Montpellier, France
| | - Claire Francoz
- Service d'Hépatologie et Transplantation Hépatique, Hôpital Beaujon, APHP, Clichy, France
| | - Emiliano Giostra
- Service de Gastroentérologie et Hépatologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Jean Gugenheim
- Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Université Côte d’Azur, CHU l’Archet, Nice, France
| | - Jean Hardwigsen
- Service Chirurgie Générale et Transplantation Hépatique, Hôpital La Timone, APHM, Marseille, France
| | | | - Jean-Baptiste Hiriart
- Service d'Hépatologie et de Transplantation Hépatique, CHU Haut-Lévêque, Pessac, France
| | - Pauline Houssel-Debry
- Service des Maladies du Foie, Hôpital Universitaire de Pontchaillou, CHU de Rennes, Rennes, France
| | - Nassim Kamar
- Département de Néphrologie et Transplantation d'Organes, CHU Rangueil, Toulouse, France
| | - Guillaume Lassailly
- Service des Maladies de l’Appareil Digestif, Hôpital Claude Huriez, CHRU Lille, Lille, France
| | - Marianne Latournerie
- Service d’hépatologie et de Gastro-entérologie, CHU Dijon-Bourgogne, Dijon, France
| | - Georges-Philippe Pageaux
- Service d’Hépato-gastroentérologie et Transplantation Hépatique, CHU Saint-Eloi, Université de Montpellier, Montpellier, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Claire Vanlemmens
- Service d'Hépatologie et Soins Intensifs Digestifs, CHU Jean Minjoz, Besançon, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Université Paris Saclay, Unité Inserm 1193, AP-HP, Villejuif, France
| | - Jérôme Dumortier
- Université Claude Bernard Lyon 1, Lyon, France,Fédération des Spécialités Digestives, Institut d’Hépatologie de Lyon, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France,Corresponding author. Address: Pavillons L, Hôpital Edouard Herriot, 69437 Cedex 03, Lyon, France; Tel.: (33) 4 72 11 01 11; fax: (33) 4 72 11 01 47
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Shalimar, Sheikh SS, Biswas S, Vaishnav M, Pathak P, Pachisia AV, Narang H, Prasad S, Mehta S, Dhooria A, Swaroop S, Golla R, Agarwal A, Kumar R, Acharya SK. Incidence and Predictors of Liver-Related Events in Patients With Nonalcoholic Fatty Liver Disease. J Clin Exp Hepatol 2023; 13:37-47. [PMID: 36647411 PMCID: PMC9840080 DOI: 10.1016/j.jceh.2022.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) is the commonest type of liver disease worldwide. We aimed to assess the incidence and predictors of liver-related events (LREs) and mortality in NAFLD patients. Methods NAFLD patients (n = 957) evaluated between January 2000 and November 2021 were included. Patients were categorised as noncirrhosis (NC), compensated cirrhosis (CC) and decompensated cirrhosis (DC), and the incidence of LRE and mortality were estimated and compared. Results The proportions of NC, CC and DC were 87.8% (n = 840), 8.8% (n = 84) and 3.4% (n = 33), respectively. The median follow-up duration was 3.9 (3.0-5.7) years, and the total cumulative duration was 4633 person-years. The incidence of LRE per 100 person-years was 0.14, 2.72 and 10.24 in patients with NC, CC and DC, respectively. The incidence of mortality was 0.12, 1.05 and 4.24 per 100 person-years, respectively, in the 3 groups. The causes of mortality in the 3 groups were liver related in 1/5 (20%), 3/4 (75%) and 6/9 (66.7%), respectively. Overall, the mortality rate was higher in those with diabetes than those without diabetes (log-rank P value = 0.005). On further analysis, diabetes was associated with poor outcomes only in NC group (log-rank P value = 0.036), and not in CC (log-rank P value = 0.353) or DC groups (log-rank P value = 0.771). On multivariate Cox proportional hazard analysis, age (hazard ratio [HR] 1.070), hypertension (HR 4.361) and DC (HR 15.036) were independent predictors of poor outcomes. Liver stiffness measurement, bilirubin, CC and DC were independent predictors of LRE. Conclusion In our study of NAFLD from India, the incidence of LRE was found to be similar to that seen in Western studies. In NC NAFLD, diabetes was associated with poor outcomes.
