Nashville Experience with Liver Transplantation in Veterans Administration Patients

Chapman, William C.; Wright, J. Kelly; Awad, J. A.; Hunter, Ellen B.; Raiford, David S.; Blair, Taylor K.; Pinson, C. Wright

doi:10.1006/jsre.1996.4969

Cited by 6 publications

(4 citation statements)

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“…The ability to transfer our findings to other VA and non‐VA facilities with or without locally affiliated liver transplant programs is unknown but deserves further study. Apart from expected differences in gender distribution, there is a higher prevalence of alcoholic liver disease and HCV in VA patients 24, 25. One VA transplant center also found higher Child‐Turcotte‐Pugh scores in VA compared with non‐VA patients at the time of initial evaluation for transplantation,24 while another did not 25.…”

Section: Discussionmentioning

confidence: 97%

“…Apart from expected differences in gender distribution, there is a higher prevalence of alcoholic liver disease and HCV in VA patients 24, 25. One VA transplant center also found higher Child‐Turcotte‐Pugh scores in VA compared with non‐VA patients at the time of initial evaluation for transplantation,24 while another did not 25. Whether VA patients are being referred later in the course of their liver disease is therefore also unknown.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation for liver transplantation: Adherence to AASLD referral guidelines in a large veterans affairs center

2005

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Evaluation for liver transplantation: Adherence to AASLD referral guidelines in a large veterans affairs center

2005

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“…Such information from the United States on HCC is scarce, but a prevalent cause of chronic liver disease is alcoholism or a combination of alcoholism and HCV, comprising 45% of referred patients in one series 27 , with the driving force in mortality seemingly due to ongoing excessive alcohol use. One study from the Veterans Affairs population indicated that patients with chronic liver disease have a greater likelihood of suffering from HCV and previous alcohol abuse 28 . Reports from Japan and South Africa indicate that rural or homeless individuals very often presented with advanced HCC 29,30 .…”

Section: Discussionmentioning

confidence: 99%

Referrals for Surgical Therapy in Patients with Hepatocellular Carcinoma: A Community Experience

Helling

Woodall

2007

Journal of Gastrointestinal Surgery

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The treatment of hepatocellular carcinoma (HCC) is notoriously difficult. Either because of oncogenic behavior or the frequent association of cirrhosis, successful therapy is elusive, particularly in cirrhotic patients. Surgical removal has been the only modality that has produced long-term, disease-free survival. In a large series of patients from specialty institutions, median survival in those who underwent resection of HCC lesions has ranged from 30 to 70 months. Similarly, liver transplantation has been shown to be an effective treatment when HCC is favorable (limited in size and number), producing long-term survival in greater than 70% of patients. However, less information is known about community-based treatment of HCC. Reports from referral centers may not accurately reflect the community experience. We have retrospectively reviewed patients with HCC seen in surgical referral from three teaching hospitals in a medium-size urban community from 1995 to 2004 who were not felt to be candidates for liver transplantation and who were not sent to referral centers. We sought to examine their suitability for operation and resection. The study group comprised 61 patients, whose ages ranged from 35 to 83 years old. There were 44 patients (72%) with cirrhosis (Childs A, B, and C in 27, 15, and 2 patients, respectively), 21 from hepatitic C virus (HCV) infection. Three recognized staging systems were used that incorporated the estimation of hepatic reserve and tumor burden. Seven patients (11%) were deemed nonoperable (five advanced disease by imaging, two comorbidities). Of the 54 patients who underwent surgical procedures, 32 underwent resection (28 patients) or cryoablation (4 patients). The reasons for unresectability were unrecognized multifocality (ten patients), poor risk for major hepatectomy (five patients), portal vein/hepatic vein involvement (three patients), metastatic disease (two patients), and excessive blood loss prior to hepatectomy (two patients). Eleven of 17 (65%) noncirrhotic patients and 21 of 44 (48%) cirrhotic patients were resectable or ablatable. There were ten postoperative deaths: six following resection, two following cryoablation, and two following exploratory celiotomy. All deaths were in cirrhotic patients (Childs A in four patients, B in five patients, and C in one patient), 10 of 44 patients (23%); 3 of 11 (27%) patients died following segmentectomy and 3 of 9 (33%) following major hepatectomy. Seven deaths that occurred were in patients with HCV; (P = NS). From this series, the difficulty in surgically treating cirrhotic patients in an urban practice is evident. From 39 to 73% of patients had advanced local disease. Less than half were resectable and, for cirrhotic patients, the postoperative mortality was high, even after "minor" hepatectomies. Noncirrhotic patients fared somewhat better. While HCC in community practice can be treated surgically in the majority of noncirrhotic patients, cirrhotic patients are less likely candidates, and surgical treatment is associated with signif...

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“…Also disappointing from an overview of liver disease treatment was the data showing that of 91 patients with active alcohol use, only 25 were enrolled in an alcohol rehabilitation program. It should be noted that the VA population is, in general, a higher‐risk group with greater co‐morbidities, a high prevalence of hepatitis C virus, and a higher prevalence of alcoholic liver disease in a mainly male cohort 3…”

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confidence: 99%

Access to liver transplantation: Can we do a better job?

Cacciarelli

2005

Liver Transpl

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Nashville Experience with Liver Transplantation in Veterans Administration Patients

Cited by 6 publications

References 0 publications

Evaluation for liver transplantation: Adherence to AASLD referral guidelines in a large veterans affairs center

Evaluation for liver transplantation: Adherence to AASLD referral guidelines in a large veterans affairs center

Referrals for Surgical Therapy in Patients with Hepatocellular Carcinoma: A Community Experience

Access to liver transplantation: Can we do a better job?

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