Liver transplant recipients mortality on the waiting list: long-term comparison to child-pugh classification and meld

Boin, I.F.S.F.; Leonardi, M.I.; Pinto, Amar; Leme, R.S.R; Udo, E.Y.; Stucchi, Raquel Silveira Bello; Soares, Elza Cotrim; Leonardi, Luiz Sérgio

doi:10.1016/j.transproceed.2004.03.095

Cited by 27 publications

(24 citation statements)

References 11 publications

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“…However, our data showed that the survival rate after 1 year in Child-Pugh C patients with HCC was 68.0%. This is longer than the reported survival rate of Child-Pugh C patients without HCC (45.9%) [20]. Although the results did not indicate the survival benefit of RFA directly, RFA may have a psychological advantage in terms of eradicating cancer.…”

Section: Discussionmentioning

confidence: 62%

Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma with Decompensated Cirrhosis

et al. 2011

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Background: Radiofrequency ablation (RFA) is used to treat early-stage hepatocellular carcinoma (HCC), but is sometimes avoided in patients with decompensated liver cirrhosis because of the possible side effect of deterioration of liver function. Aims: In this study, we report the safety and effects of RFA for treating HCC patients with Child-Pugh B/C liver cirrhosis. Methods: Sixty-six consecutive HCC patients with Child-Pugh B/C cirrhosis, who were treated by RFA, were enrolled in this study. We analyzed patient outcomes, the complications of RFA, and changes in liver function and tumor markers. Results: Fifty-six patients were classified as Child-Pugh class B, and 10 were classified as class C. The overall survival rates in patients with Child-Pugh B and C cirrhosis were 82 and 83% at 1 year and 47 and 31% at 3 years, respectively. Serum total bilirubin (T.Bil), albumin, prothrombin time, ascites, and encephalopathy were unchanged at 1, 3, and 6 months after RFA in patients with Child-Pugh B cirrhosis; however, serum T.Bil levels increased significantly at 6 months after RFA in 6/10 (60%) patients with Child-Pugh C cirrhosis. Hemothorax and rupture of esophageal varices were observed in 2 patients; however, there were no complications related to poor liver function. Conclusion: RFA is a useful modality for treating HCC in patients with poor liver function such as Child-Pugh B and C, but careful monitoring after RFA must be needed.

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Section: Discussionmentioning

confidence: 62%

Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma with Decompensated Cirrhosis

et al. 2011

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“…RUSSO (46) ressaltou, analisando alguns trabalhos (4,5,28) , que o sódio sérico, independentemente, foi fator de risco para mortalidade em análise multivariada. Em relação à hiponatremia, observou que os pacientes hiponatrêmicos apresentam menor sobrevida a curto e a longo prazo.…”

Section: Resultsunclassified

“…Em 2006, o consenso nacional (MESSAGE) para estudos do escore MELD (4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,23,25) não incorporou o sódio sérico ou a presença de ascite ao escore MELD.…”

Section: Introductionunclassified

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

Boin

Leonardi

Udo

et al. 2008

Arq. Gastroenterol.

