Can Variceal Band Ligation (VBL) Improve MELD Score for patients awaiting for liver transplantation?

2017 ◽  
Vol 2 (2) ◽  
pp. 31-34
Author(s):  
Ali Ismael ◽  
Elsayed A. El Gohary ◽  
Abdallah Nawara ◽  
Mohammad M. Sallam ◽  
Khaled Abdel-Azeem ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Meld Score ◽  
Band Ligation

scholarly journals A preoperative nomogram predicts prognosis of patients with hepatocellular carcinoma after liver transplantation: a multicenter retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dabing Huang ◽  
Yinan Shen ◽  
Wei Zhang ◽  
Chengxiang Guo ◽  
Tingbo Liang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Adjuvant Therapy ◽  
Validation Cohort ◽  
Multivariate Analyses ◽  
Meld Score ◽  
Blood Type ◽  
Intermediate Risk ◽  
Final Model ◽  
Using Data

Abstract Background Although criteria for liver transplantation, such as the Milan criteria and Hangzhou experiences, have become popular, criteria to guide adjuvant therapy for patients with hepatocellular carcinoma after liver transplantation are lacking. Methods We collected data from all consecutive patients from 2012 to 2019 at three liver transplantation centers in China retrospectively. Univariate and multivariate analyses were used to analyze preoperative parameters, such as demographic and clinical data. Using data obtained in our center, calibration curves and the concordance Harrell’s C-indices were used to establish the final model. The validation cohort comprised the patients from the other centers. Results Data from 233 patients were used to construct the nomogram. The validation cohort comprised 36 patients. Independent predictors of overall survival (OS) were identified as HbeAg positive (P = 0.044), blood-type compatibility unmatched (P = 0.034), liver transplantation criteria (P = 0.003), and high MELD score (P = 0.037). For the validation cohort, to predict OS, the C-index of the nomogram was 0.874. Based on the model, patients could be assigned into low-risk (≥ 50%), intermediate-risk (30–50%), and high-risk (≤ 30%) groups to guide adjuvant therapy after surgery and to facilitate personalized management. Conclusions The OS in patients with hepatocellular carcinoma after liver transplantation could be accurately predicted using the developed nomogram.

scholarly journals RIPK3-Mediated Necroptosis and Neutrophil Infiltration Are Associated with Poor Prognosis in Patients with Alcoholic Cirrhosis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Zhenzhen Zhang ◽  
Guomin Xie ◽  
Li Liang ◽  
Hui Liu ◽  
Jing Pan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Poor Prognosis ◽  
Alcoholic Cirrhosis ◽  
Normal Liver ◽  
Neutrophil Infiltration ◽  
Meld Score ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

Alcoholic cirrhosis is an end-stage liver disease with impaired survival and often requires liver transplantation. Recent data suggests that receptor-interacting protein kinase-3- (RIPK3-) mediated necroptosis plays an important role in alcoholic cirrhosis. Additionally, neutrophil infiltration is the most characteristic pathologic hallmark of alcoholic hepatitis. Whether RIPK3 level is correlated with neutrophil infiltration or poor prognosis in alcoholic cirrhotic patients is still unknown. We aimed to determine the correlation of RIPK3 and neutrophil infiltration with the prognosis in the end-stage alcoholic cirrhotic patients. A total of 20 alcoholic cirrhotic patients subjected to liver transplantation and 5 normal liver samples from control patients were retrospectively enrolled in this study. Neutrophil infiltration and necroptosis were assessed by immunohistochemical staining for myeloperoxidase (MPO) and RIPK3, respectively. The noninvasive score system (model for end-stage liver disease (MELD)) and histological score systems (Ishak, Knodell, and ALD grading and ALD stage) were used to evaluate the prognosis. Neutrophil infiltration was aggravated in patients with a high MELD score (≥32) in the liver. The MPO and RIPK3 levels in the liver were positively related to the Ishak score. The RIPK3 was also significantly and positively related to the Knodell score. In conclusion, RIPK3-mediated necroptosis and neutrophil-mediated alcoholic liver inflammatory response are highly correlated with poor prognosis in patients with end-stage alcoholic cirrhosis. RIPK3 and MPO might serve as potential predictors for poor prognosis in alcoholic cirrhotic patients.

