1
|
Rasic G, Beaulieu-Jones BR, Chung SH, Romatoski KS, Kenzik K, Ng SC, Tseng JF, Sachs TE. The Impact of the COVID-19 Pandemic on Hepatocellular Carcinoma Time to Treatment Initiation: A National Cancer Database Study. Ann Surg Oncol 2023; 30:4249-4259. [PMID: 37099088 PMCID: PMC10132402 DOI: 10.1245/s10434-023-13468-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic strained oncologic care access and delivery, yet little is known about how it impacted hepatocellular carcinoma (HCC) management. Our study sought to evaluate the annual effect of the COVID-19 pandemic on time to treatment initiation (TTI) for HCC. METHODS The National Cancer Database was queried for patients diagnosed with clinical stages I-IV HCC (2017-2020). Patients were categorized based on their year of diagnosis as "Pre-COVID" (2017-2019) and "COVID" (2020). TTI based on stage and type of treatment first received was compared by the Mann-Whitney U test. A logistic regression model was used to evaluate factors of increased TTI and treatment delay (> 90 days). RESULTS In total, 18,673 patients were diagnosed during Pre-COVID, whereas 5249 were diagnosed during COVID. Median TTI for any first-line treatment modality was slightly shorter during the COVID year compared with Pre-COVID (49 vs. 51 days; p < 0.0001), notably in time to ablation (52 vs. 55 days; p = 0.0238), systemic therapy (42 vs. 47 days; p < 0.0001), and radiation (60 vs. 62 days; p = 0.0177), but not surgery (41 vs. 41 days; p = 0.6887). In a multivariate analysis, patients of Black race, Hispanic ethnicity, and uninsured/Medicaid/Other Government insurance status were associated with increased TTI by factors of 1.057 (95% CI: 1.022-1.093; p = 0.0013), 1.045 (95% CI: 1.010-1.081; p = 0.0104), and 1.088 (95% CI: 1.053-1.123; p < 0.0001), respectively. Similarly, these patient populations were associated with delayed treatment times. CONCLUSIONS For patients diagnosed during COVID, TTI for HCC, while statistically significant, had no clinically significant differences. However, vulnerable patients were more likely to have increased TTI.
Collapse
Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Brendin R Beaulieu-Jones
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Sophie H Chung
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kelsey S Romatoski
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Kelly Kenzik
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Sing Chau Ng
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Surgery, Boston Medical Center, Boston, MA, USA
| | - Teviah E Sachs
- Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
- Department of Surgery, Boston Medical Center, Boston, MA, USA.
| |
Collapse
|
2
|
Vijeratnam SS, Candy B, Craig R, Marshall A, Stone P, Low JTS. Palliative Care for Patients with End-Stage Liver Disease on the Liver Transplant Waiting List: An International Systematic Review. Dig Dis Sci 2021; 66:4072-4089. [PMID: 33433811 DOI: 10.1007/s10620-020-06779-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/09/2020] [Indexed: 01/21/2023]
Abstract
People with end-stage liver disease on the liver transplant waiting list have high symptom burden, which can successfully be addressed by specialist palliative care. Potential tensions with the perceived curative nature of liver transplant make delivering specialist palliative care challenging. This systematic review seeks to establish what is known on the impact of specialist palliative care for patients on liver transplant waiting lists, healthcare professionals' perspectives of providing specialist palliative care for this population, and uptake of advance care planning (ACP). Medline, Embase, and CINAHL were searched to May 5, 2020. Qualitative and quantitative findings were grouped together according to main relevant themes. Eight studies of mixed quality and mainly quantitative, were identified. Findings suggest early palliative care intervention improve patients' symptoms and prompt ACP conversations, but patients on the waiting list receive limited palliative care input. Liver physicians' lack of clarity on referral criteria and liver transplant patients' concerns of being abandoned, were reasons for reluctance to refer to specialist palliative care. They felt referral to specialist palliative care is appropriate only for patients receiving hospice or end of life care. Uptake and understanding of ACP and goals of care designation by patients is poor. This review found evidence of benefit of specialist palliative care for patients on liver transplant waiting lists, but found in a limited understanding of their role. Evidence is limited to studies from North America. Future research is needed to understand better how palliative care could be provided into this clinical environment.
