Indicators and outcome of liver transplantation in acute liver decompensation after flares of hepatitis B

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http://www.ingentaconnect.com/content/bsc/jvh/2011/00000018/00000003/art00005

Journal of Viral Hepatitis, Volume 18, Number 3

Indicators and outcome of liver transplantation in acute liver decompensation

after flares of hepatitis B

Authors: Lee, W.-C.1; Chou, H.-S.1; Wu, T.-J.1; Lee, C.-S.2; Lee, C.-F.1; Chan,

K.-M.1

Source: Journal of Viral Hepatitis, Volume 18, Number 3, March 2011 , pp.

193-199(7)

Publisher: Wiley-Blackwell

Abstract:

Summary. 

Non-cirrhotic patients having acute liver decompensation in flares of hepatitis

B can recover spontaneously or die without liver transplantation. Criteria for

identifying patients in need of liver transplantation are lacking. Fifty-one

non-cirrhotic patients having acute liver decompensation in flares of hepatitis

B were retrospectively reviewed. The patients were divided into three groups:

group A patients (n = 18) recovered from acute liver decompensation

spontaneously; group B patients (n = 22) died of acute liver failure; and

group C patients (n = 11) had liver transplantation. Model of end-stage

liver disease (MELD) scores were evaluated to identify the criteria for liver

transplantation. The cut-off point of MELD scores for liver transplantation was

evaluated by receiver operating characteristic (ROC) curve. Comparing group A

and B patients, MELD score was an independent factor to predict prognosis. By

analysing ROC curve, a MELD score > 30 was the most optimal cut-off point to

indicate liver transplantation; however, the false positive rate was 11.1%. By

weekly measurement of MELD scores, subsequent increase in MELD scores could help

to avoid false positives. Moreover, a MELD score > 34 yielded 0% false

positive rate and indicated the necessity of definite liver transplantation. For

group C patients, ten of 11 patients were saved by liver transplantation. In

conclusion, for the patients having acute liver decompensation in flares of

hepatitis B, liver transplantation is definitely indicated by MELD

scores > 34. Liver transplantation is also indicated if the MELD score

increases in the subsequent 1-2 weeks. Liver transplantation has a good

outcome if performed on time.

Document Type: Research article

DOI: 10.1111/j.1365-2893.2010.01295.x

Affiliations:1: Departments of Liver and Transplantation Surgery 2: Hepatology,

Chang-Gung Transplantation Institute, Chang-Gung Memorial Hospital, Chang-Gung

University Medical School, Taoyuan, Taiwan

Publication date: 2011-03-01

[Guest guest]

http://www.ingentaconnect.com/content/bsc/jvh/2011/00000018/00000003/art00005

Journal of Viral Hepatitis, Volume 18, Number 3

Indicators and outcome of liver transplantation in acute liver decompensation

after flares of hepatitis B

Authors: Lee, W.-C.1; Chou, H.-S.1; Wu, T.-J.1; Lee, C.-S.2; Lee, C.-F.1; Chan,

K.-M.1

Source: Journal of Viral Hepatitis, Volume 18, Number 3, March 2011 , pp.

193-199(7)

Publisher: Wiley-Blackwell

Abstract:

Summary. 

Non-cirrhotic patients having acute liver decompensation in flares of hepatitis

B can recover spontaneously or die without liver transplantation. Criteria for

identifying patients in need of liver transplantation are lacking. Fifty-one

non-cirrhotic patients having acute liver decompensation in flares of hepatitis

B were retrospectively reviewed. The patients were divided into three groups:

group A patients (n = 18) recovered from acute liver decompensation

spontaneously; group B patients (n = 22) died of acute liver failure; and

group C patients (n = 11) had liver transplantation. Model of end-stage

liver disease (MELD) scores were evaluated to identify the criteria for liver

transplantation. The cut-off point of MELD scores for liver transplantation was

evaluated by receiver operating characteristic (ROC) curve. Comparing group A

and B patients, MELD score was an independent factor to predict prognosis. By

analysing ROC curve, a MELD score > 30 was the most optimal cut-off point to

indicate liver transplantation; however, the false positive rate was 11.1%. By

weekly measurement of MELD scores, subsequent increase in MELD scores could help

to avoid false positives. Moreover, a MELD score > 34 yielded 0% false

positive rate and indicated the necessity of definite liver transplantation. For

group C patients, ten of 11 patients were saved by liver transplantation. In

conclusion, for the patients having acute liver decompensation in flares of

hepatitis B, liver transplantation is definitely indicated by MELD

scores > 34. Liver transplantation is also indicated if the MELD score

increases in the subsequent 1-2 weeks. Liver transplantation has a good

outcome if performed on time.

Document Type: Research article

DOI: 10.1111/j.1365-2893.2010.01295.x

Affiliations:1: Departments of Liver and Transplantation Surgery 2: Hepatology,

Chang-Gung Transplantation Institute, Chang-Gung Memorial Hospital, Chang-Gung

University Medical School, Taoyuan, Taiwan

Publication date: 2011-03-01