Impact of hepatic encephalopathy on liver transplant waiting list mortality in regions with different transplantation rates.

Kerbert, Annarein J C; Reverter, Enric; Verbruggen, Lara; Tieleman, Madelon; Navasa, Miguel; Mertens, Bart J A; Rodríguez-Tajes, Sergio; de Vree, Marleen; Metselaar, Herold J; Chiang, Fang W T; Verspaget, Hein W; van Hoek, Bart; Bosch, Jaime; Coenraad, Minneke J (2018). Impact of hepatic encephalopathy on liver transplant waiting list mortality in regions with different transplantation rates. Clinical transplantation, 32(11), e13412. Wiley-Blackwell 10.1111/ctr.13412

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Overt hepatic encephalopathy (OHE) negatively impacts the prognosis of liver transplant candidates. However, it is not taken into account in most prioritizing organ allocation systems. We aimed to assess the impact of OHE on waitlist mortality in 3 cohorts of cirrhotic patients awaiting liver transplantation, with differences in the composition of patient population, transplantation policy, and transplantation rates. These cohorts were derived from two centers in the Netherlands (reference and validation cohort, n = 246 and n = 205, respectively) and one in Spain (validation cohort, n = 253). Competing-risk regression analysis was applied to assess the association of OHE with 1-year waitlist mortality. OHE was found to be associated with mortality, independently of MELD score, other cirrhosis-related complications and hepatocellular carcinoma (HCC; sHR = 4.19, 95% CI = 1.9-9.5, P = 0.001). The addition of extra MELD points for OHE counteracted its negative impact on survival. These findings were confirmed in the Dutch validation cohort, whereas in the Spanish cohort, containing a significantly greater proportion of HCC and with higher transplantation rates, OHE was not associated with mortality. In conclusion, OHE is an independent risk factor for 1-year waitlist mortality and might be a prioritization rule for organ allocation. However, its impact seems to be attenuated in settings with significantly higher transplantation rates.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

UniBE Contributor:

Bosch, Jaime

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0902-0063

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Thi Thao Anh Pham

Date Deposited:

17 Dec 2018 12:50

Last Modified:

23 Oct 2019 04:05

Publisher DOI:

10.1111/ctr.13412

PubMed ID:

30230613

Uncontrolled Keywords:

hepatic encephalopathy liver disease organ allocation

BORIS DOI:

10.7892/boris.122126

URI:

https://boris.unibe.ch/id/eprint/122126

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