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Ohio solid organ transplantation consortium criteria for liver transplantation in patients with alcoholic liver disease

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To evaluate risk of recidivism on a case-by-case basis.

Methods: From our center’s liver transplant program, we selected patients with alcoholic liver disease who were listed for transplant based on Ohio Solid Organ Transplantation Consortium (OSOTC) exception criteria. They were considered to have either a low or medium risk of recidivism, and had at least one or three or more months of abstinence, respectively. They were matched based on gender, age, and Model for End-Stage Liver Disease (MELD) score to controls with alcohol-induced cirrhosis from Organ Procurement and Transplant Network data.

Results: Thirty six patients with alcoholic liver disease were approved for listing based on OSOTC exception criteria and were matched to 72 controls. Nineteen patients (53%) with a median [Inter-quartile range (IQR)] MELD score of 24 (13) received transplant and were followed for a median of 3.4 years. They were matched to 38 controls with a median (IQR) MELD score of 25 (9). At one and five years, cumulative survival rates (± standard error) were 90% ± 7% and 92% ± 5% and 73% ± 12% and 77% ± 8% in patients and controls, respectively (Log-rank test, P = 0.837). Four (21%) patients resumed drinking by last follow-up visit.

Conclusion: Compared to traditional criteria for assessment of risk of recidivism, a careful selection process with more flexibility to evaluate eligibility on a case-by-case basis can lead to similar survival rates after transplantation.

No MeSH data available.


Related in: MedlinePlus

Selection of patients with alcoholic liver disease for liver transplantation based on Ohio Solid Organ Transplantation Consortium Criteria. OSOTC: Ohio Solid Organ Transplantation Consortium.
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Figure 1: Selection of patients with alcoholic liver disease for liver transplantation based on Ohio Solid Organ Transplantation Consortium Criteria. OSOTC: Ohio Solid Organ Transplantation Consortium.

Mentions: Between 2009 and 2013, 326 patients with alcoholic liver disease were evaluated for liver transplant at the Cleveland Clinic, of whom 279 (85%) patients were considered high-risk for recidivism or alcohol relapse based on the OSOTC criteria (Figure 1). These high-risk patients underwent the standard chemical dependency requirements defined above before being considered eligible for liver transplant. Forty-seven (15%) patients were considered by our social workers and liver transplant committee at the Cleveland Clinic to be at medium or low-risk for recidivism or alcohol relapse based on the OSOTC criteria, but only 36 (13%) patients were approved by the consortium.


Ohio solid organ transplantation consortium criteria for liver transplantation in patients with alcoholic liver disease
Selection of patients with alcoholic liver disease for liver transplantation based on Ohio Solid Organ Transplantation Consortium Criteria. OSOTC: Ohio Solid Organ Transplantation Consortium.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037328&req=5

Figure 1: Selection of patients with alcoholic liver disease for liver transplantation based on Ohio Solid Organ Transplantation Consortium Criteria. OSOTC: Ohio Solid Organ Transplantation Consortium.
Mentions: Between 2009 and 2013, 326 patients with alcoholic liver disease were evaluated for liver transplant at the Cleveland Clinic, of whom 279 (85%) patients were considered high-risk for recidivism or alcohol relapse based on the OSOTC criteria (Figure 1). These high-risk patients underwent the standard chemical dependency requirements defined above before being considered eligible for liver transplant. Forty-seven (15%) patients were considered by our social workers and liver transplant committee at the Cleveland Clinic to be at medium or low-risk for recidivism or alcohol relapse based on the OSOTC criteria, but only 36 (13%) patients were approved by the consortium.

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To evaluate risk of recidivism on a case-by-case basis.

Methods: From our center’s liver transplant program, we selected patients with alcoholic liver disease who were listed for transplant based on Ohio Solid Organ Transplantation Consortium (OSOTC) exception criteria. They were considered to have either a low or medium risk of recidivism, and had at least one or three or more months of abstinence, respectively. They were matched based on gender, age, and Model for End-Stage Liver Disease (MELD) score to controls with alcohol-induced cirrhosis from Organ Procurement and Transplant Network data.

Results: Thirty six patients with alcoholic liver disease were approved for listing based on OSOTC exception criteria and were matched to 72 controls. Nineteen patients (53%) with a median [Inter-quartile range (IQR)] MELD score of 24 (13) received transplant and were followed for a median of 3.4 years. They were matched to 38 controls with a median (IQR) MELD score of 25 (9). At one and five years, cumulative survival rates (± standard error) were 90% ± 7% and 92% ± 5% and 73% ± 12% and 77% ± 8% in patients and controls, respectively (Log-rank test, P = 0.837). Four (21%) patients resumed drinking by last follow-up visit.

Conclusion: Compared to traditional criteria for assessment of risk of recidivism, a careful selection process with more flexibility to evaluate eligibility on a case-by-case basis can lead to similar survival rates after transplantation.

No MeSH data available.


Related in: MedlinePlus