Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation
Liver transplantation (LT) is definitive treatment for end‐stage liver disease. This study evaluated factors predicting successful evaluation in patients transferred for urgent inpatient LT evaluation. Eighty‐two patients with cirrhosis were transferred for urgent LT evaluation from January 2016 to...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2021-03-01
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| Series: | Hepatology Communications |
| Online Access: | https://doi.org/10.1002/hep4.1644 |
| _version_ | 1828044494215315456 |
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| author | Omar Alshuwaykh Allison Kwong Aparna Goel Amanda Cheung Renumathy Dhanasekaran Aijaz Ahmed Tami Daugherty Deepti Dronamraju Radhika Kumari W. Ray Kim Mindie H. Nguyen Carlos O. Esquivel Waldo Concepcion Marc Melcher Andy Bonham Thomas Pham Amy Gallo Paul Yien Kwo |
| author_facet | Omar Alshuwaykh Allison Kwong Aparna Goel Amanda Cheung Renumathy Dhanasekaran Aijaz Ahmed Tami Daugherty Deepti Dronamraju Radhika Kumari W. Ray Kim Mindie H. Nguyen Carlos O. Esquivel Waldo Concepcion Marc Melcher Andy Bonham Thomas Pham Amy Gallo Paul Yien Kwo |
| author_sort | Omar Alshuwaykh |
| collection | DOAJ |
| description | Liver transplantation (LT) is definitive treatment for end‐stage liver disease. This study evaluated factors predicting successful evaluation in patients transferred for urgent inpatient LT evaluation. Eighty‐two patients with cirrhosis were transferred for urgent LT evaluation from January 2016 to December 2018. Alcohol‐associated liver disease was the common etiology of liver disease (42/82). Of these 82 patients, 35 (43%) were declined for LT, 27 (33%) were wait‐listed for LT, 5 (6%) improved, and 15 (18%) died. Psychosocial factors were the most common reasons for being declined for LT (49%). Predictors for listing and receiving LT on multivariate analysis included Hispanic race (odds ratio [OR], 1.89; P = 0.003), Asian race (OR, 1.52; P = 0.02), non‐Hispanic ethnicity (OR, 1.49; P = 0.04), hyponatremia (OR, 1.38; P = 0.04), serum albumin (OR, 1.13; P = 0.01), and Model for End‐Stage Liver Disease (MELD)‐Na (OR, 1.02; P = 0.003). Public insurance (i.e., Medicaid) was a predictor of not being listed for LT on multivariate analysis (OR, 0.77; P = 0.02). Excluding patients declined for psychosocial reasons, predictors of being declined for LT on multivariate analysis included Chronic Liver Failure Consortium (CLIF‐C) score >51.5 (OR, 1.26; P = 0.03), acute‐on‐chronic liver failure (ACLF) grade 3 (OR, 1.41; P = 0.01), hepatorenal syndrome (HRS) (OR, 1.38; P = 0.01), and respiratory failure (OR, 1.51; P = 0.01). Predictors of 3‐month mortality included CLIF‐C score >51.5 (hazard ratio [HR], 2.52; P = 0.04) and intensive care unit (HR, 8.25; P < 0.001). Conclusion: MELD‐Na, albumin, hyponatremia, ACLF grade 3, HRS, respiratory failure, public insurance, Hispanic race, Asian race, and non‐Hispanic ethnicity predicted liver transplant outcome. Lack of psychosocial support was a major reason for being declined for LT. The CLIF‐C score predicted being declined for LT and mortality. |
| first_indexed | 2024-04-10T17:57:33Z |
| format | Article |
| id | doaj.art-a4ffcf5e23564c8b96be8a0bf78fc988 |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T17:57:33Z |
