End-stage Liver Disease Research Articles

Meta-analysis of Influencing Factors of Mortality in Chinese Patients with Liver Failure Undergoing Plasma Exchange

Objective: This meta-analysis aimed to evaluate the determinants that influence mortality of individuals with liver failure who are undergoing the treatment of plasma exchange (PE). Materials and Methods: The search for relevant literature was conducted from the beginning of the database records up to January 5, 2024, encompassing a range of databases such as PubMed, Embase, the Cochrane Library, Web of Science, as well as Chinese databases including CNKI (China National Knowledge Infrastructure), WanFang, and VIP. For the analysis of continuous variables, the weighted mean difference (WMD) was utilized, while for categorical variables, the odds ratio (OR) was employed. Both statistical measures were presented alongside their respective 95% confidence intervals (CI). Subgroup analyses were conducted based on liver failure type, volume of plasma exchanged, and HBV etiology. Results: In total, 33 studies involving 5,842 patients were included. Older age, a higher MELD score, the presence of HE, cirrhosis, HRS, and peritonitis, elevated AST levels, low ALB level, low PTA, prolonged PT, low PLT, and WBC counts were associated with mortality in Chinese patients with liver failure who underwent PE (all P< 0.05). However, these influencing factors could vary depending on the type of liver failure and the exchange volume during PE. Conclusion: Several demographic indicators, liver function indicators, coagulation indicators, and routine blood are associated with mortality in patients with liver failure undergoing PE. This study may provide important clinical guidance for the care of patients with liver failure, helping to improve patient survival.

Pentoxifylline use in alcohol-associated hepatitis with acute kidney injury does not improve survival: a global study

BackgroundSevere alcohol-associated hepatitis (sAH) is a life-threatening condition with high mortality, where corticosteroid use is the only treatment that has shown short-term benefits. Pentoxifylline, an anti-tumour necrosis factor-alpha agent, has...

Development and validation of a machine learning-based model for predicting biliary complications at different time periods after liver transplantation: A multicenter study.

The risk factors for biliary complications (BCs) after liver transplantation (LT) aren't comprehensively determined. BCs also vary in times of onset. Machine learning (ML) can reveal regularities based on large-scale data to make predictions and have demonstrated good performance in LT. However, whether ML can be an efficient tool for BC prediction wasn't determined. 517 patients from two centers were enrolled. Patients were randomly divided into training and validation sets at 3:1 ratio. K-fold cross-validation and the synthetic minority oversampling technique (SMOTE) were used to debug the models, which were evaluated by receiver operating characteristic (ROC) curves. Shapley additive explanation (SHAP) values and Sankey diagrams were applied to visualize the results. Seven ML algorithms were administrated to build models for BCs prediction at 3, 6 and 12 months. Among all the models, support vector machine (SVM) produced the highest area under curve values in predicting BCs (3-month = 0.916; 6-month = 0.892; 12-month = 0.885). According to the analysis of SVM, the 3-month risk factors of BCs and corresponding SHAP value ranges were donor age (-0.13, 0.21), Model for End-Stage Liver Disease (MELD) score (-0.15, 0.18), neoplastic disease (-0.14, 0.28), diabetes (-0.12, 0.27), hypertension (-0.13, 0.21) and intraoperative blood transfusion (-0.09, 0.25), while 6-month factors were recipient age (-0.14, 0.16), donor body mass index (BMI) (-0.10, 0.13), recipient BMI (-0.13, 0.23) and diabetes (-0.12, 0.43). The 12-month risk factors were recipient age (-0.14, 0.19), diabetes (-0.13, 0.25) and basiliximab (-0.16, 0.24). The Sankey diagram enabled clear visualization of the contribution of individual risk factors to the model in different times of BCs onset. The ML algorithm was able to identify risk factors for BCs in all postoperative periods and this supplied insights in patient management.

Primary hemostasis in children with cirrhosis prior to liver transplantation: key roles of liver disease severity, von Willebrand factor, and platelet count.

