Lack of Survival Benefit Following Liver Transplantation With MELD Exception Points for Hepatocellular Carcinoma: Beyond the Unblinding of Lady Justice

Ghabril, Marwan; Charlton, Michael

doi:10.1053/j.gastro.2015.07.028

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…68 Of note, the negative impact of PVT on mortality is limited to the first trimester after transplantation, while late survival curves remain parallel in patients with and without pre-transplant PVT. 69 In summary, whereas the parenchymal damage associated with intrahepatic PVT is well known, the effect of extrahepatic PVT on the natural history of liver disease is unclear if not doubtful. Hence, PVT appears to be an excellent marker of poor outcomes in cirrhosis, while not being an independent factor for these poor outcomes.…”

Section: Splanchnic Vein Thrombosismentioning

confidence: 99%

Anticoagulation in the cirrhotic patient

et al. 2019

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In the past, patients with liver cirrhosis were thought to be prone to increased bleeding risk. However, those with compensated liver cirrhosis actually have normal coagulative balance, which can become altered when liver function worsens, or infection, bleeding, or acute kidney insufficiency occur. When this happens, it is now recognized that patients with liver cirrhosis are at higher risk of thrombotic rather than haemorrhagic complications. Anticoagulation plays a favourable role both when used therapeutically or prophylactically. Successful anticoagulation is associated with a lower rate of decompensation and with improved survival. To date, treatment has involved the use of low molecular weight heparins and vitamin K antagonists. Preliminary data suggest that novel non-vitamin K antagonist oral anticoagulants can be used safely in patients with liver cirrhosis.

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Section: Splanchnic Vein Thrombosismentioning

confidence: 99%

Anticoagulation in the cirrhotic patient

et al. 2019

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“…There have been concerns raised that the current organ allocation system gives HCC patients an unfair advantage. 1 A recent study showed that HCC patients are more likely to be placed on LT waitlists than patients with decompensated cirrhosis. 2 In addition, increasing incidence rates of HCC further contributes to HCC becoming a major indication for LT in the US.…”

Section: Introductionmentioning

confidence: 99%

Hepatocellular Carcinoma Is the Most Common Indication for Liver Transplantation and Placement on the Waitlist in the United States

Yang

Larson

Watt

et al. 2017

Clinical Gastroenterology and Hepatology

128

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Background & Aims Management strategies for patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) have changed, along with liver allocation policies based on model for end-stage liver disease (MELD) score. We investigated etiologic-specific trends in liver transplantation in the United States (US) during different time periods. Methods We performed a retrospective study, using the United Network for Organ Sharing/Organ Procurement and Transplantation Network registry data to identify all adult patients registered for liver transplantation in the US from January 1, 2004 through December 31, 2015. For subjects listed with multiple diagnoses, HCC was considered the primary listing diagnosis. To determine whether availability of direct-acting antiviral agents, which began in 2011, affected pre-transplant (death or dropout) and post-transplant outcomes for patients with HCV infection, we compared data from the time periods of 2004–2010 and 2011–2014. We used competing risk analysis to compare differences in endpoints between these periods. Differences between periods in pre- and post-transplantation outcomes were estimated using Kaplan-Maier analysis and compared using the log-rank test. Associations between year of listing and pre-liver transplant outcome, and year of liver transplant and survival following transplant, were examined using the log-rank test. Proportional hazard regression was used to evaluate the reliability of the time period effect with potential confounders. Results Among 109,018 registrants, 18.5% were registered for liver transplantation due to HCC. In 2015, HCC was the leading diagnosis among registrants (23.9% of registrations) and recipients (27.2% of recipients). Between 2004 and 2015, the ratio of registrants with vs without HCC increased 5.6-fold for patients with HCV infection, 1.9-fold for patients with HBV infection, 2.7-fold for patients with alcohol abuse, and 10.2-fold for patients with nonalcoholic steatohepatitis. After adjusting for covariates, we associated the period of 2011–2014 with a decreased probability that HCC registrants would undergo liver transplantation (hazard ratio [HR], 0.62; P<.0001). The period of 2011–2014 was also associated with decreased probability of dropout due to deterioration or death from HCV-induced (HR, 0.90; P=.0003), HBV-induced (HR, 0.71; P=.002), or alcohol-induced (HR, 0.90; P=.01) liver disease, and an increased probability of delisting due to clinical improvement in patients with HCV infection (HR, 3.4; P<.0001), HBV infection (HR, 2.3; P=.004, or alcohol abuse (HR, 2.2; P<0.0001). The period of 2011–2014 was associated with a decreased risk of graft loss or death, with the largest effect seen in HCV-infected recipients (HR, 0.76; P<.0001). Conclusion HCC was the leading indication for liver transplantation in the US in 2015. Despite this, the probability of liver transplantation decreased the most in registrants with HCC. Pre- and post-transplantation outcomes have improved, particularly in patients with HCV...

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“…The advantage of this change, however, could not be confirmed by various authors [ 137 , 138 , 139 ], even in patients who received transplants with a new liver because of liver cancer [ 140 ].…”

Section: Acetylcholinesterase and Albumin Measurement: Importance For...mentioning

confidence: 99%

Organophosphorus Poisoning: Acute Respiratory Distress Syndrome (ARDS) and Cardiac Failure as Cause of Death in Hospitalized Patients

Ramadori

2023

IJMS

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Industrial production of food for animals and humans needs increasing amounts of pesticides, especially of organophosphates, which are now easily available worldwide. More than 3 million cases of acute severe poisoning are estimated to occur worldwide every year, and even more cases remain unreported, while 200,000–350,000 incidentally or intentionally poisoned people die every year. Diagnostic and therapeutic procedures in organophosphate poisoning have, however, remained unchanged. In addition to several neurologic symptoms (miosis, fasciculations), hypersecretion of salivary, bronchial, and sweat glands, vomiting, diarrhea, and loss of urine rapidly induce dehydration, hypovolemia, loss of conscience and respiratory distress. Within hours, signs of acidosis due to systemic hypoxia can be observed at first laboratory investigation after hospitalization. While determination of serum-cholinesterase does not have any diagnostic value, it has been established that hypoalbuminemia alone or accompanied by an increase in creatinine, lactate, or C-reactive protein serum levels has negative prognostic value. Increased serum levels of C-reactive protein are a sign of systemic ischemia. Protective mechanical ventilation should be avoided, if possible. In fact, acute respiratory distress syndrome characterized by congestion and increased weight of the lung, accompanied by heart failure, may become the cause of death. As the excess of acetylcholine at the neuronal level can persist for weeks until enough newly, locally synthesized acetylcholinesterase becomes available (the value of oximes in reducing this time is still under debate), after atropine administration, intravenous albumin and fluid infusion should be the first therapeutic interventions to reestablish normal blood volume and normal tissue oxygenation, avoiding death by cardiac arrest.

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Lack of Survival Benefit Following Liver Transplantation With MELD Exception Points for Hepatocellular Carcinoma: Beyond the Unblinding of Lady Justice

Cited by 4 publications

References 18 publications

Anticoagulation in the cirrhotic patient

Anticoagulation in the cirrhotic patient

Hepatocellular Carcinoma Is the Most Common Indication for Liver Transplantation and Placement on the Waitlist in the United States

Organophosphorus Poisoning: Acute Respiratory Distress Syndrome (ARDS) and Cardiac Failure as Cause of Death in Hospitalized Patients

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