Liver transplantation plays a major role in the therapeutic path of liver diseases. The management of patients on the waiting list is an essential component of the success of liver transplantation. There is a diversity of patients on the waiting list for transplantation and equity should be preserved between those with cirrhosis of high and intermediate severity and those with HCC. For patients with cirrhosis and intermediate MELD score, waiting time can exceed 1 year therefore, regular follow-up and management are essential to maintain the patient alive on the waiting list and to achieve a good survival after liver transplantation.
For patients with HCC, a bridge therapy is frequently required to avoid progression of HCC and to maintain patients within the criteria of liver transplantation as well as to reduce the risk of post-transplant recurrence of HCC. It is also essential to identify the ideal timing for liver transplantation in order to minimise mortality rates. For the more severe cases who may swiftly access liver transplantation, it is essential to rapidly determine whether liver transplantation is indeed indicated, and to organise a fast workup ahead of this. The management of patients on the waiting list is of prime importance to avoid death and drop out from the waiting list as well as to improve post-transplant survival rates. For this latter group of patients, ‘MELD exception’ points can be arbitrarily given. These criteria can lead to a ‘competition’ on the waiting list between the above patients and those who are cirrhotic and have an intermediate MELD score or with life-threatening liver diseases not well described by the MELD score. Generally, priorities are given to cirrhotic patients with a high Model for End-Stage Liver Disease (MELD) score on the principle of the sickest first and to patients with hepatocellular carcinoma (HCC) on the principle of priority points according to the size and number of nodules of HCC. The success of liver transplantation has led to an increase in the indications for liver transplantation. doi:10.1038/s4139-9.The results of liver transplantation are excellent, with survival rates of over 90 and 80% at 1 and 5 years, respectively. On-Treatment Improvement of MELD Score Reduces Death and Hepatic Events in Patients With Hepatitis B-Related Cirrhosis. Yip TC, Chan HL, Tse YK, Lam KL, Lui GC, Wong VW, et al. University of Wisconsin School of Medicine and Public Health. Model for End-stage Liver Disease (MELD) score and liver transplant: benefits and concerns. doi:10.2147/CEG.S160537Īiello FI, Bajo M, Marti F, Gadano A, Musso CG. Liver function tests in identifying patients with liver disease. Correction factor to improve agreement between point-of-care and laboratory International Normalized Ratio values. Johnson SA, Vazquez SR, Fleming R, Lanspa MJ. Analysis of mortality prognostic factors using model for end-stage liver disease with incorporation of serum-sodium classification for liver cirrhosis complications: A retrospective cohort study. Non-alcoholic steatohepatitis is the second leading etiology of liver diseases among adults awaiting liver transplantation in the United States. Wong RJ, Aguilar M, Cheung R, Perumpail RB, Harrison SA, Younossi ZM, Ahmed A. The impact of cirrhosis and MELD score on postoperative morbidity and mortality among patients selected for liver resection. Zaydfudim VM, Turrentine FE, Smolkin ME, et al. Evaluation of model performance to predict survival after transjugular intrahepatic portosystemic shunt placement. Important predictor of mortality in patients with end-stage liver disease. Management of patients with liver diseases on the waiting list for transplantation: a major impact to the success of liver transplantation.
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