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Liver Transplants

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by

Sara Welinsky

on 15 June 2017

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Transcript of Liver Transplants

Intro to Liver Transplants
Goals
Hx of the liver Transplant

The MELD Score

How the transplant waiting list work

MELD
What is the MELD score?


How do you calculate the MELD?

How Does a Transplant Waiting List Work?
Patients referred to a liver transplant center
Listed on the UNOS waiting list
11 Regions and ~140 transplant centers
There are 62 OPOs (responsible for the retrieval, preservation, and transportation of donor livers)
When a donor organ becomes available within an OPO, the organ is allocated to the patient with the highest MELD


Test Your Knowledge
How many people listed for a liver?

How many people transplanted in the US?

How many people transplanted at MSH?

When was the MELD score adopted?

The First Liver Transplant
1963 by Dr. Thomas Starzl in Denver, Colorado

First successful transplant in 1967

Not until 1980s was it accepted as standard
Important Dates
October 19, 1984


April 2, 1998


Feb 27, 2002
Waiting List Candidates
Disparity between supply and demand has widened every year since 1994
National Organ Transplant Act
October 19, 1984
Outlawed the sale of human organs

Established the formation of the Organ Procurement and Transplantation Network (OPTN)


OPTN
- Organ Procurement and Transplantation Network


OPO
- Organ Procurement Organizations


UNOS
- United Network for Organ Sharing
The "Final Rule"
April 2, 1998
In response to perceived unfairness in organ allocation

Called for more objective ranking of waiting list patients

Based primarily on medical urgency


MELD!
February 27th, 2002
MELD officially adopted as an evidence-based means of organ allocation


Excellent predictor of short-term mortality in patients with advanced liver disease and patients listed for liver transplantation


This has improved organ access to the most severely ill patients without compromising waiting list mortality or post-transplant survival


MELD
MELD =
3.78×ln[serum bilirubin (mg/dL)] + 11.2×ln[INR] + 9.57×ln[serum creatinine (mg/dL)] + 6.43
Initially for TIPS risk stratification

To predict 3 month survival

Scores range from 6 to 40

INR, Cr, TBili and now Na

Test Your Knowledge
How many people listed for a liver?
14,419

How many people transplanted in the US?
8,151

How many people transplanted at MSH?
112

What year was the MELD score adopted?
2002



8,151 Liver Transplants in 2016
Serum Na is a reflection of the vasodilatory state in cirrhosis

Linear increase in mortality by 5% for each mmol decrease in Na
Pre MELD vs. Post MELD
12% reduction in new patients added to transplant list

A higher MELD score at the time of transplantation (24 vs. 18)

A 10% increase in the number of transplants performed

A 3.5% decrease in the number of deaths on the waiting list
Child-Pugh Classification
Mount Sinai Transplant
Full transcript