AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum ...AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.展开更多
BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(IC...BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(ICG-R15),as one of the liver function assessment tools,has been developed as a prognostic indicator in patients undergoing surgery,but there are limited data on its role in TIPS.AIM To determine whether the ICG-R15 can be used for prediction of post-TIPS HE in decompensated cirrhosis patients with portal hypertension(PHT)and compare the clinical value of ICG-R15,Child-Pugh score(CPS),and model for end-stage liver disease(MELD)score in predicting post-TIPS HE with PHT.METHODS This retrospective study included 195 patients with PHT who underwent elective TIPS at Beijing Shijitan Hospital from January 2018 to June 2019.All patients underwent the ICG-R15 test,CPS evaluation,and MELD scoring 1 wk before TIPS.According to whether they developed HE or not,the patients were divided into two groups:HE group and non-HE group.The prediction of one-year post-TIPS HE by ICG-R15,CPS and MELD score was evaluated by the areas under the receiver operating characteristic curves(AUCs).RESULTS A total of 195 patients with portal hypertension were included and 23%(45/195)of the patients developed post-TIPS HE.The ICG-R15 was identified as an independent predictor of post-TIPS HE.The AUCs for the ICG-R15,CPS,and MELD score for predicting post-TIPS HE were 0.664(95%confidence interval[CI]:0.557-0.743,P=0.0046),0.596(95%CI:0.508-0.679,P=0.087),and 0.641(95%CI:0.554-0.721,P=0.021),respectively.The non-parametric approach(Delong-Delong&Clarke-Pearson)showed that there was statistical significance in pairwise comparison between AUCs of ICG-R15 and MELD score(P=0.0229).CONCLUSION The ICG-R15 has appreciated clinical value for predicting the occurrence of post-TIPS HE and is a choice for evaluating the prognosis of patients undergoing TIPS.展开更多
Background:Acute-on-chronic liver failure(ACLF)is characterised by a sudden deterioration of underlying chronic liver disease,resulting in increased rates of mortality and liver transplantation.Early prognostication c...Background:Acute-on-chronic liver failure(ACLF)is characterised by a sudden deterioration of underlying chronic liver disease,resulting in increased rates of mortality and liver transplantation.Early prognostication can benefit optimal allocation of resources.Methods:ACLF was defined as per the disease criteria of the Asian Pacific Association for the Study of the Liver.Inpatient discharge summaries from between January 2001 and April 2013 were reviewed.The primary outcome was mortality or liver transplantation within 60 days from onset of ACLF.Absolute‘model for end-stage liver disease’(MELD)score and change in MELD at Weeks 1,2 and 4 were reviewed in order to identify the earliest point for prediction of mortality or liver transplantation.Results:Clinical data were collected on 53 subjects who fulfilled the inclusion and exclusion criteria.At 60 days from presentation,20 patients(37.7%)died and 4(7.5%)underwent liver transplantation.Increased MELD of-2 after 2 weeks was 75.0%sensitive and 75.9%specific for predicting mortality or liver transplantation.If the MELD score did not increase at 2 weeks,predictive chance of survival was 93.8%over the next 60 days.MELD change at 1 week showed poor sensitivity and specificity.Change at 4 weeks was too late for intervention.Conclusion:Change in MELD score at 2 weeks provides an early opportunity for prognostication in ACLF.A MELD score that does not deteriorate by Week 2 would predict 93.8%chance of survival for the next 60 days.This finding warrants further validation in larger cohort studies.展开更多
Background:Cirrhosis with acute decompensation(AD)and acute-on-chronic liver failure(ACLF)are characterized by high morbidity and mortality.Cytolysin,a toxin from Enterococcus faecalis(E.faecalis),is associated with m...Background:Cirrhosis with acute decompensation(AD)and acute-on-chronic liver failure(ACLF)are characterized by high morbidity and mortality.Cytolysin,a toxin from Enterococcus faecalis(E.faecalis),is associated with mortality in alcohol-associated hepatitis(AH).It is unclear whether cytolysin also contributes to disease severity in AD and ACLF.Methods:We studied the role of fecal cytolysin in 78 cirrhotic patients with AD/ACLF.Bacterial DNA from fecal samples was extracted and real-time quantitative polymerase chain reaction(PCR)was performed.The association between fecal cytolysin and liver disease severity in cirrhosis with AD or ACLF was analyzed.Results:Fecal cytolysin and E.faecalis abundance did not predict chronic liver failure(CLIF-C)AD and ACLF scores.Presence of fecal cytolysin was not associated with other liver disease markers,including Fibrosis-4(FIB-4)index,‘Age,serum Bilirubin,INR,and serum Creatinine(ABIC)’score,Child-Pugh score,model for end-stage liver disease(MELD)nor MELD-Na scores in AD or ACLF patients.Conclusions:Fecal cytolysin does not predict disease severity in AD and ACLF patients.The predictive value of fecal cytolysin positivity for mortality appears to be restricted to AH.展开更多
BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(...BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.展开更多