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Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- CC, compensated cirrhosis
- DC, decompensated cirrhosis
- ESLD, end-stage liver disease
- GI, gastrointestinal
- HCC, hepatocellular carcinoma
- HE, hepatic encephalopathy
- HR, hazard ratio
- LRE, liver-related events
- LSM, liver stiffness measurement
- MAFLD
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- NC, noncirrhosis
- alcohol
- decompensation
- metabolic syndrome
- portal hypertension
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Affiliation(s)
- Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sabreena S. Sheikh
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sagnik Biswas
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Manas Vaishnav
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Pathak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya V. Pachisia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Himanshu Narang
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Prasad
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Mehta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anugrah Dhooria
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shekhar Swaroop
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Rithvik Golla
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Subrat K. Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
- Pro-Chancellor, KIIT University, Bhubaneshwar, Odisha, 751024, India
- Executive Director Gastroenterology, Fortis Escorts Digestive & Liver Institute, Okhla, New Delhi, India
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Lal BB, Sood V, Jain K, Bihari C, Khanna R, Alam S. Progressive Familial Intrahepatic Cholestasis: Need for Genetic Analysis Before Liver Transplantation. J Clin Exp Hepatol 2022; 12:686-8. [PMID: 35535065 DOI: 10.1016/j.jceh.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022] Open
Abstract
The clinical course after liver transplantation (LT) in progressive familial intrahepatic cholestasis type 1 (PFIC1) is complicated by intractable diarrhoea, growth failure, graft steatosis and cirrhosis. Recent evidence from Japan suggests the role of genotype to predict outcome after LT. We report a case with pathogenic frameshift mutation who had failed partial external biliary diversion, underwent LT and his post-LT course has been complicated by intractable diarrhoea, growth failure, steatosis and fibrosis. This case highlights the fact that homozygous frameshift p.Gly197LeufsTer10 mutation in ATP8B1 is associated with poor outcome and genetic evaluation should be mandatory before subjecting the patient to LT.
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Abstract
BACKGROUND Cirrhotic cardiomyopathy refers to the structural and functional changes in the heart leading to either impaired systolic, diastolic, electrocardiographic, and neurohormonal changes associated with cirrhosis and portal hypertension. Cirrhotic cardiomyopathy is present in 50% of patients with cirrhosis and is clinically seen as impaired contractility, diastolic dysfunction, hyperdynamic circulation, and electromechanical desynchrony such as QT prolongation. In this review, we will discuss the cardiac physiology principles underlying cirrhotic cardiomyopathy, imaging techniques such as cardiac magnetic resonance imaging and scintigraphy, cardiac biomarkers, and newer echocardiographic techniques such as tissue Doppler imaging and speckle tracking, and emerging treatments to improve outcomes. METHODS We reviewed available literature from MEDLINE for randomized controlled trials, cohort studies, cross-sectional studies, and real-world outcomes using the search terms "cirrhotic cardiomyopathy," "left ventricular diastolic dysfunction," "heart failure in cirrhosis," "liver transplantation," and "coronary artery disease". RESULTS Cirrhotic cardiomyopathy is associated with increased risk of complications such as hepatorenal syndrome, refractory ascites, impaired response to stressors including sepsis, bleeding or transplantation, poor health-related quality of life and increased morbidity and mortality. The evaluation of cirrhotic cardiomyopathy should also guide the feasibility of procedures such as transjugular intrahepatic portosystemic shunt, dose titration protocol of betablockers, and liver transplantation. The use of targeted heart rate reduction is of interest to improve cardiac filling and improve the cardiac output using repurposed heart failure drugs such as ivabradine. Liver transplantation may also reverse the cirrhotic cardiomyopathy; however, careful cardiac evaluation is necessary to rule out coronary artery disease and improve cardiac outcomes in the perioperative period. CONCLUSION More data are needed on the new diagnostic criteria, molecular and biochemical changes, and repurposed drugs in cirrhotic cardiomyopathy. The use of advanced imaging techniques should be incorporated in clinical practice.
