Predicting Outcome After Cardiac Surgery in Patients With Cirrhosis: A Comparison of Child Pugh and MELD Scores

Size: px
Start display at page:

Download "Predicting Outcome After Cardiac Surgery in Patients With Cirrhosis: A Comparison of Child Pugh and MELD Scores"

Transcription

1 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2004;2: Predicting Outcome After Cardiac Surgery in Patients With Cirrhosis: A Comparison of Child Pugh and MELD Scores AMITABH SUMAN,* DAVID S. BARNES,* NIZAR N. ZEIN,* GAVIN N. LEVINTHAL,* JASON T. CONNOR, and WILLIAM D. CAREY* Departments of *Gastroenterology and Hepatology and Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio Background & Aims: This study aims to quantify the risk of cardiac surgery in patients with cirrhosis. Methods: Records of all adult patients with cirrhosis undergoing cardiac surgery using cardiopulmonary bypass at the Cleveland Clinic (Cleveland, OH) from January 1992 to June 2002 were analyzed for any relationship of Child Pugh class and/or score and Model for End-Stage Liver Disease (MELD) score with outcome measures of hepatic decompensation and death during the first 3 months after surgery. Results: Forty-four patients underwent coronary artery bypass grafting (16 patients), valve surgery (16 patients), a combination of the 2 procedures (10 patients), or pericardiectomy (2 patients). Twelve patients (27%) developed hepatic decompensation, and 7 patients (16%) died. Proportions of hepatic decompensation were 3 of 31, 8 of 12, and 1 of 1 patients, and death, 1 of 31, 5 of 12, and 1 of 1 patients in Child Pugh classes A, B, and C, respectively. The association of hepatic decompensation and mortality with Child Pugh class, Child Pugh score, and MELD score was significant (P < 0.005). Areas under the receiver operating characteristic curves for mortality were similar for Child Pugh ( ) and MELD scores ( ). A cutoff Child Pugh score >7 was found to have a sensitivity and specificity of 86% and 92% for mortality, with a negative value of 97% (95% confidence interval [CI ], 83 99) and positive value of 67% (95% CI, 31 91), respectively. However, a similar cutoff value for MELD score could not be established. Conclusions: Child Pugh score and/or class and MELD score are significantly associated with hepatic decompensation and mortality after cardiac surgery using cardiopulmonary bypass in patients with cirrhosis. Such surgery can be conducted safely in patients with a Child Pugh score <7. Patients with a Child Pugh score >8 have a significant risk for mortality. Patients with cirrhosis are known to be at increased risk for hepatic decompensation after surgery and anesthesia. 1,2 This conclusion is based on retrospective studies involving patients undergoing mostly abdominal surgery. 2 4 There have been only a few reports with small numbers of patients regarding the risks involved in cardiac surgery in patients with cirrhosis, especially for cardiac surgery requiring cardiopulmonary bypass (CPB). 5 9 We therefore decided to analyze our data for cardiac surgery using CPB in patients with cirrhosis to determine the predictors and quantify the risk for hepatic decompensation and mortality. The risk has been estimated by means of the preoperative Child Pugh (CP) class and/or score, which was developed with a view to stratify risk after portosystemic shunt surgery in patients with cirrhosis, 10,11 and has been found over the years to be a reliable predictor of functional status of liver and survival. The Model for End-Stage Liver Disease (MELD) scoring system initially was developed for patients undergoing transjugular intrahepatic portosystemic shunt procedures. 12 It subsequently has been validated for predicting survival in patients with end-stage liver disease. 13 Recently, it was found to be superior to CP score and/or class in predicting 3-month mortality and survival 14 in patients with end-stage liver disease on the liver transplantation wait list. The MELD scoring system has not been used to evaluate surgical risk in patients with cirrhosis. It prompted us to compare it with CP score regarding ability to determine surgical risk and prediction of outcome. Methods The study was performed retrospectively with the approval of the institutional review board. Using computer coding, patients with cirrhosis who underwent cardiac surgery using CPB from January 1992 to June 2002 were identified. Their charts and computer records were studied. A diagnosis of cirrhosis was established from liver biopsy records or a combination of clinical findings and radiological imaging of the liver, including ultrasound, computed tomographic scan, or magnetic resonance imaging, suggestive of cirrhosis. The find- Abbreviations used in this paper: CP, Child Pugh; CI, confidence interval; CPB, cardiopulmonary bypass; INR, international normalized ratio; MELD, Model for End-Stage Liver Disease; PBC, primary biliary cirrhosis by the American Gastroenterological Association /04/$30.00 PII: /S (04)

