Region 11 MELD Na exception prospective study
Journal Title: Annals of Hepatology - Year 2012, Vol 11, Issue 1
Abstract
Introduction. Hyponatremia complicates cirrhosis and predicts short term mortality, including adverse outcomes before and after liver transplantation. Material and methods. From April 1, 2008, through April 2, 2010, all adult candidates for primary liver transplantation with cirrhosis, listed in Region 11 with hyponatremia, were eligible for sodium (Na) exception. Results. Patients with serum sodium (SNa) less than 130 mg/dL, measured two weeks apart and within 30 days of Model for End Stage Liver Disease (MELD) exception request, were given preapproved Na exception. MELD Na was calculated [MELD + 1.59 (135-SNa/30 days)]. MELD Na was capped at 22, and subject to standard adult recertification schedule. On data end of follow-up, December 28, 2010, 15,285 potential U.S. liver recipients met the inclusion criteria of true MELD between 6 and 22. In Region 11, 1,198 of total eligible liver recipients were listed. Sixty-two (5.2%) patients were eligible for Na exception (MELD Na); 823 patients (68.7%) were listed with standard MELD (SMELD); and 313 patients (26.1%) received HCC MELD exception. Ninety percent of MELD Na patients and 97% of HCC MELD patients were transplanted at end of follow up, compared to 49% of Region 11 standard MELD and 40% of U.S.A. standard MELD (USA MELD) patients (p < 0.001); with comparable dropout rates (6.5, 1.6, 6.9, 9% respectively; p = 0.2). MELD Na, HCC MELD, Region 11 SMELD, and USA MELD post-transplant six-month actual patient survivals were similar (92.9, 92.8, 92.2, and 93.9 %, respectively). Conclusion. The Region 11 MELD Na exception prospective trial improved hyponatremic cirrhotic patient access to transplant equitably, and without compromising transplant efficacy.
Authors and Affiliations
Robert Fisher, Douglas Heuman, Ann Harper, Martha Behnke, Alastair Smith, Mark Russo, Steven Zacks, John McGillicuddy, James Eason, Michael Porayko, Patrick Northup, Johnathan Hundley, Satheesh Nair
Keywords
Related Articles
- EP ID EP78100
- DOI -
- Views 136
- Downloads 0
Danazol improves thrombocytopenia in HCV patients treated with peginterferon and ribavirin
Background. Thrombocytopenia is a common hematologic disorder observed in patients with chronic hepatitis C virus (HCV) infection. Combined peginterferon (PEG-INF) and ribavirin treatment may exacerbate thrombocytopenia...
Meta-analysis of the clinical value of oxymatrine on sustained virological response in chronic hepatitis B
Introduction. Oxymatrine (OMTR) is widely used for the treatment of chronic hepatitis B (CHB) in China. Several recent reportsrevealed that OMTR together with interferon yielded a higher sustained virological response (...
Is it appropriate to study blood ghrelin and obestatin in non-alcoholic fatty liver disease (NAFLD) without using protease inhibitors?
Contrast-induced acute kidney injury in cirrhotic patients. A retrospective analysis
Background. The nephrotoxic potential of intravenous iodinated contrast (IC) is controversial. Cirrhotic patients are often submitted to imaging procedures involving IC and small changes in renal function may have detrim...
Hepatogenous diabetes. Current views of an ancient problem
Diabetes developed as a complication of cirrhosis is known as hepatogenous diabetes» (HD). Around 30% to 60% of cirrhotic patients suffer from this metabolic disorder. Insulin resistance in muscular, hepatic and adipose...