Purpose:To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt(TIPS)creation in patients with cirrhosis and to explore its association with clinical outcomes.Methods:This...Purpose:To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt(TIPS)creation in patients with cirrhosis and to explore its association with clinical outcomes.Methods:This retrospective study included patients who underwent TIPS between August 2016 and December2020.Liver function was primarily evaluated using the model for end-stage liver disease(MELD)score,which was analyzed at baseline,1 week,1 month,3 months,6 months,and 12 months using one-way repeated measures ANOVA.The Kaplan-Meier method,log-rank test,and multivariate analysis were used as appropriate.Results:In total,235 patients were included in this study.The MELD score was significantly higher at 1 week(11.8±3.1 vs 13.5±3.5,p<0.05)and 1 month(11.8±3.1 vs 13.2±4.6,p<0.05)than the baseline level and recovered at 3 months(11.8±3.1 vs 11.9±3.9,p>0.05).At 12 months,the MELD score was higher than the baseline level(11.8±3.1 vs 12.4±3.2,p<0.05).Patients with a recovery of the MELD score(n=151)at 3 months had a lower probability of overt and severe HE(log-rank p=0.015 and p=0.027,respectively)than those without recovery(n=84).Logistic regression analysis revealed that albumin(odds ratio[OR],0.926;95%confidence interval[CI],0.863–0.992;p=0.029)and platelet count(OR,0.993;95%CI,0.987–0.999;p=0.033)were independent predictive factors for non-recovery of the MELD score at 3 months.Conclusions:Liver function after TIPS creation showed a trend of deterioration at first,followed by recovery.Recovery of liver function at three months was associated with reduced overt and severe HE.展开更多
Since the adoption of the model for end-stage liver disease(MELD)score for organ allocation in 2002,numerous changes to the system of liver allocation and distribution have been made with the goal of decreasing waitli...Since the adoption of the model for end-stage liver disease(MELD)score for organ allocation in 2002,numerous changes to the system of liver allocation and distribution have been made with the goal of decreasing waitlist mortality and minimizing geographic variability in median MELD score at time of transplant without worsening post-transplant outcomes.These changes include the creation and adoption of the MELD-Na score for allocation,Regional Share 15,Regional Share for Status 1,Regional Share 35/National Share 15,and,most recently,the Acuity Circles Distribution Model.However,geographic differences in median MELD at time of transplant remain as well as limits to the MELD score for allocation,as etiology of liver disease and need for transplant changes.Acute-onchronic liver failure(ACLF)is a subset of liver failure where prevalence is rising and has been shown to have an increased mortality rate and need for transplantation that is under-demonstrated by the MELD score.This underscores the limitations of the MELD score and raises the question of whether MELD is the most accurate,objective allocation system.Alternatives to the MELD score have been proposed and studied,however MELD score remains as the current system used for allocation.This review highlights policy changes since the adoption of the MELD score,addresses limitations of the MELD score,reviews proposed alternatives to MELD,and examines the specific implications of these changes and alternatives for ACLF.展开更多
BACKGROUND Corrected QT(QTc)interval is prolonged in patients with liver cirrhosis and has been proposed to correlate with the severity of the disease.However,the effects of sex,age,severity,and etiology of cirrhosis ...BACKGROUND Corrected QT(QTc)interval is prolonged in patients with liver cirrhosis and has been proposed to correlate with the severity of the disease.However,the effects of sex,age,severity,and etiology of cirrhosis on QTc have not been elucidated.At the same time,the role of treatment,acute illness,and liver transplantation(Tx)remains largely unknown.AIM To determine the mean QTc in patients with cirrhosis,assess whether QTc is prolonged in patients with cirrhosis,and investigate whether QTc is affected by factors such as sex,age,severity,etiology,treatment,acute illness,and liver Tx.METHODS In the present systematic review and meta-analysis,the searching protocol“{[QTc]OR[QT interval]OR[QT-interval]OR[Q-T syndrome]}AND{[cirrhosis]OR[Child-Pugh]OR[MELD]}”was applied in PubMed,EMBASE,and Google Scholar databases to identify studies that reported QTc in patients with cirrhosis and published after 1998.Seventy-three studies were considered eligible.Data concerning first author,year of publication,type of study,method used,sample size,mean age,female ratio,alcoholic etiology of cirrhosis ratio,Child-Pugh A/B/C ratio,mean model for end-stage liver disease(MELD)score,treatment withβ-blockers,episode of acute gastrointestinal bleeding,formula for QT correction,mean pulse rate,QTc in patients with cirrhosis and controls,and QTc according to etiology of cirrhosis,sex,Child-Pugh stage,MELD score,and liver Tx status(pre-Tx/post-Tx)were retrieved.The Newcastle-Ottawa quality assessment scale appraised the quality of the eligible studies.Effect estimates,expressed as proportions or standardized mean differences,were combined using the randomeffects,generic inverse variance method of DerSimonian and Laird.Subgroup,sensitivity analysis,and meta-regressions were applied to assess heterogeneity.RESULTS QTc combined mean in patients with cirrhosis was 444.8 ms[95%confidence interval(CI):440.4-449.2;P<0.001 when compared with the upper normal limit of 440 ms],presenting high heterogeneity(I2=97.5%;95%CI:97.2%-97.8%);both Egger’s and Begg’s tests showed non-significance.QTc was elongated in patients with cirrhosis compared with controls(P<0.001).QTc was longer in patients with Child-Pugh C cirrhosis when compared with Child-Pugh B and A(P<0.001);Child-Pugh B patients presented longer QTc when compared with Child-Pugh A patients(P=0.003).The MELD score was higher in patients with cirrhosis with QTc>440 ms when compared with QTc≤440 ms(P<0.001).No correlation of QTc with age(P=0.693),sex(P=0.753),or etiology(P=0.418)was detected.β-blockers shortened QTc(P<0.001).QTc was prolonged during acute gastrointestinal bleeding(P=0.020).Tx tended to improve QTc(P<0.001).No other sources of QTc heterogeneity were revealed.CONCLUSION QTc is prolonged in cirrhosis independently of sex,age,and etiology but is correlated with severity and affected byβ-blockers and acute gastrointestinal bleeding.QTc is improved after liver Tx.展开更多
Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for ...Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for organ allocation for liver transplantation.However,there are limited studies to compare the MELD with MELD-Na to predict mortality after TIPS.Methods:We performed a retrospective chart review of patients who underwent TIPS placement between 2006 and 2016 at our institution.The primary outcome was mortality,and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS placement.We performed receiver operating characteristic(ROC)curve analysis to assess the performance of MELD and MELD-Na.Results:There were 186 eligible patients in the analysis.The mean pre-TIPS MELD and MELD-Na were 13 and 15,respectively.Overall,mortality after TIPS was 15%at 30 days and 16.7%at 90 days.In a comparison of the areas under the ROCs for MELD and MELD-Na,MELD was superior to MELD-Na for 30-day(0.762 vs.0.709)and 90-day(0.780 vs.0.730)mortality after TIPS.The optimal cutoff score for 30-day mortality was 15(0.676–0.848)for MELD and 17(0.610–0.808)for MELD-Na,whereas the optimal cutoff score for 90-day mortality was 16(95%CI:0.705–0.855)for MELD and 17(95%CI:0.643–0.817)for MELDNa.There were 24 patients with high MELD-Na≥17,but with low MELD<15,and 90-day mortality in this group was 8.3%.Conclusions:Although MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients,MELD tended to outperform MELD-Na to predict mortality after TIPS.展开更多
Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support.Despite this fact,their mortality has decreased in re...Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support.Despite this fact,their mortality has decreased in recent decades due to improved care of critically ill patients.Acute-on-chronic liver failure(ACLF),sepsis and elevated hepatic scores are associated with increased mortality in this population,especially among those not eligible for liver transplantation.No score is superior to another in the prognostic assessment of these patients,and both liver-specific and intensive care unit-specific scores have satisfactory predictive accuracy.The sequential assessment of the scores,especially the Sequential Organ Failure Assessment(SOFA)and Chronic Liver Failure Consortium(CLIF)-SOFA scores,may be useful as an auxiliary tool in the decision-making process regarding the benefits of maintaining supportive therapies in this population.A CLIF-ACLF>70 at admission or at day 3 was associated with a poor prognosis,as well as SOFA score>19 at baseline or increasing SOFA score>72.Additional studies addressing the prognostic assessment of these patients are necessary.展开更多
Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality ha...Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana’a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endoscope (P - 47.29, P = 0.001) and high serum bilirubin (- 1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P - 1.41, P - 1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 10<sup>9</sup>/l.展开更多
Liver failure is a group of clinical syndromes with a mortality rate of>50%.The accurate evaluation of severity in patients with liver failure has been a meaningful and hot topic in clinical research and an importa...Liver failure is a group of clinical syndromes with a mortality rate of>50%.The accurate evaluation of severity in patients with liver failure has been a meaningful and hot topic in clinical research and an important guide for liver transplantation.Numerous prognosis studies have emerged in recent years with high accuracy and adequate validity.Nonetheless,different models utilize distinct parameters and have unequal efficiencies,leading to a specific value and unique application situations for each model.This review focused on the progress in recent prognostic studies including the model for end-stage liver disease,sequential organ failure assessment and its derivative models,the Chinese Group on the Study of Severe Hepatitis B Acute-on-Chronic Liver Failure,the Tongji prognostic predictor model,and other emerging prognostic models and predictors.This review aims to assist clinicians understand the framework of recent models and choose the appropriate model and treatment.展开更多
Background and Aims:Liver transplantation(LT)using ABO-incompatible(ABOi)grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation.However,concerns of the impending pro...Background and Aims:Liver transplantation(LT)using ABO-incompatible(ABOi)grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation.However,concerns of the impending prognosis associated with this option,especially for patients with liver failure and higher model for end-stage liver disease(MELD)scores,who tend to be more fragile during the waiting period before LT.Methods:Recipients undergoing LT for acute-onchronic liver failure or acute liver failure were retrospectively enrolled at four institutions.Overall survival was compared and a Cox regression analysis was performed.Propensity score matching was performed for further comparison.Patients were stratified by MELD score and cold ischemia time(CIT)to determine the subgroups with survival benefits.Results:Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible(ABOc)LT were enrolled.The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching(50.6%vs.75.7%,p<0.05).For patients with MELD scores≤30,using ABOi grafts achieved a comparable overall survival rate as using ABOc grafts(p>0.05).Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores≥40(p>0.05).For patients with MELD scores of 31-39,the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group(p<0.001);however,the rate was increased when the liver graft CIT was<8 h.Conclusions:For recipients with MELD scores≤30,ABOi LT had a prognosis comparable to that of ABOc LT and can be regarded as a feasible option.For recipients with MELD scores≥40,ABOi should be adopted with caution in emergency cases.For recipients with MELD scores of 31-39,the ABOi LT prognosis was worse.However,those patients benefited from receiving ABOi grafts with a CIT of<8 h.展开更多
