Assessment of adult patients with chronic liver failure for liver transplantation in 2015: who and when?

McCaughan, Geoffrey W.; Crawford, Michael; Sandroussi, Charbel; Koorey, David; Bowen, David G.; Shackel, Nicholas; Strasser, Simone I.

doi:10.1111/imj.13025

Cited by 14 publications

(9 citation statements)

References 48 publications

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“…It has been shown that the MELD score can serve as an indicator of multi-organ failure [ 5 ]. The score is currently used in the allocation of organs for patients waiting for liver transplantation as it also correlates significantly with waiting list mortality [ 6 ]. The MELD score captures derangements in two critical organ systems: kidney and liver.…”

Section: Introductionmentioning

confidence: 99%

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

et al. 2017

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PurposeMELD-XI, an adapted version of Model for End-stage Liver Disease (MELD) score excluding INR, was reported to predict outcomes e.g. in patients with acute heart failure. We aimed to evaluate MELD-XI in critically ill patients admitted to an intensive care unit (ICU) for prognostic relevance.MethodsA total of 4381 medical patients (66±14 years, 2862 male) admitted to a German ICU between 2004 and 2009 were included and retrospectively investigated. Admission diagnoses were e.g. myocardial infarction (n = 2034), sepsis (n = 694) and heart failure (n = 688). We divided our patients in two cohorts basing on their MELD-XI score and evaluated the MELD-XI score for its prognostic relevance regarding short-term and long-term survival. Optimal cut-offs were calculated by means of the Youden-Index.ResultsPatients with a MELD-XI score >12 had pronounced laboratory signs of organ failure and more comorbidities.MELD-XI >12 was associated with an increase in short-term (27% vs 6%; HR 4.82, 95%CI 3.93–5.93; p<0.001) and long-term (HR 3.69, 95%CI 3.20–4.25; p<0.001) mortality. In a univariate Cox regression analysis for all patients MELD-XI was associated with increased long-term mortality (changes per score point: HR 1.06, 95%CI 1.05–1.07; p<0.001) and remained to be associated with increased mortality after correction in a multivariate regression analysis for renal failure, liver failure, lactate concentration, blood glucose concentration, oxygenation and white blood count (HR 1.04, 95%CI 1.03–1.06; p<0.001). Optimal cut-off for the overall cohort was 11 and varied remarkably depending on the admission diagnosis: myocardial infarction (9), pulmonary embolism (9), cardiopulmonary resuscitation (17) and pneumonia (17). We performed ROC-analysis and compared the AUC: SAPS2 (0.78, 95%CI 0.76–0.80; p<0.0001) and APACHE (0.76, 95%CI 0.74–0.78; p<0.003) score were superior to MELD-XI (0.71, 95%CI 0.68–0.73) for prediction of mortality.ConclusionsThe easily calculable MELD-XI score is a robust and reliable tool to predict both intra-ICU and long-term mortality in critically ill medical patients admitted to an ICU. Optimal cut-off values for MELD-XI scores seem to depend on the primary disease and need to be validated in future prospective studies. Compared to SAPS2 and APACHE score, MELD-XI lacks precision but might have comparable and even additive value, as it is easily available and independent of subjective values.

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Section: Introductionmentioning

confidence: 99%

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

et al. 2017

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“…It was believed two to three decades ago that systemic vasodilation that occurs in ESLD is able to protect the cardiovascular system from coronary artery disease (CAD). 35 However, current evidence suggests that CAD is highly prevalent in LT candidates. The overall prevalence of CAD in chronic liver disease has been reported to be between 2%-28%, increasing the mortality and morbidity rates after liver transplantation.…”

Section: Ischemic Heart Diseasementioning

confidence: 99%

“…It was believed two to three decades ago that systemic vasodilation that occurs in ESLD is able to protect the cardiovascular system from coronary artery disease (CAD) 35 . However, current evidence suggests that CAD is highly prevalent in LT candidates.…”

