MELD / PELD and the allocation of deceased donor livers for status 1 recipients with acute fulminant hepatic failure, primary nonfunction, hepatic artery thrombosis, and acute Wilson's disease

Russell H. Wiesner – 21 September 2004 – Key Points 1Historical perspective of donor allocation to patients with fulminant hepatic failure (FHF).2Predicting prognosis in patients with FHF using the London and Clichy criteria.3Model for end‐stage liver disease (MELD) is a predictor of mortality in patients with FHF.4Outcomes of adults listed as Status 1 in the United States.5Outcomes of pediatric candidates listed as Status 1 in the United States.6Proposed redefinition for Status 1 in adult and pediatric candidates. (Liver Transpl 2004;10:S17–S22.)

Retransplantation for recurrent hepatitis C in the MELD era: Maximizing utility

James R. Burton, Amnon Sonnenberg, Hugo R. Rosen – 21 September 2004 – Key Points 1Retransplantation (re‐LT) for hepatitis C virus (HCV) recurrence is controversial. Although re‐LT accounts for 10% of all liver transplants (LTs), the number of patients requiring re‐LT is expected to grow as primary LT recipients survive long enough to develop graft failure from recurrent disease.2Utility, as applied to the medical ethics of transplantation, refers to allocating organs to those individuals who will make the best use of them.

Organ allocation for liver‐intestine candidates

Simon Horslen – 21 September 2004 – Key Points 1Patients listed for combined liver and intestine transplantation have the highest waitlist mortality of any transplant candidates.2Liver‐intestine candidates have higher mortality rates than other patients listed for liver transplantation at all model for end‐stage liver disease (MELD) and pediatric end‐stage liver disease (PELD) scores, sepsis rather than liver failure being the major cause of death in this group.3Increasing PELD scores appear to correlate with increasing waitlist mortality in patients awaiting combined liver and intestinal t

Selection of candidates with HCC for transplantation in the MELD era

Margarita Sala, Maria Varela, Jordi Bruix – 21 September 2004 – Key Points 1Liver transplantation is the main option for patients with early HCC who are not optimal candidates for surgical resection.2Shortage of donors is its main limitation, as waiting for a liver allows the tumor to progress and induce exclusion from the waiting list and death.3The absence of randomized controlled trials hinders the establishment of the most effective therapy to prevent tumor progression while waiting.4Live donation may be a cost‐effective approach if optimal results are expected and the mortality risk fo

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