Collapse
Affiliation(s)
- Shan Shan Vijeratnam
- Camden, Islington ELiPSe and UCLH and HCA Palliative Care Service, CNWL-Central and North West London NHS Foundation Trust, 2nd Floor Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Rachel Craig
- Palliative Care Department, Royal Free London NHS Trust, Pond Street, London, NW3 2QG, UK
| | - Aileen Marshall
- Sheila Sherlock Liver Unit, Royal Free Hospital, University College London, London, UK
- Institute of Liver and Digestive Health, UCL Royal Free Campus, Pond Street, London, NW3 2QG, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Joseph T S Low
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| |
Collapse
|
3
|
Som A, Reid NJ, DiCapua J, Cochran RL, An T, Uppot R, Zurkiya O, Wehrenberg-Klee E, Kalva S, Arellano RS. Microwave Ablation as Bridging Therapy for Patients with Hepatocellular Carcinoma Awaiting Liver Transplant: A Single Center Experience. Cardiovasc Intervent Radiol 2021; 44:1749-1754. [PMID: 34231009 DOI: 10.1007/s00270-021-02873-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the pathologic response of computed tomography-guided percutaneous microwave ablation as bridging therapy for patients with hepatocellular carcinoma awaiting liver transplant, and its subsequent effect on survival. MATERIALS AND METHODS A single-center retrospective analysis was conducted on 62 patients (M:F = 50:12) with mean age of 59.6 years ± 7.2 months (SD). Sixty-four total MWA procedures were performed for hepatocellular carcinomas within Milan criteria as bridging therapy to subsequent orthotopic liver transplant between August 2014 and September 2018. The pathology reports of the explanted livers were reviewed to assess for residual disease. Residual disease was categorized as complete or incomplete necrosis. Patient demographics, tumor/procedural characteristics, and laboratory values were evaluated. Survival from time of ablation and time of transplantation were recorded and compared between cohorts using log rank tests. RESULTS The mean tumor size was 2.4 cm ± 0.7 cm (SD), (range = 1-4.6 cm). 32 (50%) cases required hydrodissection. Histopathologic necrosis was seen in 66% of cases at time of liver transplantation. Median time to liver transplant post-MWA was 12.6 months. [IQR = 8.6-14.8 months]. The median survival from ablation was 60.8 months [IQR = 45.5-73.7 months], and the median survival from transplant was 49.3 months [IQR = 33.7-60.1 months]. There was no significant difference in survival for patients with complete versus incomplete necrosis from ablation or liver transplant (p = 0.49, p = 0.46, respectively). CONCLUSIONS Computed tomography-guided percutaneous microwave ablation is an effective bridge to orthotopic liver transplantation for patients with hepatocellular carcinoma. CEBM LEVEL OF EVIDENCE Level 3, non-randomized controlled cohort study/follow-up study.
Collapse
Affiliation(s)
- Avik Som
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Nicholas J Reid
- Harvard Medical School, 25 Shattuck Ave, Boston, MA, 02120, USA
| | - John DiCapua
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Rory L Cochran
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Thomas An
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Raul Uppot
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Omar Zurkiya
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Eric Wehrenberg-Klee
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Sanjeeva Kalva
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA
| | - Ronald S Arellano
- Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA.