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Key Words
- 2-AG, 2-arachidonylglycerol
- 2D, two-dimensional
- AEA, Anandamide
- ANP, Atrial Natriuretic Peptide
- ASE, the American Society of Echocardiography
- AUC, area under the curve
- BA, bile acid
- BNP, Brain natriuretic peptide
- CAD, coronary artery disease
- CB-1, cannabinoid −1
- CCM, Cirrhotic Cardiomyopathy
- CMR, cardiovascular magnetic resonance imaging
- CO, cardiac output
- CT, computed tomography
- CTP, Child–Turcotte–Pugh
- CVP, central venous pressure
- DT, deceleration Time
- ECG, electrocardiogram
- ECV, extracellular volume
- EF, Ejection fraction
- EMD, electromechanical desynchrony
- ESLD, end-stage liver disease
- FXR, Farnesoid X receptor
- GI, gastrointestinal
- GLS, Global Longitudinal strain
- HCN, Hyperpolarization-activated cyclic nucleotide–gated
- HE, hepatic encephalopathy
- HF, heart failure
- HO, Heme oxygenase
- HPS, hepatopulmonary syndrome
- HR, heart rate
- HRS, hepatorenal syndrome
- HVPG, hepatic venous pressure gradient
- HfmrEF, heart failure with mid-range ejection fraction
- HfrEF, heart failure with reduced ejection fraction
- IVC, Inferior Vena Cava
- IVCD, IVC Diameter
- IVS, intravascular volume status
- L-NAME, NG-nitro-L-arginine methyl ester
- LA, left atrium
- LAVI, LA volume index
- LGE, late gadolinium enhancement
- LT, liver transplant
- LV, left ventricle
- LVDD, left ventricular diastolic dysfunction
- LVEDP, left ventricular end-diastolic pressure
- LVEDV, LV end diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, LV end systolic volume
- LVOT, left ventricular outflow tract
- MAP, mean arterial pressure
- MELD, Model for End-Stage Liver Disease
- MR, mitral regurgitation
- MRI, Magnetic resonance imaging
- MV, mitral valve
- NAFLD, Nonalcoholic fatty liver disease
- NO, nitric oxide
- NOS, Nitric oxide synthases
- NTProBNP, N-terminal proBNP
- PAP, pulmonary artery pressure
- PCWP, pulmonary capillary wedged pressure
- PHT, portal hypertension
- PWD, Pulsed-wave Doppler
- RV, right ventricle
- RVOT, right ventricular outflow tract
- SA, sinoatrial
- SD, standard deviation
- SV, stroke volume
- SVR, Systemic vascular resistance
- TDI, tissue Doppler imaging
- TIPS, transjugular intrahepatic portosystemic shunt
- TR, Tricuspid valve
- TRPV1, transient receptor potential cation channel subfamily V member 1
- TTE, transthoracic echocardiography
- USG, ultrasonography
- VTI, velocity time integral
- beta blocker
- cirrhotic cardiomyopathy
- hemodynamics in cirrhosis
- left ventricular diastolic dysfunction
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Affiliation(s)
| | - Madhumita Premkumar
- Address for correspondence: Dr. Madhumita Premkumar, M.D., D.M., Department of Hepatology, Postgraduate Institute of Medical Education and Research, 60012, Chandigarh, India. Tel.: ++91-9540951061 (mobile)
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Abstract
The liver comprises both parenchymal and non-parenchymal cells with varying functions. Cirrhosis is often complicated by the development of portal hypertension and its associated complications. Hence, assessment of liver in cirrhosis should include assessment of its structural, function of both hepatic and non-hepatic tissue and haemodynamic assessment of portal hypertension. There is no single test that can evaluate all functions of liver and assess prevalence and severity of portal hypertension. Commonly available tests like serum bilirubin, liver enzymes (alanine [ALT] and aspartate aminotransferase [AST], serum alkaline phosphatase [ALP], gamma glutamyl transpeptidase [GGT]), serum albumin and prothrombin time for assessment of liver functions partly assess liver functions. quantitative liver functions like indocyanine clearance tests [ICG-K], methacetin breath test [MBT] were developed to assess dynamic status of liver but has its own limitation and availability. Imaging based assessment of liver by transient elastography, MRI based 99 mTc-coupled asialoglycoprotein mebrofenin scan help the clinician to assess liver function, functional volume of liver left after surgery and portal hypertension [PH]. Hepatic venous pressure gradient still remains the gold standard for the assessment of portal hypertension but is invasive and not available in all centres. Combinations of blood parameters in form of various indices like fibrosis score of 4 [FIB-4], Lok index, scores like model for end stage liver disease (MELD) and Child-Turcotte Pugh score are commonly used for assessing liver function in clinical practice.