Section: Etiologymentioning

confidence: 99%

Acute heart failure after liver transplantation: A narrative review

Sharma

Sonny

Dalia

et al. 2020

Clinical Transplantation

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Acute heart failure (AHF) is present in a substantial proportion of patients after liver transplantation (LT), and is associated with significant morbidity and mortality. 1-4 The pretransplant hemodynamic changes (decreased systemic vascular resistance (SVR), poor ventricular response to stress and increased cardiac output) that occur in patients with end-stage liver disease (ESLD) coupled with the effects of pro-inflammatory cytokines released during reperfusion of the liver during transplantation have been implicated in both systolic and diastolic dysfunction, contributing to AHF. 5 Both ischemic and non-ischemic causes have been implicated. While ischemic heart disease, has well defined risk factors, and may be identified preoperatively, non-ischemic AHF, is a poorly understood entity and can occur in the absence of obvious risk factors. Standard preoperative workup including electrocardiogram (EKG), echocardiography at rest or on stress, or biomarkers has limitations in predicting this risk. Cirrhotic cardiomyopathy, iron overload cardiomyopathy, and stress-induced cardiomyopathy are some of the commonly implicated entities. Distinguishing one etiology from the other is difficult and multiple etiologies may coexist in the same patient. While early recognition of risk factors and diagnosis is difficult, once diagnosed, there are no clear-cut rules for candidacy of transplant in these patients and no guidelines exist to help optimize these patients prior to transplant. These patients are at a high-risk of cardiovascular collapse either during the intraoperative period or in the immediate postoperative period and approaches to mitigate these risks as

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“…A presença do apoio e suporte social foi elencada nos artigos como um critério a ser avaliado e considerado na seleção para a listagem do transplante hepático. Como justificativa principal para isso, os estudos demarcam que a abstinência convencionada para a realização do procedimento (consenso encontrado nos estudos, de um mínimo de seis meses abstinentes para ser elegível ao recebimento do órgão) está diretamente relacionada à presença ou ausência de pessoas que auxiliem o indivíduo a manter-se sem o uso de álcool (Dom, Francque & Michielsen, 2009;Heyes et al, 2016;McCaughan et al, 2016;Satapathy et al, 2015;Telles-Correia, 2011).…”

Section: Funções Da Rede Socialunclassified

Rede social significativa no processo de adoecimento de pessoas com cirrose hepática alcoólica: uma revisão integrativa.

Nardi

Moré

Peres

2017

MPS

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O presente trabalho apresenta uma revisão integrativa da produção científica nacional e internacional, sobre a relação entre a rede social configurada em torno de pessoas com cirrose hepática alcoólica e o processo de adoecimento. Foram acessadas publicações indexadas nas bases de dados PubMed/Medline, PsycINFO, LILACS, Web of Science e Scopus, no período de 2006 a 2016. Por meio da combinação de descritores encontrou-se 50 publicações, das quais 15 atenderam aos critérios de inclusão estabelecidos e constituem o corpus de análise deste artigo. Nos resultados constatou-se: a) a ausência do descritor rede social, aparecendo somente os descritores suporte social e apoio social; b) falta de referência conceitual sobre rede social, apoio social e suporte social, c) houve o predomínio de artigos cujos participantes foram as equipes de saúde de transplante hepático; d) a presença do apoio e/ou suporte social se deu no momento da avaliação para o transplante, como um recurso da equipe para controle da abstinência e cotejamento de informações a respeito do paciente e, e) a qualidade das relações estabelecidas pelo paciente foi mencionada como um aspecto importante para o processo de transplante em si. Concluiu-se que o reconhecimento das redes sociais, em termos de apoio e suporte, esteve restrito ao momento do processo de transplante, respondendo eminentemente às necessidades das equipes. Destaca-se a ausência de artigos sobre a rede social configurada ao longo do processo de adoecimento e/ou tratamento da cirrose hepática alcoólica, na perspectiva de paciente e familiares, nas bases de dados pesquisadas.

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Assessment of adult patients with chronic liver failure for liver transplantation in 2015: who and when?

Cited by 14 publications

References 48 publications

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

Model for End-stage Liver Disease excluding INR (MELD-XI) score in critically ill patients: Easily available and of prognostic relevance

Acute heart failure after liver transplantation: A narrative review

Rede social significativa no processo de adoecimento de pessoas com cirrose hepática alcoólica: uma revisão integrativa.

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