HIGHER VALUES IN LIVER ELASTOGRAPHY AND MELD SCORE ARE MORTALITY PREDICTORS ON LIVER TRANSPLANT WAITING LIST.

Autor:	Nacif LS; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo., Paranagua-Vezozzo DC; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo., Matsuda A; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo., Alves VAF; Department of Pathology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil., Carrilho FJ; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo., Farias AQ; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo., D'Albuquerque LC; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo., Andraus W; Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, School of Medicine, University of São Paulo.
Jazyk:	English; Portuguese
Zdroj:	Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery [Arq Bras Cir Dig] 2018 Jun 21; Vol. 31 (1), pp. e1360. Date of Electronic Publication: 2018 Jun 21.
DOI:	10.1590/0102-672020180001e1360
Abstrakt:	Background: Liver elastography have been reported in hepatocellular carcinoma (HCC) with higher values; however, it is unclear to identify morbimortality risk on liver transplantation waiting list. Aim: To assess liver stiffness, ultrasound and clinical findings in cirrhotic patients with and without HCC on screening for liver transplant and compare the morbimortality risk with elastography and MELD score. Method: Patients with cirrhosis and HCC on screening for liver transplant were enrolled with clinical, radiological and laboratory assessments, and transient elastography. Results: 103 patients were included (without HCC n=58 (66%); HCC n=45 (44%). The mean MELD score was 14.7±6.4, the portal hypertension present on 83.9% and the mean transient elastography value was 32.73±22.5 kPa. The median acoustic radiation force impulse value of liver parenchyma was 1.98 (0.65-3.2) m/s and 2.16 (0.59-2.8) m/s in HCC group. The HCC group was significantly associated with HCV infection (OR 26.84; p<0.0001), higher levels of serum alpha-fetoprotein (OR 5.51; p=0.015), clinical portal hypertension (OR 0.25; p=0.032) and similar MELD score (p=0.693). The area under the receiver operating characteristics (AUROC) showed sensitivity and specificity for serum alpha-fetoprotein (cutoff 9.1 ng/ml), transient elastography value (cutoff value 9 kPa), and acoustic radiation force impulse value (cutoff value 2.56 m/s) of 50% and 86%, 92% and 17% and 21% and 92%, respectively. The survival group had a mean transient elastography value of 31.65±22.2 kPa vs. 50.87±20.9 kPa (p=0.098) and higher MELD scores (p=0.035). Conclusion: Elastography, ultrasound and clinical findings are important non-invasive tools for cirrhosis and HCC on screening for liver transplant. Higher values in liver elastography and MELD scores predict mortality.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu