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Liver, Biliary Tract and Pancreatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The prognosis of those with advanced liver disease is assessed by the MELD (Model for End-stage Liver Disease) score or UKELD (United Kingdom score for End-stage Liver Disease). Any patient who may be a potential candidate for transplantation should be discussed with the local transplant centre before the condition becomes terminal.
Cirrhosis in Surgery
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
For cirrhotic patients who require elective non-hepatic surgery, operative repair has traditionally been considered high risk. The most significant challenge is deciding when, or if, to operate. To guide the decision are two grading systems that quantify the severity of liver disease. The Child-Turcotte-Pugh (CTP) score is computed by rating the severity of five contributing factors (total bilirubin, serum albumin, prothrombin time, ascites, and encephalopathy) on a scale of 1–3 with the resulting score ranging from 5 to 15. Scores are then grouped into one of three grades from A to C. The Model for End-Stage Liver Disease (MELD) score was primarily developed to rate severity of end-stage liver disease among candidates for liver transplantation by predicting 90-day mortality, but is now widely used in many settings. The score is derived from incorporating international normalized ratio (INR), serum creatinine (Cr), total bilirubin, and now also serum sodium (Na). Of note, the two most heavily weighted variables in the MELD scoring system are the INR and the creatinine. The MELD score can guide the mortality risk for elective surgical procedures. Thirty-day mortality ranges from 5.7% for MELD score less than 8 to more than 50% for MELD score greater than 20 (Teh et al., 2007).
Life Care Planning for Organ Transplantation
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Waiting periods for individuals with end-stage liver failure are variable and are determined on the basis of medical acuity of the prospective recipients. UNOS has assigned a methodology for rating liver transplant patients on the waiting list, the Model for End-stage Liver Disease, referred to as MELD. MELD is a “continuous disease severity scale that is highly predictive of the risk of dying from liver disease for patients waiting on the transplant list” (UNOS, 2006). This model incorporates the patient's bilirubin, international normalized ratio (INR), and creatinine in an equation that results in a patient score of up to 40 points. Liver organ candidates with higher scores are moved forward on the waiting list, thereby increasing their opportunity to receive an organ and hopefully reducing the number of deaths due to liver failure while awaiting transplantation. Exception points are available for certain conditions such as hepatocellular carcinoma (HCC). HCC is a growing indication for liver transplantation provided that the combined tumor size is below a specific threshold (generally 9 cm). In the setting of HCC, time is of increased significance, as the liver tumors may grow too large for transplantation to remain an option.
Elevated D-Dimer levels correlate with the development of hepatorenal syndrome and a poor outcome in patients with cirrhosis
Published in Scandinavian Journal of Gastroenterology, 2022
Baode Chen, Jing Liu, Yongtao Li, Xuelin He, Cheng Zhou, Yu Chen, Min Zheng
We collected data on demographics, cause of liver cirrhosis, medical history and laboratory data from electronic medical records. All data were collected through a manual review of the medical records. In the patient with an available sCr value before admission, the most recent stable value of sCr within the last 3 months before admission was considered as baseline; In the patient without an available sCr before hospitalisation, the sCr on admission was used as baseline [19]. Patients were followed up by clinical record review until death, liver transplant (LT) or the end of follow-up. The occurrence and classification of AKI were monitored based on their clinical and laboratory data. All assays for serum biochemical parameters were routinely performed at the central clinical laboratory of this hospital. Plasma D-Dimer was analyzed on the SYSMEX CS 5100 using the INNOVANCE D-Dimer assay (Siemens Healthcare, Marburg, Germany). D-Dimer values at baseline ranged from 0.19 to 4.4 mg/l FEU. Automated sample redilution extends the measuring range up to 35.2 mg/L FEU. The coefficients of variation of D-dimer determination were 3.2%(within-run) and 5.5%(between-run). The eGFR was calculated based on the Modification of Diet in Renal Disease (MDRD) [22]. The equation of MDRD is as follow: eGFR (ml/min/1.73 m2) = 186×(sCr)−1.154× (age) −0.203× (0.742 female). Model for end-stage liver disease (MELD) score = 3.78*ln (TBil mg/dl) + 11.2*ln (INR) + 9.57*ln (Cr mg/dl) + 6.43*(Bile or alcohol = 0, Other = 1).
Prognostic value of decline in model for end-stage liver disease score and hepatic encephalopathy in hepatitis B-related acute-on-chronic liver failure patients treated with plasma exchange
Published in Scandinavian Journal of Gastroenterology, 2022
Lu Wang, Shu Zhu, Ying Liu, Lihua Zheng, Wenxiong Xu, Qiumin Luo, Yeqiong Zhang, Hong Deng, Xinhua Li, Chan Xie, Liang Peng
The model for end-stage liver disease (MELD) score is a metric for predicting the short-term prognosis of patients with liver failure and is the reference index to screen patients with liver failure for LT. Previous studies have shown that MELD scores ranging from 15 to 40 are an indication for LT [6,7]. Hepatic encephalopathy (HE) is widely acknowledged as a predominant complication in HBV-ACLF patients. A large multicenter cohort confirmed that HE was an independent risk factor for 28-day LT-free mortality in HBV-ACLF patients [8]. Due to the critical condition of HBV-ACLF patients, it is crucial to accurately evaluate the therapeutic effect of ALSS and initiate LT therapy as soon as possible to enhance the survival rate of patients. At present, it remains unclear which patient populations derive the most benefit from ALSS. Accordingly, in the present study, we investigated the predictive value of a decline in MELD score at one week combined with HE for the short-term prognosis of HBV-ACLF patients treated with PE to help clinicians in decision-making.
Excellent outcome following emergency deceased donor ABO-incompatible liver transplantation using rituximab and antigen specific immunoadsorption
Published in Scandinavian Journal of Gastroenterology, 2022
Ulrika Skogsberg Dahlgren, Gustaf Herlenius, Bengt Gustafsson, Johan Mölne, Lennart Rydberg, Andreas Socratous, William Bennet
The study population consisted of 20 emergency ABOi LTs performed between 2009 and 2019 at the Transplant Institute, Sahlgrenska University Hospital in Gothenburg, Sweden. All patients were primarily listed for a ABOid LT but were accepted for an ABOi LT as a life-saving procedure or a rescue re-transplant when their clinical status rapidly deteriorated and no ABOid/c liver was available. The indications for LT and the patient characteristics are summarized in Table 1. Seventeen recipients were adults and three were children. Seven recipients were male and 13 were female. The Model of End-Stage Liver Disease score (MELD-score) was calculated on the day of LT or the day before. Median MELD-score for the patients >12 years was 40 (range 18–40). The two patients <12 years of age had PELD scores of 21 and 8, respectively. The recipients were blood group O (n = 16), B (n = 3) and A (n = 1). Fifteen patients (75%) had a primary transplant and five (25%) had a re-transplant (four with a secondary graft and one with a tertiary graft). The total median waiting time for a LT (including waiting time for a ABOid LT) was 3 days (range 0–86).