Region 11 MELD Na exception prospective study
Robert A Fisher1, Douglas M Heuman, Ann M Harper
1Department of Surgery/Medicine, Virginia Commonwealth University, Medical College of Virginia Hospitals, Hume/Lee Transplant Ctr., Richmond Virginia, USA. rafisher@vcu.edu
Annals of Hepatology
|December 15, 2011
Summary
Hyponatremia in cirrhosis patients complicates liver transplants. A MELD Na exception improved access to transplantation for these patients without impacting transplant success rates.
Area of Science:
- Hepatology
- Transplantation Medicine
- Nephrology
Background:
- Hyponatremia is a common complication in cirrhosis patients.
- It is associated with increased short-term mortality and adverse outcomes.
- These outcomes extend to the pre- and post-liver transplantation periods.
Purpose of the Study:
- To evaluate the impact of a sodium (Na) exception policy on liver transplant access for cirrhotic patients with hyponatremia.
- To determine if this exception policy affects transplant efficacy.
Main Methods:
- Adult candidates for primary liver transplantation with cirrhosis and hyponatremia in Region 11 were eligible for a Na exception.
- Patients with serum sodium (SNa) < 130 mg/dL, measured twice within 30 days, qualified for pre-approved Na exception.
- Model for End Stage Liver Disease (MELD) Na score was calculated and capped at 22.
Main Results:
- Ninety percent of MELD Na exception patients were transplanted, compared to 49% of standard MELD patients in Region 11.
- Transplant and dropout rates were comparable between MELD Na, HCC MELD, and standard MELD groups.
- Six-month post-transplant survival rates were similar across all groups (92.2%–93.9%).
Conclusions:
- The MELD Na exception policy in Region 11 improved equitable access to liver transplantation for hyponatremic cirrhotic patients.
- The policy did not compromise the efficacy of liver transplantation.
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