| |
Collapse
|
4
|
Impact of liver-directed therapy and non-therapy on the waiting time list of patient candidates for liver transplantation: retrospective survival analysis. Clin Exp Hepatol 2021; 6:304-312. [PMID: 33511277 PMCID: PMC7816629 DOI: 10.5114/ceh.2020.102175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/23/2020] [Indexed: 11/22/2022] Open
Abstract
Aim of the study To determine whether liver-directed therapies (LDT) and no therapy affect waiting list times for liver transplant candidates from a single center. Material and methods This retrospective study included patients > 12 years of age diagnosed with hepatocellular carcinoma between January 2014 and June 2019 and followed until the date of transplant, date of delisting, loss to follow-up, or date of death. Waiting list time and associated factors were analyzed using Kaplan-Meier and Cox proportional-hazards methods. Results A total of 181 patients met the selection criteria. The mean age was 60 years with standard deviation (SD) of 7.8 years. Sixty-six percent underwent transplant, and 64% were classified within the Milan criteria. Men had a lower median waiting list time than women (191 days vs. 236 days, p = 0.0093). The overall median survival time or time to transplant for 50% of the population was 218 days (95% CI: 195-235). Men displayed a 3.1-fold (95% CI: 1.5-6.2) higher probability of transplantation than women (p = 0.002). Patients who received no therapy had a 5-fold higher probability of undergoing transplantation than patients under arterial LDT (HR [95% CI]: 5 [1.2, 20], p = 0.02). Patients under combined LDT displayed a 70% reduced probability of transplantation compared to patients who received arterial LDTs (p = 0.0009). Conclusions LDT was associated with a prolonged stay on the transplant list, likely due to the presence of an aggressive liver tumor. However, LDTs allow the patient to remain active on the liver transplant list, increasing their chances of undergoing transplantation.
Collapse
|
5
|
Robinson A, Hirode G, Wong RJ. Ethnicity and Insurance-Specific Disparities in the Model for End-Stage Liver Disease Score at Time of Liver Transplant Waitlist Registration and its Impact on Mortality. J Clin Exp Hepatol 2021; 11:188-194. [PMID: 33746443 PMCID: PMC7953015 DOI: 10.1016/j.jceh.2020.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Disparities in timely referral to liver transplantation (LT) evaluation persist. We aim to examine race/ethnicity and insurance-specific differences in the Model for End-Stage Liver Disease (MELD) score at time of waitlist (WL) registration and its impact on WL survival. METHODS We retrospectively evaluated U.S. adults listed for LT using 2005-2018 United Network for Organ Sharing LT registry. Multiple linear regression methods examined factors associated with MELD at listing, and Fine-Gray competing risks regression were used to analyze WL mortality. RESULTS Among 144,163 WL registrants (median age = 56 years, 65.3% male, 56.4% private insurance, 23.3% Medicare, 15.7% Medicaid), mean WL MELD at listing was higher in African Americans versus non-Hispanic whites (2.57 points higher, 95%CI: 2.40-2.74, P < 0.001). Compared with patients with private insurance, adjusted mean WL MELD was higher among those with no insurance, Medicare, or Medicaid (P < 0.001 for all). After correcting for differences in MELD at listing, Asians had lower risk of WL death versus non-Hispanic whites (subhazard ratio (SHR): 0.92, 95% CI: 0.86-1.00, P = 0.04), but no difference was observed in African Americans or Hispanics. Compared with patients with private insurance, higher risk of WL death was observed in patients with no insurance (SHR: 1.33, 95%CI: 1.14-1.56, P < 0.001), Medicare (SHR: 1.20, 95%CI: 1.16-1.25, P < 0.001), or Medicaid (SHR: 1.22, 95%CI: 1.17-1.27, P < 0.001). CONCLUSION Higher MELD scores at listing among African Americans did not translate into increased WL mortality. Patients with Medicare, Medicaid, or uninsured had significantly higher WL mortality than privately insured patients, even after correcting for disparities in MELD scores at listing.