Current State and Future Possibilities in Liver Transplantation

2021 ◽  
Author(s):  
Sebastian Rademacher ◽  
◽  
Niklas Aehling ◽  
Robert Sucher ◽  
Thomas Berg ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Survival Rates ◽  
Tolerance Induction ◽  
Meld Score ◽  
Long Term Results ◽  
Future Research ◽  
Industrialized Countries ◽  
Normothermic Machine Perfusion ◽  
Donor Characteristics

Due to medical and surgical progress, liver transplantation (LT) is is nowadays a routine treatment for terminal liver failure and hepatic malignancies. However, in recent years there has been a change in the indications for LT. Especially in western industrialized countries, the use of LT for chronic hepatis B and hepatitis C cirrhosis is continuously decreasing since the introduction of effective antiviral drugs. Liver cirrhosis due to non-alcoholic steatohepatitis (NASH), alcoholic liver disease and hepatocellular carcinoma (HCC) in cirrhosis are now among the leading indications for LT. Due to tremendous progress in oncology, immunology, and technical aspects, multidisciplinary cancer treatment increasingly includes LT for non-HCC hepatobiliary malignancies. Excellent 5-year survival rates of 75 to 80% can now be achieved after LT. However, in patients with liver cirrhosis, the implementation of a ‘sickest first’ principle for liver allocation has led to an increasing number of critically ill patients undergoing liver transplantation. This results in an increased morbidity and mortality after liver transplantation. Moreover, donor characteristics have markedly shifted to less ideal grafts due to an increasing shortage of donor organs in many countries. In this context, normothermic machine perfusion with oxygenated blood components using pulsatile flow has been shown to reduce liver damage despite a prolonged preservation time and might be able to provide viability testing for otherwise discarded organs. With favorable donor and recipient conditions, excellent long-term results can be obtained with a 10-year survival rate of close to 70%. However, in patients with a high MELD score (>30), survival rates markedly decrease by 12-18%. Future research should focus on optimization of organ allocation, optimization of immunosuppression including tolerance induction, and on increasing the donor organ pool to further improve and the numbers of successful LT.

scholarly journals Effect of "the Awakening Protocol" in the outcome of liver transplantation

2013 ◽  
Vol 28 (suppl 1) ◽  
pp. 72-76
Author(s):  
Agnaldo Soares Lima ◽  
Leandro Ricardo de Navarro Amado ◽  
Malvina Maria de Freitas Duarte ◽  
Marcelo Dias Sanches ◽  
Alexandre Prado de Resende ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Base Excess ◽  
Risk Index ◽  
Graft Loss ◽  
Early Morning ◽  
Meld Score ◽  
The Awakening ◽  
Transplant Patients ◽  
Surgical Tactics ◽  
Patient And Graft Survival

PURPOSE: To analyze mortality (7 days) or graft loss in liver transplantation (Tx) performed within the Awakening Protocol (AP) compared to sequential Tx. METHODS: Analysis of 243 liver tx (230 patients), divided into sequential tx or PD (early morning) to compare graft loss or death (7 days). Significant differences at p <0.05 RESULTS: The PD was adopted in 32.5% of tx. The cold ischemia time (p <0.01) and the interval until transplantation (p <0.01) were significantly different. Age of the donor and recipient, Donor Risk Index, MELD score, and donor base excess, sodium, creatinine and glucose were not different between groups. Previous abdominal surgery was a risk factor for early mortality, but was equally distributed between the groups. There was no difference in mortality or graft loss within 7 days (p = 0.521) CONCLUSION: The adoption of PD, to start tx the morning when harvesting occurs after 10p.m. did not result in worse patient and graft survival. Transplant patients with fulminant hepatic failure and high-risk grafts do not apply to this surgical tactics.

