دورية أكاديمية
The impact of MELD exception points for hydrothorax on posttransplant mortality: a propensity score-matched analysis.
| العنوان: | The impact of MELD exception points for hydrothorax on posttransplant mortality: a propensity score-matched analysis. |
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| المؤلفون: | Fathma S; Department of Internal Medicine, Waterbury Hospital, Waterbury., Boateng S; Department of Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport., Amatya A; Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA., Ameyaw P; Department of Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport., Banini BA; Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA. |
| المصدر: | European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2024 Aug 01; Vol. 36 (8), pp. 1016-1021. Date of Electronic Publication: 2024 May 29. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams And Wilkins Country of Publication: England NLM ID: 9000874 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1473-5687 (Electronic) Linking ISSN: 0954691X NLM ISO Abbreviation: Eur J Gastroenterol Hepatol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: London : Lippincott Williams And Wilkins Original Publication: [London, UK ; Philadelphia, PA, USA] : Current Science, c1989- |
| مواضيع طبية MeSH: | Hydrothorax*/etiology , Hydrothorax*/mortality , Propensity Score* , Liver Transplantation*/mortality , End Stage Liver Disease*/surgery , End Stage Liver Disease*/mortality , End Stage Liver Disease*/complications, Humans ; Male ; Female ; Middle Aged ; Treatment Outcome ; Retrospective Studies ; Risk Factors ; Databases, Factual ; Logistic Models ; Aged ; United States/epidemiology ; Severity of Illness Index ; Multivariate Analysis ; Time Factors ; Waiting Lists/mortality ; Adult ; Risk Assessment |
| مستخلص: | Background: Hepatic hydrothorax is a challenging complication of end-stage liver disease, and.patients with this complication can receive model for end-stage liver disease (MELD) exception points if they meet specific criteria as defined by United Network for Organ Sharing (UNOS). This research aimed to analyze the effect of receiving MELD exception points for hepatic hydrothorax on posttransplant mortality, using a national transplant database. Methods: Patients >18 years in the UNOS database awaiting liver transplant between 2012 and 2023 were identified based on their petition for MELD exception points. Using a 1: 1 propensity score-matched analysis, 302 patients who received MELD exception points for hepatic hydrothorax were compared with 302 patients who did not receive MELD exception points.Demographic, clinical and laboratory values were compared. The primary outcome was posttransplant mortality. Multivariate logistic regression controlled for potential confounders. Results: No significant difference was observed in mean age (58.20 vs 57.62 years), mean initial MELD score (16.93 vs 16.54), or mean Child-Pugh score (9.77 vs 9.74) in patients with hepatic hydrothorax receiving MELD exception points versus their matched cohort who did not recieve exception points. The proportion of males was slightly higher among patients who received MELD exception points (57.6% males vs 53.6% males). A majority of patients in both groups had Child-Pugh grade C (>56%). Patients receiving MELD exception points for hepatic hydrothorax had a statistically significant 44% decrease in the odds of posttransplant death compared to those who did not (OR 0.56; 95% CI 0.37-0.88; P = 0.01). Among the combined cohort, each year increase in age resulted in a 3.9% increase in mortality (OR 1.04; 95% CI 1.01-1.07; P = 0.005), and every one-unit increase in serum creatinine resulted in a 40% increase in mortality (OR 1.40; 95% CI 1.03-1.92; P = 0.03). Conclusion: Receiving MELD exception points for hepatic hydrothorax is associated with a significant reduction in the odds of posttransplant mortality. These findings underscore the importance of MELD exception points for hepatic hydrothorax among patients with decompensated cirrhosis, potentially improving patient prioritization for liver transplantation and influencing clinical decision-making. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
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| معلومات مُعتمدة: | K12 CA215110 United States CA NCI NIH HHS; U54 AA027989 United States AA NIAAA NIH HHS; P30 CA016359 United States GF NIH HHS; 1U54AA027989-01 United States GF NIH HHS |
| تواريخ الأحداث: | Date Created: 20240603 Date Completed: 20240708 Latest Revision: 20240722 |
| رمز التحديث: | 20240723 |
| مُعرف محوري في PubMed: | PMC11230850 |
| DOI: | 10.1097/MEG.0000000000002792 |
| PMID: | 38829948 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1473-5687 |
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| DOI: | 10.1097/MEG.0000000000002792 |