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Model for end-stage liver disease and model for end-stage liver disease-Na scores predict both before-listing and wait-list mortality.
Transplant Proc. 2012 Mar; 44(2):389-92.TP

Abstract

BACKGROUND

Due to the organ shortage, many patients die without transplantation, even before completing an evaluation for candidacy. We analyzed outcomes after patient referral and factors associated with mortality both before and after listing for cadaveric donor liver transplantation.

METHODS

We analyzed 132 consecutive patients who were evaluated for candidacy for cadaveric donor liver transplantation between 2003 and 2010.

RESULTS

The study included 69 men and 63 women of median age 49 years (range, 1-65). Etiologies of diseases were acute hepatic failure (n=19), liver cirrhosis due to hepatitis B or C (n=36), primary biliary cirrhosis (n=19), nonviral cirrhosis (n=14), hepatocellular carcinoma (n=13), or other causes (n=31). After evaluation for candidacy, we listed 68 (52%), subjects whereas 24 (18%) died before listing. Factors affecting death before listing were the levels of albumin (P<.001), bilirubin (P<.001), sodium (P<.001), international normalized ratio (INR; P<.001), Model for End-stage Liver Disease (MELD) score (P<.001), MELD-Na score (P<.001), and Child-Pugh-Turcotte (CPT) score (P<.001). Based on multivariate Cox regression analysis, MELD score (hazard ratio [HR] 1.201, P=.017), MELD-Na score (HR 1.244, P=.014), CPT score (HR 1.468, P=.033), and INR (HR 0.491, P=.027) were independently associated with death before listing. Among 68 listed candidates, 11 (16%) underwent transplantation, whereas 29 (43%) died without transplantation. Based on multivariate Cox regression analysis, MELD score (HR 1.102, P=.001), MELD-Na score (HR 1.128, P=.001), and CPT score (HR 1.282, P=.038) independently predicted wait-list mortality. All 11 patients who underwent cadaveric liver transplantation were alive at 29 months (range, 1-55) after transplantation.

CONCLUSIONS

Patients with a higher MELD, higher MELD-Na, and higher CPT score at referral were at greater risk for death without transplantation, especially before listing. Evaluation for transplantation candidacy is a time-consuming process. Therefore, earlier referral is mandatory to achieve successful listing for transplantation.

Authors+Show Affiliations

Department of Gastroenterology, University of Tokyo, Graduate School of Medicine, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22410024

Citation

Yamashiki, N, et al. "Model for End-stage Liver Disease and Model for End-stage Liver disease-Na Scores Predict Both Before-listing and Wait-list Mortality." Transplantation Proceedings, vol. 44, no. 2, 2012, pp. 389-92.
Yamashiki N, Sugawara Y, Tamura S, et al. Model for end-stage liver disease and model for end-stage liver disease-Na scores predict both before-listing and wait-list mortality. Transplant Proc. 2012;44(2):389-92.
Yamashiki, N., Sugawara, Y., Tamura, S., Kaneko, J., Nojiri, K., Aoki, T., Sakamoto, Y., Hasegawa, K., Koike, K., & Kokudo, N. (2012). Model for end-stage liver disease and model for end-stage liver disease-Na scores predict both before-listing and wait-list mortality. Transplantation Proceedings, 44(2), 389-92. https://doi.org/10.1016/j.transproceed.2012.01.037
Yamashiki N, et al. Model for End-stage Liver Disease and Model for End-stage Liver disease-Na Scores Predict Both Before-listing and Wait-list Mortality. Transplant Proc. 2012;44(2):389-92. PubMed PMID: 22410024.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Model for end-stage liver disease and model for end-stage liver disease-Na scores predict both before-listing and wait-list mortality. AU - Yamashiki,N, AU - Sugawara,Y, AU - Tamura,S, AU - Kaneko,J, AU - Nojiri,K, AU - Aoki,T, AU - Sakamoto,Y, AU - Hasegawa,K, AU - Koike,K, AU - Kokudo,N, PY - 2012/3/14/entrez PY - 2012/3/14/pubmed PY - 2012/8/2/medline SP - 389 EP - 92 JF - Transplantation proceedings JO - Transplant. Proc. VL - 44 IS - 2 N2 - BACKGROUND: Due to the organ shortage, many patients die without transplantation, even before completing an evaluation for candidacy. We analyzed outcomes after patient referral and factors associated with mortality both before and after listing for cadaveric donor liver transplantation. METHODS: We analyzed 132 consecutive patients who were evaluated for candidacy for cadaveric donor liver transplantation between 2003 and 2010. RESULTS: The study included 69 men and 63 women of median age 49 years (range, 1-65). Etiologies of diseases were acute hepatic failure (n=19), liver cirrhosis due to hepatitis B or C (n=36), primary biliary cirrhosis (n=19), nonviral cirrhosis (n=14), hepatocellular carcinoma (n=13), or other causes (n=31). After evaluation for candidacy, we listed 68 (52%), subjects whereas 24 (18%) died before listing. Factors affecting death before listing were the levels of albumin (P<.001), bilirubin (P<.001), sodium (P<.001), international normalized ratio (INR; P<.001), Model for End-stage Liver Disease (MELD) score (P<.001), MELD-Na score (P<.001), and Child-Pugh-Turcotte (CPT) score (P<.001). Based on multivariate Cox regression analysis, MELD score (hazard ratio [HR] 1.201, P=.017), MELD-Na score (HR 1.244, P=.014), CPT score (HR 1.468, P=.033), and INR (HR 0.491, P=.027) were independently associated with death before listing. Among 68 listed candidates, 11 (16%) underwent transplantation, whereas 29 (43%) died without transplantation. Based on multivariate Cox regression analysis, MELD score (HR 1.102, P=.001), MELD-Na score (HR 1.128, P=.001), and CPT score (HR 1.282, P=.038) independently predicted wait-list mortality. All 11 patients who underwent cadaveric liver transplantation were alive at 29 months (range, 1-55) after transplantation. CONCLUSIONS: Patients with a higher MELD, higher MELD-Na, and higher CPT score at referral were at greater risk for death without transplantation, especially before listing. Evaluation for transplantation candidacy is a time-consuming process. Therefore, earlier referral is mandatory to achieve successful listing for transplantation. SN - 1873-2623 UR - https://www.unboundmedicine.com/medline/citation/22410024/Model_for_end_stage_liver_disease_and_model_for_end_stage_liver_disease_Na_scores_predict_both_before_listing_and_wait_list_mortality_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(12)00071-1 DB - PRIME DP - Unbound Medicine ER -