Background:Selection of the optimal treatment modality for primary liver cancers remains complex,balancing patient condition,liver function,and extent of disease.In individuals with preserved liver function,liver rese...Background:Selection of the optimal treatment modality for primary liver cancers remains complex,balancing patient condition,liver function,and extent of disease.In individuals with preserved liver function,liver resection remains the primary approach for treatment with curative intent but may be associated with significant mortality.The purpose of this study was to establish a simple scoring system based on Model for End-stage Liver Disease(MELD)and extent of resection to guide risk assessment for liver resections.Methods:The 2005-2015 NSQIP database was queried for patients undergoing liver resection for primary liver malignancy.We first developed a model that incorporated the extent of resection(1 point for major hepatectomy)and a MELD-Na score category of low(MELD-Na=6,1 point),medium(MELD-Na=7-10,2 points)or high(MELD-Na>10,3 points)with a score range of 1-4,called the Hepatic Resection Risk Score(HeRS).We tested the predictive value of this model on the dataset using logistic regression.We next developed an optimal multivariable model using backwards sequential selection of variables under logistic regression.We performed K-fold cross validation on both models.Receiver operating characteristics were plotted and the optimal sensitivity and specificity for each model were calculated to obtain positive and negative predictive values.Results:A total of 4,510 patients were included.HeRS was associated with increased odds of 30-day mortality[HeRS=2:OR=3.23(1.16-8.99),P=0.025;HeRS=3:OR=6.54(2.39-17.90),P<0.001;HeRS=4:OR=13.69(4.90-38.22),P<0.001].The AUC for this model was 0.66.The AUC for the optimal multivariable model was higher at 0.76.Under K-fold cross validation,the positive predictive value(PPV)and negative predictive value(NPV)of these two models were similar at PPV=6.4%and NPV=97.7%for the HeRS only model and PPV=8.4%and NPV=98.1%for the optimal multivariable model.Conclusions:The HeRS offers a simple heuristic for estimating 30-day mortality after resection of primary liver malignancy.More complicated models offer better performance but at the expense of being more difficult to integrate into clinical practice.展开更多
With the dawn of organ donation after a citizen's death in China,the use of split-liver transplantation(SLT)can effectively increase the source of donor liver,reduce the waiting time for organ transplantation in p...With the dawn of organ donation after a citizen's death in China,the use of split-liver transplantation(SLT)can effectively increase the source of donor liver,reduce the waiting time for organ transplantation in patients,and particularly solve the problem of organ shortage in children.In recent years,many transplantation centers have been performing SLT to varying degrees and efficacy.At the current stage,the experiences of countries with advanced transplantation techniques should be used to establish an SLT consensus that is suitable for China to further increase the ratio and efficacy of SLT.In this paper,we combined expert experiences to generate an SLT expert consensus that included donor and donor liver evaluation,recipient selection criteria,donor and recipient matching,selection of splitting form and tools,blood vessels and bile ducts dissection and allocation,perioperative management of SLT,and organ allocation.展开更多
Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.).We evaluat...Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.).We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT.Methods:All U.S.adult LDLT recipients with MELD< 25 were evaluated using the 1995-2012 United Network for Organ Sharing registry.Survival following LDLTwas stratified into three MELD categories (MELD< 15 vs.MELD 15-19 vs.MELD 20-24) and evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards models.Results:Overall,2,258 patients underwent LDLT.Compared to patients with MELD< 15,overall 5-year survival following LDLT was similar among patients with MELD 15-19 (80.9% vs.80.3%,p =0.77) and MELD 20-24 (81.2% vs.80.3%,p =0.73).When compared to patients with MELD<15,there was no significant difference in long-term post-LDLT survival among those with MELD 15-19 (HR:1.11,95% CI:0.85-1.45,p =0.45) and a non-significant trend towards lower survival in patients with MELD 20-24 (HR:1.28,95%CI:0.91-1.81,p =0.16).Only 14% of LDLTs were performed in patients with MELD 20-24 and the remaining 86% in patients with MELD< 20.Conclusion:LDLT is underutilized in patients with MELD 20 and higher.展开更多
文摘AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.
基金Beijing Municipal Science and Technology Commision,No.Z181100001718097.
文摘BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)implantation.The preoperative indocyanine green retention rate at 15 min(ICG-R15),as one of the liver function assessment tools,has been developed as a prognostic indicator in patients undergoing surgery,but there are limited data on its role in TIPS.AIM To determine whether the ICG-R15 can be used for prediction of post-TIPS HE in decompensated cirrhosis patients with portal hypertension(PHT)and compare the clinical value of ICG-R15,Child-Pugh score(CPS),and model for end-stage liver disease(MELD)score in predicting post-TIPS HE with PHT.METHODS This retrospective study included 195 patients with PHT who underwent elective TIPS at Beijing Shijitan Hospital from January 2018 to June 2019.All patients underwent the ICG-R15 test,CPS evaluation,and MELD scoring 1 wk before TIPS.According to whether they developed HE or not,the patients were divided into two groups:HE group and non-HE group.The prediction of one-year post-TIPS HE by ICG-R15,CPS and MELD score was evaluated by the areas under the receiver operating characteristic curves(AUCs).RESULTS A total of 195 patients with portal hypertension were included and 23%(45/195)of the patients developed post-TIPS HE.The ICG-R15 was identified as an independent predictor of post-TIPS HE.The AUCs for the ICG-R15,CPS,and MELD score for predicting post-TIPS HE were 0.664(95%confidence interval[CI]:0.557-0.743,P=0.0046),0.596(95%CI:0.508-0.679,P=0.087),and 0.641(95%CI:0.554-0.721,P=0.021),respectively.The non-parametric approach(Delong-Delong&Clarke-Pearson)showed that there was statistical significance in pairwise comparison between AUCs of ICG-R15 and MELD score(P=0.0229).CONCLUSION The ICG-R15 has appreciated clinical value for predicting the occurrence of post-TIPS HE and is a choice for evaluating the prognosis of patients undergoing TIPS.