Collapse
Key Words
- BMI, body mass index
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HR, hazards ratio
- LT, liver transplantation
- MELD, Model for End-Stage Liver Disease
- NASH, nonalcoholic steatohepatitis
- OPTN, Organ Procurement and Transplantation Network
- UNOS, United Network for Organ Sharing
- UNOS/OPTN
- WL, waitlist
- insurance
- liver transplantation
- survival
- waitlist mortality
Collapse
Affiliation(s)
- Ann Robinson
- Department of Medicine, Division of Gastroenterology and Hepatology, Alameda Health System, Highland Hospital, Oakland, CA, USA
| | - Grishma Hirode
- Toronto Centre for Liver Disease, University Health Network, Toronto General Hospital, University of Toronto, Canada
| | - Robert J. Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA,Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA,Address for correspondence: Robert J. Wong. Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, 3801 Miranda Ave, Palo Alto, CA 94304, USA.
| |
Collapse
|
6
|
Yang G, Mahadik B, Mollot T, Pinsky J, Jones A, Robinson A, Najafali D, Rivkin D, Katsnelson J, Piard C, Fisher JP. Engineered Liver Tissue Culture in an In Vitro Tubular Perfusion System. Tissue Eng Part A 2020; 26:1369-1377. [PMID: 33054685 DOI: 10.1089/ten.tea.2020.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Liver disease and the subsequent loss of liver function is an enormous clinical challenge. A severe shortage of donor liver tissue greatly limits patients' options for a timely transplantation. Tissue engineering approaches offer a promising alternative to organ transplantation by engineering artificial implantable tissues. We have established a platform of cell-laden microbeads as basic building blocks to assemble macroscopic tissues via different mechanisms. This modular fabrication strategy possesses great potential for liver tissue engineering in a bottom-up manner. In this study, we encapsulated human hepatocytes into microbeads presenting a favorable microenvironment consisting of collagen and mesenchymal stem cells, and then we perfused the beads in a three-dimensional printed tubular perfusion bioreactor that promoted oxygen and medium diffusion to the impregnated cells. We noted high cell vitality and retention of parenchymal cell functionality for up to 30 days in this culture system. Our engineering-based approach led to the advancement in tissue size and long-term functionality of an artificial liver tissue in vitro.
Collapse
Affiliation(s)
- Guang Yang
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA.,NIBIB/NIH Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland, USA
| | - Bhushan Mahadik
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA.,NIBIB/NIH Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland, USA
| | - Trevor Mollot
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Julia Pinsky
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Athenia Jones
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Alexis Robinson
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Daniel Najafali
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Daniel Rivkin
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Jenny Katsnelson
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - Charlotte Piard
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA
| | - John P Fisher
- Tissue Engineering and Biomaterials Laboratory, Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, College Park, Maryland, USA.,NIBIB/NIH Center for Engineering Complex Tissues, University of Maryland, College Park, Maryland, USA
| |
Collapse
|
7
|
A New Recalibrated Four-Category Child-Pugh Score Performs Better than the Original Child-Pugh and MELD Scores in Predicting In-Hospital Mortality in Decompensated Alcoholic Cirrhotic Patients with Acute Variceal Bleeding: a Real-World Cohort Analysis. World J Surg 2020; 44:241-246. [PMID: 31583458 DOI: 10.1007/s00268-019-05211-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There currently is no consensus on how to accurately predict early rebleeding and death after a major variceal bleed. This study investigated the relative predictive performances of the original Child-Pugh (CP), model for end-stage liver disease (MELD) and a four-category recalibrated Child-Pugh (rCP). METHODS This prospective study included all adult patients admitted to Groote Schuur Hospital with acute esophageal variceal bleeding secondary to alcoholic cirrhosis, between January 2000 and December 2017. CP and rCP grades and MELD score were calculated on admission, and the predictive ability in discriminating in-hospital rebleeding and death was compared by area under receiver-operating characteristic (AUROC) curves. RESULTS During the study period, 403 consecutive adult patients were treated for bleeding esophageal varices of whom 225 were secondary to alcoholic cirrhosis. Twenty-four (10.6%) patients were CP grade A, 88 (39.1%) grade B and 113 (50.2%) grade C on hospital admission. MELD scores ranged from 6 to 40. Thirty-one (13.8%) patients rebleed, and 41 (18.2%) patients died. There was no difference in the discriminatory capacity of the CP (AUROC 0.59, 95% CI 0.50-0.670) and MELD (AUROC 0.62, 95% CI 0.51-0.73) to predict rebleeding (p = 0.72), or between the Child-Pugh (AUROC 0.75, 95% CI 0.71-0.81) and MELD (AUROC 0.71, 95% CI 0.62-0.80) to predict death (p = 0.35). The rCP classification (A-D) had a significantly improved discriminatory capacity (AUROC 0.83 95% CI 0.77-0.89) compared to the CP score (A-C) and MELD to predict death (p = 0.004). CONCLUSION A recalibrated Child-Pugh score outperforms the original Child-Pugh grade and MELD score in predicting in-hospital death in patients with bleeding esophageal varices secondary to alcoholic cirrhosis.