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Key Words
- 99mTc-GSA, technetium-99m galactosyl human serum albumin
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- ARFI, Acoustic Radiation Force Impulse
- AST, aspartate aminotransferase
- BUN, blood urea nitrogen
- CLD, chronic liver disease
- ESLD, end-stage liver disease
- FIB-4, fibrosis score of 4
- GGT, gamma glutamyl transpeptidase
- HVPG, Hepatic venous pressure gradient
- ICG-K, indocyanine clearance tests
- INR, International normalised ratio
- LFTs, liver function tests
- MBT, methacetin breath test
- NAFLD, non-alcoholic fatty liver disease
- PBS, primary biliary cholangitis
- PHT, portal hypertension
- PSC, primary Sclerosing cholangitis
- cirrhosis
- liver function tests
- portal hypertension
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Affiliation(s)
- Praveen Sharma
- Address for correspondence: Praveen Sharma, Associate Professor, Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India.
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Pflüger MJ, Maurer MM, Hillebrandt KH, Andreou A, Geisel D, Schmelzle M, Pratschke J, Eurich D. Intrahepatic De Novo Tumors in Liver Recipients are Highly Associated With Recurrent Viral Hepatitis. J Clin Exp Hepatol 2021; 11:435-442. [PMID: 34276150 PMCID: PMC8267361 DOI: 10.1016/j.jceh.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Long-term survival of liver transplant recipients is endangered by tumorigenesis at different sites. Little is known about primary de novo tumors developing in the graft. METHODS We analyzed the follow-up data of 2731 liver recipients that were transplanted between 1988 and 2019 at our institution (Charité - Universitätsmedizin Berlin, Department of Surgery). All cases with new intrahepatic tumors during follow-up were identified. RESULTS A total of nine patients were diagnosed at a median of 16 years (range, 2-24 years) after surgery. Eight patients presented with hepatocellular carcinoma (HCC), and one patient presented with epithelioid hemangioendothelioma (EHE). All eight HCC patients had a recurrence of the initial disease that had caused liver failure before transplantation. This was associated with viral reinfection with either HCV or HBV in seven cases. Of the nine patients, three underwent surgical resection and only one patient was alive at data abstraction. CONCLUSION Intrahepatic de novo neoplasms in the liver graft need to be considered in the long-term follow-up of liver recipients and were strongly associated with recurrent viral hepatitis in our study. Although prognosis of this rare complication is generally poor, patients may benefit from surgical resection of localized disease.
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Key Words
- AFP, alpha-fetoprotein
- ALF, acute liver failure
- CA 19-9, carbohydrate antigen 19-9
- CCA, cholangiocarcinoma
- CEA, carcinoembryonic antigen
- DCV, daclatasvir
- EHE, epithelioid hemangioendothelioma
- ESLD, end-stage liver disease
- HBIG, hepatitis B immune globulin
- HBsAg, hepatitis B surface antigen
- HCC, hepatocellular carcinoma
- IS, immunosuppressive therapy
- LT, liver transplantation
- NUCs, nucleos(t)ide analogues
- PSC, primary sclerosing cholangitis
- PTLD, post-transplantation lymphoproliferative disorder
- PegIFN, pegylated interferon
- RBV, ribavirin
- SOF, sofosbuvir
- SVR, sustained viral response
- epithelioid hemangioendothelioma
- hepatocellular carcinoma
- liver transplant
- long-term survival
- surgical resection
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Affiliation(s)
- Michael J. Pflüger
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany,Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Max M. Maurer
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Karl H. Hillebrandt
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Andreas Andreou
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany,Liver and Kidney Transplant Center, Inselspital – Bern University Hospital, Switzerland
| | - Dominik Geisel
- Department of Radiology (including Pediatric Radiology), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Dennis Eurich
- Department of Surgery, Campus Charité Mitte
- Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany,Address for correspondence. Dr. Dennis Eurich, PD, Charité – Universitätsmedizin Berlin, Department of Surgery, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.
