Improvement in the Outcomes of MELD ≥ 40 Liver Transplantation

Nekrasov, Victor; Matsuoka, Lea; Kaur, Navpreet; Pita, Alejandro; Whang, Gilbert; Cao, Shu; Groshen, Susan; Alexopoulos, Sophoclis P.

doi:10.1097/tp.0000000000001738

Cited by 10 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As the UK moves to an organ allocation system based on wait list mortality it would be interesting to observe the impact on outcomes of patients after this change as those with organ failures will be more likely to receive an offer. In countries where MELD based allocation is already in use(31) it would be interesting to see if the outcomes of patients with cirrhosis and organ failure in general is different to what we report here.…”

Section: Discussioncontrasting

confidence: 62%

Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*

McPhail

Parrott

Wendon

et al. 2018

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 62%

Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*

McPhail

Parrott

Wendon

et al. 2018

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…This has been most readily demonstrated with the early implementation of the model for end-stage liver disease score when some considered the transplantation of those with scores ≥40 to be futile. 35 , 36 Surgeons frequently utilize nonquantifiable judgment, often referred to as the “eye-ball” test aiming to assess the patient’s function, skeletal muscle mass, nutritional status, and global health status and identify patients that will do well posttransplant. Most studies evaluating skeletal muscle mass have used some form of imaging for measurement of skeletal muscle mass, alone or in combination with functional assessment of physical performance or strength.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Serial Ultrasound Measurements of the Rectus Femoris Muscle Area to Assess Muscle Loss in Patients Awaiting Liver Transplantation in the Intensive Care Unit

Pita

Ziogas

et al. 2020

Transplantation Direct

Self Cite

View full text Add to dashboard Cite

Background. End-stage liver disease (ESLD) patients requiring intensive care unit (ICU) care before liver transplantation (LT) often experience significant muscle mass loss, which has been associated with mortality. In this exploratory study, we primarily aimed to assess the feasibility of serial ultrasound (US) rectus femoris muscle area (RFMA) measurements for the evaluation of progressive muscle loss in ICU-bound potential LT candidates and describe the rate of muscle loss as assessed by sequential US RFMA measurements. Secondarily, we sought to identify patient characteristics associated with muscle loss and determine how muscle loss is associated with survival. Methods. We prospectively enrolled 50 ESLD adults (≥18 y old) undergoing evaluation for LT candidacy in the ICU. A baseline computed tomography measurement of psoas muscle area (PMA) and serial bedside US measurements of RFMA were obtained. The associations between patient characteristics, PMA, RFMA, ICU stay, and survival were analyzed. Results. Rapid decline in muscle mass by RFMA measurements was ubiquitously present and correlated to baseline PMA and length of ICU stay. RFMA normalized by body surface area decreased by 0.013 cm2/m2 (95% confidence interval, 0.010-0.016; P < 0.001) for each day in the ICU. Decreased RFMA normalized by body surface area was associated with poor overall survival (adjusted hazard ratio, 0.42; 95% confidence interval, 0.18-0.99; P = 0.047). Conclusions. In this exploratory, prospective study, serial US RFMA measurements in ESLD patients in the ICU are feasible, demonstrate progressive time-dependent muscle loss, and are associated with mortality. Further large-scale assessment of this modality compared with static PMA or performance-based dynamic assessments should be performed.

show abstract

“…However, Kwang et al have recently reported a significantly improved 1year survival among patients having MELD scores of 35 or higher compared to those with lower MELD scores, 27 and another study by Nekrasov et al observed improved outcomes in patients with MELD scores of 40 or higher after the implantation of Share 35 policy. 28 Further efforts are recommended to focus on patients with NASH having MELD scores of 35 or higher to improve post-transplantation outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effects of Share 35 Policy on Liver Transplantation Outcomes for Patients With Nonalcoholic Steatohepatitis

Zhang

Boktour

2019

Prog Transpl

View full text Add to dashboard Cite

Background: To examine the temporal variation and outcomes of liver transplantation between pre- and post-Share 35 eras for patients with nonalcoholic steatohepatitis. Methods: A retrospective analysis was performed among 4380 patients with end-stage liver disease from the United Network for Organ Sharing database from 2009 to 2017 due to primary diagnosis of nonalcoholic steatohepatitis or cryptogenic cirrhosis with body mass index greater than 30. Cox regressions were used to model the effect of Share 35 policy on patient and graft survival comparing the first 3 years of Share 35 policy to an equivalent time period before. Results: The number of nonalcoholic steatohepatitis-related transplants increased from 232 (14.1%) in 2009 to 266 (20.5%) in 2017. In post-Share 35 era, average waitlist time and cold ischemic time decreased, while Model for End-Stage Liver Disease (MELD) scores increased with higher proportion of recipients having MELD ≥35. No significant difference in average length of hospitalization or survival was found after Share 35. Conclusions: The Share 35 policy benefits patients with nonalcoholic steatohepatitis from reduced liver transplantation waiting time. It is also associated with comparable outcomes in 2 eras without increasing cold ischemic time or posttransplant length of hospitalization.

show abstract

Improvement in the Outcomes of MELD ≥ 40 Liver Transplantation

Cited by 10 publications

References 17 publications

Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*

Incidence and Outcomes for Patients With Cirrhosis Admitted to the United Kingdom Critical Care Units*

Feasibility of Serial Ultrasound Measurements of the Rectus Femoris Muscle Area to Assess Muscle Loss in Patients Awaiting Liver Transplantation in the Intensive Care Unit

Effects of Share 35 Policy on Liver Transplantation Outcomes for Patients With Nonalcoholic Steatohepatitis

Contact Info

Product

Resources

About