Tool value: The liver donor risk index 8 years on

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107560/1/lt23920.pd

Serum sodium and survival benefit of liver transplantation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110717/1/lt24063.pd

Response to “Dynamic Challenges Inhibiting Optimal Adoption of Kidney Paired Donation: Findings of a Consensus Conference” by Melcher et al.

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99040/1/ajt12345.pd

Systematic bias in surgeons' predictions of the donor‐specific risk of liver transplant graft failure

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99664/1/lt23683.pd

End‐stage liver disease candidates at the highest model for end‐stage liver disease scores have higher wait‐list mortality than status‐1A candidates

Candidates with fulminant hepatic failure (Status‐1A) receive the highest priority for liver transplantation (LT) in the United States. However, no studies have compared wait‐list mortality risk among end‐stage liver disease (ESLD) candidates with high Model for End‐Stage Liver Disease (MELD) scores to those listed as Status‐1A. We aimed to determine if there are MELD scores for ESLD candidates at which their wait‐list mortality risk is higher than that of Status‐1A, and to identify the factors predicting wait‐list mortality among those who are Status‐1A. Data were obtained from the Scientific Registry of Transplant Recipients for adult LT candidates (n = 52,459) listed between September 1, 2001, and December 31, 2007. Candidates listed for repeat LT as Status‐1 A were excluded. Starting from the date of wait listing, candidates were followed for 14 days or until the earliest occurrence of death, transplant, or granting of an exception MELD score. ESLD candidates were categorized by MELD score, with a separate category for those with calculated MELD > 40. We compared wait‐list mortality between each MELD category and Status‐1A (reference) using time‐dependent Cox regression. ESLD candidates with MELD > 40 had almost twice the wait‐list mortality risk of Status‐1A candidates, with a covariate‐adjusted hazard ratio of HR = 1.96 ( P = 0.004). There was no difference in wait‐list mortality risk for candidates with MELD 36‐40 and Status‐1A, whereas candidates with MELD 20 ( P = 0.6). Conclusion : Candidates with MELD > 40 have significantly higher wait‐list mortality and similar posttransplant survival as candidates who are Status‐1A, and therefore, should be assigned higher priority than Status‐1A for allocation. Because ESLD candidates with MELD 36‐40 and Status‐1A have similar wait‐list mortality risk and posttransplant survival, these candidates should be assigned similar rather than sequential priority for deceased donor LT. (H epatology 2012)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89518/1/24632_ftp.pd

Organ quality and quality of life after liver transplantation

Not only is there a limited supply of organs for liver transplantation, but the quality of the available organs is not uniform. Risk factors such as donor age and cause of death are known to predict graft failure, but their impact on the recipient's quality of life (QOL) has not been reported. We sent a QOL survey to 299 adults at our institution who had received a liver transplant 1 to 7 years before the study. For the 171 patients (57%) who completed the Medical Outcomes Study Short Form 36 (SF‐36), the mean Physical Composite Score (PCS) and the mean Mental Composite Score (MCS) were 61 and 66, respectively; the highest scores were for the Social Functioning subscale, and the lowest scores were for the Role Functioning/Physical and Energy/Fatigue subscales. The mean donor risk index (DRI) of the organs that the subjects received was 1.4 (range = 0.8‐2.4). There was no correlation between the SF‐36 scores and the DRI [there were changes of −4.8 and −2.8 in the PCS and MCS per unit increase in the DRI ( P = 0.4 and 0.6, respectively)], even though we controlled for potential confounders such as age, sex, hospitalization before transplantation, the Model for End‐Stage Liver Disease score at transplantation, years since transplantation, previous transplantation, and the Charlson comorbidity index. In conclusion, we found no association between organ quality and QOL after liver transplantation. If this finding is confirmed in prospective, multicenter studies, it will be useful in counseling patients about the decision to accept or not accept high‐risk organ offers. Liver Transpl, 2011. © 2011 AASLD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88022/1/22425_ftp.pd

Virus? Why us?

A poem by Debbie Merio

Predicting clinical outcomes using baseline and follow‐up laboratory data from the hepatitis C long‐term treatment against cirrhosis trial

