Health
Expanding risk assessment parameters improves mortality prediction with a waiting list for liver transplants
A top priority in the field of transplantation is to ensure that donor organs are assigned to patients with the greatest needs.
In a large joint international project carried out by the Vienna Medical University and the May York Clinic in Rochester (USA), researchers from the Department of General Surgery and Gastroenterological Hepatology at Medical University of Vienna III have liver transplantation by including additional parameters. An important step forward in improving the prediction of survival on the waiting list.
Donor livers are assigned to patients on the waiting list for liver transplantation based on their individual medical needs. Patients are currently ranked by a score consisting of a blood level of 3 (+/- sodium) (model of end-stage liver disease or MELD score). However, in the last few years, significant limitations of MELD-based systems have been identified, and the mortality rate on the waiting list remains at 20%.
A particular challenge in this context is the ability to identify patients at high risk of portal hypertension or complications from acute-chronic liver failure because the MELD score may not map these conditions properly. ..
“We are now addressing these existing weaknesses in MELD-based allocation systems and attempting to identify patients at high risk of death despite their relatively low MELD scores,” said MedUni Vienna. Patrick Starlinger, Senior Researcher in General Surgery, explains. He is also currently working at the Mayo Clinic in Rochester. “It was of particular importance to us to confirm our findings internationally and thereby document potential improvements in organ allocation in other transplant centers and other transplant systems.”
A simple blood test to assess risk
Von Willebrand Factor (vWF) is a central component of the blood coagulation system, but vWF antigen Blood levels are also an excellent marker for portal hypertension. This offers a great advantage as vWF antigen levels can be easily determined by taking blood samples when listing patients. C-reactive protein (CRP) is also an easily measurable routine parameter involved in the inflammatory process in the body of patients with liver disease, even before the onset of infection or chronic liver failure. is.
In a Patrick Starlinger study, co-created with researchers at the Medical University of Vienna and the Mayo Clinic in Rochester, the MELD score currently in use is the vWF antigen level and CRP value. This was also confirmed in the US patient cohort.
We were also able to show that both blood parameters reflect pathophysiological processes that promote the development of acute life-threatening complications in patients on the waiting list for liver transplantation. This study, which established vWF-Ag and CRP as valuable markers of portal hypertension and inflammatory processes in patients with cirrhosis in a previous paper, sets another important step in applying this blood test to clinical care. Represents. “
Mattias Mandorfer, Director of Hemodynamics Institute, Medical University of Vienna
Therefore, this study has significant and long-term implications for the existing allocation system of donor liver and may ultimately significantly reduce patient waiting list mortality.
Source:
Journal reference:
Starlinger, P. , et al. (2021) The addition of C-reactive protein and von Willebrand factor to MELD-Na improves the prediction of mortality on the waiting list. Hepatology. doi.org/10.1002/hep.31838..
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