Impact of hepatic encephalopathy on liver transplant waiting list mortality in regions with different transplantation rates
| Autor: | Sergio Rodríguez-Tajes, Bart Mertens, Lara Verbruggen, Hein W. Verspaget, Bart van Hoek, Fang W. T. Chiang, Marleen de Vree, Enric Reverter, Minneke J. Coenraad, Miguel Navasa, Herold J. Metselaar, M Tieleman, Annarein J. C. Kerbert, Jaime Bosch |
|---|---|
| Přispěvatelé: | Gastroenterology & Hepatology |
| Rok vydání: | 2018 |
| Předmět: |
Liver Cirrhosis
Male PREDICTOR medicine.medical_specialty organ allocation Waiting Lists medicine.medical_treatment hepatic encephalopathy 030230 surgery Liver transplantation Severity of Illness Index 03 medical and health sciences Liver disease 0302 clinical medicine Risk Factors Internal medicine SCORE medicine Humans Risk factor 610 Medicine & health Hepatic encephalopathy Netherlands Retrospective Studies Transplantation business.industry Transplant Waiting List Middle Aged Prognosis medicine.disease Liver Transplantation DISEASE MELD Survival Rate MODEL Spain Hepatocellular carcinoma Cohort SURVIVAL Female 030211 gastroenterology & hepatology BURDEN business liver disease Follow-Up Studies |
| Zdroj: | Clinical Transplantation, 32(11):e13412. Wiley-Blackwell Publishing Ltd Clinical Transplantation Clinical Transplantation, 32(11):13412. Wiley Clinical Transplantation, 32(11) |
| ISSN: | 0902-0063 |
| Popis: | Overt hepatic encephalopathy (OHE) negatively impacts the prognosis of liver transplant candidates. However, it is not taken into account in most prioritizing organ allocation systems. We aimed to assess the impact of OHE on waitlist mortality in 3 cohorts of cirrhotic patients awaiting liver transplantation, with differences in the composition of patient population, transplantation policy, and transplantation rates. These cohorts were derived from two centers in the Netherlands (reference and validation cohort, n = 246 and n = 205, respectively) and one in Spain (validation cohort, n = 253). Competing-risk regression analysis was applied to assess the association of OHE with 1-year waitlist mortality. OHE was found to be associated with mortality, independently of MELD score, other cirrhosis-related complications and hepatocellular carcinoma (HCC; sHR = 4.19, 95% CI = 1.9-9.5, P = 0.001). The addition of extra MELD points for OHE counteracted its negative impact on survival. These findings were confirmed in the Dutch validation cohort, whereas in the Spanish cohort, containing a significantly greater proportion of HCC and with higher transplantation rates, OHE was not associated with mortality. In conclusion, OHE is an independent risk factor for 1-year waitlist mortality and might be a prioritization rule for organ allocation. However, its impact seems to be attenuated in settings with significantly higher transplantation rates. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text