The MELD score predicts the short-term and overall survival after liver transplantation in patients with primary sclerosing cholangitis or autoimmune liver diseases
详细信息 查看全文
- 作者：Katrin Hoffmann (1)
Ulf Hinz (1)
Norbert Hillebrand (1)
Tom Ganten (2)
Daniel Gotthardt (2)
Thomas Longerich (3)
Peter Schirmacher (3)
Peter Schemmer (1) - 关键词：Liver transplantation ; Primary sclerosing cholangitis ; Autoimmune hepatitis ; Overlap syndrome
- 刊名：Langenbeck's Archives of Surgery
- 出版年：2014
- 出版时间：December 2014
- 年：2014
- 卷：399
- 期：8
- 页码：1001-1009
- 全文大小：298 KB
- 参考文献：1. Bjoro K, Brandsaeter B, Foss A, Schrumpf E (2006) Liver transplantation in primary sclerosing cholangitis. Semin Liver Dis 26(1):69-9 CrossRef
2. Mottershead M, Neuberger J (2008) Transplantation in autoimmune liver diseases. World J Gastroenterol 14(21):3388-395 CrossRef
3. Vogel A, Heinrich E, Bahr MJ et al (2004) Long-term outcome of liver transplantation for autoimmune hepatitis. Clin Transplant 18(1):62-9 CrossRef
4. Garcia CE, Garcia RF, Gunson B et al (2004) Analysis of marginal donor parameters in liver transplantation for primary biliary cirrhosis. Exp Clin Transplant 2:183-88
5. Silveira MG, Talwalkar JA, Angulo P, Lindor KD (2007) Overlap of autoimmune hepatitis and primary biliary cirrhosis: long-term outcomes. Am J Gastroenterol 102(6):1244-250 CrossRef
6. Krawitt EL (2006) Autoimmune hepatitis. N Engl J Med 354(1):54-6 CrossRef
7. Kaplan MM, Gershwin ME (2005) Primary biliary cirrhosis. N Engl J Med 353(12):1261-273 CrossRef
8. Eurotransplant International Foundation, Leiden, Netherlands. personal cummunication (2010)
9. Devlin J, O’Grady J (1999) Indications for referral and assessment in adult liver transplantation: a clinical guideline. Br Soc Gastroenterol Gut 45(Suppl 6):VI1–VI22
10. Mendes FD, Kim WR, Pedersen R, Therneau T, Lindor KD (2008) Mortality attributable to cholestatic liver disease in the United States. Hepatology 47(4):1241-247 CrossRef
11. Graziadei IW, Wiesner RH, Marotta PJ et al (1999) Long-term results of patients undergoing liver transplantation for primary sclerosing cholangitis. Hepatology 30(5):1121-127 CrossRef
12. Floreani A, Niro G, Rosa RE et al (2006) Type I autoimmune hepatitis: clinical course and outcome in an Italian multicentre study. Aliment Pharmacol Ther 24(7):1051-057 CrossRef
13. Khalaf H, Mourad W, El-Sheikh Y et al (2007) Liver transplantation for autoimmune hepatitis: a single-center experience. Transplant Proc 39(4):1166-170 CrossRef
14. Rust C, Beuers U (2008) Overlap syndromes among autoimmune liver diseases. World J Gastroenterol 14(21):3368-373 CrossRef
15. Alvarez F, Berg PA, Bianchi FB et al (1999) International autoimmune hepatitis group report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol 31(5):929-38, 18 CrossRef
16. Belghiti J, Panis Y, Sauvanet A, Gayet B, Fekete F (1992) A new technique of side to side caval anastomosis during orthotopic hepatic transplantation without inferior vena caval occlusion. Surg Gynecol Obstet 175(3):270-72
17. Hoffmann K, Weigand M, Hillebrand N, Büchler MW, Schmidt J, Schemmer P (2009) Is veno-venous bypass still needed during liver transplantation? A review of the literature. Clin Transplant 23(1):1- CrossRef
18. Bruns H, Lozanovski VJ, Schultze D et al (2014) Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis. PLoS ONE 9(6):e98782 CrossRef
19. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205-13 Ulf Hinz (1)
Norbert Hillebrand (1)
Tom Ganten (2)
Daniel Gotthardt (2)
Thomas Longerich (3)
Peter Schirmacher (3)
Peter Schemmer (1)
1. Department of General and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
2. Department of Internal Medicine, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
3. Institute of Pathology, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany - ISSN：1435-2451
文摘
Purpose Liver transplantation (LT) is well established in patients with autoimmune liver disease. Despite excellent outcomes, organ scarcity demands careful patients-selection and timing of transplantation. Methods This retrospective study analyzes data of 79 consecutive patients with primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and overlap syndrome, undergoing LT between 2001 and 2012. Overall survival (OS) and graft survival were assessed using Kaplan-Meier estimate. Multivariate survival analysis was performed to identify prognostic factors by using Cox regression model. Results After 59.6-month median follow-up, the 5-year OS and graft survival were 75.3 and 68.8?%, respectively. The 5-year survival rates for patients with PSC (n--7), AIH (n--7), and overlap syndrome (n--) were 76.3, 76.0, and 60.0?%. The 90-day mortality rate of 70.0?% was significantly higher in patients with a labMELD score ?0 (n--0) compared to 26.1?% in 69 patients with a labMELD p--.009). A lab Model for End-Stage Liver Disease (MELD) score ?0 was an independent predictor of impaired OS (p--.050, hazard ratio 2.5). The 5-year OS was 55.7?% in patients with a labMELD score ?0 compared to 84.7?% in patients with a labMELD score Conclusion The recipients-MELD score is a predictor for the short-term outcome after LT in patients with autoimmune liver disease. Meticulous selection for transplant listing remains necessary to safe scarce donor organs.