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Burra P, Becchetti C, Germani G. NAFLD and liver transplantation: Disease burden, current management and future challenges. JHEP Rep 2020; 2:100192. [PMID: 33163950 PMCID: PMC7607500 DOI: 10.1016/j.jhepr.2020.100192] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), specifically its progressive form non-alcoholic steatohepatitis (NASH), represents the fastest growing indication for liver transplantation in Western countries. Diabetes mellitus, morbid obesity and cardiovascular disease are frequently present in patients with NAFLD who are candidates for liver transplantation. These factors require specific evaluation, including a detailed pre-surgical risk stratification, in order to improve outcomes after liver transplantation. Moreover, in the post-transplantation setting, the incidence of cardiovascular events and metabolic complications can be amplified by immunosuppressive therapy, which is a well-known driver of metabolic alterations. Indeed, patients with NASH are more prone to developing early post-transplant complications and, in the long-term, de novo malignancy and cardiovascular events, corresponding to higher mortality rates. Therefore, a tailored multidisciplinary approach is required for these patients, both before and after liver transplantation. Appropriate candidate selection, lifestyle modifications and specific assessment in the pre-transplant setting, as well as pharmacological strategies, adjustment of immunosuppression and a healthy lifestyle in the post-transplant setting, play a key role in correct management.
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Key Words
- CKD, chronic kidney disease
- CNI, calcineurin inhibitors
- DM, diabetes mellitus
- DPP-4, dipeptidyl peptidase-4
- ELTR, European Liver Transplant Registry
- ESLD, end-stage liver disease
- GLP1 RAs, glucagon-like peptide-1 receptor agonists
- Graft survival
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hypertension
- IRR, incidence rate ratio
- Immunosuppressant
- LT, liver transplant
- MAFLD, metabolic dysfunction-associated fatty liver disease
- Metabolic complication
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- New-onset diabetes after transplantation
- Non-alcoholic fatty liver disease
- Non-alcoholic steatohepatitis
- OR, odds ratio
- Obesity
- Patient survival
- SGLT2, sodium-glucose co-transporter-2
- Solid organ transplantation
- UNOS, United Network for Organ Sharing
- mTORi, mammalian target of rapamycin inhibitors
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
- Corresponding author. Address: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital. Tel.: +39 0498212892; fax: + 390498217848.
| | - Chiara Becchetti
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
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Peng JK, Chang HH, Higginson IJ, Gao W. Intensive care utilization in patients with end-stage liver disease: A population-based comparative study of cohorts with and without comorbid hepatocellular carcinoma in taiwan. EClinicalMedicine 2020; 22:100357. [PMID: 32462117 PMCID: PMC7240333 DOI: 10.1016/j.eclinm.2020.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND End-of-life intensive care may be futile and can be a cause of distress to both patients and their families. This study aimed to understand the utilization of intensive care and its associated factors in patients with End-stage liver disease (ESLD) during terminal hospitalization. METHODS Population-based retrospective cohort study using the National Health Institute Research Database of Taiwan. All adult patients with ESLD who died during their hospitalization in 2010-2013 were included. FINDINGS Of the 14,247 patients with ESLD, the majority (60·8%) was comorbid with hepatocellular carcinoma (HCC). Patients with ESLD only were younger, more deprived, more alcohol-related, and less likely to receive palliative care prior to terminal hospitalization (6·0% vs 29·2% with HCC). Compared to patients with comorbid HCC, relatively more patients without HCC were admitted to ICU (59·6% vs 22·3%), receiving CPR (11·1% vs 4·3%) and mechanical ventilation (36·3% vs 12·5%) during terminal hospitalization. Etiology of alcoholic hepatitis, esophageal varices, septicemia, pneumonia and respiratory failure, and renal failure were associated with a higher probability of ICU admission (adjusted rate ratio (aRR) range: 1·09-2·09). Prior palliative care was associated with lower probability of ICU admission (aRR range: 0·24-0·38). INTERPRETATION The intensive care utilization by patients with ESLD in their terminal hospitalization was substantial in Taiwan. Those who are not comorbid with HCC need more attention, especially in terms of their palliative care needs, choices regarding intensive care, and their healthcare utilization. FUNDING National Institute of Health Research Health Applied Research Collaboration (ARC) South London.