Predicting clinical outcomes in patients with chronic hepatitis C is challenging. We used the hepatitis C long‐term treatment against cirrhosis (HALT‐C) trial database to develop two models, using baseline values of routinely available laboratory tests together with changes in these values during follow‐up to predict clinical decompensation and liver‐related death/liver transplant in patients with advanced hepatitis C. Patients randomized to no treatment and who had ≥2‐year follow‐up without a clinical outcome were included in the analysis. Four variables (platelet count, aspartate aminotransferase [AST]/alanine aminotransferase [ALT] ratio, total bilirubin, and albumin) with three categories of change (stable, mild, or severe) over 2 years were analyzed. Cumulative incidence of clinical outcome was determined by Kaplan‐Meier analysis and Cox regression was used to evaluate predictors of clinical outcome. In all, 470 patients with 60 events were used to develop models to predict clinical decompensation. Baseline values of all four variables were predictive of decompensation. There was a general trend of increasing outcomes with more marked worsening of laboratory values over 2 years, particularly for patients with abnormal baseline values. A model that included baseline platelet count, AST/ALT ratio, bilirubin, and severe worsening of platelet count, bilirubin, and albumin was the best predictor of clinical decompensation. A total of 483 patients with 79 events were used to evaluate predictors of liver‐related death or liver transplant. A model that included baseline platelet count and albumin as well as severe worsening of AST/ALT ratio and albumin was the best predictor of liver‐related outcomes. Conclusion: Both the baseline value and the rapidity in change of the value of routine laboratory variables were shown to be important in predicting clinical outcomes in patients with advanced chronic hepatitis C. (H EPATOLOGY 2011;)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88084/1/24550_ftp.pd

Vitamin D status and latent tuberculosis infection : a preliminary study in a group of healthy Mexican agricultural workers

Vitamin D metabolites are important in the regulation of bone and calcium homeostasis, but also have a more ubiquitous role in the regulation of cell differentiation and immune function. Severely low circulating 25-dihydroxyvitamin D [25(OH)D] concentrations have been associated with the onset of active tuberculosis (TB) in immigrant populations, although the association with latent TB infection (LTBI) has not received much attention. A previous study identified the prevalence of LTBI among a sample of Mexican migrant workers enrolled in Canada's Seasonal Agricultural Workers Program (SA WP) in the Niagara Region of Ontario. The aim of the present study was to determine the vitamin D status of the same sample, and identify if a relationship existed with LTBI. Studies of vitamin D deficiency and active TB are most commonly carried out among immigrant populations to non-endemic regions, in which reactivation of LTBI has occurred. Currently, there is limited knowledge of the association between vitamin D deficiency and LTBI. Entry into Canada ensured that these individuals did not have active TB, and L TBI status was established previously by an interferon-gamma release assay (IGRA) (QuantiFERON-TB Gold In-Tube®, Cellestis Ltd., Australia). Awareness of vitamin D status may enable individuals at risk of deficiency to improve their nutritional health, and those with LTBI to be aware of this risk factor for disease. Prevalence of vitamin D insufficiency among the Mexican migrant workers was determined from serum samples collected in the summer of 2007 as part of the cross sectional LTBI study. Samples were measured for concentrations of the main circulating vitamin D metabolite, 25(OH)D, with a widely used 1251 250HD RIA (DiaSorin Inc.®, Stillwater, MN), and were categorized as deficient «37.5 nmoI/L), insufficient (>37.5 nmollL, < 80 nmol/L) or sufficient (2::80 nmoI/L). Fisher's exact tests and t tests were used to determine if vitamin D status (sufficiency or insufficiency) or 25(OH)D concentrations significantly differed by sex or age categories. Predictors of vitamin D insufficiency and 25(OH)D concentrations were taken from questionnaires carried out during the previous study, and analyzed in the present study using multiple regression prediction models. Fisher's exact test and t test was used to determine if vitamin D status or 25(OH)D concentration differed by LTBI status. Strength of the relationship between interferongamma (IFN-y) concentration (released by peripheral T cells in response to TB antigens) and 25(OH)D concentration was analyzed using a Spearman correlation. Out of 87 participants included in the study (78% male; mean age 38 years), 14 were identified as LTBI positive but none had any signs or symptoms of TB reactivation. Only 30% of the participants were vitamin D sufficient, whereas 68% were insufficient and 2% were deficient. Significant independent predictors of lower 25(OH)D concentrations were sex, number of years enrolled in the SA WP and length of stay in Canada. No significant differences were found between 25(OH)D concentrations and LTBI status. There was a significant moderate correlation between IFN-y and 25(OH)D concentrations ofLTBI-positive individuals. The majority of participants presented with Vitamin D insufficiency but none were severely deficient, indicating that 25(OH)D concentrations do not decrease dramatically in populations who temporarily reside in Canada but go back to their countries of origin during the Canadian winter. This study did not find a statistical relationship between low levels of vitamin D and LTBI which suggests that in the presence of overall good health, lower than ideal levels of 2S(OH)D, may still be exerting a protective immunological effect against LTBI reactivation. The challenge remains to determine a critical 2S(OH)D concentration at which reactivation is more likely to occur

2009 SRTR Report on the State of Transplantation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79187/1/j.1600-6143.2010.03072.x.pd