Use of model for end-stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature
| العنوان: | Use of model for end-stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature |
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| المؤلفون: | Sofia Simona Jakab, Norman Werdiger, Michael L. Schilsky, Cary Caldwell, Sanjay Kulkarni, Sukru Emre, Antonios Arvelakis |
| المصدر: | Liver Transplantation. 16:818-826 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health), 2010. |
| سنة النشر: | 2010 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, Time Factors, Tissue and Organ Procurement, Cirrhosis, medicine.medical_treatment, Liver transplantation, Spinal Cord Diseases, Decision Support Techniques, Myelopathy, Liver disease, Model for End-Stage Liver Disease, medicine, Humans, Transplantation, Hepatology, business.industry, Liver Diseases, Middle Aged, medicine.disease, Liver Transplantation, Surgery, Treatment Outcome, Corticospinal tract, business, Hepatic decompensation |
| الوصف: | Hepatic myelopathy (HM) is a rarely reported disorder characterized by progressive spastic paraparesis due to impaired corticospinal tract function in the setting of cirrhosis or portosystemic shunting. HM has not to date been recognized as a Model for End-Stage Liver Disease (MELD) exception for transplantation. Outcomes for a small number of patients from Europe and Asia who have undergone liver transplantation (LT) for HM suggest a potential neurological benefit, especially with earlier transplantation. We report the first use of MELD exception points for the condition of HM to enable early LT resulting in the reversal of marked spastic paraparesis. Our patient, whose myelopathy had markedly progressed without further hepatic decompensation, underwent LT 14 months after the diagnosis of HM with an adjusted MELD score of 30, which was granted as a United Network for Organ Sharing exception. After LT, there was significant neurological improvement as the patient progressed from wheelchair dependency to full ambulation. We reviewed the literature of other HM patients who had undergone LT. With our patient, there were in all 15 reported cases of LT in individuals with HM. LT can lead to a marked improvement in HM, particularly in the earlier clinical stages of the disorder. Early LT can be accomplished, as in our case, by the submission of an appeal for a MELD upgrade. |
| تدمد: | 1527-6473 1527-6465 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::2d178585376f097cae13a4da3b78e42d https://doi.org/10.1002/lt.22077 |
| حقوق: | CLOSED |
| رقم الأكسشن: | edsair.doi.dedup.....2d178585376f097cae13a4da3b78e42d |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15276473 15276465 |
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