Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Based on data reported to the OPTN/UNOS Liver Transplant Registry between 1988-2004: 1. There was a very small difference in 5-year graft survival rates comparing living and deceased donors in adult (4.3%) and pediatric patients (2.4%). 2. Although graft survival rates of split liver transplants were lower than whole liver grafts before 1998, 5-year graft survival results of more recent split grafts (65.8%) have become comparable to those of whole liver grafts (66.5%). Among recipients in good condition, split (67.7%) and whole grafts (70.0%) yielded equivalent survival rates. 3. Lower graft survival rates were noted in ABO incompatible grafts, non-heartbeating donors, regrafted patients, and recipients who were in the ICU before transplantation. 4. There was no recipient gender effect on liver transplant outcome. 5. Primary disease distributions were different for different races. Among adult patients, the largest fraction of white patients had alcoholic cirrhosis. Among Asians, Type B cirrhosis was most frequent. Among pediatric patients, biliary atresia constituted the majority of patients. Most of the patients with alpha-1 antitrypsin deficiency were white. Autoimmune hepatitis was most frequently found among black patients. 6. Although 5-year graft survival of black patients (60.2%) was lower than whites (68.1%), Hispanics (67.6%), and Asians (68.0%), black recipients with PBC (73.3%) and PSC (69.9%) had graft survival rates similar to those of whites (78.1%) (73.6%) and Hispanics (75.3%) (77.1%). 7. Zero HLA-A,-B,-DR mismatched livers had very rapid early failures. HLA matching correlated with graft survival in autoimmune hepatitis patients, but not in cirrhosis patients. 8. Short-term graft survival for liver transplants has improved steadily since 1990. However, long-term graft survival after the first year actually declined over time. 9. In adult transplants, 5-year graft survival of autoimmune-related diseases, PBC (77.3%), PSC (73.3%), AIH (74.2%) yielded higher graft survival rates than those of hepatitis B (71.5%) and C (63.2%). 10. In pediatric patients, 5-year survival of biliary atresia (75.4%), autoimmune cirrhosis (70.8%), and alpha-1-antitrypsin deficiency (85.0%) had high graft survival rates, except for acute liver failure (61.6%). 11. Hepatitis C recurrence is now one of the major causes of graft failure in adults. Thrombosis is a major factor in graft failure for pediatric transplants.
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PMID:An analysis of the OPTN/UNOS Liver Transplant Registry. 1670 60

Based on the data reported to the OPTN/UNOS Liver Transplant Registry between 1987-2005, we found: 1. The number of deceased-donor liver transplantations increased slowly each year, with most of the increase being in adult recipients. The number of LD transplants, on the other hand, decreased sharply after 2002, following 3 years of rapid increase from 1998-2001 in both pediatric and adult recipients. 2. The number of DD liver recipients with non-cholestatic liver diseases increased very quickly during the past 18 years. Malignant disease as a cause of end-stage liver disease increased after implementation of MELD in 2002. Among LD liver recipients, non-cholestatic disease increased sharply from 1998-2001, but decreased from 2002. Malignant diseases as a cause for LD transplants decreased after 2002. 3. Among pediatric recipients, LD transplants provided better 5-year graft survival rates than transplants from deceased donors; in contrast, LD transplants in adults had poorer graft survival rates than those from deceased donors. 4. The use of marginal donors, including older donors, HCV (+) donors, donation after cardiac death donors, and diabetic donors, increased in the past 18 years. HCV(+) livers transplanted into HCV(+) cirrhosis recipients had similar graft survival when compared with HCV(-) donor livers, whereas when they were transplanted into non-HCV cirrhosis patients, they had poorer graft survival (60% vs. 70% at 5 years, respectively). When livers from diabetic donors were transplanted into diabetic recipients, they had much poorer graft survival than transplants from non-diabetic donors (54% vs. 77% at 5 years, respectively). 5. Split and partial liver transplants had poorer 5-year graft survival rates (58% and 57%, respectively) than whole liver transplants (62%), but the difference was mainly due to poorer outcomes during the first posttransplant year. 6. PELD allocation has resulted in improved one- and 3-year graft survival rates among pediatric liver recipients. Among adults MELD-based allocation has resulted in better one-year survival rates. When comparing the different original diseases, only HCC patients showed better one- and 3-year graft survival rates after MELD. 7. Within one year after transplantation, primary non-function and infection were the major causes of graft failure. These decreased after 1996, but recurrent hepatitis has increased as a cause of graft failure. After one year, chronic rejection and infection had decreased, while hepatitis recurrence still increased. 8. Cardiovascular deaths and deaths from multiorgan failure that occurred within the first year after transplantation have increased since 1996, while deaths due to infections have decreased. After the first year, deaths from graft failure increased, while CVD and infections decreased.
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PMID:Liver transplantation in the United States. 1742 22

This chapter summarizes analyses of 51,060 adult primary liver-only transplants from deceased donors reported to the OPTN/UNOS Liver Transplant Registry from 1995 to 2009. Despite advances in surgical techniques and immunosuppression, analysis shows improvement in one-year graft but no improvement in long-term graft survival. Adoption of the Model for End-Stage Liver Disease (MELD) score for organ allocation--prioritizing sicker patients for transplantation--has significantly influenced liver transplant procedures. Accordingly, we classified the transplants into two groups: 1995-2001 (pre-MELD era) and 2002-2007 (MELD era), and our analyses found that long-term survival of liver grafts remained almost unchanged between the two eras. Patient pre-transplant status was better in the MELD era. But when we analyzed the grafts that survived more than one year, survival rates were slightly better pre-MELD than in the MELD era (82.2% and 80.34%, respectively) and risk of graft failure was slightly higher in the MELD era. This chapter also provides analyses of current graft survival rates for 10 different primary liver diseases. Hepatocellular carcinoma, hepatitis C virus cirrhosis, and alcoholic liver disease account for almost 50 % of the primary diseases, and have worse graft survival than the other primary diseases. The lack of improvement in long-term survival suggests an on-going need for means to avoid chronic liver graft dysfunction and to develop therapeutic interventions to control chronic graft loss.
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PMID:An analysis of the OPTN/UNOS Liver Transplant Registry. 2052 76

MELD (model for end-stage liver disease) exception awards affect the liver allocation process. Award rates of specific nonhepatocellular carcinoma exceptions, termed symptom-based exceptions (SBE), differ across UNOS regions. We aimed to characterize the regional variability in SBE awards and examine predictive factors for receiving a SBE in the MELD era. The OPTN liver transplant and waiting list dataset was analyzed for waiting list registrants during the MELD allocation on February 27, 2002, until November 22, 2006. Competing risks proportional hazards regression analysis was used to examine predictors for receiving a SBE in 39 169 registrants. The hazard ratios for receiving a SBE differed significantly across regions when adjusted for multiple variables including age, gender, ethnicity, physiologic MELD score, blood group, functional status, etiology of liver disease, insurer and education level. Utilization of SBE is highly significantly variable across UNOS regions, and does not correlate with organ availability as estimated by the regional mean physiologic MELD score at transplantation. Patients with Medicaid as their primary payer have a lower likelihood of receiving a SBE award, while patients with cryptogenic/NASH cirrhosis or cholestatic liver disease have a higher likelihood of receiving a SBE. Reasons for these regional and demographic disparities deserve further investigation.
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PMID:Regional variability in symptom-based MELD exceptions: a response to organ shortage? 2192 22