2 720 SUMAN ET AL. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol. 2, No. 8 ing of a cirrhotic liver on laparoscopy or laparotomy also was taken as evidence of cirrhosis. Cause of cirrhosis was determined by using the available records. Type of cardiac surgery performed was noted. Preoperative laboratory data and clinical findings and medical history were used to determine CP class and/or score and MELD score for each patient. Intubation time, CPB time, and anesthetic medications administered were obtained from records maintained by the Department of Anesthesiology. The course of events was followed up for up to 3 months after cardiac surgery. The occurrence of hepatic decompensation, evidenced by the new appearance of ascites, portosystemic encephalopathy, jaundice, coagulopathy, variceal bleed, and hepatorenal syndrome, was noted, as was the cause of death in relevant patients. The diagnosis of hepatic encephalopathy was made after ruling out hypoxemia or other metabolic factors, including drug effects responsible for a change in mental status. Patients who underwent liver or cardiac transplantation or had inadequate documentation to support a diagnosis of cirrhosis or inadequate data to calculate CP and/or MELD score were excluded from the study. Statistical Analysis The outcome measures of hepatic decompensation and death were compared with a variety of explanatory variables, including age, sex, cause of cirrhosis, type of cardiac surgery, CP score and/or class, MELD score, bilirubin level, albumin level, international normalization ratio (INR), creatinine level, intubation time, CPB time, and anesthetic medications administered. Relationships between explanatory variables and outcome measures of hepatic decompensation and mortality were assessed by using Fisher s exact tests for categorical variables and Wilcoxon s rank-sum test for continuous variables. The area under the empiric receiver operating characteristic curve for mortality was calculated and plotted for the purpose of comparison. Results Initially, 66 patients with possible cirrhosis undergoing cardiac surgery using CPB were identified. Twenty-two patients were excluded; 13 patients because the diagnosis of cirrhosis was not proven, and 9 patients because of unavailability of sufficient laboratory data. Forty-four patients with cirrhosis undergoing cardiac surgery using CPB were analyzed. Twenty-seven patients (61%) were men. Ages ranged from 15 to 74 years. Causes of cirrhosis were alcohol in 11 patients; hepatitis C, hepatitis B, or autoimmune hepatitis in 3 patients each; and cholestatic liver disease (primary biliary cirrhosis [PBC]/primary sclerosing cholangitis, and cardiac cirrhosis) in 2 patients each. In 20 patients, the cause was unknown. They were classified as cryptogenic. Types of cardiac surgery were coronary artery bypass graft in 16 patients, valve surgery in 16 patients, combined coronary artery bypass graft and valve surgery in 10 patients, and pericardiectomy in 2 patients. All except 1 patient underwent cardiac surgery electively. No patient had congestive heart failure at the time of surgery. The number of patients in CP classes A, B, and C were 31, 12, and 1 at the time of surgery, respectively. Preoperative MELD scores varied from 6 to 27. Twelve patients (27%; 95% confidence interval [CI ], 14 40) developed hepatic decompensation (inclusive of those who died), whereas 7 patients (16%; 95% CI, 5 27) died. Modes of hepatic decompensation were hepatic encephalopathy in 8 patients, ascites in 4 patients, and gastrointestinal bleed, hepatorenal syndrome, and jaundice in 1 patient each. All patients who died had hepatic decompensation; acute renal failure was noted in 6 patients, and sepsis was evident in 5 patients. No patient had cardiac complications contributing directly to death. Numbers of patients who had hepatic decompensation from CP classes A, B, and C were 3 (9.7%), 8 (66%), 1 (100%), and numbers of patients who died were 1 (3%), 5 (41%), and 1 (100%), respectively. Factors found to be significantly associated with hepatic decompensation and death were CP class, CP score, MELD score, bilirubin level, albumin level, and INR (Table 1). Cause of liver disease, type of cardiac surgery, serum creatinine level, CPB time, and intubation time were not found to be associated with either hepatic decompensation or death (Table 1). A cutoff CP score 7 was found to offer 86% sensitivity and 92% specificity for predicting mortality and 66% sensitivity and 97% specificity for hepatic decompensation. For MELD scores, a cutoff value 13 offered 71% sensitivity and 89% specificity for mortality and 67% sensitivity and 97% specificity for hepatic decompensation. Parameters of bilirubin, albumin, and INR did not provide a cutoff value, with sensitivity and specificity as high as CP score (Table 2). Areas under the receiver operating characteristic curve for mortality were similar for CP score and MELD score; and , respectively (P 0.72; Figure 1). A cutoff CP score 7 gave a positive value of 67% (95% CI, 31 91) and a negative value of 97% (95% CI, ) for mortality (Figure 2). No significant association was found between use of medications, including enflurane, isoflurane, fentanyl, midazolam, morphine, and sufentanil, and hepatic decompensation and mortality in 43 patients for whom data were available. Discussion Our report on the outcome of cardiac surgery in patients with cirrhosis is the largest series published to

3 August 2004 CARDIAC SURGERY IN CIRRHOTICS 721 Table 1. Relationship Between Variables and Outcome Measures Hepatic decompensation Death Factor Yes (n 12) No (n 32) P Yes (n 7) No (n 37) P Continuous variables (N 44) Age (yr) a a Bilirubin (mg/dl) a a Albumin (g/dl) a a INR a a Creatinine (mg/dl) a a MELD score a a CP score a a Operating room intubation time (hr) a a CPB time (min) a a Categorical variables Sex 0.99 b 0.40 b Men Women CP class b b A B C CP score a a Type of surgery 0.17 b 0.22 b CABG VS CABG VS Pericardiectomy Cause of cirrhosis 0.83 b 0.87 b Alcohol Cryptogenic Other NOTE. Continuous variables expressed as mean SD, categorical values expressed as number of patients. INR, international normalized ratio; MELD, Model for End-Stage Liver Disease; CP, Child Pugh; CPB; cardiopulmonary bypass; CABG, coronary artery bypass graft; VS, valve surgery. a Wilcoxon s rank-sum test. b Fisher exact test. date. Patients with well-compensated cirrhosis may safely undergo cardiac surgery using CPB. Our data show a similar and significant association of CP score and MELD score with hepatic decompensation and mortality. The best cutoff values of these scores for predicting mortality and hepatic decompensation were 7 for CP score and 13 for MELD score (Figure 3). Although both these cutoff values had high specificity, they lacked Table 2. Sensitivity, Specificity, and Positive and Negative Predictive Values of Different Parameters Mortality Hepatic decompensation Parameters Cutoff value Sensitivity Specificity Positive value Negative value Sensitivity Specificity Positive value Negative value CP score MELD score Bilirubin Albumin INR CP, Child Pugh; MELD, Model for End-Stage Liver Disease; INR, international normalized ratio.

4 722 SUMAN ET AL. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol. 2, No. 8 Figure 1. Receiver operating characteristic curve for mortality. Areas under the curve (AUCs) for Child Pugh (CP) score and Model for End-Stage Liver Disease (MELD) score are similar (P 0.72). sensitivity (Table 2). However, CP scores 7 had high sensitivity, as well, but only for mortality (Table 2) and therefore appear as the most acceptable cutoff value for predicting mortality. Although 1 patient with a CP score 7 died, the mortality rate of 1 of 35 patients (3%) is not different from that of overall mortality in large cardiac surgery databases. 15 Its low sensitivity for hepatic decompensation is consistent with the 4 patients with a Figure 2. Model for End-Stage Liver Disease (MELD) score versus Child Pugh (CP) score. Outcome is denoted as death (D) or survival (S). Figure 3. Model for End-Stage Liver Disease (MELD) score versus Child Pugh (CP) score. Decompensation is denoted as positive ( ) and negative (filled circle). CP score 7 who developed hepatic decompensation. Studies have used CP classification to compare risk among CP classes A, B, and C. None have used CP score as a continuous variable to assess the risk of cardiac surgery. The present study confirms the poor prognosis of patients with CP classes B and C reported elsewhere in much smaller studies. 5 8 At the same time, use of a CP numerical score further refines the conclusion. It aligns patients with CP class B with a score of 7 with patients with CP class A regarding the safety of cardiac surgery. The negative value of 97% for mortality in patients with a CP score 7 appears reassuring given the overall cardiac surgery mortality rate of 4.8% in a multinational database of 19,030 patients. 15 At the same time, risk for mortality increases substantially in those with a CP score 7. MELD score has not been used as a means of assessing surgical risk in patients with cirrhosis. In our study, it turns out to be as good a predictor of hepatic decompensation as CP score, but lacked sensitivity in predicting mortality. The individual parameters of bilirubin, albumin, and INR showed a significant relation with the outcome measures, but none was as strongly associated with mortality and hepatic decompensation as CP score and MELD score. There are few reports of cardiac surgery in patients with cirrhosis. In a retrospective review of 13 patients, Klemperer et al. 5 found an 80% mortality rate in patients with CP class B cirrhosis who underwent surgery, mostly urgently, compared with none in those with CP class A. Bizouarn et al. 6 studied 12 patients, most CP class A, who underwent surgery electively and reported