文摘Background:Acute-on-chronic liver failure(ACLF)is characterised by a sudden deterioration of underlying chronic liver disease,resulting in increased rates of mortality and liver transplantation.Early prognostication can benefit optimal allocation of resources.Methods:ACLF was defined as per the disease criteria of the Asian Pacific Association for the Study of the Liver.Inpatient discharge summaries from between January 2001 and April 2013 were reviewed.The primary outcome was mortality or liver transplantation within 60 days from onset of ACLF.Absolute‘model for end-stage liver disease’(MELD)score and change in MELD at Weeks 1,2 and 4 were reviewed in order to identify the earliest point for prediction of mortality or liver transplantation.Results:Clinical data were collected on 53 subjects who fulfilled the inclusion and exclusion criteria.At 60 days from presentation,20 patients(37.7%)died and 4(7.5%)underwent liver transplantation.Increased MELD of-2 after 2 weeks was 75.0%sensitive and 75.9%specific for predicting mortality or liver transplantation.If the MELD score did not increase at 2 weeks,predictive chance of survival was 93.8%over the next 60 days.MELD change at 1 week showed poor sensitivity and specificity.Change at 4 weeks was too late for intervention.Conclusion:Change in MELD score at 2 weeks provides an early opportunity for prognostication in ACLF.A MELD score that does not deteriorate by Week 2 would predict 93.8%chance of survival for the next 60 days.This finding warrants further validation in larger cohort studies.
基金This study was supported in part by National Institutes of Health(NIH)grant(K12 HD85036)University of California San Diego Altman Clinical and Translational Research Institute(ACTRI)/NIH grant(KL2TR001444)+14 种基金Pinnacle Research Award in Liver Diseases Grant(PNC22-159963)from the American Association for the Study of Liver Diseases Foundation(to Hartmann P)Deutsche Forschungsgemeinschaft(DFG,German Research Foundation)fellowship(LA 4286/1-1)the“Clinical and Translational Research Fellowship in Liver Disease”by the American Association for the Study of Liver Diseases(AASLD)Foundation(to Lang S)National Institutes of Health grants(R01 AA24726,R01 AA020703,U01 AA026939)Award Number BX004594 from the Biomedical Laboratory Research&Development Service of the VA Office of Research and DevelopmentBiocodex Microbiota Foundation Grant(to Schnabl B)services provided by NIH centers(P30 DK120515 and P50 AA011999)This study was also supported by the German Research Foundation(DFG)project(403224013-SFB 1382)(to Trebicka J)the German Federal Ministry of Education and Research(BMBF)for the DEEP-HCC project(to Trebicka J)the Hessian Ministry of Higher Education,Research and the Arts(HMWK)for the ENABLE and ACLF-I cluster projects(to Trebicka J)The MICROB-PREDICT(825694)DECISION(847949)GALAXY(668031)LIVERHOPE(731875)IHMCSA(964590)projects(all to Trebicka J)have received funding from the European Union’s Horizon 2020 research and innovation program.
文摘Background:Cirrhosis with acute decompensation(AD)and acute-on-chronic liver failure(ACLF)are characterized by high morbidity and mortality.Cytolysin,a toxin from Enterococcus faecalis(E.faecalis),is associated with mortality in alcohol-associated hepatitis(AH).It is unclear whether cytolysin also contributes to disease severity in AD and ACLF.Methods:We studied the role of fecal cytolysin in 78 cirrhotic patients with AD/ACLF.Bacterial DNA from fecal samples was extracted and real-time quantitative polymerase chain reaction(PCR)was performed.The association between fecal cytolysin and liver disease severity in cirrhosis with AD or ACLF was analyzed.Results:Fecal cytolysin and E.faecalis abundance did not predict chronic liver failure(CLIF-C)AD and ACLF scores.Presence of fecal cytolysin was not associated with other liver disease markers,including Fibrosis-4(FIB-4)index,‘Age,serum Bilirubin,INR,and serum Creatinine(ABIC)’score,Child-Pugh score,model for end-stage liver disease(MELD)nor MELD-Na scores in AD or ACLF patients.Conclusions:Fecal cytolysin does not predict disease severity in AD and ACLF patients.The predictive value of fecal cytolysin positivity for mortality appears to be restricted to AH.
基金Supported by the National Natural Science Foundation of China,No.81960120 and 81660110the Postgraduate Innovation Special Foundation of Jiangxi Province,No.YC2022-B052“Gan-Po Talent 555”Project of Jiangxi Province,No.GCZ(2012)-1.
文摘BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.
基金National Natural Science Foundation of China(81873917)
文摘Purpose:To evaluate the dynamic changes in liver function after transjugular intrahepatic portosystemic shunt(TIPS)creation in patients with cirrhosis and to explore its association with clinical outcomes.Methods:This retrospective study included patients who underwent TIPS between August 2016 and December2020.Liver function was primarily evaluated using the model for end-stage liver disease(MELD)score,which was analyzed at baseline,1 week,1 month,3 months,6 months,and 12 months using one-way repeated measures ANOVA.The Kaplan-Meier method,log-rank test,and multivariate analysis were used as appropriate.Results:In total,235 patients were included in this study.The MELD score was significantly higher at 1 week(11.8±3.1 vs 13.5±3.5,p<0.05)and 1 month(11.8±3.1 vs 13.2±4.6,p<0.05)than the baseline level and recovered at 3 months(11.8±3.1 vs 11.9±3.9,p>0.05).At 12 months,the MELD score was higher than the baseline level(11.8±3.1 vs 12.4±3.2,p<0.05).Patients with a recovery of the MELD score(n=151)at 3 months had a lower probability of overt and severe HE(log-rank p=0.015 and p=0.027,respectively)than those without recovery(n=84).Logistic regression analysis revealed that albumin(odds ratio[OR],0.926;95%confidence interval[CI],0.863–0.992;p=0.029)and platelet count(OR,0.993;95%CI,0.987–0.999;p=0.033)were independent predictive factors for non-recovery of the MELD score at 3 months.Conclusions:Liver function after TIPS creation showed a trend of deterioration at first,followed by recovery.Recovery of liver function at three months was associated with reduced overt and severe HE.
