Update on the management of the liver transplant patient

Current Opinion in Gastroenterology
Allison J Kwong, Oren K Fix

Abstract

To review and highlight recent literature regarding the medical management of adult patients undergoing liver transplantation. The addition of serum sodium concentration to the model for end-stage liver disease (MELD) score more accurately predicts 90-day waitlist mortality. Predictors of waitlist mortality and posttransplant survival include lower albumin and the presence of ascites, varices, and encephalopathy, as well as more nontraditional predictors such as older age, obesity, frailty, and sarcopenia. Indications for liver transplantation are evolving with the advent of effective therapy for hepatitis C and the increased prevalence of nonalcoholic steatohepatitis. Disparities persist in the current allocation system, including geographic variation and MELD inflation for hepatocellular carcinoma. Share 35 allows for broader regional sharing of organs for patients with the highest need, without detrimental effects on waitlist mortality or survival. Everolimus is a recently approved option for posttransplant immunosuppression that spares renal function. The MELD score has enabled the liver transplant community to equitably allocate organs. Recent literature has focused on the limitations of the MELD score and the disparities ...Continue Reading

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Mar 22, 2018·Progress in Transplantation : Official Publication, North American Transplant Coordinators Organization ... [et Al.]·Yefei Zhang, Maha R Boktour
Jun 3, 2016·Critical Care Nursing Quarterly·Cynthia Scheuher
Oct 27, 2015·World Journal of Gastroenterology : WJG·Daan Dierickx, Nina Cardinaels

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