5 August 2004 CARDIAC SURGERY IN CIRRHOTICS 723 significant hepatic dysfunction in only 2 patients. The experience of elective cardiac surgery in 3 patients with CP class A cirrhosis reported in 2001 did not show postoperative decompensation. 7 In another retrospective study, 8 of 10 patients with cirrhosis undergoing cardiac surgery reported no deaths in 4 patients with CP class A and a 50% mortality rate in 6 patients with CP class B; CPB was used in half these patients. A common conclusion of these studies is that cardiac surgery is reasonably safe in patients with CP class A, whereas it may not be advisable in patients with CP class B. However, the number of patients is uniformly small, and some surgeries were performed on a beating heart. Hence, firm recommendations were difficult to make regarding advisability of cardiac surgery. Moreover, CP class (A, B, and C), rather than number (5 15), was reported; therefore, some patients who are good risks for cardiac surgery (CP class/score B7) might be excluded. In a large retrospective review, patients with PBC were suggested to fare better than those with cirrhosis of other causes, especially cryptogenic cirrhosis, after anesthesia and surgery. 2 However, only 12 patients in that series underwent cardiac surgery, and it is not known how many of them had PBC. We had only 2 patients with PBC and/or primary sclerosing cholangitis, and a valid comparison is not possible, However, a comparison of patients with alcoholic cirrhosis, cryptogenic cirrhosis, and all other causes grouped into one did not show a significant relationship between cause of cirrhosis and hepatic decompensation (P 0.83) or death (P 0.87). Although we found statistically significant results to suggest relationships between many variables and outcome, it was not possible to perform a multivariate analysis because of the small number of events (hepatic decompensation and/or death). It is a difficult problem to solve because most hepatic decompensations and/or deaths occurred in patients with advanced cirrhosis, and they do not undergo surgery frequently. The clinical findings of ascites and hepatic encephalopathy are thought to have some subjectivity involved, and that could mitigate the choice of a CP score cutoff value. However, notwithstanding these limitations, the present study comes to a categorical conclusion. Risks for postoperative mortality for patients with cirrhosis being considered for cardiac surgery using CPB can be assessed accurately by using the numerical CP score. A score 7 is associated with low mortality, whereas a score 7 is associated with a very high mortality rate. A prospective study using the cutoff CP score 7 and involving a large number of patients with CP class B is desirable, but probably not practical, to prove its clinical usefulness. References 1. Friedman LS. The risk of surgery in patients with liver disease. Hepatology 1999;29: Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology 1999;90: Poggio JL, Rowland CM, Gores GJ, Nagorney DM, Donohue JH. A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and gallstone disease. Surgery 2000;127: Yeh CN, Chen MF, Jan YY. Laparoscopic cholecystectomy in 226 patients. Experience of a single center in Taiwan. Surg Endosc 2002;16: Klemperer JD, Ko W, Krieger KH, Connolly M, Rosengart TK, Altorki NK, Lang S, Isom OW. Cardiac operations on patients with cirrhosis. Ann Thorac Surg 1998;65: Bizouarn P, Ausseur A, Desseigne P, Le Teurnier Y, Nougarede B, Train M, Michaud JL. Early and late outcome after elective cardiac surgery in patients with cirrhosis. Ann Thorac Surg 1999;67: Nimomiya M, Takamoto S, Kotsuka Y, Ohtsuka T. Indication and perioperative management for cardiac surgery in patients with liver cirrhosis. Jpn J Thorac Cardiovasc Surg 2001;49: Kaplan M, Cimen S, Sinen M, Demirtas MM. Cardiac operations for patients with chronic liver disease. Heart Surg Forum 2002; 5: Watanbe Y, Kumon K. Assessment by pulse dye-densitometry indocyanine green (ICG) clearance test of hepatic function of patients before cardiac surgery: its value as a predictor of serious postoperative liver dysfunction. J Cardiothorac Vasc Anesth 1999;13: Child CG III, Turcotte JG. Surgery and portal hypertension. In: Child CG III, ed. The liver and portal hypertension. Philadelphia, PA: Saunders, 1964: Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of esophagus for the bleeding varices. Br J Surg 1973;60: Malinchoc M, Kamath PS, Gordon FD, Peine CJ, Rank J, terborg PC. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000; 31: Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D Amico G, Dickson ER, Kim WR. A model to predict survival in patients with end stage liver disease. Hepatology 2001;34: Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, Kremers W, Lake J, Howard T, Merion RM, Wolfe RA, Krom R, United Network for Organ Sharing Liver Disease Severity Score Committee. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003;124: Roques F, Nashef SAM, Michel P, Gauducheau E, de Vincentiis C, Baudet E, Cortina J, David M, Faichney A, Gabrielle F, Gams E, Harjula A, Jones MT, Pintor PP, Salamon R, Thulin L. Risk factors and outcome in European cardiac surgery: analysis of the Euro- Score multinational database of patients. Eur J Cardiothorac Surg 1999;15: Address requests for reprints to: William D. Carey, M.D., Department of Gastroenterology and Hepatology, A-30, 9500 Euclid Avenue, Cleveland, Ohio careyw@ccf.org; fax: (216)

Anaesthetic considerations and peri-operative risks in patients with liver disease

Anaesthetic considerations and peri-operative risks in patients with liver disease Anaesthetic considerations and peri-operative risks in patients with liver disease Dr. C. K. Pandey Professor & Head Department of Anaesthesiology & Critical Care Medicine Institute of Liver and Biliary

More information

An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery

An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery The American Journal of Surgery (2012) 203, 589 593 North Pacific Surgical Association An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery Marlin Wayne Causey,

More information

Cardiac surgery in patients with liver cirrhosis: Risk factors for predicting mortality

Cardiac surgery in patients with liver cirrhosis: Risk factors for predicting mortality Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.3748/wjg.v20.i35.12608 World J Gastroenterol 2014 September 21; 20(35): 12608-12614 ISSN 1007-9327

More information

Chronic liver failure affects multiple organ systems and

Chronic liver failure affects multiple organ systems and ORIGINAL ARTICLES Model for End-Stage Liver Disease (MELD) Predicts Nontransplant Surgical Mortality in Patients With Cirrhosis Patrick G. Northup, MD,* Ryan C. Wanamaker, MD, Vanessa D. Lee, MD, Reid