Primary hemostasis in children with cirrhosis prior to liver transplantation: key roles of liver disease severity, von Willebrand factor, and platelet count.

Developing palliative care interventions in liver disease using formative and summative qualitative evaluation.

Evaluation of the effectiveness of nascent care delivery interventions to integrate palliative care into end-stage-liver disease (ESLD) is limited. Intervention development and evaluation is a systematic, complex, and time-consuming process. Qualitative research approaches, known as formative and summative evaluations, are recommended during intervention development to explore intervention mechanisms, to determine the need for refinement, and to provide a deeper understanding of intervention efficacy, effectiveness, and implementation barriers and facilitators. Although qualitative formative and summative evaluations are resource-intensive, they provide critical information about intervention feasibility, patient and clinician acceptability, and patient-centeredness. This review summarizes how qualitative formative and summative evaluation methods can inform the design, adaptation, and evaluation of interventions to integrate palliative care into ESLD. We describe the completed qualitative summative evaluation study, embedded within PAL-LIVER, an in progress 19-site cluster randomized trial of hepatologist- vs palliative specialist-led palliative care for patients with ESLD and their caregivers. We include patient, family, and clinician demographic data emphasizing how the sample is representative of the parent RCT and describe how the embedded qualitative study explored patient, family, and clinicians' perspectives on the intervention. Specifically, we sought to understand how the intervention was enacted (fidelity) and to provide a roadmap for future palliative care practice integration in ESLD. In conclusion, formative and summative evaluations play a vital role in improving interventions so that valuable and scarce palliative care resources are applied equitably and effectively and so that patients and their caregivers experience the best possible care and quality of life as they live with ESLD.

Understanding Alcohol Abuse in Deceased Donors: Effects on Liver Transplant Results

Background/Objectives: Liver transplantation is a life-saving procedure for patients with end-stage liver disease. In recent years, the demand for liver transplantation has surpassed the supply of available donor organs. Utilizing extended-criteria donors (ECDs) alleviates the scarcity of suitable donor livers for transplantation. One of the ECD was donors with a history of alcohol abuse. Liver grafts from donors with a history of chronic and active alcohol abuse are typically promptly excluded, diminishing the available organ pool. This highlights the need to re-evaluate the donor exclusion criteria and expand the organ pool to address the ongoing shortage. Methods: We examined adult (>18 years) liver transplant recipients who received deceased donor livers and had a documented history of alcohol abuse between 2011 and 2024. Liver transplant indications were conventional and included hepatitis C virus (HCV), non-alcoholic steatohepatitis, alcoholic liver disease, alcoholic liver disease coexisting with HCV, cryptogenic cirrhosis, chronic cholestatic liver disease, primary biliary cholangitis, primary sclerosing cholangitis, metabolic liver disease, hepatocellular carcinoma, and alcoholic hepatitis. We compared the 1-year, 5-year, and 9-year survival rates with those of liver recipients from non-alcohol-consuming donors. Results: In total, 370 liver recipients from deceased donors with a documented history of alcohol abuse were included. At 1 year post-transplant, survival was comparable between the two groups. Conclusions: Liver transplantation from deceased donors with a history of alcohol abuse yielded survival rates and liver function outcomes comparable to those from non-alcohol-using donors. By expanding the criteria to include carefully screened alcohol-using donors, transplant programs can improve access to life-saving transplantations.

