Keeping high model for end‐stage liver disease score liver transplantation candidates alive

O’Leary, Jacqueline G.; Orloff, Susan L.; Levitsky, Josh; Martin, Paul; Foley, David P.

doi:10.1002/lt.24329

Cited by 12 publications

(5 citation statements)

References 69 publications

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“…Figure 5: Continued. In all of these analyses, patients with MELD scores ≥40 were grouped with patients with lower MELD scores (9,10,14,15); however, recipients with MELD scores ≥40 are very different from most other liver transplant recipients and suffer from sarcopenia, renal failure and pretransplant infection at much higher rates (16). In the current study, 57% of recipients achieving a pretransplant MELD score ≥40 received pretransplant dialysis, and the 13% incidence of CLKT is nearly double the overall rate of 6.7% reported for 2010.…”

Section: Discussionmentioning

confidence: 99%

National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35

Nekrasov

Matsuoka

Rauf

et al. 2016

American Journal of Transplantation

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In certain regions of the United States in which organ donor shortages are persistent and competition is high, recipients wait longer and are critically ill with Model for End-Stage Liver Disease (MELD) scores ≥40 when they undergo liver transplantation. Recent implementation of Share 35 has increased the percentage of recipients transplanted at these higher MELD scores. The purpose of our study was to examine national data of liver transplant recipients with MELD scores ≥40 and to identify risk factors that affect graft and recipient survival. During the 12-year study period, 5002 adult recipients underwent deceased donor whole-liver transplantation. The 1-, 3-, 5- and 10-year graft survival rates were 77%, 69%, 64% and 50%, respectively. The 1-, 3-, 5- and 10-year patient survival rates were 80%, 72%, 67% and 53%, respectively. Multivariable analysis identified previous transplant, ventilator dependence, diabetes, hepatitis C virus, age >60 years and prolonged hospitalization prior to transplant as recipient factors increasing the risk of graft failure and death. Donor age >30 years was associated with an incrementally increased risk of graft failure and death. Recipients after implementation of Share 35 had shorter waiting times and higher graft and patient survival compared with pre-Share 35 recipients, demonstrating that some risk factors can be mitigated by policy changes that increase organ accessibility.

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Section: Discussionmentioning

confidence: 99%

National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35

Nekrasov

Matsuoka

Rauf

et al. 2016

American Journal of Transplantation

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“…An early study by the Asian Pacific Association for the Study of the Liver (APASL) defined ACLF as the deterioration of existing liver function in a patient with chronic liver disease with or without cirrhosis, in response to an acute insult . This definition excluded patients with decompensated cirrhosis due to the consensus that decompensation is a state in which recovery is dismal and it will lead to death without liver transplantation (LT) . This group neglected type C ACLF, which consists of decompensated cirrhotic patients with MOF and AD.…”

Section: Introductionmentioning

confidence: 99%

Acute‐on‐chronic liver failure exists in patients with hepatitis B virus‐related decompensated cirrhosis

Wang

Yin

et al. 2018

J of Digest Diseases

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“…However, our study had limitations, such as the patients belonged to a single center and their number was small. MELDs in our center are relatively low when compared with other parts of the world 57 . High MELDs and severe HBV infection may affect the peripheral blood NK-cell population, 58,59 which underlines the need to verify the results in a high MELD cohort.…”

Section: Discussionmentioning

confidence: 91%

“…MELDs in our center are relatively low when compared with other parts of the world. [57] High MELDs and severe HBV infection may affect the peripheral blood NK-cell population, [58,59] which underlines the need to verify the results in a high MELD cohort. The infiltrated recipient peripheral NK-cell expression in the graft of the rejecting patient and its correlation with the peripheral blood counterpart remain unknown.…”

Section: Discussionmentioning

confidence: 99%

Immature and activated phenotype of blood NK cells is associated with acute rejection in adult liver transplant

Song

Liu

Tian

et al. 2023

Liver Transplantation

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Natural killer (NK) cells contribute to liver transplant (LTx) rejection. However, the blood-circulating NK-cell dynamics of patients who experience acute rejection (AR) are unclear. Herein, we longitudinally profiled the total NK cells and their subsets, along with the expression of activating and inhibitory receptors in sequential peripheral blood mononuclear cell samples, spanning from before LTx to the first year after LTx of 32 patients with AR and 30 patients under a steady immune status. Before transplantation, patients with AR (rejectors) contained a significantly higher proportion of the immature CD56 bright CD16subset and a lower cytolytic CD56 dim CD16 + in the total blood-circulating NK cells than patients with steady immunity. Both subsets contained a high NKp30-positive population, and CD56 dim CD16 + additionally exhibited a high NKp46-positive ratio. The NKp30-positive ratio in CD56 dim CD16 + subset showed the most prominent AR predictive ability before LTx and was an independent risk factor of LTx AR. After transplantation, the blood-circulating NK cells in rejectors maintained a higher CD56 bright CD16 − and lower CD56 dim CD16 + composition than the controls throughout the first year after LTx. Moreover, both subsets maintained a high NKp30-positive ratio, and CD56 dim CD16 + retained a high NKp46-positive ratio. The blood-circulating NK cell subset composition was consistent during AR, while the expressions of NKp30 and NKp46 were augmented. Collectively, a more immature CD56 bright CD16 − subset composition and an activated phenotype of high NKp30 expression were the general properties of blood-circulating NK cells in rejected LTx recipients, and the NKp30-positive ratio in CD56 dim CD16 + NK subset before LTx possessed AR predictive potential.

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Keeping high model for end‐stage liver disease score liver transplantation candidates alive

Cited by 12 publications

References 69 publications

National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35

National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35

Acute‐on‐chronic liver failure exists in patients with hepatitis B virus‐related decompensated cirrhosis

Immature and activated phenotype of blood NK cells is associated with acute rejection in adult liver transplant

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