More information

Coronary Revascularization in Patients With Liver Cirrhosis

Coronary Revascularization in Patients With Liver Cirrhosis Coronary Revascularization in Patients With Liver Cirrhosis Akira Marui, MD, PhD, Takeshi Kimura, MD, PhD, Shiro Tanaka, PhD, Senri Miwa, MD, PhD, Kazuhiro Yamazaki, MD, PhD, Kenji Minakata, MD, PhD, Tomohiro

More information

ORIGINAL ARTICLE Gastroenterology & Hepatology INTRODUCTION

ORIGINAL ARTICLE Gastroenterology & Hepatology INTRODUCTION ORIGINAL ARTICLE Gastroenterology & Hepatology http://dx.doi.org/10.3346/jkms.2013.28.8.1207 J Korean Med Sci 2013; 28: 1207-1212 The Model for End-Stage Liver Disease Score-Based System Predicts Short

More information

In patients undergoing cardiovascular operations, advanced

In patients undergoing cardiovascular operations, advanced Risk Factor Analysis in Patients With Liver Cirrhosis Undergoing Cardiovascular Operations Akimasa Morisaki, MD, Mitsuharu Hosono, MD, Yasuyuki Sasaki, MD, Shoji Kubo, MD, Hidekazu Hirai, MD, Shigefumi

More information

Development of the Allocation System for Deceased Donor Liver Transplantation

Development of the Allocation System for Deceased Donor Liver Transplantation Clinical Medicine & Research Volume 3, Number 2: 87-92 2005 Marshfield Clinic http://www.clinmedres.org Review Development of the Allocation System for Deceased Donor Liver Transplantation John M. Coombes,

More information

The MELD Score in Advanced Liver Disease: Association with Clinical Portal Hypertension and Mortality

The MELD Score in Advanced Liver Disease: Association with Clinical Portal Hypertension and Mortality The MELD Score in Advanced Liver Disease: Association with Clinical Portal Hypertension and Mortality Sammy Saab, 1,2 Carmen Landaverde, 3 Ayman B Ibrahim, 2 Francisco Durazo, 1,2 Steven Han, 1,2 Hasan

More information

Peri-operative Abnormal Liver Function Test

Peri-operative Abnormal Liver Function Test Peri-operative Abnormal Liver Function Test Naichaya Chamroonkul. MD. Division of Gastroenterology and Hepatology,Department of Internal Medicine Faculty of Medicine, Prince of Songkla University Liver

More information

The pediatric end-stage liver disease (PELD) score

The pediatric end-stage liver disease (PELD) score Selection of Pediatric Candidates Under the PELD System Sue V. McDiarmid, 1 Robert M. Merion, 2 Dawn M. Dykstra, 2 and Ann M. Harper 3 Key Points 1. The PELD score accurately predicts the 3 month probability

More information

In the United States, the Model for End-Stage Liver. Re-weighting the Model for End-Stage Liver Disease Score Components

In the United States, the Model for End-Stage Liver. Re-weighting the Model for End-Stage Liver Disease Score Components GASTROENTEROLOGY 2008;135:1575 1581 Re-weighting the Model for End-Stage Liver Disease Score Components PRATIMA SHARMA,* DOUGLAS E. SCHAUBEL,, CAMELIA S. SIMA,, ROBERT M. MERION,, and ANNA S. F. LOK* *Division

More information

Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association

Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension Gastroenterology Teaching Project American Gastroenterological Association WHAT IS CIRRHOSIS? What is Cirrhosis? DEFINITION OF CIRRHOSIS

More information

age, serum levels of bilirubin, albumin, and aspartate aminotransferase

age, serum levels of bilirubin, albumin, and aspartate aminotransferase The Relative Role of the Child-Pugh Classification and the Mayo Natural History Model in the Assessment of Survival in Patients With Primary Sclerosing Cholangitis W. RAY KIM, JOHN J. POTERUCHA, RUSSELL

More information

Primary sclerosing cholangitis (PSC) is a chronic

Primary sclerosing cholangitis (PSC) is a chronic Predicting Clinical and Economic Outcomes After Liver Transplantation Using the Mayo Primary Sclerosing Cholangitis Model and Child-Pugh Score Jayant A. Talwalkar, * Eric Seaberg, W. Ray Kim, * and Russell

More information

Survival Outcomes Following Liver Transplantation (SOFT) Score: A Novel Method to Predict Patient Survival Following Liver Transplantation

Survival Outcomes Following Liver Transplantation (SOFT) Score: A Novel Method to Predict Patient Survival Following Liver Transplantation American Journal of Transplantation 2008; 8: 2537 2546 Wiley Periodicals Inc. C 2008 The Authors Journal compilation C 2008 The American Society of Transplantation and the American Society of Transplant

More information

Liver Transplantation Evaluation: Objectives

Liver Transplantation Evaluation: Objectives Liver Transplantation Evaluation: Essential Work-Up Curtis K. Argo, MD, MS VGS/ACG Regional Postgraduate Course Williamsburg, VA September 13, 2015 Objectives Discuss determining readiness for transplantation

More information

Biomarkers of PSC. Steve Helmke, Ph.D.

Biomarkers of PSC. Steve Helmke, Ph.D. Biomarkers of PSC Steve Helmke, Ph.D. steve.helmke@ucdenver.edu Biomarkers of PSC Currently Used in Clinical Practice Biomarkers Used in Prognostic Models of PSC Wiesner et al, 1989 Age Bilirubin Biopsy

More information

Presentation and mortality of primary biliary cirrhosis in older patients

Presentation and mortality of primary biliary cirrhosis in older patients Age and Ageing 2000; 29: 305 309 Presentation and mortality of primary biliary cirrhosis in older patients JULIA L. NEWTON 1,DAVID E. JONES 2,JANE V. METCALF 2,JAY B. PARK 2,ALISTAIR D. BURT 2, MARGARET

More information

Update in abdominal Surgery in cirrhotic patients

Update in abdominal Surgery in cirrhotic patients Update in abdominal Surgery in cirrhotic patients Safi Dokmak HBP department and liver transplantation Beaujon Hospital, Clichy, France Cairo, 5 April 2016 Cirrhosis Prevalence in France (1%)* Patients

More information

Contraindications. Indications. Complications. Currently TIPS is considered second or third line therapy for:

Contraindications. Indications. Complications. Currently TIPS is considered second or third line therapy for: Contraindications Absolute Relative Primary prevention variceal bleeding HCC if centrally located Active congestive heart failure Obstruction all hepatic veins Thomas D. Boyer, M.D. University of Arizona

More information

Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients

Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients Murata and Kato et al. Liver dysfunction and open heart surgery, page 1 Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients undergoing cardiac surgery: Utilization

