Liver Transplantation: From Child to MELD

Gallegos‐Orozco, Juan F.; Vargas, Hugo E.

doi:10.1016/j.mcna.2009.03.010

Cited by 26 publications

(16 citation statements)

References 138 publications

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“…First, more than 50% of included studies were of poor quality. Only a few studies reported that the baseline Child-Pugh class or MELD score, which was considered as the most important prognostic factor for the patients undergoing LT [44][45][46], were matched between the LT recipients with and without pre-LT PVT. Thus, we barely avoided the potential bias regarding the difference in the survival between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Dai

Jia

et al. 2015

JGLD

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Background & Aims: Portal vein thrombosis (PVT) increases the technical complexity of liver transplantation (LT). This systematic review and meta-analysis aim to analyze the association of pre-LT PVT with the overall survival after LT.Methods. PubMed, EMBASE, and Cochrane library databases were used to search for papers related to the association between pre-LT PVT and survival of LT recipients. The differences in the survival rates between the LT recipients with and without pre-LT PVT were expressed as odds ratios (ORs) with 95% confidence intervals (CIs).Results. Twenty-seven papers were included. Overall meta-analysis showed that the total LT recipients with pre-LT PVT had a significantly lower 1-year survival rate than those without pre-LT PVT (OR=0.733, 95%CI=0.621-0.865; P=0.0002). But no statistically significant difference was observed in the in-hospital (OR=0.713, 95%CI=0.343-1.482; P=0.365), 1-month (OR=0.679, 95%CI=0.345-1.333; P=0.261), or 5-year survival rate (OR=0.788, 95%CI=0.587-1.058; P=0.113). Additionally, the 1-year survival rate was significantly lower in the LT recipients with complete PVT than in those without PVT (OR=0.503, 95%CI=0.295-0.858; P=0.012). However, no statistically significant difference in the 1-year survival rate between them was observed in the meta-analysis of high-quality studies (OR=0.899, 95%CI=0.657-1.230; P=0.505) or that of studies in which LT was performed after 2000 (OR=0.783, 95%CI=0.566-1.083; P=0.140).Conclusion. Pre-LT PVT, especially complete PVT, decreased the 1-year survival rate after LT. However, the detrimental effect of pre-LT PVT on the survival of LT recipients became inconclusive in high-quality studies. Additionally, further well-designed cohort studies should validate the association in patients undergoing LT during the latter years.

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Section: Discussionmentioning

confidence: 99%

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Dai

Jia

et al. 2015

JGLD

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“…The severity of the liver disease, assessed by using MELD or Child-Pugh scores and the development of complications, determines when a patient should be referred for liver transplantation. 109,110 Health care providers, including PCPs, should be educated to facilitate timely referral, and they must be able to recognize essential turning points at which a patient may become eligible for a transplantation referral. 109,110 Chronic disease management programs have met with success in other chronic disease areas, including heart disease and diabetes.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

“…109,110 Health care providers, including PCPs, should be educated to facilitate timely referral, and they must be able to recognize essential turning points at which a patient may become eligible for a transplantation referral. 109,110 Chronic disease management programs have met with success in other chronic disease areas, including heart disease and diabetes. A pilot study applying such a model to patients with chronic liver failure did not seem to reduce hospital admission rates or disease severity or to improve patient quality of life.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

Understanding the Complexities of Cirrhosis

Muir

2015

Clinical Therapeutics

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Patients at risk for cirrhosis should be screened and the underlying etiologic factor(s) of the liver disease treated or appropriately managed when possible. Primary care physicians should be aware of the signs and symptoms of cirrhosis and its related complications and adopt a low threshold for referral to a specialist when the condition is suspected. An integrated, multidisciplinary approach to care between specialists and primary care physicians may improve early detection of cirrhosis and its related complications and strengthen management strategies.

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“…After almost 50 years of the 1 st TxF in humans, alterations and additions in the knowledge of the hemodynamic changes of these patients were acquired by changing the management of these critically ill patients in the perioperative period 9 . Despite the hyperdynamic circulation and various syndromes (hepatorenal, hepatopulmonary hepatocirculatory, hepatoadrenal) better handling with fluid replacement, vasopressors and best technique (more delicate dissection and shorter operative time) have attenuated the postoperative complications after TxF 13 .…”

Section: The Conventional Liver Transplantation Without Venovenous Bymentioning

confidence: 99%

Transplante de fígado clínico sem desvio venovenoso

Fonseca-Neto¹

2011

ABCD, arq. bras. cir. dig.

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-Introduction -The use of a venovenous bypass in liver transplantation is a controversy source and discussion among anesthetists and transplant surgeons.Although it provides a stable hemodynamic state and metabolism during the anhepatic stage, venovenous bypass may lead to a number of complications, some of them with death. Aim -To review the current practice of using clinic venovenous bypass in liver transplantation, with its advantages and disadvantages. Method -A broad review of the literature was carried out, paying especial attention to articles published in the past ten years and indexed in PubMed and Medline. The following cross-referenced headings were used: liver transplantation, venovenous bypass, conventional technique, classic technique. The articles chosen for analysis were those of the greatest relevance and those considered "classics" in the subject. Conclusion -Liver transplantation without venovenous bypass is a safe and rapid technique. In most cases it can be used without giving rise to serious complications in patients with liver disease. ABCDDV/783RESUMO -Introdução -O problema da utilização do desvio venovenoso no transplante de fígado é um ponto de discussão e controvérsia entre anestesistas e cirurgiões transplantadores. Apesar de proporcionar ambiente hemometabólico estável durante a fase anepática o seu uso poderá levar a algumas complicações, inclusive fatais. Objetivo -Revisar a prática atual do uso do desvio venovenoso no transplante de fígado clínico, com suas vantagens e desvantagens. Método -Foi realizada ampla pesquisa na literatura, com especial atenção aos artigos publicados nos últimos 10 anos e indexados ao PubMed e Medline. Foram utilizados os seguintes descritores de forma cruzada: liver transplantation, venovenous bypass, conventional technique, classic technique. Entre os artigos encontrados foram considerados para análise os mais relevantes além dos considerados "clássicos" sobre o assunto. Conclusão -Transplante de fígado sem desvio venovenoso é técnica segura e rápida. Pode ser utilizada, com poucas exceções, sem acarretar complicações maiores nos pacientes com doença hepática.

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Liver Transplantation: From Child to MELD

Cited by 26 publications

References 138 publications

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Association between Portal Vein Thrombosis and Survival of Liver Transplant Recipients: a Systematic Review and Meta-analysis of Observational Studies

Understanding the Complexities of Cirrhosis

Transplante de fígado clínico sem desvio venovenoso

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