标题: Indicators and outcome of liver transplantation in acute liver decompensation af [打印本页] 作者: StephenW 时间: 2011-2-10 00:01 标题: Indicators and outcome of liver transplantation in acute liver decompensation af
Indicators and outcome of liver transplantation in acute liver decompensation
after flares of hepatitis B
W.-C. Lee1, H.-S. Chou1, T.-J. Wu1, C.-S. Lee2, C.-F. Lee1, K.-M. Chan1Article
first published online: 28 MAR 2010
Journal of Viral Hepatitis
Volume 18, Issue 3, pages 193–199, March 2011
Summary. Non-cirrhotic patients having acute liver decompensation in flares
of hepatitis B can recover spontaneously or die without liver transplantation.
Criteria for identifying patients in need of liver transplantation are lacking.
Fifty-one non-cirrhotic patients having acute liver decompensation in flares of
hepatitis B were retrospectively reviewed. The patients were divided into three
groups: group A patients (n = 18) recovered from acute liver decompensation
spontaneously; group B patients (n = 22) died of acute liver failure; and group
C patients (n = 11) had liver transplantation. Model of end-stage liver disease
(MELD) scores were evaluated to identify the criteria for liver transplantation.
The cut-off point of MELD scores for liver transplantation was evaluated by
receiver operating characteristic (ROC) curve. Comparing group A and B patients,
MELD score was an independent factor to predict prognosis. By analysing ROC
curve, a MELD score > 30 was the most optimal cut-off point to indicate liver
transplantation; however, the false positive rate was 11.1%. By weekly
measurement of MELD scores, subsequent increase in MELD scores could help to
avoid false positives. Moreover, a MELD score > 34 yielded 0% false positive
rate and indicated the necessity of definite liver transplantation. For group C
patients, ten of 11 patients were saved by liver transplantation. In conclusion,
for the patients having acute liver decompensation in flares of hepatitis B,
liver transplantation is definitely indicated by MELD scores > 34. Liver
transplantation is also indicated if the MELD score increases in the subsequent
1–2 weeks. Liver transplantation has a good outcome if performed on time.