Alcohol related hepatitis in intensive care units: clinical and biological spectrum and mortality risk factors: a multicenter retrospective study

BackgroundAlcohol related hepatitis is responsible for high morbidity and mortality, but little is known about the management of patients with hepatitis specifically in intensive care units (ICU).MethodsRetrospective study including patients with alcohol related hepatitis hospitalized in 9 French ICUs (2006–2017). Alcohol related hepatitis was defined histologically or by an association of clinical and biological criteria according to current guidelines.Results187 patients (median age: 53 [43–60]; male: 69%) were included. A liver biopsy was performed in 51% of cases. Patients were admitted for impaired consciousness (71%), sepsis (64%), shock (44%), respiratory failure (37%). At admission, median SOFA and MELD scores were 10 [7–13] and 31 [26–40] respectively. 63% of patients received invasive mechanical ventilation, 62% vasopressors, and 36% renal replacement therapy. 66% of patients received corticosteroids, and liver transplantation was performed in 16 patients (8.5%). ICU and in-hospital mortality were 37% and 53% respectively. By multivariate analysis, ICU mortality was associated with SOFA score (without total bilirubin) (SHR 1.08 [1.02–1.14] per one-point increase), arterial lactate (SHR 1.08 [1.03–1.13] per 1 mmol/L) and MELD score (SHR 1.09 [1.04–1.14] per 1 point), while employment was associated with increased survival (HR 0.49 [0.28–0.86]). After propensity score weighting, the use of corticosteroids did not affect ICU mortality in the overall population but had a beneficial effect in the subgroup of patients with histological proof. Patient prognosis was also better in responders assessed by Lille score at day 7 (OR 6.67 [2.44–20.15], p < 0.001).ConclusionAlcohol related hepatitis is a severe condition leading to high mortality in ICU patients. Severity of organ failure at admission are mortality risk factors. Outcome was significantly better in responders to corticosteroids therapy according to Lille score. Early referral to tertiary centers to discuss liver transplantation should more widely be considered.

Phase I safety and tolerability dose escalation study of microencapsulated hepatocyte intraperitoneal transplantation therapy in adult patients with liver failure: a study protocol

IntroductionChina has a high prevalence of liver diseases, with about 300 million patients suffering from various types of liver diseases, where the incidence of severe liver diseases is 1%–3%. More...

Minimal Hepatic Encephalopathy in Cirrhotic Patients: A New Simple and Fast Digital Screening Method.

Minimal hepatic encephalopathy is a common and prognostically severe complication of cirrhosis with a significant impact on the quality of life. Detailed diagnostic work-up of minimal hepatic encephalopathy is time-consuming and difficult to integrate into daily clinical routine. We aimed to develop a new, simple, and easy-applicable smartphone-based self-assessment method for screening of minimal hepatic encephalopathy. 92 patients with cirrhosis and 20 healthy controls were recruited to perform 3 different short digital tests on smartphones (Tip test (TT), number connection test (dNCT) and modified Stroop test (ST)). Results were correlated with the Psychometric Hepatic Encephalopathy Score (PHES) as the presumed gold standard for minimal hepatic encephalopathy. The impact of age, gender, education, CHILD and MELD scores was further investigated. All 3 digital tests showed good correlation with PHES (TT r=-0.76, dNCT r=-0.58, and ST r=-0.65; all p<0.001). Digital tests were performed significantly faster (TT median 41s (IQR 36-51s); dNCT median 21s (IQR 8-16s); ST median 76s (IQR 55-99s) than PHES (median 322s; IQR 261-434s); There were significant differences between age groups and different levels of education (p<0.05). AUC for TT was 0.835 (95% confidence interval 0.747-0.922, p<0.001) and highest among all digital tests. All 3 digital tests proved to be suitable for screening of minimal hepatic encephalopathy. TT showed the highest correlation with reference PHES and was not affected by language skills or color blindness, and, thus, might represent a new and fast method for minimal hepatic encephalopathy detection. Intra-individually adjusted smartphone-based thresholds might further eliminate the influence of age, gender, educational level or training, to refine early app-based alerts in case of cognitive deterioration in cirrhotic patients.

Living donor liver transplantation for autoimmune hepatitis in identical monozygotic twins: a case report.

