Since the publication of the American Association for the Study of Liver Diseases (AASLD) practice guidelines on the management of hepatocellular carcinoma (HCC) in 2005, new information has emerged that requires that the guidelines be updated. The full version of the new guidelines is available on the AASLD Web site at http://www.aasld.org/practiceguidelines/ Documents/Bookmarked%20Practice%20Guidelines/ HCCUpdate2010.pdf. Here, we briefly describe only new or changed recommendations.

/pdf/aasld-practice-guideline-management-of-hepatocellular-51bocalv0r.pdf

AASLD PRACTICE GUIDELINE Management of Hepatocellular Carcinoma: An Update

There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies. We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research. We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at http://www.ADQI.net
 ) Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.

/pdf/acute-renal-failure-definition-outcome-measures-animal-3m4l0j5jsf.pdf

Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.20933

Management of hepatocellular carcinoma.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1053/jhep.2001.22172

A model to predict survival in patients with end‐stage liver disease

https://www.gastrojournal.org/article/S0016-5085(03)50022-1/pdf

Model for end-stage liver disease (MELD) and allocation of donor livers

https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.12022

OPTN/SRTR 2011 Annual Data Report: intestine.

Excellent liver transplant survival rates under the meld/peld system

Purpose of reviewDeceased-donor liver allocation has undergone a significant change in approach and execution with the adoption of the MELD/PELD (model for end-stage liver disease/pediatric end-stage liver disease) system in February 2002. This review focuses on the key reports summarising the results of this allocation system and studies examining different aspects and deficiencies of this system. Recent findingsThe institution of the MELD/PELD system was preceded by several important analyses in which prospective validation of the MELD and PELD models showed they had a high degree of concordance for predicting mortality risk for adult and pediatric candidates, respectively, who were waiting for liver transplantation. Additional studies documented the rationale for the policy change and outlined the specifics of the system. Results after 1 year of allocation under this new system showed a slight reduction in waiting list mortality and an increase in liver transplant rates compared with liver allocation for the year prior. Other reports examined regional differences in MELD score at transplant, the effect of changes in priority for candidates with hepatocellular carcinoma, the effectiveness of regional review boards for identifying higher-risk candidates, and variations in MELD score calculation due to international normalised ratio laboratory technique differences as well as patient survival. SummaryThe MELD/PELD-based liver allocation system is a much more objective system that can be quantified and studied for results. Future modifications will be made using this evidence-based approach.

Liver transplantation outcomes under the model for end-stage liver disease and pediatric end-stage liver disease

BACKGROUND Although the Organ Procurement and Transplantation Network (OPTN) database contains a rich set of data on United States transplant recipients, follow-up data may be incomplete. It was of interest to determine if augmenting OPTN data with external death data altered patient survival estimates. METHODS Solitary kidney, liver, heart, and lung transplants performed between January 1, 2011, and January 31, 2013, were queried from the OPTN database. Unadjusted Kaplan-Meier 3-year patient survival rates were computed using 4 nonmutually exclusive augmented datasets: OPTN only, OPTN + verified external deaths, OPTN + verified + unverified external deaths (OPTN + all), and an additional source extending recipient survival time if no death was found in OPTN + all (OPTN + all [Assumed Alive]). Pairwise comparisons were made using unadjusted Cox Proportional Hazards analyses applying Bonferroni adjustments. RESULTS Although differences in patient survival rates across data sources were small (≤1 percentage point), OPTN only data often yielded slightly higher patient survival rates than sources including external death data. No significant differences were found, including comparing OPTN + verified (hazard ratio [HR], 1.05; 95% confidence interval [95% CI], 1.00-1.10); P = 0.0356), OPTN + all (HR, 1.06; 95% CI, 1.01-1.11; P = 0.0243), and OPTN + all (Assumed Alive) (HR, 1.00; 95% CI, 0.96-1.05; P = 0.8587) versus OPTN only, or OPTN + verified (HR, 1.05; 95% CI, 1.00-1.10; P = 0.0511), and OPTN + all (HR, 1.05; 95% CI, 1.00-1.10; P = 0.0353) versus OPTN + all (Assumed Alive). CONCLUSIONS Patient survival rates varied minimally with augmented data sources, although using external death data without extending the survival time of recipients not identified in these sources results in a biased estimate. It remains important for transplant centers to maintain contact with transplant recipients and obtain necessary follow-up information, because this information can improve the transplantation process for future recipients.

Erick B. Edwards

Papers

OPTN/SRTR 2011 Annual Data Report: intestine.

Excellent liver transplant survival rates under the meld/peld system

Liver transplantation outcomes under the model for end-stage liver disease and pediatric end-stage liver disease

The Effect of Augmenting OPTN Data With External Death Data on Calculating Patient Survival Rates After Organ Transplantation.

435 Does the model for end-stage liver disease (MELD) predict post liver transplant graft survival?