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RESUMO -Racional -Utiliza-se o escore MELD (Model End-Stage Liver Disease) para o prognóstico da mortalidade em lista de espera para transplante de fígado e, em alguns estudos, para predição da sobrevida pós-operatória a longo prazo. Objetivo -Verificar a aplicação do escore MELD como predição da sobrevida após o transplante. Métodos -Por intermédio de dados coletados prospectivamente efetuou-se um estudo de coorte longitudinal retrospectivo em 232 pacientes. Excluíram-se os retransplantes, insuficiência hepática aguda, crianças e enxertos duplos ou reduzidos. Avaliaram-se os dados dos doadores: idade, sexo, peso, creatinina, bilirrubina, sódio, aspartato aminotransferase, antecedentes pessoais, causa da morte, presença de esteatose, número de critérios expandidos do doador e índice de risco do doador. Em relação aos receptores, analisaram-se as variáveis: sexo, idade, peso, doença hepática, pontos de Child-Turcotte-Pugh, escore MELD, depuração de creatinina, sódio, tempos de isquemia e de hospitalização, quantidade de hemoderivados transfundidos, presença e grau de disfunção do enxerto. A análise estatística foi efetuada usando-se a análise de regressão univariada e/ou múltipla, estatística 'c', teste exato de Fisher, método de Kaplan-Meier (teste log-rank) para sobrevida, e análise de regressão de Cox para risco de óbito ajustado para as condições clínicas. Resultados -O ponto de corte MELD para sobrevida foi 20 e de Child-Turcotte-Pugh foi 11,5. Para escore MELD maior ou igual a 20, os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e o sódio do doador. Para os hiponatrêmicos os fatores preditivos de sobrevida foram: volume de sangue transfundido, disfunção do enxerto e sódio do doador. A sobrevida estimada para pacientes com escore MELD ≥25 foi menor ao final de 12 meses (68,86% vs 39,13%). A sobrevida estimada para os pacientes sem hiponatremia foi maior (65,16% vs 44,44%). A sobrevida aos 5 e 10 anos também seguiu o mesmo padrão. O uso de doadores limítrofes não alterou a sobrevida, mas quando se utilizou o índice de risco do doador observou-se que a sobrevida foi maior para pacientes com índice de risco do doador menor que 1,7 (63,62% vs 53,70%). A associação deste índice com o escore MELD não mostrou diferença estatística em relação à sobrevida. Observou-se que a falência e disfunção do enxerto foram associadas ao número crescente de critérios expandidos do doador. Os receptores de doadores maiores de 50 anos tiveram menor sobrevida (65,58% vs 38,40%) e o escore delta-MELD não discriminou a sobrevida. Conclusão -A sobrevida dos receptores a curto e longo prazo é associada a escores MELD acima de 25, ao volume de sangue transfundido, à disfunção do enxerto, à hiponatremia, à idade do doador acima de 50 anos e àqueles doadores com índice de risco do doador acima de 1,7. DESCRITORES -Transplante de fígado. Sobrevida. Doadores de tecidos. Índices de gravidade de doenças. INTRODUÇÃOO transplante de fígado vem sendo usado como terapia para doenças hepáticas terminais ...

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“…This has caused an increase in waiting time and mortality of candidates to liver transplant (23) . One Brazilian liver transplantation center has shown a 20% mortality for patients on waiting list (4) . Other study has shown 12% mortality rate for 3-month waiting list (24) .…”

Section: Introductionmentioning

confidence: 99%

The impact of the model for end-stage liver disease (MELD) on liver transplantation in one center in Brazil

Freitas

Itikawa

Kurogi

et al. 2010

Arq. Gastroenterol.

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-Context -Presently the MELD score is used as the waiting list criterion for liver transplantation in Brazil. In this method more critical patients are considered priority to transplantation. Objective -To compare the results of liver transplantation when the chronologic waiting list was the criterion for organ allocation (pre-MELD era) with MELD score period (MELD era) in one liver transplantation unit in Brazil. Methods -The charts of the patients subjected to liver transplantation at the Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, PR, Brazil, were reviewed from January of 2001 to August of 2008. Patients were divided into two groups: pre-MELD era and MELD era. They were compared in relation to demographics of donors and receptors, etiology of cirrhosis, cold and warm ischemia time, presence of hepatocellular carcinoma, MELD score and Child-Pugh score and classification at the time of transplantation, units of red blood cells transfused during the transplantation, intensive care unit stay, total hospital stay and 3 month and 1 year survival. Results -Initially, 205 liver transplantations were analyzed. Ninety four were excluded and 111 were included: 71 on the pre-MELD era and 40 on the MELD era. The two groups were comparable in relation to donors and receptors age and sex, etiology of cirrhosis and cold and warm ischemia time. The receptors of the MELD era had more hepatocellular carcinoma than those of the pre-MELD era (37.5% vs 16.9%). Patients with hepatocellular carcinoma had less advanced cirrhosis on both eras. The MELD score was the same on both eras. Excluding the cases of hepatocellular carcinoma, MELD era score was higher than pre-MELD score (18.2 vs 15.8). There were an increased number of transplants on Child-Pugh A and C and a decreased number on Child-Pugh B receptors on MELD era. Both eras had the same need of red blood cells transfusion, intensive care unit stay and hospital stay. Also, 3 month and 1 year survival were the same: 76% and 74.6% on pre-MELD era and 75% and 70.9% on MELD era. Conclusion -In our center, after the introduction of MELD score as the priority criterion for liver transplantation there were an increased number of transplants with hepatocellular carcinoma. Excluding these patients, the receptors were operated upon with more advanced cirrhosis. Nevertheless the patients had the same need for red blood cells transfusion, intensive care unit and hospital stay and 3 months and 1 year survival.

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Liver transplant recipients mortality on the waiting list: long-term comparison to child-pugh classification and meld

Cited by 27 publications

References 11 publications

Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma with Decompensated Cirrhosis

Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma with Decompensated Cirrhosis

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

The impact of the model for end-stage liver disease (MELD) on liver transplantation in one center in Brazil

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