Collapse
|
8
|
Dashti H, Ebrahimi A, Khorasani NR, Moazzami B, Khojasteh F, Shabanan SH, Jafarian A. The utility of early post-liver transplantation model for end-stage liver disease score in prediction of long-term mortality. Ann Gastroenterol 2019; 32:633-641. [PMID: 31700242 PMCID: PMC6826064 DOI: 10.20524/aog.2019.0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Little is known about the prognostic ability of post-liver transplantation (LT) model for end-stage liver disease (MELD) score measurement in assessing long-term outcomes. The aim of the present study was to investigate this possible relationship. Methods: In this retrospective cohort study, the medical records of LT recipients operated under a LT program were reviewed. The accuracy of post-operation MELD score for predicting mortality was evaluated based on receiver operating characteristic (ROC) curves. Univariate and Cox proportional hazard regression models were used to assess the risk factors associated with mortality. Results: Eight hundred twenty-six consecutive LT recipients were included in the study. The areas under the ROC curve on postoperative days (POD) 5 and 9 for predicting 1-year mortality were 0.712 (95% confidence interval [CI] 0.614-0.811) and 0.682 (95%CI 0.571-0.798), respectively. A cutoff point of 14.5 was obtained for MELD score on POD5 that significantly differentiated between survivors and non-survivors with a sensitivity of 69.8% (95%CI 50.7-83.1) and a specificity of 57.2% (95%CI 50.6-63.6). In the Cox multivariate analysis, factors including MELD score on POD5 (hazard ratio [HR] 1.83, 95%CI 1.07-3.12; P=0.026), pre-transplant MELD (HR 1.064, 95%CI 1.025-1.104; P=0.001) and operation duration (min) (HR 1.004, 95%CI 1.003-1.006; P=0.013) were identified as independent risk factors for predicting overall survival. Conclusion: The immediate postoperative MELD scores after LT may be of value in predicting mortality and could be used as a tool for postoperative risk assessment of patients.
Collapse
Affiliation(s)
- Habibollah Dashti
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences (Halibollah Dashti, Amirpasha Ebrahimi, Ali Jafarian).,Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (Habibollah Dashti, Niloofar Razavi Khorasani, Bobak Moazzami, Ali Jafarian)
| | - Amirpasha Ebrahimi
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences (Halibollah Dashti, Amirpasha Ebrahimi, Ali Jafarian)
| | - Niloofar Razavi Khorasani
- Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (Habibollah Dashti, Niloofar Razavi Khorasani, Bobak Moazzami, Ali Jafarian)
| | - Bobak Moazzami
- Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (Habibollah Dashti, Niloofar Razavi Khorasani, Bobak Moazzami, Ali Jafarian)
| | - Fatemeh Khojasteh
- Tehran University of Medical Sciences (Fatemeh Khojasteh, Sediqe Hosseini Shabanan), Iran
| | | | - Ali Jafarian
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences (Halibollah Dashti, Amirpasha Ebrahimi, Ali Jafarian).,Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (Habibollah Dashti, Niloofar Razavi Khorasani, Bobak Moazzami, Ali Jafarian)
| |
Collapse
|