More information

The effect of preoperative liver dysfunction on cardiac surgery outcomes

The effect of preoperative liver dysfunction on cardiac surgery outcomes Araujo et al. Journal of Cardiothoracic Surgery (2017) 12:73 DOI 10.1186/s13019-017-0636-y RESEARCH ARTICLE Open Access The effect of preoperative liver dysfunction on cardiac surgery outcomes Luiz Araujo,

More information

The Management of Ascites & Hepatorenal Syndrome. Florence Wong University of Toronto. Falk Symposium March 14, 2008

The Management of Ascites & Hepatorenal Syndrome. Florence Wong University of Toronto. Falk Symposium March 14, 2008 The Management of Ascites & Hepatorenal Syndrome Florence Wong University of Toronto Falk Symposium March 14, 2008 Management of Ascites Sodium Restriction Mandatory at all stages of ascites in order to

More information

EDUCATION PRACTICE. Management of Refractory Ascites. Clinical Scenario. The Problem

EDUCATION PRACTICE. Management of Refractory Ascites. Clinical Scenario. The Problem CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1187 1191 EDUCATION PRACTICE Management of Refractory Ascites ANDRÉS CÁRDENAS and PERE GINÈS Liver Unit, Institute of Digestive Diseases, Hospital Clínic,

More information

Death in patients waiting for liver transplantation. Liver Transplant Recipient Selection: MELD vs. Clinical Judgment

Death in patients waiting for liver transplantation. Liver Transplant Recipient Selection: MELD vs. Clinical Judgment ORIGINAL ARTICLES Liver Transplant Recipient Selection: MELD vs. Clinical Judgment Michael A. Fink, 1,2 Peter W. Angus, 1 Paul J. Gow, 1 S. Roger Berry, 1,2 Bao-Zhong Wang, 1,2 Vijayaragavan Muralidharan,

More information

Hepatology for the Nonhepatologist

Hepatology for the Nonhepatologist Hepatology for the Nonhepatologist Kenneth E. Sherman, MD, PhD Gould Professor of Medicine Director, Division of Digestive Diseases University of Cincinnati College of Medicine Cincinnati, Ohio Learning

More information

LIVER. Question 1 ~ Anatomy. Answer 1 ~ Anatomy 1/5/2018. SEMCME Board Review January 11-12, 2017

LIVER. Question 1 ~ Anatomy. Answer 1 ~ Anatomy 1/5/2018. SEMCME Board Review January 11-12, 2017 SEMCME Board Review January 11-12, 2017 Surgical Treatment of Hepatobiliary and Splenic Disorders Michael J. Jacobs, MD, FACS, FICS Clinical Professor of Surgery- MSU CHM Associate Chair of Surgery Director

More information

Surgical Treatment of Hepatobiliary and Splenic Disorders

Surgical Treatment of Hepatobiliary and Splenic Disorders SEMCME Board Review January 10-11, 2019 Surgical Treatment of Hepatobiliary and Splenic Disorders Michael J. Jacobs, MD, FACS, FICS Clinical Professor of Surgery- MSU CHM Associate Chair of Surgery Director

More information

Alcoholic hepatitis (AH) is an acute, inflammatory. MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis

Alcoholic hepatitis (AH) is an acute, inflammatory. MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis Winston Dunn, 1 Laith H. Jamil, 1 Larry S. Brown, 2 Russell H. Wiesner, 1 W. Ray Kim, 1 K. V. Narayanan Menon, 1 Michael Malinchoc,

More information

Chronic liver failure Assessment for liver transplantation

Chronic liver failure Assessment for liver transplantation Chronic liver failure Assessment for liver transplantation Liver Transplantation Dealing with the organ shortage Timing of listing must reflect length on waiting list Ethical issues Justice, equity, utility

More information

Perioperative risk prediction scores

Perioperative risk prediction scores I N T E N S I V E C A R E Tutorial 343 Perioperative risk prediction scores Dr. Maria Chereshneva and Dr. Ximena Watson Anaesthetic Registrars, Croydon University Hospital, UK Dr. Mark Hamilton Anaesthetic

More information

Organ allocation for liver transplantation: Is MELD the answer? North American experience

Organ allocation for liver transplantation: Is MELD the answer? North American experience Organ allocation for liver transplantation: Is MELD the answer? North American experience Douglas M. Heuman, MD Virginia Commonwealth University Richmond, VA, USA March 1998: US Department of Health and

More information

Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database

Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 1-6 Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database Judy A.

More information

Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis

Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis Gastroenterology Report, 5(3), 2017, 232 236 doi: 10.1093/gastro/gow010 Advance Access Publication Date: 1 May 2016 Original article ORIGINAL ARTICLE Ammonia level at admission predicts in-hospital mortality

More information

Following the introduction of adult-to-adult living

Following the introduction of adult-to-adult living LIVER FAILURE/CIRRHOSIS/PORTAL HYPERTENSION Liver Transplant Recipient Survival Benefit with Living Donation in the Model for Endstage Liver Disease Allocation Era Carl L. Berg, 1 Robert M. Merion, 2 Tempie

More information

Evaluation Process for Liver Transplant Candidates

Evaluation Process for Liver Transplant Candidates Evaluation Process for Liver Transplant Candidates 2 Objectives Identify components of the liver transplant referral to evaluation Describe the role of the liver transplant coordinator Describe selection

More information

Assessment of Liver Function: Implications for HCC Treatment

Assessment of Liver Function: Implications for HCC Treatment Assessment of Liver Function: Implications for HCC Treatment A/P Dan Yock Young MBBS, PhD, MRCP, MMed. FAMS Chair, University Medicine Cluster. NUHS Head, Department of Medicine, National University of

More information

Serum Sodium and Survival Benefit of Liver Transplantation

Serum Sodium and Survival Benefit of Liver Transplantation LIVER TRANSPLANTATION 21:308 313, 2015 ORIGINAL ARTICLE Serum Sodium and Survival Benefit of Liver Transplantation Pratima Sharma, 1 Douglas E. Schaubel, 2 Nathan P. Goodrich, 4 and Robert M. Merion 3,4

More information

TEMPORAL PREDICTION MODELS FOR MORTALITY RISK AMONG PATIENTS AWAITING LIVER TRANSPLANTATION

TEMPORAL PREDICTION MODELS FOR MORTALITY RISK AMONG PATIENTS AWAITING LIVER TRANSPLANTATION Proceedings of the 3 rd INFORMS Workshop on Data Mining and Health Informatics (DM-HI 2008) J. Li, D. Aleman, R. Sikora, eds. TEMPORAL PREDICTION MODELS FOR MORTALITY RISK AMONG PATIENTS AWAITING LIVER

More information

Patterns of abnormal LFTs and their differential diagnosis

Patterns of abnormal LFTs and their differential diagnosis Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function / liver function

More information

Child-Pugh Score Predicts Mortality Better than Model of End Stage Liver Disease: A Study in a Tertiary Care Hospital in the Periphery of Karachi

Child-Pugh Score Predicts Mortality Better than Model of End Stage Liver Disease: A Study in a Tertiary Care Hospital in the Periphery of Karachi Original Article Child-Pugh Score Predicts Mortality Better than Model of End Stage Liver Disease: A Study in a Tertiary Care Hospital in the Periphery of Karachi Ashok Kumar 1, Ajeet Kumar 2, Syeda Urooj

More information

Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995

Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Steven H. Belle, Kimberly C. Beringer, and Katherine M. Detre T he Scientific Liver Transplant Registry (LTR) was established

More information

Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is It Time to Accept Remodeled Scores?

Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is It Time to Accept Remodeled Scores? Original Paper Received: March 8, 2015 Accepted: September 27, 2016 Published online: September 27, 2016 Predictors of Mortality in Long-Term Follow-Up of Patients with Terminal Alcoholic Cirrhosis: Is

More information

Prognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark

Prognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark Prognosis of untreated Primary Sclerosing Cholangitis (PSC) Erik Christensen Copenhagen, Denmark Study of Prognosis of PSC Difficulties: Disease is rare The duration of the course of disease may be very

More information

European. Young Hepatologists Workshop. Organized by : Quantification of fibrosis and cirrhosis outcomes

European. Young Hepatologists Workshop. Organized by : Quantification of fibrosis and cirrhosis outcomes supported by from Gilea Quantification of fibrosis and cirrhosis outcomes th 5 European 5 European Young Hepatologists Workshop Young Hepatologists Workshop August, 27-29. 2015, Moulin de Vernègues Vincenza

More information

T here is an increasing discrepancy between the number of

T here is an increasing discrepancy between the number of 134 LIVER DISEASE MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study F Botta, E Giannini, P Romagnoli,

More information

Home Intravenous Antibiotic Treatment for Intractable Cholangitis in Biliary Atresia

Home Intravenous Antibiotic Treatment for Intractable Cholangitis in Biliary Atresia Home Intravenous Antibiotic Treatment for Intractable Cholangitis in Biliary Atresia Hye Kyung Chang, Jung-Tak Oh, Seung Hoon Choi, Seok Joo Han Division of Pediatric Surgery, Department of Surgery, Yonsei

More information

Information for patients (and their families) waiting for liver transplantation

Information for patients (and their families) waiting for liver transplantation Information for patients (and their families) waiting for liver transplantation Waiting list? What is liver transplant? Postoperative conditions? Ver.: 5/2017 1 What is a liver transplant? Liver transplantation

More information

Patients with liver cirrhosis and concomitant coronary

Patients with liver cirrhosis and concomitant coronary Outcomes of Simultaneous Liver Transplantation and Elective Cardiac Surgical Procedures Brian Lima, MD, Edward R. Nowicki, MD, Charles M. Miller, MD, Koji Hashimoto, MD, Nicholas G. Smedira, MD, and Gonzalo

More information

SERUM CYSTATIN C CONCENTRATION IS A POWERFUL PROGNOSTIC INDICATOR IN PATIENTS WITH CIRRHOTIC ASCITES

SERUM CYSTATIN C CONCENTRATION IS A POWERFUL PROGNOSTIC INDICATOR IN PATIENTS WITH CIRRHOTIC ASCITES SERUM CYSTATIN C CONCENTRATION IS A POWERFUL PROGNOSTIC INDICATOR IN PATIENTS WITH CIRRHOTIC ASCITES YEON SEOK SEO, 1 SOO YOUNG PARK, 2 MOON YOUNG KIM, 3 SANG GYUNE KIM, 4 JUN YONG PARK, 5 HYUNG JOON YIM,

More information

Learning Objectives. After attending this presentation, participants will be able to:

Learning Objectives. After attending this presentation, participants will be able to: Learning Objectives After attending this presentation, participants will be able to: Describe HCV in 2015 Describe how to diagnose advanced liver disease and cirrhosis Identify the clinical presentation

More information

Management of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy

Management of Ascites and Hepatorenal Syndrome. Florence Wong University of Toronto. June 4, /16/ Gore & Associates: Consultancy Management of Ascites and Hepatorenal Syndrome Florence Wong University of Toronto June 4, 2016 6/16/2016 1 Disclosures Gore & Associates: Consultancy Sequana Medical: Research Funding Mallinckrodt Pharmaceutical:

More information

For patients with cirrhosis, increased operative risk relative

For patients with cirrhosis, increased operative risk relative CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:451 457 ORIGINAL ARTICLES LIVER, PANCREAS, AND BILIARY TRACT Factors That Predict Outcome of Abdominal Operations in Patients With Advanced Cirrhosis DANA

More information

Outcome and Characteristics of Patients on the Liver Transplant Waiting List: Shiraz Experience

Outcome and Characteristics of Patients on the Liver Transplant Waiting List: Shiraz Experience 63 Original Article Outcome and Characteristics of Patients on the Liver Transplant Waiting List: Shiraz Experience F Khademolhosseini 1, SA Malekhosseini 2, H Salahi 2, S Nikeghbalian 2, A Bahador 2,

More information

Hepatocytes produce. Proteins Clotting factors Hormones. Bile Flow

Hepatocytes produce. Proteins Clotting factors Hormones. Bile Flow R.J.Bailey MD Hepatocytes produce Proteins Clotting factors Hormones Bile Flow Trouble.. for the liver! Trouble for the Liver Liver Gall Bladder Common Alcohol Hep C Fatty Liver Cancer Drugs Viruses Uncommon

More information

Editorial Process: Submission:07/25/2018 Acceptance:10/19/2018

Editorial Process: Submission:07/25/2018 Acceptance:10/19/2018 RESEARCH ARTICLE Editorial Process: Submission:07/25/2018 Acceptance:10/19/2018 Clinical Outcome and Predictive Factors of Variceal Bleeding in Patients with Hepatocellular Carcinoma in Thailand Jitrapa

More information

Patterns of abnormal LFTs and their differential diagnosis

Patterns of abnormal LFTs and their differential diagnosis Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function tests / tests of

More information

Factors Predicting Survival after Transjugular Intrahepatic Portosystemic Shunt Creation: 15 Years Experience from a Single Tertiary Medical Center

Factors Predicting Survival after Transjugular Intrahepatic Portosystemic Shunt Creation: 15 Years Experience from a Single Tertiary Medical Center Factors Predicting Survival after Transjugular Intrahepatic Portosystemic Shunt Creation: 15 Years Experience from a Single Tertiary Medical Center Jen-Jung Pan, MD, PhD, Chaoru Chen, PhD, James G. Caridi,