Liver transplantation (LT) is an effective treatment for end-stage liver diseases, including autoimmune hepatitis. Advances in immunosuppressive therapy have improved patient and graft survival; however, these treatments can cause serious side effects such as cardiovascular and metabolic complications. Some recipients achieve immunotolerance after LT, enabling them to safely reduce or even discontinue immunosuppression. In transplantation between identical twins, perfect human leukocyte antigen matching eliminates the need for immunosuppressive medications, thereby reducing long-term morbidity. We present a case of living donor LT between identical twins in which both the donor and recipient have remained healthy for over 2 years without the need for immunosuppression.

Prevalence and predicting factors of caregiver burden in cirrhotic patients

Background: Cirrhosis is a major cause of morbidity and mortality. Caregivers of cirrhotic patients provide significant support related to disease manifestations and complications. This scoping review aims to identify the prevalence of caregiver burden among patients with cirrhosis and to identify patient and caregiver factors that predict caregiver burden in patients with cirrhosis. Methods: A literature search was conducted using MEDLINE, EMBASE, CINAHL, and Web of Science to identify studies for inclusion. Screening and data extraction were performed using Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia). Results: 604 articles were identified, and 15 were included in the review. Caregivers were predominantly female and spouses of the patient. The average age of patients varied between 41.2 and 57.2 (SD 10.3 to 12.5). The most common cirrhotic aetiologies were alcohol-related, viral hepatitis–related, and metabolic-related aetiologies. The most used survey tools to assess burden were the Zarit Burden Interview (ZBI) score, Short Form-36 Health Survey (SF-36), and Beck Depression/Anxiety Inventory (BDI or BAI). Patient factors contributing toward caregiver burden included prior hepatic encephalopathy (HE), alcohol use, and high Model for End-Stage Liver Disease (MELD) scores. Caregiver factors that contribute toward caregiver burden included poor perceived social supports, low and disrupted income, and being the spouse of the patient. Conclusions: Several patient and caregiver factors contribute to caregiver burden, and greater levels of burden may affect multiple aspects of a caregiver's life, potentially worsening patient outcomes. A multidisciplinary approach is critical to alleviate caregiver burnout and optimize the overall care for a patient with cirrhosis.

Hepcidin as a Therapeutic Target in Liver Cirrhosis: A Cohort Study on Iron Dysregulation

Background: Iron metabolism dysregulation in liver cirrhosis leads to iron accumulation which triggers oxidative stress and advances liver tissue damage. This study investigated how Hepcidin modulation affects iron accumulation and liver function alongside cirrhosis complications among liver cirrhosis patients. Methods: Researchers conducted a prospective cohort study (January 2024 to January 2025) by monitoring 120 liver cirrhosis patients at Asian Institute of Medical Sciences Hyderabad and remaining from Liaquat University Hospital Jamshoro (ERC/9303/24) in adherence with the Declaration of Helsinki. The study documented both baseline clinical data alongside liver function tests and Hepcidin measurements. Two separate groups were formed through randomization for treatment with Hepcidin-modulating. Disease severity using Child-Pugh and MELD scores was determined. The study used both Kaplan-Meier survival and Cox regression methods to examine clinical outcomes. Data were analyzed using SPSS version 22. Paired t-tests evaluated within-group changes, and one way ANOVA was employed for between-group comparisons (p-value&lt;0.05, Statistical Significance). Results: The intervention group experienced a substantial Hepcidin level rise from 45.7 ng/mL to 87.5 ng/mL. The levels of serum ferritin declined from 890.5 ng/mL to 510.2 ng/mL. The intervention group achieved notable liver function improvement through their Child-Pugh score drop from 8.2 to 6.5 (p=0.003) and their MELD score reduction from 18.2 to 14.9 (p=0.002). Conclusion: The modulation of Hepcidin treatment leads to major reductions in iron burden while also supporting improved liver function and lowering cirrhosis-related complications among liver cirrhosis patients.

