(An online MELD calculator that accepts SI units is accessible at One of the requirements for listing in the United Network for Organ Sharing in the US is a MELD score of at least 14. High MELD scores are associated with a poor short-term prognosis. The MELD score is based on laboratory values for serum bilirubin, serum creatinine, and international normalized ratio (INR) in a log-transformed equation where Ln is the natural logarithm: (3.8 + 11.2 + 9.6 + 6.4). It has been prospectively validated in several patient populations and is currently used by most transplant centres in the world.
Today MELD is the most commonly used prognostic model for estimating disease severity and survival in end-stage liver disease. One of these systems is the model for end-stage liver disease (MELD), which was originally developed to estimate procedure-related mortality in patients undergoing transjugular intrahepatic portosystemic shunts.
In the first stage, patients are assessed to see if they are suitable to be “activated” on the waiting list, and in the second stage a decision is made regarding which patient will receive a given donor organ.ĭuring assessment, scoring systems are used to determine patient status and suitability. A successful outcome depends on optimal patient selection and timing.Ī patient should be considered for liver transplantation if this option extends life expectancy and improves quality of life beyond the expectation of the natural history of the underlying liver disease.Ĭurrent candidate selection in BC occurs in two stages. The transplant team has an ethical obligation to act in the best interests of both the individual patient referred for assessment and the entire group of patients who are in need of transplantation. In recent years the rate of death on the wait list has been approximately 30%.Ĭareful patient selection and proper organ allocation are critical given the scarcity of this life-saving resource. While the number of liver transplants has increased across North America, there has been a greater increase in the number of patients who are on a liver transplant wait list.īC Transplant data for the number of referrals for transplantation and the number of transplants performed reflect the situation across North America, and mean longer waiting times for very ill patients ( Figure 2). Initial referrals for liver transplant assessment usually come from community specialists with expertise in the area who have decided that there are no options other than transplantation. The number of transplants performed increased from 3 in 1989 to 47 in 2008. In British Columbia liver transplantation has been available since 1989. Today orthotopic liver transplantation (OLT) has become an accepted treatment for patients with acute or chronic decompensated liver disease of various causes, as well as a form of gene replacement therapy for several systemic metabolic diseases in the absence of structural liver disease. In BC this most notably takes the form of urea cycle defects in adolescence.Īpproximately 400 liver transplants are performed in Canada every year.
In addition to the survival benefit, liver transplantation provides patients with a distinct improvement in quality of life. In contrast, the expected survival of a patient with Child class C cirrhosis is in the order of 20% to 30% at 1 year. The availability of tacrolimus as an alternative to cyclosporine and the introduction of other immunosuppressive agents, including biologicals and mycophenolate mofetil, as well as refinements of surgical techniques, intensive care, and diagnostic modalities, have led to current 1-year survival rates of 85% to 95% and 5-year survival rates of 75% after liver transplantation in BC ( Figure 1). The first successful human liver transplant was performed by Dr Thomas Starzl and his colleagues in 1968 in Colorado on an 18-month-old child who survived 400 days.ĭespite improved technical aspects of transplant surgery, the 1-year survival rates were not above 35% in the 1960s and 1970s, mainly because of graft failure due to allograft rejection.Ī major breakthrough in the field was the development of calcineurin inhibitors, with a landmark paper reporting 11 of 12 patients alive 1 year post-transplant on cyclosporine-based immunosuppresion.
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