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

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2010.01295.x/abstract

Indicators and outcome of liver transplantation in acute liver decompensation

after flares of hepatitis B

W.-C. Lee1, H.-S. Chou1, T.-J. Wu1, C.-S. Lee2, C.-F. Lee1, K.-M. Chan1Article

first published online: 28 MAR 2010

DOI: 10.1111/j.1365-2893.2010.01295.x

© 2010 Blackwell Publishing Ltd

Issue

Journal of Viral Hepatitis

Volume 18, Issue 3, pages 193–199, March 2011

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.

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2893.2010.01295.x/abstract

Indicators and outcome of liver transplantation in acute liver decompensation

after flares of hepatitis B

W.-C. Lee1, H.-S. Chou1, T.-J. Wu1, C.-S. Lee2, C.-F. Lee1, K.-M. Chan1Article

first published online: 28 MAR 2010

DOI: 10.1111/j.1365-2893.2010.01295.x

© 2010 Blackwell Publishing Ltd

Issue

Journal of Viral Hepatitis

Volume 18, Issue 3, pages 193–199, March 2011

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.