So far, local expertise remains the last safeguard to LT. Consideration of a patient’s comorbidities and frailty is an appealing predictive approach in this population that has proven of great value in many other diseases. Despite this, the performance of scores based on these variables is still insufficient.
Variables associated with poor immediate post-LT outcomes have been identified in large studies. Yet, the increased relative scarcity of graft resource must be considered alongside the increased risk of losing a graft in the initial postoperative period when performing LT in “too sick to transplant” patients. LT is still the only curative treatment in this population. Although the prognosis of severely ill cirrhotic patients has recently improved, transplant-free mortality remains high. Sequential assessment of scores or classification based on organ failures within the first days after admission help to stratify the risk of mortality in this population. Such patients are often admitted in a context of acute-on-chronic liver failure with extrahepatic failures. In the era of the “sickest first” policy, patients with very high model for end-stage liver disease (MELD) scores have been increasingly admitted to the intensive care unit with the expectation that they will receive a liver transplant (LT) in the absence of improvement on supportive therapies.
0 kommentar(er)
