Showing papers on "Model for End-Stage Liver Disease published in 2015"
TL;DR: Patients with NASH are less likely to undergo liver transplantation (LT) andLess likely to survive for 90 days on the waitlist than patients with HCV, ALD, or HCV and ALD.
1,444 citations
Primary Children's Hospital1, University of Colorado Denver2, Northwestern University3, Georgetown University4, University of Washington5, Columbia University6, University of North Carolina at Chapel Hill7, University of California, San Francisco8, Baylor University Medical Center9, Mayo Clinic10, University of California, San Diego11, University of Miami12, Johns Hopkins University13, University of Kansas14, Henry Ford Health System15, Indiana University16, Washington University in St. Louis17, Duke University18, New York University19, University of Michigan20, University of Pennsylvania21, Harvard University22
TL;DR: In this article, the NS5A inhibitor ledipasvir, the nucleotide polymerase inhibitor sofosbuvir, and ribavirin were used to treat chronic hepatitis C virus (HCV) infection in patients with advanced liver disease.
659 citations
TL;DR: The most significant change in allocation policy affecting liver waitlist trends in 2013 was the Share 35 policy, whereby organs from an entire region are available to candidates with model for end‐stage liver disease scores of 35 or higher.
315 citations
Harvard University1, University of Barcelona2, University of California, San Francisco3, Columbia University4, Thomas Jefferson University Hospital5, Lahey Hospital & Medical Center6, Baylor University Medical Center7, University of California, San Diego8, Icahn School of Medicine at Mount Sinai9, University of Colorado Denver10, University of Miami11, Saint Louis University12, Auckland City Hospital13, University of California, Los Angeles14, Henry Ford Health System15, Beth Israel Deaconess Medical Center16
TL;DR: Administration of sofosbuvir and ribavirin before liver transplantation can prevent post-transplant HCV recurrence, related inversely to the number of consecutive days of undetectable HCV RNA before transplantation.
305 citations
TL;DR: In the largest single-institution experience with LT for HCC, excellent long-term survival was achieved and incorporation of routine pretransplantation biomarkers to existing radiographic size criteria significantly improves the ability to predict post-transplant recurrence, and should be considered in recipient selection.
Abstract: Background Although radiologic size criteria (Milan/University of California, San Francisco [UCSF]) have led to improved outcomes after liver transplantation (LT) for hepatocellular carcinoma (HCC), recurrence remains a significant challenge. We analyzed our 30-year experience with LT for HCC to identify predictors of recurrence. Study Design A novel clinicopathologic risk score and prognostic nomogram predicting post-transplant HCC recurrence was developed from a multivariate competing-risk Cox regression analysis of 865 LT recipients with HCC between 1984 and 2013. Results Overall patient and recurrence-free survivals were 83%, 68%, 60% and 79%, 63%, and 56% at 1-, 3-, and 5-years, respectively. Hepatocellular carcinoma recurred in 117 recipients, with a median time to recurrence of 15 months, involving the lungs (59%), abdomen/pelvis (38%), liver (35%), bone (28%), pleura/mediastinum (12%), and brain (5%). Multivariate predictors of recurrence included tumor grade/differentiation (G4/poor diff hazard ratio [HR] 8.86; G2-3/mod-poor diff HR 2.56), macrovascular (HR 7.82) and microvascular (HR 2.42) invasion, nondownstaged tumors outside Milan criteria (HR 3.02), nonincidental tumors with radiographic maximum diameter ≥5 cm (HR 2.71) and Conclusions In the largest single-institution experience with LT for HCC, excellent long-term survival was achieved. Incorporation of routine pretransplantation biomarkers to existing radiographic size criteria significantly improves the ability to predict post-transplant recurrence, and should be considered in recipient selection. A novel clinicopathologic prognostic nomogram accurately predicts HCC recurrence after LT and may guide frequency of post-transplantation surveillance and adjuvant therapy.
189 citations
TL;DR: Liver transplant candidates with MELD exceptions have superior outcomes compared to nonexception candidates and the current MELD exception system is largely responsible for steadily increasing MELD scores at transplant independent of geography.
153 citations
TL;DR: A joint-effect model to predict patient survival after 2 and 6 months is created and predicted outcome significantly better than either static or dynamic models alone (P < .01 for all comparisons).
137 citations
TL;DR: A smartphone app called EncephalApp, a streamlined version of Stroop App, has good face validity, test-retest reliability, and external validity for the diagnosis of CHE.
119 citations
TL;DR: Patients hospitalized with cirrhosis and infections are at high risk for subsequent infections, mostly at different sites, within 6 months of index infection resolution, although these associations do not prove that these factors cause the infections.