More information

Improving liver allocation: MELD and PELD

Improving liver allocation: MELD and PELD American Journal of Transplantation 24; 4 (Suppl. 9): 114 131 Blackwell Munksgaard Blackwell Munksgaard 24 Improving liver allocation: MELD and PELD Richard B. Freeman Jr a,, Russell H. Wiesner b, John

More information

Severity and Mortality Prediction in Chronic Liver Disease using Child PUGH and MELD scales

Severity and Mortality Prediction in Chronic Liver Disease using Child PUGH and MELD scales International Journal of Advanced Biotechnology and Research (IJABR) ISSN 0976-2612, Online ISSN 2278 599X, Vol-10, Issue-1, 2019, pp519-524 http://www.bipublication.com Research Article Severity and Mortality

More information

Mortality after cardiac surgery in patients with liver cirrhosis classified by the Child-Pugh score

Mortality after cardiac surgery in patients with liver cirrhosis classified by the Child-Pugh score Interactive CardioVascular and Thoracic Surgery 20 (2015) 520 530 doi:10.1093/icvts/ivu438 Advance Access publication 22 January 2015 STATE OF THE ART ADULTCARDIAC Cite this article as: Jacob KA, Hjortnaes

More information

Preoperative Serum Bicarbonate Levels Predict Acute Kidney Iinjry after Cardiac Surgery

Preoperative Serum Bicarbonate Levels Predict Acute Kidney Iinjry after Cardiac Surgery International Journal of ChemTech Research CODEN (USA): IJCRGG, ISSN: 0974-4290, ISSN(Online):2455-9555 Vol.11 No.06, pp 203-208, 2018 Preoperative Serum Bicarbonate Levels Predict Acute Kidney Iinjry

More information

The burden of chronic liver disease continues to grow dramatically

The burden of chronic liver disease continues to grow dramatically Session 2B: Liver Disease THE RISKS OF SURGERY IN PATIENTS WITH LIVER DISEASE Joseph K. Lim, MD, FACG The burden of chronic liver disease continues to grow dramatically in the United States, driven primarily

More information

Thirty-day hospital readmission rates frequently are used as

Thirty-day hospital readmission rates frequently are used as CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2011;9:254 259 Incidence and Predictors of 30-Day Readmission Among Patients Hospitalized for Advanced Liver Disease KENNETH BERMAN,*, SWETA TANDRA,* KATE FORSSELL,

More information

Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients

Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients Badreldin et al. Journal of Cardiothoracic Surgery 2013, 8:126 RESEARCH ARTICLE Open Access Preoperative risk stratification models fail to predict hospital cost of cardiac surgery patients Akmal MA Badreldin

More information

Transfusion & Mortality. Philippe Van der Linden MD, PhD

Transfusion & Mortality. Philippe Van der Linden MD, PhD Transfusion & Mortality Philippe Van der Linden MD, PhD Conflict of Interest Disclosure In the past 5 years, I have received honoraria or travel support for consulting or lecturing from the following companies:

More information

Clinical Study The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

Clinical Study The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil Transplantation, Article ID 219789, 4 pages http://dx.doi.org/1.1155/214/219789 Clinical Study The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo,

More information

Chronic severe hepatitis (CSH) can cause

Chronic severe hepatitis (CSH) can cause Original Article / Liver The MELD scoring system for predicting prognosis in patients with severe hepatitis after plasma exchange treatment Jian-Wu Yu, Gui-Qiang Wang, Yong-Hua Zhao, Li-Jie Sun, Shu-Qin

More information

Dynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy

Dynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy Dynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy Liana Gheorghe 1, Speranta Iacob 1, Razvan Iacob 1, Gabriela Smira 1, Corina Pietrareanu 1, Doina

More information

Michele Bettinelli RN CCRN Lahey Health and Medical Center

Michele Bettinelli RN CCRN Lahey Health and Medical Center Michele Bettinelli RN CCRN Lahey Health and Medical Center Differentiate the types of varices Identify glue preparations utilized when treating gastric varices Review the process of glue administration

More information

Effects of Liver Disease on Pharmacokinetics

Effects of Liver Disease on Pharmacokinetics Effects of Liver Disease on Pharmacokinetics Juan J.L. Lertora, M.D., Ph.D. Director Clinical Pharmacology Program October 31, 2013 National Institutes of Health Clinical Center 1 GOALS of Effects of Liver

More information

Treating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC

Treating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC Treating patients with end-stage liver disease: Are we ready? Dr. Mino R. Mitri, M.D., C.M., M.Ed., FRCPC mino.mitri@ubc.ca No Conflict of Interest 157 patients 157 patients 6 transplanted Criteria Liver

More information

Management of Cirrhotic Complications Uncontrolled Ascites. Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University

Management of Cirrhotic Complications Uncontrolled Ascites. Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University Management of Cirrhotic Complications Uncontrolled Ascites Siwaporn Chainuvati, MD Siriraj Hospital Mahidol University Topic Definition, pathogenesis Current therapeutic options Experimental treatments

More information

Liver Transplantation: The End of the Road in Chronic Hepatitis C Infection

Liver Transplantation: The End of the Road in Chronic Hepatitis C Infection University of Massachusetts Medical School escholarship@umms UMass Center for Clinical and Translational Science Research Retreat 2012 UMass Center for Clinical and Translational Science Research Retreat

More information

CIRROSI E IPERTENSIONE PORTALE NELLA DONNA

CIRROSI E IPERTENSIONE PORTALE NELLA DONNA Cagliari, 16 settembre 2017 CIRROSI E IPERTENSIONE PORTALE NELLA DONNA Vincenza Calvaruso, MD, PhD Ricercatore di Gastroenterologia Gastroenterologia & Epatologia, Di.Bi.M.I.S. Università degli Studi di

More information

Hepatology For The Nonhepatologist

Hepatology For The Nonhepatologist Hepatology For The Nonhepatologist Andrew Aronsohn, MD Associate Professor of Medicine University of Chicago Chicago, Illinois Learning Objectives After attending this presentation, learners will be able

More information

Predicting Early Allograft Failure and Mortality After Liver Transplantation: The Role of the Postoperative Model for End-Stage Liver Disease Score

Predicting Early Allograft Failure and Mortality After Liver Transplantation: The Role of the Postoperative Model for End-Stage Liver Disease Score LIVER TRANSPLANTATION 19:534 542, 2013 ORIGINAL ARTICLE Predicting Early Allograft Failure and Mortality After Liver Transplantation: The Role of the Postoperative Model for End-Stage Liver Disease Score

More information

FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery

FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 2010 FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery Nicholas L Mills, David A McAllister, Sarah Wild, John D MacLay,

More information

ORIGINAL ARTICLE. Did the New Liver Allocation Policy Affect Waiting List Mortality?

