Risk factors for long-term mortality in a large cohort of patients wait-listed for liver transplantation in Brazil

Abstract

Liver donor shortage and long waiting times are observed in many liver transplant programs worldwide. The aim of this study was to evaluate the wait list in a developing country, before and after the introduction of the MELD scoring system. In addition, the MELD score ability to predict mortality in this setting was assessed. A single-center retrospective study of patients wait-listed for liver transplantation between 1997 and 2010 was undertaken. There were 1339 and 762 patients on the list in pre-MELD and MELD era, respectively. A competitive risk analysis was performed to assess age, gender, disease diagnosis, serum sodium, MELD, Child-Pugh, ABO type, and body mass index. Also, MELD score predictive ability at 3, 6, 12, and 24 months after list enrollment was evaluated. The overall mortality rates on waiting list were 31.0% and 28.1% (P ¼ 0.16), and the median waiting times were 412 and 952 days (P < 0.001), in pre and MELD eras, respectively. The competitive risk analysis yielded the following significant P values for both eras: HCC (0.03 and <0.001), MELD (<0.001 and 0.002), sodium level (0.002 and <0.001), and Child-Pugh (0.02 and <0.001). The MELD mortality predictions at 3, 6, 12, and 24 months were similar. In conclusion, in a liver transplant program with long waiting times, the MELD system introduction did not improve mortality rate. In either pre and MELD eras, HCC diagnosis, serum sodium, Child-Pugh, and MELD were significant predictors of prognosis. Short-and long-term MELD based mortality predictions were similarly accurate. Strategies for increasing the liver donor pool should be implemented to improve mortality.

Therapeutic Effect of Human Umbilical Cord Mesenchymal Stem Cells at Various Passages on Acute Liver Failure in Rats

“…Reasons for failure to receive transplantation have included lack of available organs, high expense, and the requirement for lifelong immunosuppressive medication. Other treatment strategies include bioartificial livers that are short of liver cells and medical management [ 2 ]. Consequently, there is an urgent need for novel therapeutic options.…”

Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: The RELIEF trial

“…Besides medical management of organ dysfunction there are no specific approaches to treat patients with ACLF. The use of liver transplantation in this context is hampered by the shortage of organs5 as well as by the high frequency of concomitant conditions that contraindicate the procedure. The use of extracorporeal albumin dialysis by the molecular adsorbent recirculating system (MARS) has been shown to remove protein‐bound substances and decrease the plasma concentrations of bilirubin, ammonium, and creatinine in patients with ACLF.…”

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

“…Recent studies have reported that hyponatremia is associated with a high mortality rate in various medical conditions (Baran and Hutchinson 1984;Tierney et al 1986;Gill et al 2006;Whelan et al 2009;Waikar et al 2009;Wald et al 2010). Hyponatremia is particularly prevalent in chronic liver disease and associated with a poor prognosis in patients with end stage liver disease waiting for a liver transplant (Angeli et al 2006;Kim et al 2008;Basto et al 2011). However, the impact of pre-transplantation hyponatremia on outcomes following liver transplantation is still controversial.…”