Predictive scoring systems for mortality in heart transplant patients with liver cirrhosis

To compare the Model for End-Stage Liver Disease (MELD), MELD-XI, and Child-Turcotte-Pugh (CTP) scores for risk prediction in patients with cirrhosis undergoing heart transplantation. This study enrolled 66 consecutive patients (26 males; median age, 46 [18–68] years) with liver cirrhosis who underwent heart transplantation at our institution from 1994 to 2022. Potential preoperative outcome predictors and the preoperative MELD, MELD-XI, and CTP scores were calculated. The median follow-up duration was 45.2 months. The MELD (p = 0.01) and MELD-XI scores (p < 0.01) were significantly different between survivors and non-survivors. Cox regression analysis showed that high MELD (hazard ratio [HR] 1.07; 95% confidence interval [CI], 1.03–1.11; p < 0.01), MELD-XI (HR, 1.16; 95% CI, 1.06–1.21; p < 0.01), and CTP scores (HR, 1.43; 95% CI, 1.20–1.75; p = 0.01) were associated with the risk of all-cause mortality. Receiver operating characteristic curve analysis revealed that the optimal cut-off values of MELD, MELD-XI, and CTP scores were 12.2, 12.0, and 7.5, respectively (sensitivity: 69.2, 61.5, and 69.2%; specificity: 68.6, 60.0, and 62.9%, respectively) for all-cause mortality (area under the curve: 0.75, 0.69, and 0.73, respectively). Patients with advanced heart failure and liver cirrhosis have high mortality and morbidity rates after heart transplantation. However, these scoring systems can be used as risk stratification tools in patients with liver cirrhosis undergoing heart transplantation.Research registration unique identifying number: Research Registry (UIN: resarchregistry10791).

Bariatric Surgery and Risk of End-Stage Liver Disease in a Four-Country Cohort Study.

Metabolic dysfunction-associated steatotic liver disease can progress to end-stage liver disease. Whether bariatric surgery influences this risk is uncertain. This population-based cohort study included all patients with an obesity diagnosis between 1989 and 2020 according to the nationwide patient registries in Denmark, Finland, Norway, and Sweden. Bariatric surgery was compared with non-operative care for incidence and mortality in end-stage liver disease. Patients with a history of alcohol overconsumption or liver disease at baseline were excluded. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for sex, calendar year, diabetes, Charlson comorbidity index, and country. Among 654,409 participants with obesity, 86,356 (12.6%) underwent bariatric surgery. During a follow-up period of up to 31 years (median 7.3 years), bariatric surgery was followed by increased incidence (HR 1.23, 95% CI 1.11-1.37) and mortality (HR 1.93, 95% CI 1.56-2.38) in end-stage liver disease compared to non-operative care. The incidence decreased between 1 and 5years after bariatric surgery but thereafter increased. Censoring patients who developed specific liver diseases (not steatotic liver disease) or alcohol overconsumption during follow-up canceled the association (HR 0.92, 95% CI 0.70-1.06). The mortality in end-stage liver disease was similar after bariatric surgery compared to non-operative care within 1-5 years of follow-up, but thereafter more than twofold increased. Analyses restricted to gastric bypass showed similar associations regarding both incidence (HR 1.26, 95% CI 1.11-1.43) and mortality (HR 2.20, 95% CI 1.72-2.82) of end-stage liver disease. Bariatric surgery might be followed by an increased risk of end-stage liver disease.

Validation and expansion of Baveno VII recompensation criteria in patients with cirrhosis and curable liver disease.

Validation and expansion of Baveno VII recompensation criteria in patients with cirrhosis and curable liver disease.

Predicting Mortality and Cirrhosis-Related Complications with MELD3.0: A Multicenter Cohort Analysis.