文摘Since the adoption of the model for end-stage liver disease(MELD)score for organ allocation in 2002,numerous changes to the system of liver allocation and distribution have been made with the goal of decreasing waitlist mortality and minimizing geographic variability in median MELD score at time of transplant without worsening post-transplant outcomes.These changes include the creation and adoption of the MELD-Na score for allocation,Regional Share 15,Regional Share for Status 1,Regional Share 35/National Share 15,and,most recently,the Acuity Circles Distribution Model.However,geographic differences in median MELD at time of transplant remain as well as limits to the MELD score for allocation,as etiology of liver disease and need for transplant changes.Acute-onchronic liver failure(ACLF)is a subset of liver failure where prevalence is rising and has been shown to have an increased mortality rate and need for transplantation that is under-demonstrated by the MELD score.This underscores the limitations of the MELD score and raises the question of whether MELD is the most accurate,objective allocation system.Alternatives to the MELD score have been proposed and studied,however MELD score remains as the current system used for allocation.This review highlights policy changes since the adoption of the MELD score,addresses limitations of the MELD score,reviews proposed alternatives to MELD,and examines the specific implications of these changes and alternatives for ACLF.
文摘BACKGROUND Corrected QT(QTc)interval is prolonged in patients with liver cirrhosis and has been proposed to correlate with the severity of the disease.However,the effects of sex,age,severity,and etiology of cirrhosis on QTc have not been elucidated.At the same time,the role of treatment,acute illness,and liver transplantation(Tx)remains largely unknown.AIM To determine the mean QTc in patients with cirrhosis,assess whether QTc is prolonged in patients with cirrhosis,and investigate whether QTc is affected by factors such as sex,age,severity,etiology,treatment,acute illness,and liver Tx.METHODS In the present systematic review and meta-analysis,the searching protocol“{[QTc]OR[QT interval]OR[QT-interval]OR[Q-T syndrome]}AND{[cirrhosis]OR[Child-Pugh]OR[MELD]}”was applied in PubMed,EMBASE,and Google Scholar databases to identify studies that reported QTc in patients with cirrhosis and published after 1998.Seventy-three studies were considered eligible.Data concerning first author,year of publication,type of study,method used,sample size,mean age,female ratio,alcoholic etiology of cirrhosis ratio,Child-Pugh A/B/C ratio,mean model for end-stage liver disease(MELD)score,treatment withβ-blockers,episode of acute gastrointestinal bleeding,formula for QT correction,mean pulse rate,QTc in patients with cirrhosis and controls,and QTc according to etiology of cirrhosis,sex,Child-Pugh stage,MELD score,and liver Tx status(pre-Tx/post-Tx)were retrieved.The Newcastle-Ottawa quality assessment scale appraised the quality of the eligible studies.Effect estimates,expressed as proportions or standardized mean differences,were combined using the randomeffects,generic inverse variance method of DerSimonian and Laird.Subgroup,sensitivity analysis,and meta-regressions were applied to assess heterogeneity.RESULTS QTc combined mean in patients with cirrhosis was 444.8 ms[95%confidence interval(CI):440.4-449.2;P<0.001 when compared with the upper normal limit of 440 ms],presenting high heterogeneity(I2=97.5%;95%CI:97.2%-97.8%);both Egger’s and Begg’s tests showed non-significance.QTc was elongated in patients with cirrhosis compared with controls(P<0.001).QTc was longer in patients with Child-Pugh C cirrhosis when compared with Child-Pugh B and A(P<0.001);Child-Pugh B patients presented longer QTc when compared with Child-Pugh A patients(P=0.003).The MELD score was higher in patients with cirrhosis with QTc>440 ms when compared with QTc≤440 ms(P<0.001).No correlation of QTc with age(P=0.693),sex(P=0.753),or etiology(P=0.418)was detected.β-blockers shortened QTc(P<0.001).QTc was prolonged during acute gastrointestinal bleeding(P=0.020).Tx tended to improve QTc(P<0.001).No other sources of QTc heterogeneity were revealed.CONCLUSION QTc is prolonged in cirrhosis independently of sex,age,and etiology but is correlated with severity and affected byβ-blockers and acute gastrointestinal bleeding.QTc is improved after liver Tx.