106 citations
TL;DR: A delay of 6‐9 months would eliminate the geographic variability in the discrepancy between HCC and non‐HCC transplant rates under current policy and may allow for more equal access to transplant for all candidates.
106 citations
TL;DR: In a single-center randomized trial, a significantly larger proportion of patients with decompensated cirrhosis given a combination of G-CSF and darbopoietin α survived for 12 months more than patients given only placebo.
TL;DR: An algorithm to extrapolate an eCTP score from data in a large administrative database with excellent correlation to actual CTP score on chart review is developed and validated and is a highly useful predictor of survival when compared with multiple other published liver disease severity indices.
TL;DR: MHE is associated with a reduced 5-year survival rate of patients with cirrhosis and Evaluation of MHE could help predict survival times and outcomes of Patients with specific MELD scores.
01 Jul 2015
TL;DR: In this paper, the authors evaluated the utility of magnetic resonance elastography (MRE) in screening patients for hepatic fibrosis, cirrhosis, and hepatocellular carcinoma after the Fontan operation.
Abstract: Objective To evaluate the utility of magnetic resonance elastography (MRE) in screening patients for hepatic fibrosis, cirrhosis, and hepatocellular carcinoma after the Fontan operation. Patients and Methods Hepatic MRE was performed in conjunction with cardiac magnetic resonance imaging in patients who had undergone a Fontan operation between 2010 and 2014. Liver stiffness was calculated using previously reported techniques. Comparisons to available clinical, laboratory, imaging, and histopathologic data were made. Results Overall, 50 patients at a median age of 25 years (range, 21-33 years) who had undergone a Fontan operation were evaluated. The median interval between Fontan operation and MRE was 22 years (range, 16-26 years). The mean liver stiffness values were increased: 5.5±1.4 kPa relative to normal participants. Liver stiffness directly correlated with liver biopsy-derived total fibrosis score, time since operation, mean Fontan pressure, γ-glutamyltransferase level, Model for End-Stage Liver Disease score, creatinine level, and pulmonary vascular resistance index. Liver stiffness was inversely correlated with cardiac index. All 3 participants with hepatic nodules exhibiting decreased contrast uptake on delayed postcontrast imaging and increased nodule stiffness had biopsy-proven hepatocellular carcinoma. Conclusion The association between hepatic stiffness and fibrosis scores, Model for End-Stage Liver Disease scores, and γ-glutamyltransferase level suggests that MRE may be useful in detecting (and possibly quantifying) hepatic cirrhosis in patients after the Fontan operation. The correlation between stiffness and post-Fontan time interval, mean Fontan pressure, pulmonary vascular resistance index, and reduced cardiac index suggests a role for long-term hepatic congestion in creating these hepatic abnormalities. Magnetic resonance elastography was useful in detecting abnormal nodules ultimately diagnosed as hepatocellular carcinoma. The relationship between stiffness with advanced fibrosis and hepatocellular carcinoma provides a strong argument for additional study and broader application of MRE in these patients.
TL;DR: The hepatic venous pressure gradient can be used before surgery to stratify the risk of PHLF but the proposed cut-off of 10mmHg excludes approximately one-quarter of the patients who would benefit from surgery without short to mid-term postoperative sequelae.
TL;DR: Transsplenic PVR-TIPS is a potentially safe and effective method to treat PVT and improve transplant candidacy and was successful in all 11 patients with no major complications.
TL;DR: In the United States there are fewer women than men on the liver transplant waitlist and women are two times less likely to receive a deceased or living-related liver transplant.
TL;DR: Among patients with cirrhosis on liver transplant waiting lists, patients with PVT have lower mortality than patients without PVT and similar results were found by competing risks analyses.
TL;DR: Investigation of liver transplantation due to acute decompensation of hepatitis B virus-associated liver cirrhosis found SMHN is a critical histological feature of HBV-associated ACLF, and identification of a characteristic pathological feature strongly supports that ACLF is a separate entity in end-stage liver disease.
TL;DR: Investigation of the clinical and radiological characteristics, and biochemical markers of cirrhotic patients to determine the high-risk individuals for PVT attending a center found diabetes mellitus, lower levels of hemoglobin, platelet counts, and portal vein flow velocity as well as increased MELD score, platelets indices, portal vein diameter, and splenic thickening were associated with PVT.
Abstract: Background and objectivesPortal vein thrombosis (PVT) is a potential lethal complication in late liver cirrhosis. There is a lack of knowledge of the clinical features and risk factors of PVT. We aimed to investigate the clinical and radiological characteristics, and biochemical markers of cirrhotic
TL;DR: Overweight and obese LT recipients do not have increased risk of death or graft loss regardless of MELD, and underweight patients are at increased risk for poor outcomes post‐LT, specifically underweight recipients with low MELD have increasedrisk for death and graft loss.
