Abstract
Whether and when recovery beyond the need for transplant may occur in patients listed for decompensation remains unclear. This study aimed to investigate the characteristics of patients delisted following recompensation. Seventy-seven patients who were listed between 2005 and 2015 for decompensation, but later delisted following recompensation were included. Alcohol-related liver disease (ALD) was the underlying etiology in the majority (n = 47, 61%). Listing characteristics of these patients were compared with those of decompensated ALD patients who either underwent deceased donor liver transplantation or died on the waiting list. The model for end-stage liver disease (MELD) score <20 and serum albumin ≥32 g/l at listing were the only independent predictors of recompensation/delisting in ALD. The probability of recompensation was 70% when both factors were present at listing. Interestingly, about a tenth of decompensated ALD patients who died on the waiting list (median duration on waiting list 11 months) and a quarter of decompensated ALD patients who underwent living donor liver transplantation (median duration on waiting list 2 months) also had both factors at listing. In conclusion, ALD seems to be the most favorable etiology for recompensation beyond the need for transplantation. Both MELD and serum albumin at listing independently predict recompensation/delisting in ALD. It seems advisable to implement a period of observation for ALD patients with both favorable factors, before embarking on living donor liver transplantation.
Highlights
Development of hepatic decompensation, which marks the onset of end-stage liver disease, is an ominous milestone of chronic liver disease progression, irrespective of the etiology
Clinical characteristics of all patients delisted following recompensation A total of 935 patients were listed for decompensation alone and underwent liver transplantation (LT), died on the waiting list, or delisted following recompensation during the 10-year study period – Alcohol-related liver disease (ALD) (n=284, 30%), hepatitis C (n=239, 26%), and non-alcohol-related fatty liver disease (n=115, 12%) were the three most common etiologies, followed by primary sclerosing cholangitis (n=71, 8%), hepatitis B (n=55, 6%), primary biliary cholangitis (n=47, 5%), cryptogenic cirrhosis (n=45, 5%), autoimmune hepatitis (n=38, 4%), and others (n=41, 4%)
Potential predictors of delisting following recompensation was assessed only for ALD; other etiologies were present in too small numbers in the recompensation group to allow a meaningful statistical analysis
Summary
Development of hepatic decompensation, which marks the onset of end-stage liver disease, is an ominous milestone of chronic liver disease progression, irrespective of the etiology It is defined as the manifestation of an index complication such as ascites, hepatic encephalopathy, variceal hemorrhage or hepatocellular dysfunction in a patient with cirrhosis [1, 2]. Development of ascites is associated with a 1-year mortality of 15%, which increases to >60% when complicated by hyponatremia, hepatorenal syndrome and/or superimposed spontaneous bacterial peritonitis [5, 6]. Both hepatic encephalopathy [7] and variceal bleeding [8] are associated with poor prognosis. Improvement in hepatic function and recompensation is occasionally seen in day-to-day clinical practice, even in patients listed for LT
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