Region 11 MELD Na exception prospective study

被引:16
作者
Fisher, Robert A. [1 ]
Heuman, Douglas M.
Harper, Ann M. [2 ]
Behnke, Martha K.
Smith, Alastair D. [3 ]
Russo, Mark W. [4 ]
Zacks, Steven [5 ]
McGillicuddy, John W. [6 ]
Eason, James [7 ]
Porayko, Michael K. [8 ]
Northup, Patrick [9 ]
Marvin, Michael R. [10 ]
Hundley, Johnathan [11 ]
Nair, Satheesh [7 ]
机构
[1] Virginia Commonwealth Univ, Liver Transplant Program, Dept Surg Med, Med Coll,Virginia Hosp,Hume Lee Transplant Ctr, Richmond, VA 23298 USA
[2] United Network Organ Sharing, Richmond, VA USA
[3] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[4] Carolinas Med Ctr, Dept Med, Charlotte, NC 28203 USA
[5] Univ N Carolina, Dept Med, Chapel Hill, NC USA
[6] Med Univ S Carolina, Dept Surg, Charleston, SC 29425 USA
[7] Univ Tennessee, Ctr Hlth Sci, Dept Surg, Methodist Transplant Inst, Memphis, TN 38163 USA
[8] Vanderbilt Univ, Med Ctr, Dept Med, Nashville, TN USA
[9] Univ VA, Dept Med, Charlottesville, VA USA
[10] Univ Jewish Hosp, Dept Surg, Louisville, KY USA
[11] Univ Kentucky, Dept Surg, Lexington, KY USA
关键词
Liver transplantation; Risk factors; Organ allocation; Resource utilization; Wait list mortality; STAGE LIVER-DISEASE; SERUM SODIUM; CIRRHOTIC-PATIENTS; PROGNOSTIC VALUE; WAITING-LIST; TRANSPLANTATION; HYPONATREMIA; MORTALITY; ASCITES; ALLOCATION;
D O I
10.1016/S1665-2681(19)31487-5
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Introduction. Hyponatremia complicates cirrhosis and predicts short term mortality, including adverse outcomes before and after liver transplantation. Material and methods. From April 1, 2008, through April 2, 2010, all adult candidates for primary liver transplantation with cirrhosis, listed in Region 11 with hyponatremia, were eligible for sodium (Na) exception. Results. Patients with serum sodium (SNa) less than 130 mg/dL, measured two weeks apart and within 30 days of Model for End Stage Liver Disease (MELD) exception request, were given preapproved Na exception. MELD Na was calculated [MELD + 1.59 (135-SNa/30 days)]. MELD Na was capped at 22, and subject to standard adult recertification schedule. On data end of follow-up, December 28, 2010, 15,285 potential U.S. liver recipients met the inclusion criteria of true MELD between 6 and 22. In Region 11, 1,198 of total eligible liver recipients were listed. Sixty-two (5.2%) patients were eligible for Na exception (MELD Na); 823 patients (68.7%) were listed with standard MELD (SMELD); and 313 patients (26.1%) received HCC MELD exception. Ninety percent of MELD Na patients and 97% of HCC MELD patients were transplanted at end of follow up, compared to 49% of Region 11 standard MELD and 40% of U.S.A. standard MELD (USA MELD) patients (p < 0.001); with comparable dropout rates (6.5, 1.6, 6.9, 9% respectively; p = 0.2). MELD Na, HCC MELD, Region 11 SMELD, and USA MELD post-transplant six-month actual patient survivals were similar (92.9, 92.8, 92.2, and 93.9 %, respectively). Conclusion. The Region 11 MELD Na exception prospective trial improved hyponatremic cirrhotic patient access to transplant equitably, and without compromising transplant efficacy.
引用
收藏
页码:62 / 67
页数:6
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