Impact of cytomegalovirus reactivation just before liver transplantation: A prospective cohort study.

BACKGROUND: Cytomegalovirus (CMV) is the most common viral pathogen after liver transplantation (LT). Although reactivation of CMV infection is generally described in the context of immunosuppression, it has also been described in critically ill immunocompetent patients including cirrhotic patients. AIM: To determine the incidence of reactivated CMV prior to LT. METHODS: This was a prospective cohort study evaluating adult patients who underwent LT between 2014 and 2016. A plasma sample was obtained from all patients for CMV quantitative real-time PCR testing right before transplantation. Patients were followed for at least 1 year to assess the following outcomes: Incidence of CMV infection, organ rejection and overall mortality. RESULTS: A total of 72 patients were enrolled. Four patients died before transplantation, thus 68 patients were followed up for a median of 44 mo (20-50 mo). In 23/72 patients (31.9%) CMV was reactivated before transplantation. Post-transplantation, 16/68 (23.5%) patients had CMV infection and that was significantly associated with the recipient being CMV negative and a CMV-positive donor. Pre-transplant CMV reactivation was not associated with overall mortality (log rank: 0.9). CONCLUSION: This study shows that CMV infection is common in patients with chronic liver disease just before LT, but the clinical impact of this infection seems to be negligible.

D-MELD does not predict post-liver transplantation survival: a single-center experience from Brazil.

BACKGROUND: The D-MELD score was designed to prevent donor-recipient matches with a high risk of unfavorable outcome. The main objective of the present study was to assess the predictive value of the DMELD score for 1-month and 3-month post-transplant mortality in a cohort of patients who underwent deceased-donor liver transplantation in Southern Brazil. MATERIAL AND METHODS: A cohort study was conducted. Receiver operating characteristic c-statistics were used to determine the ability of the D-MELD score to predict mortality. The Kaplan-Meier method was used to analyze survival as a function of time regarding D-MELD scores, and the Cox model was employed to assess the association between D-MELD and mortality. RESULTS: Most recipients were male, with a mean age of 54.3 ± 9.6 years (n = 233 transplants). Mean donor age was 44.9 ± 16.8 years (19.3% of donors were aged ≥ 60 years). Mean MELD and D-MELD scores were 16.3 ± 7.1 and 733.1 ± 437.8 respectively. Overall survival at 1 and 3 months was 83.6%. The c-statistic value for 1- and 3-month mortality was < 0.5 for the D-MELD. Analysis of Kaplan-Meier curves for groups with D-MELD scores < 1,600 and ≥ 1,600 did not show statistically significant differences in survival (p = 0.722). CONCLUSION: D-MELD scores were unable to predict survival in this cohort of Brazilian liver transplant recipients.

MELD and other predictors of survival after liver transplantation.

BACKGROUND: This study examined how reliable is the pre-transplant model for end-stage liver disease (MELD) score in predicting post-transplantation survival and analyzed variables associated with patient survival. METHODS: A cohort study was conducted. Receiver operating characteristic curve c-statistics were used to determine the ability of MELD score to predict mortality. The Kaplan-Meier (KM) method was used to analyze survival as a function of time regarding the MELD score and Child-Turcotte-Pugh (CTP) category. The Cox model was employed to assess the association between baseline risk factors and mortality. RESULTS: Recipients and donors were mostly male, with a mean age of 51.6 and 38.5 yr, respectively (n = 436 transplants). The c-statistic values for three-month patient mortality were 0.60 and 0.61 for MELD score and CTP category, respectively. KM survival at three, six and 12 months were lower in those who had a MELD score > or =21 or were CTP category C. Multivariate analysis revealed that recipient age > or =65 yr, MELD > or = 21, CTP C category, bilirubin > or = 7 mg/dL, creatinine > or = 1.5 mg/dL, platelet transfusion, hepatocellular carcinoma, and non-white color donor skin were predictors of mortality. CONCLUSIONS: Severe pre-transplant liver disease, age > or = 65, non-white skin donor, and hepatocellular carcinoma are associated with poor outcome.

Model for the end-stage liver disease and death prediction in a cohort of Brazilian patients on the waiting list for liver transplantation.

BACKGROUND/AIM: To examine the performance of the model for end-stage liver disease (MELD) score to predict mortality three and six months after enlistment of patients with chronic diseases for their first liver transplantation (LT) and to compare the performances of the Child-Turcotte-Pugh (CTP) and the Erasmus Model for End-stage Resistant-to-therapy All etiology Liver Disease (EMERALD) scores with the MELD to predict mortality. METHODS: Cohort study. Receiver operating characteristics curve (ROC) curves were used to determine the ability of the scores for predicting three and six month mortality, the c-statistic to establish the predictive power of each score and the Cox proportional hazard model to estimate the risk of dying. RESULTS: We studied 271 patients. At enlistment, the mean MELD and EMERALD scores were 14.8 and 26.6, respectively. Approximately 61% of the cases were in the CTP B category. During the three or six month follow-up period, the percentage of patients dying, receiving LT or remaining on the list were 11.8%, 9.2%, and 79.0% or 19.2%, 17.7%, and 63.1%, respectively. The three-month mortality was similarly predicted by the scores MELD, EMERALD and CTP (c-statistic of 0.79, 0.74, and 0.70, respectively). Six-month mortality presented similar AUC and ROC curves. CONCLUSION: The scores predicted mortality for the three or six months, but the performance of the MELD was better than CTP and EMERALD scores.

Evoluçäo dos pacientes pediátricos avaliados para transplante hépatico / Follow-up of pediatric patients evaluated for liver transplantation

Objetivo: analisar a evoluçäo de pacientes pediátricos avaliados para Transplante Hepático. Métodos: Foram revisados os prontuários das primeiras 65 crianças e adolescentes portadores de hepatopatias crônicas, com idades de 5 meses a 19 anos (x=6,8 anos), que foram avaliados, de agosto de 1994 a março de 1996, para realizar transplante de fígado. Os dados colhidos foram referenes às características demográficas dos pacientes, causa da hepatopatia, avaliaçäo psicossocial dos pacientes e de seus responsáveis e avaliaçäo clínico-laboratorial. De acordo com a gravidade da doença, os pacientes foram classificados como ativos (aguardando doaçäo), em avaliaçäo, inativos (hepatopatia compensada) e excluídos por motivos psicossociais, médicos ou por má indicaçäo...