A new prognostic model to predict dropout from the waiting list in cirrhotic candidates for liver transplantation with MELD score &lt;18

Biselli, Maurizio; Dall'Agata, M.; Gramenzi, Annagiulia; Gitto, Stefano; Liberati, Caterina; Brodosi, Lucia; Ravaioli, Matteo; Gambato, Martina; Montalti, Roberto; Pinna, Antonio Daniele; Burra, Patrizia; Gerunda, G.E.; Cillo, Umberto; Andreone, Pietro; Bernardi, Mauro

doi:10.1111/liv.12538

Cited by 18 publications

(12 citation statements)

References 34 publications

(38 reference statements)

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“…A prognostic score able to identify patients with low MELD score (<18) at high risk of 12-month adverse outcome has recently been proposed, but it still has limited application. 41…”

Section: Prognosis Of Patients With Ascitesmentioning

confidence: 99%

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Angeli¹,

Bernardi

Villanueva³

et al. 2018

Journal of Hepatology

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The natural history of cirrhosis is characterised by an asymptomatic compensated phase followed by a decompensated phase, marked by the development of overt clinical signs, the most frequent of which are ascites, bleeding, encephalopathy, and jaundice. The following Clinical Practice Guidelines (CPGs) represent the first CPGs on the management of decompensated cirrhosis. In this context, the panel of experts, having emphasised the importance of initiating aetiologic treatment for any degree of hepatic disease at the earliest possible stage, extended its work to all the complications of cirrhosis, which had not been covered by the European Association for the Study of the Liver guidelines, namely: ascites, refractory ascites, hyponatremia, gastrointestinal bleeding, bacterial infections, acute kidney injury, hepatorenal syndrome, acute-on-chronic liver failure, relative adrenal failure, cirrhotic cardiomyopathy, hepatopulmonary syndrome, and porto-pulmonary hypertension. The panel of experts, produced these GPGs using evidence from PubMed and Cochrane database searches providing up to date guidance on the management of decompensated cirrhosis with the only purpose of improving clinical practice.

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“…A prognostic score able to identify patients with low MELD score (<18) at high risk of 12-month adverse outcome has recently been proposed, but it still has limited application. 41…”

Section: Prognosis Of Patients With Ascitesmentioning

confidence: 99%

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Angeli¹,

Bernardi

Villanueva³

et al. 2018

Journal of Hepatology

Self Cite

1,953

1,750

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“…Various scoring symptoms for patients with low MELD have been proposed and validated in order to predict the longer-term risk of waitlist dropout or liver-related death, incorporating variables such as sodium, albumin, bilirubin, renal function, hepatic encephalopathy, ascites, or varices with or without bleeding (17, 18). …”

Section: Discussionmentioning

confidence: 99%

Outcomes for liver transplant candidates listed with low model for end‐stage liver disease score

Kwong¹,

Lai²,

Dodge³

et al. 2015

Liver Transpl

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Background The Model for End-Stage Liver Disease (MELD) score, which estimates mortality within 90 days, determines priority for liver transplantation (LT). However, longer-term outcomes on the waitlist for patients who are initially listed with low MELD scores are not well-characterized. Methods All adults listed for primary liver transplantation at a single, high-volume center from 2005-12 with an initial laboratory MELD 22 or lower were evaluated. Excluded were those listed with MELD exception points, who underwent living donor LT (LDLT) or transplant at another center, or who were removed from the waitlist for non-medical reasons. Outcomes and causes of death were identified by UNOS, the National Death Index, and an electronic medical record review. Multivariable competing risk analysis evaluated predictors of death compared to deceased donor LT (DDLT). Results 893 patients were listed from 2005-12. By the end of follow-up, 27% had undergone DDLT, and 31% were removed from the waitlist for death or clinical deterioration. In competing risks assessment, only MELD 6-9, older age, lower serum albumin, lower BMI, and diabetes conferred increased risk of waitlist dropout compared to DDLT. Listing for SLK was protective against waitlist dropout. 275 patients died or were delisted for being too sick; 87% of the identifiable causes of death were directly related to end-stage liver disease or hepatocellular carcinoma. Conclusion Patients with low listing MELD scores remain at significant risk for death due to liver-related causes and may benefit from early access to transplantation, such as LDLT or acceptance of high-risk donor livers. Predictors of death compared to transplantation may allow for early identification of patients who are at risk for waitlist mortality.

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“…In the US Veterans' Administration database, for example, 48% of early mortality occurred in patients with an initial MELD of ≤20 points [6]. Another study found MELD had very poor accuracy in predicting waitlist drop-out (i.e., death or withdrawal from the list due to deterioration of medical status) in patients with MELD <18 points, with a c-statistic of only 0.582 [16]. While serum sodium concentration improves the accuracy of MELD in this sub-population, MELD-Na has not been widely adopted as an organ allocation system [17].…”

Section: Discussionmentioning

confidence: 94%

Use of the methacetin breath test to classify the risk of cirrhotic complications and mortality in patients evaluated/listed for liver transplantation

Stravitz

Reuben

Mizrahi

et al. 2015

Journal of Hepatology

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A new prognostic model to predict dropout from the waiting list in cirrhotic candidates for liver transplantation with MELD score <18

Abstract: In patients with low MELD (<18), combination of ascites, sodium, albumin, bilirubin and renal function in a new score (LIRER) discriminates patients at high risk of medium-term adverse outcome from those in whom LT may be safely deferred.

Cited by 18 publications

References 34 publications

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis

Outcomes for liver transplant candidates listed with low model for end‐stage liver disease score

Use of the methacetin breath test to classify the risk of cirrhotic complications and mortality in patients evaluated/listed for liver transplantation

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