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Affiliation(s)
- Jen-Kuei Peng
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Address: Bessemer Road, London, SE5 9PJ, United Kingdom
- Department of Family Medicine, National Taiwan University College of Medicine, Address: No.1 Jen-Ai Road, Section 1, Taipei 100, Taiwan
- Department of Family Medicine, National Taiwan University Hospital, Address: No.7, Chung Shan South Road, Taipei 100, Taiwan
- Corresponding author: Tel.: 886-2-928595969
| | - Hao-Hsiang Chang
- Department of Family Medicine, National Taiwan University College of Medicine, Address: No.1 Jen-Ai Road, Section 1, Taipei 100, Taiwan
- Department of Family Medicine, National Taiwan University Hospital, Address: No.7, Chung Shan South Road, Taipei 100, Taiwan
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Address: Bessemer Road, London, SE5 9PJ, United Kingdom
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, Address: Bessemer Road, London, SE5 9PJ, United Kingdom
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Barakat AAEK, Nasr FM, Metwaly AA, Morsy S, Eldamarawy M. Atherosclerosis in chronic hepatitis C virus patients with and without liver cirrhosis. Egypt Heart J 2016; 69:139-147. [PMID: 29622968 PMCID: PMC5839344 DOI: 10.1016/j.ehj.2016.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/16/2016] [Indexed: 12/19/2022] Open
Abstract
Background Chronic Hepatitis C virus (HCV) infection and liver cirrhosis may be associated with atherosclerosis and coronary artery disease (CAD). There are two phases to atherosclerosis, Subclinical and Clinical. Assessment of atherosclerosis may be started at its Subclinical phase by the evaluation of Epicardial Fat Thickness (EpFT) and Carotid Intima Thickness (CIMT). Aim of the study The aim of the study was to evaluate Clinical and Subclinical atherosclerosis in chronic HCV patients with and without liver cirrhosis by evaluating CIMT and EpFT and correlating the results with Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease. Patients and methods This study involved 64 chronic HCV patients that were divided into two groups: 24 patients without liver cirrhosis and 40 patients with liver cirrhosis in addition to 20 apparently healthy volunteers serving as control. All of the 84 subjects were subjected to the following: Clinical evaluation; Routine Laboratory Evaluation (CBC, Liver Function Tests, Renal Function Tests, Serum electrolytes, Cholesterol, Triglycerides, HBs antigen and HCV antibody); ECG; Abdominal ultrasound; Echocardiographic evaluation of segmental wall motion abnormalities and EpFT and B-Mode Carotid ultrasonography for evaluation of CIMT. Results In the cirrhotic HCV group, the CIMT and EpFT were both significantly increased [Compared to control group (p = 0.000), compared to the non-cirrhotic HCV group (p = 0.000)]. In the non-cirrhotic HCV group, the CIMT and EpFT were both significantly increased compared to the control group with a p-value of 0.003 for CIMT and 0.048 for EpFT. The CIMT and EpFT were also positively correlated with each other (r = 0.456, p = 0.001). There was a statistically significant increase in the EpFT and CIMT in Child class B patients compared to Child class A (p = 0.007 for CIMT and p = 0.028 for EpFT) and in Child class C patients compared to Child class B patients (p = 0.001 for CIMT and 0.005 for EpFT). CIMT and EpFT were correlated positively with AST (r = 0.385, p = 0.002 for CIMT, and r = 0.379, p = 0.003 for EpFT), Total Bilirubin (r = 0.378, p = 0.003 for CIMT, and r = 0.384, p = 0.002 for EpFT), INR% (r = 0.456, p = 0.001 for CIMT, and r = 0.384, p = 0.001 for EpFT), CRP (r = 0.378, p = 0.003 for CIMT, and r = 0.386, p = 0.002 for EpFT), spleen span (r = 0.417, p = 0.001 for CIMT, and r = 0.437, p = 0.001 for EpFT) and portal Vein Diameter (r = 0.372, p = 0.003 for CIMT, and r = 0.379, p = 0.003 for EpFT). CIMT and EpFT were correlated negatively with Albumin (r = -0.379, p = 0.003 for CIMT, and r = -0.370, p = 0.003 for EpFT), platelets count (r = -0.382, p = 0.002 for CIMT, and r = -0.378, p = 0.003 for EpFT) and Liver Span (r = -0.433, p = 0.001 for CIMT, and r = -0.424, p = 0.001 for EpFT). Conclusion EpFT and CIMT significantly increased in chronic hepatitis C virus patients especially in those with cirrhosis and closely correlated with each other. Their thickness also correlated with the Child-Pugh functional scoring of cirrhosis as well as with ultrasound and laboratory parameters that define the severity of liver disease.The echocardiographic assessment of EpFT and the carotid Doppler assessment of CIMT may provide appropriate and simple screening markers for subclinical atherosclerosis and cardiovascular risk in chronic HCV patients with and without cirrhosis.