/Aims: This study aimed to evaluate the performance of the Model for End-Stage Liver Disease (MELD) 3.0 for predicting mortality and liver-related complications compared with the Child-Pugh classification, albumin-bilirubin (ALBI) grade, the MELD, and the MELD sodium (MELDNa) score. We evaluated a multicenter retrospective cohort of incorporated patients with cirrhosis between 2013 and 2019. We conducted comparisons of the area under the receiver operating characteristic curve (AUROC) of the MELD3.0 and other models for predicting 3-month mortality. Additionally, we assessed the risk of cirrhosis-related complications according to the MELD3.0 score. A total of 3,314 patients were included. The mean age was 55.9±11.3 years, and 70.2% of the patients were male. Within the initial 3 months, 220 patients (6.6%) died, and the MELD3.0 had the best predictive performance among the tested models, with an AUROC of 0.851, outperforming the Child-Pugh classification, ALBI grade, MELD, and MELDNa. A high MELD3.0 score was associated with an increased risk of mortality. Compared with that of the group with a MELD3.0 score <10 points, the adjusted hazard ratio of the group with a score of 10-20 points was 2.176, and that for the group with a score of ≥20 points was 4.892. Each 1-point increase in the MELD3.0 score increased the risk of cirrhosis-related complications by 1.033-fold. The risk of hepatorenal syndrome showed the highest increase, with an adjusted hazard ratio of 1.149, followed by hepatic encephalopathy and ascites. The MELD3.0 demonstrated robust prognostic performance in predicting mortality in patients with cirrhosis. Moreover, the MELD3.0 score was linked to cirrhosis-related complications, particularly those involving kidney function, such as hepatorenal syndrome and ascites.

Elevated Alpha-Fetoprotein Levels in Children with Metabolic Dysfunction-Associated Liver Disease.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to end-stage liver disease and hepatocellular carcinoma (HCC), albeit infrequently in childhood. Our objectives were to (1) investigate the prevalence of elevated alpha-fetoprotein (AFP) in children with advanced, MASLD-related, fibrosis (bridging fibrosis or cirrhosis) and (2) ascertain whether pediatric MASLD is associated with AFP elevations regardless of fibrosis severity. Methods: Retrospective cohort study of patients aged 6-18 years seen at a single center between 2000 and 2024. Demographics, anthropometrics, blood work, histological data, and relevant imaging studies were collected. Descriptive statistics were used. Results: Out of a cohort of 483 pediatric patients followed for MASLD with available AFP data, 161 had undergone liver biopsy, and of those, 22 had advanced fibrosis. Children with advanced fibrosis were predominantly male (82%) and non-Hispanic (55%), with a median age of 11 years (interquartile range [IQR] = 10-18) and severe obesity (median [IQR] body mass index z-score 2.56 [2.33-2.75]). No patients with advanced fibrosis had elevated AFP levels. Of the entire MASLD cohort, however, nine had elevated AFP levels. None were diagnosed with HCC or other tumors. Conclusions: In a pediatric cohort with MASLD, severe fibrosis was not associated with elevated AFP levels. AFP elevations were seen however in some patients with MASLD but were not associated with malignancies.

Sex-based Differences and Comparative Predictive Value of MELD 3.0 in Simultaneous Liver-Kidney Transplantation Waitlist Outcomes After Standardization of Listing Criteria in the United States.

Sex disparities in solid organ transplantation are well documented. Relative changes in sex-based outcome disparities after the 2017 standardization of simultaneous liver-kidney (SLK) listing criteria in the United States have not been reported. We hypothesized that this policy's objective measures of kidney dysfunction may differentially affect SLK patients by sex and that the use of MELD 3.0 in the SLK population might provide unique benefit to female transplant candidates. Organ Procurement and Transplantation Network data were retrospectively analyzed comparing 2013-2016 with 2018-2021 SLK listings. Waitlist outcomes and Model for End-stage Liver Disease (MELD) 3.0 reclassifications were compared by sex and listing period. There were 2626 and 2609 male patients and 1670 and 1919 female patients pre- and post-policy changes, respectively. The proportion of female SLK listings post-policy change (42.4%) was higher than both female SLK listings pre-policy change (38.9%) and female single-organ liver listings post-policy change (36.8%; P < 0.01). A statistically significant interaction between sex and listing group (pre- versus post-policy change) was present in multivariable analysis (P = 0.02). Female patients were more likely to have a higher MELD 3.0 score than the listing MELD/MELD-Na score when the listing MELD score was <30 (P < 0.01). Among all patients who died on the waitlist, female patients were nearly twice as likely to be underrepresented by listing MELD compared with MELD 3.0 (23% female and 13% male patients; P < 0.01). Waitlist outcomes were changed differentially between male and female patients after the 2017 SLK policy change. The application of MELD 3.0 to SLK patients is likely to benefit female patients.

