Heart Transplant and Hepato-Renal Dysfunction: The Model of End-Stage Liver Disease Excluding International Normalized Ratio as a Predictor of Postoperative Outcomes

2019 ◽  
Vol 51 (9) ◽  
pp. 2962-2966 ◽  
Author(s):  
Antonio Loforte ◽  
Mariafrancesca Fiorentino ◽  
Gregorio Gliozzi ◽  
Carlo Mariani ◽  
Gianluca Folesani ◽  
...  
Keyword(s):  
Liver Disease ◽  
Renal Dysfunction ◽  
Heart Transplant ◽  
International Normalized Ratio ◽  
Postoperative Outcomes ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Experiences from six years of quality assured Model of End Stage Liver Disease (MELD) diagnostics

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254219
Author(s):  
Pascal Hunold ◽  
Thomas Berg ◽  
Daniel Seehofer ◽  
Robert Sucher ◽  
Adam Herber ◽  
...  
Keyword(s):  
Liver Disease ◽  
Diagnostic Errors ◽  
Quality Criteria ◽  
International Normalized Ratio ◽  
Meld Score ◽  
Medical Laboratory ◽  
Laboratory System ◽  
Verification Algorithm ◽  
End Stage Liver Disease ◽  
End Stage

Background The model of end-stage liver disease (MELD) score was established for the allocation of liver transplants. The score is based on the medical laboratory parameters: bilirubin, creatinine and the international normalized ratio (INR). A verification algorithm for the laboratory MELD diagnostic was established, and the results from the first six years were analyzed. Methods We systematically investigated the validity of 7,270 MELD scores during a six-year period. The MELD score was electronically requested by the clinical physician using the laboratory system and calculated and specifically validated by the laboratory physician in the context of previous and additional diagnostics. Results In 2.7% (193 of 7,270) of the cases, MELD diagnostics did not fulfill the specified quality criteria. After consultation with the sender, 2.0% (145) of the MELD scores remained invalid for different reasons and could not be reported to the transplant organization. No cases of deliberate misreporting were identified. In 34 cases the dialysis status had to be corrected and there were 24 cases of oral anticoagulation with impact on MELD diagnostics. Conclusion Our verification algorithm for MELD diagnostics effectively prevented invalid MELD results and could be adopted by transplant centers to prevent diagnostic errors with possible adverse effects on organ allocation.

Groin Herniorrhaphy in Patients with Cirrhosis and after Liver Transplantation

2009 ◽  
Vol 75 (10) ◽  
pp. 962-965
Author(s):  
Elise H. Lawson ◽  
Elizabeth Benjamin ◽  
Ronald W. Busuttil ◽  
Jonathan R. Hiatt
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
International Normalized Ratio ◽  
Wound Complications ◽  
End Stage Liver Disease ◽  
Proper Patient Selection ◽  
Cirrhotic Patients ◽  
End Stage ◽  
Cirrhotic Group

We report on 43 groin herniorrhaphy operations, 18 in 18 patients with documented cirrhosis and 25 in 24 patients after liver transplantation (LT), over a 10-year period at UCLA. Average follow up was 33 months. Most patients were males (84%) with reducible inguinal hernias (70%). Child's class of cirrhotic patients was B in 66 per cent and A and C in 17 per cent each; 7 patients (39%) went on to LT. Compared with post-LT patients, patients with cirrhosis had significantly lower platelets and significantly higher bilirubin, international normalized ratio, and Model for End-stage Liver Disease scores. Mesh was used in 33 per cent of the cirrhotic group and 48 per cent of the LT group. There were four minor wound complications but no deaths, major complications, infections, or ascitic leaks in either group. Two hernias recurred in the cirrhosis group (11%) and none after LT. We conclude that with proper patient selection, groin herniorrhaphy with or without mesh is a safe and durable procedure in patients with cirrhosis and after LT. This is the first large series of groin herniorrhaphy after LT.

Influence of the MELD-XI (Model of End-Stage Liver Disease Excluding INR) on Heart Transplant Outcomes

2017 ◽  
Vol 36 (4) ◽  
pp. S229-S230
Author(s):  
A. Loforte ◽  
M. Gremolini ◽  
M. Cefarelli ◽  
G. Jafrancesco ◽  
E. Pilato ◽  
...  
Keyword(s):  
Liver Disease ◽  
Heart Transplant ◽  
Transplant Outcomes ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Prognostic Value of the Modified Model for End-Stage Liver Disease (MELD) Score Including albumin in acute heart failure

2020 ◽  
Author(s):  
Shengen Liao ◽  
Xinyi Lu ◽  
Iokfai Cheang ◽  
Xu Zhu ◽  
Ting Yin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Liver Disease ◽  
Acute Heart Failure ◽  
Prognostic Value ◽  
Cox Regression ◽  
International Normalized Ratio ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
All Cause Mortality ◽  
End Stage

Abstract Background: Liver and renal function evaluated by the model for end-stage liver disease (MELD) score, the MELD excluding the international normalized ratio (MELD_XI) score and the MELD including sodium (MELD_sodium) score have been considered predictors of adverse events for patients with acute heart failure (AHF). However, the prognostic value of the MELD including albumin (MELD_albumin) score in patients with AHF has not been assessed. Methods: A total of 466 patients with AHF were prospectively evaluated. We compared the accuracy of the 4 MELD score formulas using the time-dependent receiver operating characteristic (ROC) curve and corresponding areas under the curve (AUC). Results: During a median follow-up period of 34 months, 196 deaths occurred. In the fully adjusted Cox regression model, standardized hazard ratios with 95% confidence interval expressing the risk of all-cause mortality were 1.22 (1.06–1.40), 1.20 (1.04–1.39), 1.21 (1.05-1.41) and 1.23 (1.06–1.42) for MELD, MELD_XI, MELD_albumin and MELD_sodium scores, respectively. The MELD_albumin score showed the best prognostic accuracy (AUC = 0.658) for the prediction of long-term all-cause mortality, followed by the MELD_sodium score (AUC = 0.590), the MELD score (AUC = 0.580), and the MELD_XI score (AUC = 0.544). Conclusions: The MELD_albumin score performs more accurately than the MELD score and the other modified MELD scores for predicting the risk of all-cause mortality in patients with acute heart failure.

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