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Stratifying Mortality in a Model for End-Stage Liver Disease Waiting List: A Brazilian Single-Center Study
- Source :
- Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual), Universidade de São Paulo (USP), instacron:USP
- Publication Year :
- 2018
-
Abstract
- The Model for End-Stage Liver Disease (MELD) system reliably predicts mortality in cirrhotic patients. However, the etiology of liver disease and presence of portal vein thrombosis are not directly taken into account in MELD score. Its impact on the outcomes of patients on the waiting list is still unclear. The aim of this study was to investigate mortality and access to transplantation regarding etiology of liver disease and portal vein thrombosis (PVT).A total of 465 adult patients on the liver waiting list from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to the etiology of liver disease and presence of PVT.The most frequent etiologies were hepatitis C (26.88%), alcoholic cirrhosis (26.02%) and cryptogenic cirrhosis (10.75%). Death while on the waiting list occurred in 168 patients (36.1%) and was more frequent in nonalcoholic steatohepatitis (NASH, 65.4%) and alcoholic cirrhosis (41.3%). A total of 142 (30.5%) patients underwent transplantation and viral, autoimmune, and biliary diseases showed higher proportion of transplantation (36.3%, 53.8%, and 34%, respectively; P .01). Mean delta-MELD at the study endpoint was higher in patients with autoimmune hepatitis, biliary diseases, and NASH (8.3 ± 7.2, 8.3 ± 9.1, and 7.5 ± 9.1, respectively; P .01). A total 77 patients (16.7%) presented PVT. There was no significant difference in outcomes between patients with and without PVT.Patients with NASH and alcoholic liver disease had higher mortality while on the waiting list, whereas patients with viral and autoimmune hepatitis had higher transplantation rate. Outcomes were not influenced by PVT.
- Subjects :
- Adult
Liver Cirrhosis
Male
medicine.medical_specialty
Alcoholic liver disease
Waiting Lists
Autoimmune hepatitis
010501 environmental sciences
Severity of Illness Index
01 natural sciences
Gastroenterology
End Stage Liver Disease
03 medical and health sciences
Liver disease
0302 clinical medicine
Model for End-Stage Liver Disease
Liver Cirrhosis, Alcoholic
Non-alcoholic Fatty Liver Disease
Internal medicine
Humans
Medicine
0105 earth and related environmental sciences
Venous Thrombosis
Transplantation
Portal Vein
business.industry
Hepatitis C
Middle Aged
medicine.disease
MORTALIDADE
Liver Transplantation
Portal vein thrombosis
Etiology
Female
030211 gastroenterology & hepatology
Surgery
business
Brazil
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual), Universidade de São Paulo (USP), instacron:USP
- Accession number :
- edsair.doi.dedup.....30cc2e03d15e4ceffa0444c8ac84b2d7