| publishDate | 2021-03-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-a4ffcf5e23564c8b96be8a0bf78fc9882023-02-02T17:30:49ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2021-03-015351652510.1002/hep4.1644Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation EvaluationOmar Alshuwaykh0Allison Kwong1Aparna Goel2Amanda Cheung3Renumathy Dhanasekaran4Aijaz Ahmed5Tami Daugherty6Deepti Dronamraju7Radhika Kumari8W. Ray Kim9Mindie H. Nguyen10Carlos O. Esquivel11Waldo Concepcion12Marc Melcher13Andy Bonham14Thomas Pham15Amy Gallo16Paul Yien Kwo17Division of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USADivision of Abdominal Transplantation Stanford University Medical Center Stanford CA USADivision of Abdominal Transplantation Stanford University Medical Center Stanford CA USADivision of Abdominal Transplantation Stanford University Medical Center Stanford CA USADivision of Abdominal Transplantation Stanford University Medical Center Stanford CA USADivision of Abdominal Transplantation Stanford University Medical Center Stanford CA USADivision of Abdominal Transplantation Stanford University Medical Center Stanford CA USADivision of Gastroenterology and Hepatology Stanford University Medical Center Stanford CA USALiver transplantation (LT) is definitive treatment for end‐stage liver disease. This study evaluated factors predicting successful evaluation in patients transferred for urgent inpatient LT evaluation. Eighty‐two patients with cirrhosis were transferred for urgent LT evaluation from January 2016 to December 2018. Alcohol‐associated liver disease was the common etiology of liver disease (42/82). Of these 82 patients, 35 (43%) were declined for LT, 27 (33%) were wait‐listed for LT, 5 (6%) improved, and 15 (18%) died. Psychosocial factors were the most common reasons for being declined for LT (49%). Predictors for listing and receiving LT on multivariate analysis included Hispanic race (odds ratio [OR], 1.89; P = 0.003), Asian race (OR, 1.52; P = 0.02), non‐Hispanic ethnicity (OR, 1.49; P = 0.04), hyponatremia (OR, 1.38; P = 0.04), serum albumin (OR, 1.13; P = 0.01), and Model for End‐Stage Liver Disease (MELD)‐Na (OR, 1.02; P = 0.003). Public insurance (i.e., Medicaid) was a predictor of not being listed for LT on multivariate analysis (OR, 0.77; P = 0.02). Excluding patients declined for psychosocial reasons, predictors of being declined for LT on multivariate analysis included Chronic Liver Failure Consortium (CLIF‐C) score >51.5 (OR, 1.26; P = 0.03), acute‐on‐chronic liver failure (ACLF) grade 3 (OR, 1.41; P = 0.01), hepatorenal syndrome (HRS) (OR, 1.38; P = 0.01), and respiratory failure (OR, 1.51; P = 0.01). Predictors of 3‐month mortality included CLIF‐C score >51.5 (hazard ratio [HR], 2.52; P = 0.04) and intensive care unit (HR, 8.25; P < 0.001). Conclusion: MELD‐Na, albumin, hyponatremia, ACLF grade 3, HRS, respiratory failure, public insurance, Hispanic race, Asian race, and non‐Hispanic ethnicity predicted liver transplant outcome. Lack of psychosocial support was a major reason for being declined for LT. The CLIF‐C score predicted being declined for LT and mortality.https://doi.org/10.1002/hep4.1644 |
| spellingShingle | Omar Alshuwaykh Allison Kwong Aparna Goel Amanda Cheung Renumathy Dhanasekaran Aijaz Ahmed Tami Daugherty Deepti Dronamraju Radhika Kumari W. Ray Kim Mindie H. Nguyen Carlos O. Esquivel Waldo Concepcion Marc Melcher Andy Bonham Thomas Pham Amy Gallo Paul Yien Kwo Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation Hepatology Communications |
| title | Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation |
| title_full | Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation |
| title_fullStr | Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation |
| title_full_unstemmed | Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation |
| title_short | Predictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation |
| title_sort | predictors of outcomes of patients referred to a transplant center for urgent liver transplantation evaluation |
| url | https://doi.org/10.1002/hep4.1644 |
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