文摘Background and Aim:The model for end-stage liver disease(MELD)was originally developed to predict survival after transjugular intrahepatic portosystemic shunt(TIPS).The MELD-sodium(MELD-Na)score has replaced MELD for organ allocation for liver transplantation.However,there are limited studies to compare the MELD with MELD-Na to predict mortality after TIPS.Methods:We performed a retrospective chart review of patients who underwent TIPS placement between 2006 and 2016 at our institution.The primary outcome was mortality,and the secondary outcomes sought to assess which variables could provide prognostic information for mortality after TIPS placement.We performed receiver operating characteristic(ROC)curve analysis to assess the performance of MELD and MELD-Na.Results:There were 186 eligible patients in the analysis.The mean pre-TIPS MELD and MELD-Na were 13 and 15,respectively.Overall,mortality after TIPS was 15%at 30 days and 16.7%at 90 days.In a comparison of the areas under the ROCs for MELD and MELD-Na,MELD was superior to MELD-Na for 30-day(0.762 vs.0.709)and 90-day(0.780 vs.0.730)mortality after TIPS.The optimal cutoff score for 30-day mortality was 15(0.676–0.848)for MELD and 17(0.610–0.808)for MELD-Na,whereas the optimal cutoff score for 90-day mortality was 16(95%CI:0.705–0.855)for MELD and 17(95%CI:0.643–0.817)for MELDNa.There were 24 patients with high MELD-Na≥17,but with low MELD<15,and 90-day mortality in this group was 8.3%.Conclusions:Although MELD-Na is a superior prognostic tool to MELD for predicting overall mortality in cirrhotic patients,MELD tended to outperform MELD-Na to predict mortality after TIPS.
文摘Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support.Despite this fact,their mortality has decreased in recent decades due to improved care of critically ill patients.Acute-on-chronic liver failure(ACLF),sepsis and elevated hepatic scores are associated with increased mortality in this population,especially among those not eligible for liver transplantation.No score is superior to another in the prognostic assessment of these patients,and both liver-specific and intensive care unit-specific scores have satisfactory predictive accuracy.The sequential assessment of the scores,especially the Sequential Organ Failure Assessment(SOFA)and Chronic Liver Failure Consortium(CLIF)-SOFA scores,may be useful as an auxiliary tool in the decision-making process regarding the benefits of maintaining supportive therapies in this population.A CLIF-ACLF>70 at admission or at day 3 was associated with a poor prognosis,as well as SOFA score>19 at baseline or increasing SOFA score>72.Additional studies addressing the prognostic assessment of these patients are necessary.
文摘Background and aims: Acute variceal hemorrhage (AVH) is the most serious encountered complication of liver cirrhosis and carries high mortality rate. Several risk factors that predict early rebleeding and mortality have been studied and there is no similar study in our country, so the aim of this study was to identify the risk factors of early rebleeding and mortality after bleeding episode in cirrhotic patients in Yemen. Patients and Method: It was a prospective study of cirrhotic patients with AVH who were admitted to the main public hospitals in Sana’a between April 2014 and March 2015. Demographic information, medical histories, physical examination findings, and laboratory test results were collected. Endoscopic and pharmacologic treatment was performed. The patients were followed up since admission and up to 6 weeks for the occurrence of rebleeding and mortality after the acute attack. Univariate and multivariate analyses were performed to identify independent risk factors for rebleeding and mortality. Survival analysis was estimated using the Kaplan-Meier method. Result: A total of 102 patients were analyzed. 26 patients (25.5%) rebleeded within 6 weeks period. The predictive factors significantly associated with rebleeding within 6 weeks period in univariate analysis were clot on varix at index endoscope (P - 47.29, P = 0.001) and high serum bilirubin (- 1.19, P = 0.01). Sixteen patients died (15.7%) within 6 weeks period. Predictors of mortality with significant difference in univariate analysis were hypovolemic shock (P = 0.001), high WBCs count (P - 1.41, P - 1.40, P < 0.05) were independent risk factors for mortality within 6 weeks period. Conclusion: Early rebleeding in cirrhotic patients with AVH was associated with clot on varix at endoscope and high serum bilirubin more than 3 mg/dl. Early mortality rate was associated with high MELD score (≥19) and WBCs over 10.3 × 10<sup>9</sup>/l.
基金This study was supported by the Science and Technology Planning Project of Guangdong Province,China(No.2019B020228001)the 5010 Project of Sun Yat-sen University(No.2018024).
文摘Liver failure is a group of clinical syndromes with a mortality rate of>50%.The accurate evaluation of severity in patients with liver failure has been a meaningful and hot topic in clinical research and an important guide for liver transplantation.Numerous prognosis studies have emerged in recent years with high accuracy and adequate validity.Nonetheless,different models utilize distinct parameters and have unequal efficiencies,leading to a specific value and unique application situations for each model.This review focused on the progress in recent prognostic studies including the model for end-stage liver disease,sequential organ failure assessment and its derivative models,the Chinese Group on the Study of Severe Hepatitis B Acute-on-Chronic Liver Failure,the Tongji prognostic predictor model,and other emerging prognostic models and predictors.This review aims to assist clinicians understand the framework of recent models and choose the appropriate model and treatment.
基金This research was partially supported by National Natural Science Funds for Distinguished Young Scholar of China,(No.81625003)Key Program,National Natural Science Foundation of China,(No.81930016,No.81570589,No.81702858)+1 种基金Youth Program of National Natural Science Foundation of Zhejiang Province(No.LQ17H160006)National S&T Major Project(No.2017ZX10203205).