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Key Words
- BMI, body mass index
- CAD, coronary artery disease
- CHD, coronary heart disease
- CIMT, carotid intima media thickness
- Carotid intima media thickness
- Chronic hepatitis C virus
- ESLD, end-stage liver disease
- EpFT, epicardial fat thickness
- Epicardial fat thickness
- FRS, Framingham risk score
- HBs, hepatitis B surface antigen
- HCV, chronic hepatitis C virus
- LT, liver transplantation
- Liver cirrhosis
- TTE, transthoracic echocardiography
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Affiliation(s)
| | - Fatma Mohammad Nasr
- Intensive Care Department (ICU), Theodor Bilharz Research Institute (TBRI), Giza, Egypt
- Corresponding author at: ICU, Theodor Bilharz Research Institute, 12-14 El-Nile Street, Warraq El-hadar, Giza 12411, Egypt and 15 Wadi Degla Street, Zahraa Al-Maadi, Cairo, Egypt.
| | - Amna Ahmed Metwaly
- Intensive Care Department (ICU), Theodor Bilharz Research Institute (TBRI), Giza, Egypt
| | - Sherif Morsy
- Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute (TBRI), Giza, Egypt
| | - Mervat Eldamarawy
- Intensive Care Department (ICU), Theodor Bilharz Research Institute (TBRI), Giza, Egypt
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Varghese J, Sachan D, Reddy MS, Cherian T, Jothimani D, Venugopal K, Arikichenin O, Perumalla R, Narasimhan G, Shanmugam V, Vijaya S, Venkataraman J, Rela M. Hepatitis B immunoglobulin prophylaxis after liver transplantation: experience in a tertiary transplant centre. J Clin Exp Hepatol 2014; 4:209-13. [PMID: 25755562 PMCID: PMC4284215 DOI: 10.1016/j.jceh.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/17/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prophylaxis with hepatitis B immunoglobulin (HBIG) and nucleoside analogs can prevent hepatitis B virus (HBV) recurrence after liver transplant (LT). AIM To determine the efficacy and cost of maintaining immunoprophylaxis with HBIG and hyperimmune plasma (HIP) for 6 months after LT. MATERIAL & METHODS The study included 22 HBV related LT recipients who were on entecavir and either HBIG or HIP for 6 months. Post transplant HBIG or HIP dose and cost incurred towards prophylaxis were noted. The cost of 200 IU of HBIG at the time of study was Rs 8250/- (US Dollars 135) and that of 2000 IU of HIP was Rs 8000/- (USD 130.7). The loading and maintenance costs at end of 6 months were compared between the two groups. Response to HBIG and HIP was assessed by checking for HBsAg reactivity, anti HBs titer response and HBV DNA viral load. STATISTICAL ANALYSIS Median and range, Kruskal Wallis (KW) sign rank Sum Test and Correlation Coefficient (r2) was used for analysis. RESULTS Thirteen recipients received HBIG and 9 recipients HIP. The anti HBs response to HIP was significantly high compared to HBIG (KW Sign rank Sum test P < 0.05); titers remained high until the study period. Between 8 and 30 days, the titer achieved by both HBIG and HIP was similar (KW Sign rank Sum test not significant). Despite low anti HBs titer of <100 IU/L, none of the recipients on HBIG had HBsAg reactivity while 3 on HIP had transient HBsAg positivity. The total cost with HBIG was 13.9 times the cost of HIP. CONCLUSION HIP immunoprophylaxis in combination with entecavir achieves a high anti HBs titer at a significant low cost during anhepatic and loading phase. HBV reactivation rates with HBIG and HIP is low despite low anti HBs titer.