TL;DR: Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC, and limited donor availability precludes widespread application.
Abstract: Background The incidence of hepatocellular cancer (HCC) is increasing dramatically worldwide. Optimal management remains undefined, especially for well-compensated cirrhosis and HCC. Study Design This retrospective analysis included 5 US liver cancer centers. Patients with surgically treated HCC between 1990 and 2011 were analyzed; demographics, tumor characteristics, and survival rates were included. Results There were 1,765 patients who underwent resection (n = 884, 50.1%) or transplantation (n = 881, 49.9%). Overall, 248 (28.1%) resected patients were transplant eligible (1 tumor Conclusions The increasing incidence of HCC stresses limited resources. Although transplantation results in better long-term survival, limited donor availability precludes widespread application. Hepatic resection will likely remain a standard therapy in selected patients with HCC. In this large series, only about 10% of patients with cirrhosis were transplant-eligible based on tumor status. Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC.
TL;DR: The regimen of SMV+SOF with or without RBV for 12 weeks was very well tolerated and resulted in high sustained virological response (SVR) rates along with minimal adverse events (AEs) in patients with hepatitis C genotype 1 (HCV GT1).
TL;DR: The HCC MELD exception policy has unintentionally resulted in a large reduction in transplantation-related survival benefit, with 5-year survival benefit increasing with actual MELD score for patients with and without HCC.
TL;DR: Elevated levels of CXCL9 are associated with shorter survival in cirrhotic patients with severe portal hypertension receiving TIPS, and this chemokine should be further evaluated as a novel biomarker for the outcome in patients with cirrhosis and portal hypertension.
TL;DR: Implementation of the MELD score led to a reduction in waiting-list registration and waiting- list mortality and an increase in the number of deceased-donor transplants without adversely affecting long-term outcomes after liver transplantation (LT).
Abstract: The model for end-stage liver disease (MELD) score has been used as an objective scale of disease severity for management of patients with end-stage liver disease; it currently serves as the basis of an urgency-based organ-allocation policy in several countries. Implementation of the MELD score led to a reduction in waiting-list registration and waiting-list mortality and an increase in the number of deceased-donor transplants without adversely affecting long-term outcomes after liver transplantation (LT). The MELD score has been used for management of non-transplant patients with chronic liver disease. MELD exceptions serve as a mechanism to advance the needs of subsets of patients with liver disease not adequately addressed by MELD-based organ allocation. Several models have been proposed to refine and improve the MELD score as the environment within which it operates continues to evolve toward transplantation for sicker patients. The MELD score continues to serve and be used as a template to improve upon as an objective gauge of disease severity and as a metric enabling optimization of allocation of scarce donor organs for LT.
TL;DR: Living donor liver trasplantation is a viable treatment option for unresectable HCC, providing recurrence rates similar to those achieved with DDLT.
Abstract: Background Living donor liver transplantation (LDLT) is an important treatment option for unresectable hepatocellular carcinoma (HCC), but whether recurrence and survival in LDLT differ from those in deceased donor liver transplantation (DDLT) remains controversial. Study Design A retrospective analysis was performed between patients with HCC who underwent LDLT in a Japanese institute (n = 133) and those who underwent DDLT in a United States institute (n = 362). Results Although there was a difference in patient background characteristics (eg, body mass index, donor age, Model for End-Stage Liver Disease [MELD] score), tumor aggressiveness represented by Milan criteria and microscopic vascular invasion were comparable between the 2 groups. The cumulative 5-year recurrence rates of the LDLT group and the DDLT group were similar (14.8% vs 19.0%, p = 0.638), but overall survival in the LDLT group was significantly better than that in the DDLT group (84.2% vs 63.5%, p 300 in the LDLT group, beyond Milan criteria in the DDLT group). Combined multivariate analysis of the 2 groups identified recipient's body mass image >30 kg/m 2 as an independent risk factor for overall survival; the technique of transplantation (LDLT or DDLT) was not found to be a risk factor. Conclusions When compared between the institutes where LDLT or DDLT were the first treatment choices for unresectable HCC, recurrence rates were comparable. Living donor liver trasplantation is a viable treatment option for unresectable HCC, providing recurrence rates similar to those achieved with DDLT.
TL;DR: Treatment paradigms continue to evolve but consist of early recognition, supportive intensive care, and consideration of liver transplantation before onset of irreversible multiple organ failure.
TL;DR: A model based on platelet count and total bilirubin level that identifies patients at increased risk for ALF with high sensitivity is developed and compared with Hy's Law, which predicts severity of DILI based on levels of alanine aminotransferase.
TL;DR: Pre-transplant ICU status modifies the risk of early post-Transplant mortality, independent of MELD score, and should be considered when determining candidacy for transplantation in order to optimize efficient use of a scarce resource.