Cirrhosis in Surgery
Stephen M. Cohn, Peter Rhee in 50 Landmark Papers, 2019
For cirrhotic patients who require elective non-hepatic surgery, operative repair has traditionally been considered high risk. The most significant challenge is deciding when, or if, to operate. To guide the decision are two grading systems that quantify the severity of liver disease. The Child-Turcotte-Pugh (CTP) score is computed by rating the severity of five contributing factors (total bilirubin, serum albumin, prothrombin time, ascites, and encephalopathy) on a scale of 1–3 with the resulting score ranging from 5 to 15. Scores are then grouped into one of three grades from A to C. The Model for End-Stage Liver Disease (MELD) score was primarily developed to rate severity of end-stage liver disease among candidates for liver transplantation by predicting 90-day mortality, but is now widely used in many settings. The score is derived from incorporating international normalized ratio (INR), serum creatinine (Cr), total bilirubin, and now also serum sodium (Na). Of note, the two most heavily weighted variables in the MELD scoring system are the INR and the creatinine. The MELD score can guide the mortality risk for elective surgical procedures. Thirty-day mortality ranges from 5.7% for MELD score less than 8 to more than 50% for MELD score greater than 20 (Teh et al., 2007).
Adefovir Dipivoxil
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
A cohort of 128 patients awaiting liver transplantation and 196 patients after transplantation with lamivudine-resistant chronic HBV infection were given 10 mg daily adefovir for 18 and 56 weeks, respectively. Both groups experienced significant improvements in disease variables (Schiff et al., 2003). At week 48 undetectable HBV DNA levels were achieved in 81% and 34% of pre- and posttransplant patients, respectively; normalization of ALT in 76% and 49% of pre- and posttransplant patients, and > 90% of both cohorts had improvements in Child–Pugh–Turcotte (CPT) scores. The predictive abilities of the model for end-stage liver disease (MELD) score and the CPT score for intermediate (1-year) and long-term (5-year) mortality have been studied (Said et al., 2004). One-year survival (Kaplan–Meier analysis) was 84% and 93% for pre- and posttransplant patients, respectively.
Overview of liver transplantation
Nizar Zein, Bret Lashner in The Year in Gastroenterology and Hepatology, 2005
The year 2003 was an important year in many respects for liver transplant physicians and surgeons, marking the first year after implementation of the new liver allocation system within the United States, the Model for End-Stage Liver Disease (MELD) score. Advances in our understanding of the pathophysiology of liver disease have also allowed new therapies and approaches to the treatment of patients with endstage liver disease. Despite aggressive attempts to expand the availability of liver transplantation, an unacceptably high rate of deaths on the liver transplant waiting lists remains. By June of 2003, the liver transplant waiting list in the US stood at 17155 |1|. Despite this, the pool of donors has not kept pace, with a conversion rate (the number of actual donors divided by the number of potential donors) that has been relatively stable at approximately 42% |2|.
Serum exosomal long noncoding RNA nuclear-enriched abundant transcript 1 predicts 90-day mortality in acute-on-chronic hepatitis B liver failure
Published in Expert Review of Clinical Immunology, 2021
Shuai Gao, Yu-Chen Fan, Li-Yan Han, Kai Wang
Ascites was detected by abdominal ultrasound. The blood samples were collected from each patient on the first day of diagnosis with ACHBLF. The serum biochemical markers (COBAS 8000, Roche Diagnostics, Mannheim, Germany) included alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), gamma-glutamyl transferase (GGT), total bilirubin (TBIL), albumin (ALB) and creatinine (Cr). Hematologicalmarkers (Sysmex XE-2100, Sysmex Corporation, Kobe, Japan) included white blood cell (WBC), hemoglobin (HGB) and platelet (PLT). Hemostasis markers (ACL TOP 700, Instrument laboratory, Brea, CA, USA) included prothrombin time-international normalized ratio (PT-INR). Hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) were measured by an automatic analyzer (Cobas 6000 analyzer series, Roche Diagnostics, Rotkreuz, Switzerland). HBV-DNA was determined by a Real-Time polymerase chain reaction (PCR) System (ABI 7300, Applied Biosystems, Foster City, CA, USA), with a detection sensitivity of 500 IU/mL. These markers were determined at the Department of Laboratory Medicine, Qilu Hospital of Shandong University. Furthermore, model for end-stage liver disease (MELD) score was calculated according to this formula:
Using Marginal Grafts for Liver Transplantation: The Balance of Risk
Published in Journal of Investigative Surgery, 2020
Marit Kalisvaart, M. Thamara P. R. Perera
The outcomes after liver transplantation do, however, not only depend on quality of the graft. Recipient age, Model for End Stage Liver Disease (MELD)-score and comorbidities and surgical issues during the transplant procedure also have an impact on recipient outcomes. This Balance of Risk concept follows the principle that a patient with limited risk can sustain the injury of marginal grafts, i.e. a young patient with a low MELD-score and hepatocellular carcinoma that needs urgent transplantation for oncological reasons might benefit from a DCD graft that is earlier available than a Donation after Brain Death (DBD) graft. On the contrary, a critically ill patient requiring organ support and renal replacement therapy can only receive the best DBD graft, to minimize the peri-transplant risk. Therefore, recent prediction models for graft loss or mortality after liver transplantation assess the cumulative risk of donor, graft and recipient factors. Examples include the BAR Score from Zürich, the SOFT Score from Columbia University and the UK DCD Risk Score for DCD grafts, developed by our team in Birmingham [4–6]. The ideal organ allocation system takes in to account all these aspects but such systems do not exist. In this context, a new allocation scheme has been introduced in the United Kingdom earlier this year called “Transplant Benefit Score” that combines a host of recipient and donor criteria and aims to match grafts and recipients in such a way that the graft is allocated to a recipient who will have the most benefit [7].
Elevated D-Dimer levels correlate with the development of hepatorenal syndrome and a poor outcome in patients with cirrhosis
Published in Scandinavian Journal of Gastroenterology, 2022
Baode Chen, Jing Liu, Yongtao Li, Xuelin He, Cheng Zhou, Yu Chen, Min Zheng
We collected data on demographics, cause of liver cirrhosis, medical history and laboratory data from electronic medical records. All data were collected through a manual review of the medical records. In the patient with an available sCr value before admission, the most recent stable value of sCr within the last 3 months before admission was considered as baseline; In the patient without an available sCr before hospitalisation, the sCr on admission was used as baseline [19]. Patients were followed up by clinical record review until death, liver transplant (LT) or the end of follow-up. The occurrence and classification of AKI were monitored based on their clinical and laboratory data. All assays for serum biochemical parameters were routinely performed at the central clinical laboratory of this hospital. Plasma D-Dimer was analyzed on the SYSMEX CS 5100 using the INNOVANCE D-Dimer assay (Siemens Healthcare, Marburg, Germany). D-Dimer values at baseline ranged from 0.19 to 4.4 mg/l FEU. Automated sample redilution extends the measuring range up to 35.2 mg/L FEU. The coefficients of variation of D-dimer determination were 3.2%(within-run) and 5.5%(between-run). The eGFR was calculated based on the Modification of Diet in Renal Disease (MDRD) [22]. The equation of MDRD is as follow: eGFR (ml/min/1.73 m2) = 186×(sCr)−1.154× (age) −0.203× (0.742 female). Model for end-stage liver disease (MELD) score = 3.78*ln (TBil mg/dl) + 11.2*ln (INR) + 9.57*ln (Cr mg/dl) + 6.43*(Bile or alcohol = 0, Other = 1).