文摘Background and Aims:Liver transplantation(LT)using ABO-incompatible(ABOi)grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation.However,concerns of the impending prognosis associated with this option,especially for patients with liver failure and higher model for end-stage liver disease(MELD)scores,who tend to be more fragile during the waiting period before LT.Methods:Recipients undergoing LT for acute-onchronic liver failure or acute liver failure were retrospectively enrolled at four institutions.Overall survival was compared and a Cox regression analysis was performed.Propensity score matching was performed for further comparison.Patients were stratified by MELD score and cold ischemia time(CIT)to determine the subgroups with survival benefits.Results:Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible(ABOc)LT were enrolled.The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching(50.6%vs.75.7%,p<0.05).For patients with MELD scores≤30,using ABOi grafts achieved a comparable overall survival rate as using ABOc grafts(p>0.05).Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores≥40(p>0.05).For patients with MELD scores of 31-39,the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group(p<0.001);however,the rate was increased when the liver graft CIT was<8 h.Conclusions:For recipients with MELD scores≤30,ABOi LT had a prognosis comparable to that of ABOc LT and can be regarded as a feasible option.For recipients with MELD scores≥40,ABOi should be adopted with caution in emergency cases.For recipients with MELD scores of 31-39,the ABOi LT prognosis was worse.However,those patients benefited from receiving ABOi grafts with a CIT of<8 h.
基金The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013).The study was approved by institutional review board(IRB#Pro00103324)and informed consent was taken from individual participants where applicable.
文摘Background:Selection of the optimal treatment modality for primary liver cancers remains complex,balancing patient condition,liver function,and extent of disease.In individuals with preserved liver function,liver resection remains the primary approach for treatment with curative intent but may be associated with significant mortality.The purpose of this study was to establish a simple scoring system based on Model for End-stage Liver Disease(MELD)and extent of resection to guide risk assessment for liver resections.Methods:The 2005-2015 NSQIP database was queried for patients undergoing liver resection for primary liver malignancy.We first developed a model that incorporated the extent of resection(1 point for major hepatectomy)and a MELD-Na score category of low(MELD-Na=6,1 point),medium(MELD-Na=7-10,2 points)or high(MELD-Na>10,3 points)with a score range of 1-4,called the Hepatic Resection Risk Score(HeRS).We tested the predictive value of this model on the dataset using logistic regression.We next developed an optimal multivariable model using backwards sequential selection of variables under logistic regression.We performed K-fold cross validation on both models.Receiver operating characteristics were plotted and the optimal sensitivity and specificity for each model were calculated to obtain positive and negative predictive values.Results:A total of 4,510 patients were included.HeRS was associated with increased odds of 30-day mortality[HeRS=2:OR=3.23(1.16-8.99),P=0.025;HeRS=3:OR=6.54(2.39-17.90),P<0.001;HeRS=4:OR=13.69(4.90-38.22),P<0.001].The AUC for this model was 0.66.The AUC for the optimal multivariable model was higher at 0.76.Under K-fold cross validation,the positive predictive value(PPV)and negative predictive value(NPV)of these two models were similar at PPV=6.4%and NPV=97.7%for the HeRS only model and PPV=8.4%and NPV=98.1%for the optimal multivariable model.Conclusions:The HeRS offers a simple heuristic for estimating 30-day mortality after resection of primary liver malignancy.More complicated models offer better performance but at the expense of being more difficult to integrate into clinical practice.
基金This workwas supported by the National 13th 5-year Plan Major Science and Technology Research Project(2017ZX10203205-006-001)National Key Research and Development Program of China(2017YFA0104304)+3 种基金National Natural Science Foundation of China(81570593,81670601,81770648,81870449,81972286)Natural Science Foundation of Guangdong Province(2015A030312013,2016A030313224,2017A030311034)Science and Technology Planning Project of Guangdong Province(2017B020209004,20169013,2017B030314027)Guangzhou Science and Technology Planning Project(2014Y2-00200,201604020001,201508020262,201400000001-3,201607010024).
文摘With the dawn of organ donation after a citizen's death in China,the use of split-liver transplantation(SLT)can effectively increase the source of donor liver,reduce the waiting time for organ transplantation in patients,and particularly solve the problem of organ shortage in children.In recent years,many transplantation centers have been performing SLT to varying degrees and efficacy.At the current stage,the experiences of countries with advanced transplantation techniques should be used to establish an SLT consensus that is suitable for China to further increase the ratio and efficacy of SLT.In this paper,we combined expert experiences to generate an SLT expert consensus that included donor and donor liver evaluation,recipient selection criteria,donor and recipient matching,selection of splitting form and tools,blood vessels and bile ducts dissection and allocation,perioperative management of SLT,and organ allocation.
文摘Background and Aims:Utilization of living donor liver transplantation (LDLT) and its relationship with recipient Model for End-Stage Liver Disease (MELD) needs further evaluation in the United States (U.S.).We evaluated the association between recipient MELD score at the time of surgery and survival following LDLT.Methods:All U.S.adult LDLT recipients with MELD< 25 were evaluated using the 1995-2012 United Network for Organ Sharing registry.Survival following LDLTwas stratified into three MELD categories (MELD< 15 vs.MELD 15-19 vs.MELD 20-24) and evaluated using Kaplan-Meier methods and multivariate Cox proportional hazards models.Results:Overall,2,258 patients underwent LDLT.Compared to patients with MELD< 15,overall 5-year survival following LDLT was similar among patients with MELD 15-19 (80.9% vs.80.3%,p =0.77) and MELD 20-24 (81.2% vs.80.3%,p =0.73).When compared to patients with MELD<15,there was no significant difference in long-term post-LDLT survival among those with MELD 15-19 (HR:1.11,95% CI:0.85-1.45,p =0.45) and a non-significant trend towards lower survival in patients with MELD 20-24 (HR:1.28,95%CI:0.91-1.81,p =0.16).Only 14% of LDLTs were performed in patients with MELD 20-24 and the remaining 86% in patients with MELD< 20.Conclusion:LDLT is underutilized in patients with MELD 20 and higher.