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Key Words
- ESLD, end-stage liver disease
- HBIG, hepatitis B immunoglobulin
- HBV recurrence
- HBV, hepatitis B virus
- HBsAg, hepatitis B surface antigen
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HIP, hyper-immune plasma
- HIV, human immunodeficiency virus
- Hepatitis B virus
- KW, Kruskal Wallis
- LT, liver transplantation
- NA, nucleos(t)ide analogs
- USD, US Dollars
- anti HBs Ab, anti hepatitis B virus antibody
- hepatitis B immunoglobulin
- hyper-immune plasma
- liver transplantation
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Affiliation(s)
- Joy Varghese
- Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Deepti Sachan
- Department of Transfusion Medicine, Global Hospitals & Health City, Chennai, India
| | - Mettu S. Reddy
- Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Tom Cherian
- Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Dinesh Jothimani
- Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Kota Venugopal
- Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Olithselvan Arikichenin
- Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Rajasekar Perumalla
- Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Gomathy Narasimhan
- Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Vivekananthan Shanmugam
- Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Srinivasan Vijaya
- Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
| | - Jayanthi Venkataraman
- Department of Hepatology & Liver Transplantation, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
- Address for correspondence: Dr. Jayanthi Venkataraman, Department of Gastroenterology and Hepatology, Global Hospitals & Health City, Chennai 600 100, India. Tel.: +91 44 2277700; fax: +91 44 22777100.
| | - Mohamed Rela
- Department of Liver Transplant & Hepato Biliary Surgery, Institute of Liver Diseases & Transplantation, Global Hospitals & Health City, Chennai, India
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Abstract
Model for end-stage liver disease (MELD) score, initially developed to predict survival following transjugular intrahepatic portosystemic shunt was subsequently found to be accurate predictor of mortality amongst patents with end-stage liver disease. Since 2002, MELD score using 3 objective variables (serum bilirubin, serum creatinine, and institutional normalized ratio) has been used worldwide for listing and transplanting patients with end-stage liver disease allowing transplanting sicker patients first irrespective of the wait time on the list. MELD score has also been shown to be accurate predictor of survival amongst patients with alcoholic hepatitis, following variceal hemorrhage, infections in cirrhosis, after surgery in patients with cirrhosis including liver resection, trauma, and hepatorenal syndrome (HRS). Although, MELD score is closest to the ideal score, there are some limitations including its inaccuracy in predicting survival in 15-20% cases. Over the last decade, many efforts have been made to further improve and refine MELD score. Until, a better score is developed, liver allocation would continue based on the currently used MELD score.
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Key Words
- AH, alcoholic hepatitis
- BAR, balance risk
- CTP, Child–Pugh–Turcotte
- Cirrhosis
- DFI, discriminate function index
- EDC, extended donor criteria
- ESLD, end-stage liver disease
- FHF, fulminant hepatic failure
- GFR, glomerular filtration rate
- HVPG, hepatic venous pressure gradient
- LT, liver transplantation
- Liver transplantation
- MDRD, modification of diet in renal disease
- MELD
- MELD, model for end-stage liver disease
- MLP, multi-layer perceptron
- QALY, quality adjusted life years
- SLK, simultaneous liver kidney transplantation
- SOFA, sequential organ failure assessment
- SOFT, survival outcomes following transplantation
- TIPS, transjugular intrahepatic portosystemic
- UKELD, UK end stage liver disease score
- UNOS, United Network for Organ Sharing
- VH, variceal hemorrhage
- deMELD, drop-out equivalent MELD
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Affiliation(s)
| | - Patrick S. Kamath
- Address for correspondence: Patrick S. Kamath, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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