scholarly journals The use of MELD scores in critically ill cirrhotic patients

2016 ◽  
Vol 4 (16) ◽  
pp. 45
Author(s):  
Supannee Rassameehiran ◽  
Tinsay Woreta
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Hospital Mortality ◽  
Organ Failure ◽  
Critically Ill ◽  
Meld Score ◽  
Chronic Liver Failure ◽  
End Stage Liver Disease ◽  
Cirrhotic Patients ◽  
End Stage

The Model for End-Stage Liver Disease (MELD) was originally created to predict survival following transjugular intrahepatic portosystemic shunt and was subsequently found to accurately predict mortality in patients with end-stage liver disease. It has been used in the United States for liver allocation since 2002, and implementation of the MELD score resulted in a reduction in total number of deaths on the waitlist and a reduction in waiting time. Critically ill cirrhotic patients have an in-hospital mortality greater than 50%. Although the MELD score was also found to be an accurate predictor of in-ICU mortality and in-hospital mortality after ICU admission in critically ill cirrhotic patients, the Sequential Organ Failure Assessment (SOFA) score appears to perform better in many studies. The Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score was later developed by using specific cut-points for each organ failure score system in CLIF patients to predict mortality in patients with ACLF. Neither the MELD nor SOFA score independently predicts post-liver transplantation mortality in cirrhotic patients with extrahepatic organ failure and should not be use as a delisting criterion for these patients. More data are needed to determine the accuracy of the CLIF-C ACLF score in predicting post-liver transplantation outcomes. Prospective evaluation of critically ill cirrhotic patients is needed to optimize liver organ allocation.

scholarly journals Contemporaneous Portal-Arterial Reperfusion during Liver Transplantation: Preliminary Results

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
G. L. Adani ◽  
A. Rossetto ◽  
V. Bresadola ◽  
D. Lorenzin ◽  
U. Baccarani ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Artery ◽  
Graft Survival ◽  
Meld Score ◽  
Warm Ischemia ◽  
Biliary Strictures ◽  
Arterial Revascularization ◽  
Group 2 ◽  
One Year ◽  
Group 1

We prospectively compared sequential portal-arterial revascularization (SPAr, group 1 no. 19) versus contemporaneous portal-hepatic artery revascularization (CPAr, group 2 no. 21) in 40 consecutive liver transplantation (LT). There were no differences in the demographics characteristics, MELD score, indication to LT, and donor's parameters between the two groups. CPAr had longer warm ischemia66±8versus37±7min (P<.001), while SPAr had longer arterial ischemia103±42 min (P=.0004). One-year patient's and graft survival were, respectively, 89% and 95% versus 94% and 100% (P=.29). At median followup of13±6versus14±7months biliary complications were anastomotic stenosis in 15% versus 19% (P=.78), and intrahepatic nonanastomotic biliary strictures in 26% versus none (P=.01), respectively, in SPAr and CPAr. CPAr reduces the incidence of intrahepatic biliary strictures by decreasing the duration of arterial ischemia.

scholarly journals Reduced Priority MELD Score for Hepatocellular Carcinoma Does Not Adversely Impact Candidate Survival Awaiting Liver Transplantation

2006 ◽  
Vol 6 (8) ◽  
pp. 1957-1962 ◽  
Author(s):  
P. Sharma ◽  
A. M. Harper ◽  
J. L. Hernandez ◽  
T. Heffron ◽  
D. C. Mulligan ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Meld Score

Interaction between tacrolimus, MELD score and acute kidney injury after liver transplantation. Analysis on a large contemporary bicenter meld‐era series

2020 ◽  
Vol 34 (9) ◽  
Author(s):  
Rubén Ciria ◽  
Irene Gómez‐Luque ◽  
Miriam Cortés ◽  
Shirin E. Khorsandi ◽  
Maria D. Ayllón ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Meld Score
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