Also, only a small number of LDLT recipients had high MELD-Na scores, which precluded analyses in this group.
The authors acknowledged limitations to the data, including selection bias. LDLT recipients were younger than waitlist candidates (mean 53 vs 55 years, respectively), and a greater proportion were women (47% vs 37%), white (81% vs 70%), and had education beyond high school (62% vs 51%), non-alcoholic steatohepatitis (NASH 20% vs 16%), or cholestatic liver disease (24% vs 7%).Īmong patients who underwent LDLT, the life-years saved were as follows:
Patients were stratified by MELD-Na score. Excluded were those with prior kidney/liver transplants and those listed for multiorgan transplant or re-transplant. LDLT is typically offered to patients with these lower scores, given that they are less likely to be offered a full organ from a deceased donor, and due to the idea that they may better tolerate a partial graft.įor their study, Malamon and colleagues conducted a retrospective, secondary analysis of the Scientific Registry of Transplant Recipient database, which included 119,275 liver transplant candidates from 2012 to 2021. Scores of 20 or higher on the MELD-Na (which ranges from 6-40) are associated with a higher risk of death, Malamon's group noted, and individuals with low scores are often overlooked and not prioritized for transplant. "This study's findings definitively demonstrate the association of a marked benefit in survival and life-years with receipt of an LDLT." Adjustments to the method: This log scales calculations therefore any value that is less than 1 is automatically adjusted to the lower limit value of 1 to prevent. With Serum Sodium between 125 and 137 mEq/L. "Many in the transplant community have questioned the risks and benefits of a transplant for patients with lower MELD-Na scores, particularly given previous studies with deceased donors," the team wrote in JAMA Surgery. MELD Score (2016) MELD(i) + 1.32(137-Na) 0.033MELD(i)(137-Na) Where MELD(i) is the original MELD score without serum sodium. All rights reserved.Their study looked at nearly 120,000 waitlist patients, 2.3% of whom ultimately underwent LDLT, and found that these transplants were associated with significant reductions in mortality at 1 year among patients with a MELD-Na of 11 or higher: The main factors related to cost are the volume of fluid drained due to the need for albumin replacement and the severity of liver disease that is related to the frequency of paracentesis.Ĭopyright © 2014 Elsevier Inc. Paracentesis in cirrhotic patients is a high-cost procedure in health care. 001) and patients on the transplant waiting list (P =. Factors associated with higher costs in the period were a Model for End-Stage Liver Disease score higher than 24 (P =. The majority of patients were on the liver transplant list (54.2%).
The most frequent liver disease diagnoses were hepatitis C (24%) and alcoholic cirrhosis (24%). The average cost per procedure was $219.50. The total cost of all procedures was $193,126.60 and the most costly component was albumin ($87,162.10). Patients underwent an average of 5.3 paracentesis procedures per year (range 1 to 32). We conducted a total of 881 paracentesis procedures in a group of 155 patients that included 60.5% men and 39.5% women with a mean age of 57 years (range 20 to 80 years). Statistical analysis was performed using SPSS version 20. The remaining cost components were drugs, materials used during the procedure, and human resources. Microcost analysis was performed with individual tabbed data regarding the consumption of albumin and containers for ascites. This prospective study included all patients with cirrhosis who underwent paracentesis between March 2012 and March 2013 at the Outpatient Service of the Liver Transplantation Unit, Clinical Hospital, University of São Paulo School of Medicine. The objective of this study is to evaluate the cost of paracentesis in cirrhotic patients and to determine the factors related to this cost. In cirrhotic patients with refractory ascites, treatment is based on repeat paracentesis. Ascites is the most common complication of cirrhosis and indicates that the disease is at an advanced stage.
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