ORIGINAL ARTICLE. Did the New Liver Allocation Policy Affect Waiting List Mortality? ORIGINAL ARTICLE Model for End-stage Liver Disease Did the New Liver Allocation Policy Affect Waiting List Mortality? Mary T. Austin, MD, MPH; Benjamin K. Poulose, MD, MPH; Wayne A. Ray, PhD; Patrick G.

More information

RECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY

RECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY RECURRENT HEPATITIS C CIRRHOSIS AFTER LIVER TRANSPLANTATION: A NATURAL HISTORY STUDY By VIRGINIA C. CLARK A THESIS PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF

More information

Liver Transplantation

Liver Transplantation Liver Transplantation Dr Mathew Jacob - MRCS FRCS CCT (UK) Lead Consultant HPB/Transplant Surgeon Aster Integrated Liver Care Program AsterMedcity, kochi, kerala, India mathew@transplantationliver.com

More information

Submitted: Revised: Published:

Submitted: Revised: Published: ORIGINAL ARTICLE ASIAN JOURNAL OF MEDICAL SCIENCES A comparative study of albumin-bilirubin score, MELD and Child Pugh scores for predicting the in-hospital mortality in cirrhotic patients complicated

More information

Management of Cirrhosis Related Complications

Management of Cirrhosis Related Complications Management of Cirrhosis Related Complications Ke-Qin Hu, MD, FAASLD Professor of Clinical Medicine Director of Hepatology University of California, Irvine Disclosure I have no disclosure related to this

More information

Different models in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Different models in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure ORIGINAL ARTICLE Short-term prognosis of patients with HBV-related ACLF., 2012; 11 (3): 311-319 May-June, Vol. 11 No.3, 2012: 311-319 311 Different models in predicting the short-term prognosis of patients

More information

Combined Orthotopic Heart and Liver Transplantation: The Need for Exception Status Listing 1

Combined Orthotopic Heart and Liver Transplantation: The Need for Exception Status Listing 1 SHORT REPORTS Combined Orthotopic Heart and Liver Transplantation: The Need for Exception Status Listing 1 Paige M. Porrett, 1 Shashank S. Desai, 2 Kathleen J. Timmins, 3 Carol R.Twomey, 4 Seema S. Sonnad,

More information

Preoperative Risk Assessment for Patients with Liver Disease

Preoperative Risk Assessment for Patients with Liver Disease Preoperative Risk Assessment for Patients with Liver Disease Shahid M. Malik, MD, Jawad Ahmad, MD, MRCP* KEYWORDS Operative risk Liver disease Cirrhosis CTP score MELD Underlying liver disease has effects

More information

What Is the Real Gain After Liver Transplantation?

What Is the Real Gain After Liver Transplantation? LIVER TRANSPLANTATION 15:S1-S5, 9 AASLD/ILTS SYLLABUS What Is the Real Gain After Liver Transplantation? James Neuberger Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, United Kingdom;

More information

Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery

Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal surgery REVIEW ARTICLE Annals of Gastroenterology (2017) 31, 330-337 Preoperative elective transjugular intrahepatic portosystemic shunt for cirrhotic patients undergoing abdominal Deepanshu Jain a, Ejaz Mahmood

More information

Norepinephrine versus Terlipressin for the Treatment of Hepatorenal Syndrome

Norepinephrine versus Terlipressin for the Treatment of Hepatorenal Syndrome Norepinephrine versus Terlipressin for the Treatment of Hepatorenal Syndrome Disclosure I have no conflicts of interest to disclose Name: Margarita Taburyanskaya Title: PharmD, PGY1 Pharmacy Practice Resident

More information

The Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust

The Yellow Patient. Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust The Yellow Patient Dr Chiradeep Raychaudhuri, Consultant Hepatologist, Hull University Teaching Hospitals NHS Trust there s a yellow patient in bed 40. It s one of yours. Liver Cirrhosis Why.When.What.etc.

More information

Geographic Differences in Event Rates by Model for End-Stage Liver Disease Score

Geographic Differences in Event Rates by Model for End-Stage Liver Disease Score American Journal of Transplantation 2006; 6: 2470 2475 Blackwell Munksgaard C 2006 The Authors Journal compilation C 2006 The American Society of Transplantation and the American Society of Transplant

More information

Liver Transplantation

Liver Transplantation 1 Liver Transplantation Department of Surgery Yonsei University Wonju College of Medicine Kim Myoung Soo M.D. ysms91@wonju.yonsei.ac.kr http://gs.yonsei.ac.kr History Development of Liver transplantation

More information

Evidence-Based Incorporation of Serum Sodium Concentration Into MELD

Evidence-Based Incorporation of Serum Sodium Concentration Into MELD GASTROENTEROLOGY 2006;130:1652 1660 Evidence-Based Incorporation of Serum Sodium Concentration Into MELD SCOTT W. BIGGINS, W. RAY KIM, NORAH A. TERRAULT, SAMMY SAAB, VIJAY BALAN, THOMAS SCHIANO, JOANNE

More information

Are we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting?

Are we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting? Rajani Sharma, PGY1 Geriatrics CRC Project, 12/19/13 Are we adequately screening at-risk patients for hepatocellular carcinoma in the outpatient setting? A. Study Purpose and Rationale Hepatocellular carcinoma

More information

B C Outlines. Child-Pugh scores

B C Outlines. Child-Pugh scores B C 2016-12-09 Outlines Child-Pugh scores CT MRI Fibroscan / ARFI Histologic Scoring Systems for Fibrosis Fibrosis METAVIR Ishak None 0 0 Portal fibrosis (some) 1 1 Portal fibrosis (most) 1 2 Bridging

More information

Assessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington

Assessing Cardiac Risk in Noncardiac Surgery. Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Assessing Cardiac Risk in Noncardiac Surgery Murali Sivarajan, M.D. Professor University of Washington Seattle, Washington Disclosure None. I have no conflicts of interest, financial or otherwise. CME

More information

Bariatric Surgery For Patients With End-Organ Failure

Bariatric Surgery For Patients With End-Organ Failure Bariatric Surgery For Patients With End-Organ Failure Arnold D. Salzberg, M.D. Andrew M. Posselt, M.D., PhD Divisions of Transplant and Minimally Invasive Surgery University of California, San Francisco

More information

Causes of Liver Disease in US

Causes of Liver Disease in US Learning Objectives Updates in Outpatient Cirrhosis Management Jennifer Guy, MD MAS Director, Liver Cancer Program California Pacific Medical Center guyj@sutterhealth.org Review cirrhosis epidemiology,

More information