Recipient 3-Hepatic Vein Technique with Graft Venoplasty to Maximize Venous Outflow in Left Lobe Living Donor Liver Transplantation.

Augmentation of hepatic venous outflow is crucial in living donor liver transplantation (LDLT) to maximize functional graft size and prevent venous complications. We present details of our outflow augmentation technique for left lobe grafts (LLG) in adult LDLTs, which uses all recipient 3 hepatic veins and venoplasty of graft left and middle hepatic veins. This study examines the effectiveness of our technique in preventing outflow complications and the correlation between anatomical variations of the graft hepatic veins and surgical outcomes. We retrospectively reviewed 88 patients who underwent LLG-LDLT between 2012 and 2023. The patients were classified into 3 groups based on the graft hepatic vein anatomy and usage of venoplasty: group 1 (n = 10, common trunk without venoplasty), group 2 (n = 62, common trunk with venoplasty), and group 3 (n = 16, no common trunk with venoplasty). No patient developed clinically significant venous outflow complications or graft loss related to venous outflow. There were no significant differences in complication rates or ascites production among the groups. Five-year graft survival was comparable among the groups (P = 0.43). Multiple regression analysis revealed that the model for end-stage liver disease score was the only independent risk factor for increased ascites after transplant (standardized beta, 0.546; t value,4.20; P < 0.001; 95% confidence interval, 0.287-0.804), but anatomical variations of the graft hepatic veins did not influence ascites output. The recipient 3 hepatic vein outflow augmentation technique with graft venoplasty can be applied to various graft hepatic venous anatomy and effectively prevents outflow-related graft loss in LLG-LDLT.

Palliative Care Referral Patterns and Outcomes for Patients with End-Stage Liver Disease at an Academic Liver Transplant Center.

Background: Patients with end-stage liver disease (ESLD) have complex needs and may benefit from palliative care (PC), which is often underutilized or delayed. Objectives: To characterize patients with ESLD who received inpatient PC consultation and to explore differences in characteristics between those who received PC consultation before (pre-Pall) or after (post-Pall) PC participation at weekly liver transplant (LT) Patient Selection Committee (PSC) meetings. Design: Single-center retrospective cohort study. Setting/Subjects: Hospitalized patients with ESLD who received inpatient PC consultation between February 2017 and February 2019 at an academic LT center in the United States. Measurements: PC referral reasons and timing, code status, hospice referrals, discharge location, and mortality. Results: Two hundred five patients were included. The primary reason for PC was goals of care (88.8%; n = 182). Most (86.8%; n = 178) were Full Code at hospital admission, while 81% (n = 166) were do-not-resuscitate at discharge. Nearly one quarter (22.9%; n = 47) sought life-prolonging care at discharge, while 41.5% (n = 85) were discharged with hospice, and 34.1% (n = 70) died before discharge. By the end of the study, 85.9% (n = 176) were confirmed as deceased. Median time from PC to hospice referral was 12 days [95% confidence interval [CI]: 8-23]. Median time from PC consult to death was 13 days [95% CI: 9-17] and from hospice referral to death was 7 days [95% CI: 4-13]. There were no statistically significant differences between the pre- and post-Pall groups related to PC referral patterns or outcomes. Conclusions: Most PC contacts occurred near end of life, and many led to comfort-focused care. Late referrals may be due to reliance on inpatient consults during acute illness. PC presence at PSC meetings represents an important step in collaboration with LT teams but did not lead to direct impact on PC referral patterns or outcomes.