Risk factors and waiting time on the liver transplant patients list from the Republic of Moldova
Keywords:
liver transplantation, MELD score, acute liver failureAbstract
Liver transplantation is an important treatment for acute liver failure and end-stage liver disease. In 2002, the model for endstage liver disease (MELD) was incorporated to prioritize patients awaiting liver transplantation. While there are data on how the MELD score affects wait time, there is a dearth of literature regarding other components. We aimed to evaluate the factors affecting the waiting time for TH. Using the database from the Republic of Moldova, patients aged 18-65 listed for liver transplants in the period 2013-2022 were included. Variables tested in the model included patient characteristics, biochemical analyses, MELD score, and ABO blood group. The MELD score is used in prioritizing liver allocation and was expected to predict time on the waiting list. Mechanical ventilation and other markers of disease severity are associated with higher MELD scores, thus shorter waiting time. Further research is needed to address the reasons for variation in waiting time in an attempt to reduce time to TH, standardize the listing process and improve patient outcomes.
References
1. lberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17:445-450. https://doi.org/10.1016/S0899-9007(01)00521-4
2. Bernardi M, Gitto S, Biselli M. The MELD score in patients awaiting liver transplant: strengths and weaknesses. J Hepatol. 2011;54:1297-1306. https://doi.org/10.1016/j.jhep.2010.11.008
3. Borroni G, Maggi A, Sangiovanni A, Cazzaniga M, Salerno F. Clinical relevance of hyponatraemia for the hospital outcome of cirrhotic patients. Dig Liver Dis. 2000;32:605-610. https://doi.org/10.1016/S1590-8658(00)80844-0
4. Brown RS, Jr, Lake JR. The survival impact of liver transplantation in the MELD era, and the future for organ allocation and distribution. Am J Transplant. 2005;5:203-204. https://doi.org/10.1111/j.1600-6143.2005.00769.x
5. Cholongitas E, Burroughs AK. The evolution in the prioritization for liver transplantation. Ann Gastroenterol. 2012;25:6-13.
6. Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R, United Network for Organ Sharing Organ Procurement and Transplantation Network Liver and Transplantation Committee Results of the first year of the new liver allocation plan. Liver Transpl. 004;10:7-15. https://doi.org/10.1002/lt.20024
7. Gunsar F, Raimondo ML, Jones S, et al. Nutritional status and prognosis in cirrhotic patients. Aliment Pharmacol Ther. 2006;24:563-572. 8. John S, Thuluvath PJ. Hyponatremia in cirrhosis: pathophysiology and management. World J Gastroenterol. 2015;21:3197-3205. https://doi.org/10.3748/wjg.v21.i11.3197
9. Kamath PS, Wiesner RH, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464-470. https://doi.org/10.1053/jhep.2001.22172
10. Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018-1026. https://doi.org/10.1056/NEJMoa0801209
11. Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, ter Borg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology. 2000;31:864-871. https://doi.org/10.1053/he.2000.5852
12. Merion RM, Schaubel DE, Dykstra DM, Freeman RB, Port FK, Wolfe RA. The survival benefit of liver transplantation. Am J Transplant. 2005;5:307-313. https://doi.org/10.1111/j.1600-6143.2004.00703.x
13. Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis?PINC (Policentrica Italiana Nutrizione Cirrosi) Hepatology. 1996;23:1041-1046. https://doi.org/10.1002/hep.510230516
14. Myers RP, Tandon P, Ney M, et al. Validation of the fivevariable Model for End-stage Liver Disease (5vMELD) for prediction of mortality on the liver transplant waiting list. Liver Int. 2014;34:1176-1183. https://doi.org/10.1111/liv.12373
15. Porcel A, Díaz F, Rendón P, Macías M, Martín-Herrera L, Girón-González JA. Dilutional hyponatremia in patients with cirrhosis and ascites. Arch Intern Med. 2002;162:323-328. https://doi.org/10.1001/archinte.162.3.323
16. Ruf AE, Kremers WK, Chavez LL, Descalzi VI, Podesta LG, Villamil FG. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone. Liver Transpl. 2005;11:336-343. https://doi.org/10.1002/lt.20329
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