Indicators and outcome of liver transplantation in acute liver decompensation af

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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

DOI: 10.1111/j.1365-2893.2010.01295.x
© 2010 Blackwell Publishing Ltd
Issue

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.

指标和肝移植治疗急性肝失代偿的结果
乙型肝炎后弹

W.-C. Lee1，火盛Chou1，T.-J. Wu1，刘家瑄Lee2，C.-F. Lee1，杨耿明Chan1Article
第一次在网上公布：2010年3月28日

分类号：10.1111/j.1365-2893.2010.01295.x
© 2010布莱克韦尔出版有限公司
发行

作者：病毒性肝炎
18卷第3期，页193-199，2011年3月

综述。非肝硬化患者中有急性肝失代偿耀斑
乙肝可以恢复自发或死无肝移植。
为确定在需要的病人肝移植标准缺乏。
五十一个非肝硬化患者中有急性肝失代偿耀斑
B型肝炎进行回顾性分析。将患者分为三
组：A组患者（n = 18），急性肝功能失代偿康复
自发，B组患者（n = 22）死于急性肝功能衰竭，组
ç患者（n = 11）有肝移植。终末期肝病模型
（MELD评分）评分进行评估，以确定肝移植的标准。
截止肝移植的MELD评分点进行了评估
受试者工作特征（ROC）曲线。比较A，B组患者，
MELD评分是一个独立的预后预测因素。通过分析我国
曲线，MELD评分“30是最理想的切点以表明肝
移植，但假阳性率分别为11.1％。按每周
测量的MELD评分，MELD评分在随后的增加可能有助于
避免误报。此外，个人的MELD评分“34％的假阳性产生了0
率，并表示了明确的肝移植的必要性。 C组
患者，11例为救十肝移植。总之，
在对病人有B型肝炎急性肝失代偿耀斑，
肝移植是绝对MELD分数指示> 34。肝
移植也表示，如果在随后的MELD评分增加
1-2周。肝移植有一个好的结果，如果按时完成。