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Impact of a Transplantation Critical Care Model on Short-Term Outcomes Following Liver Transplantation in High Acuity Patients: A Single-Center Experience. Transplant Proc 2018 Dec;50(10):3544-3548

Date

12/24/2018

Pubmed ID

30577234

DOI

10.1016/j.transproceed.2018.08.013

Scopus ID

2-s2.0-85058559732

Abstract

BACKGROUND: Orthotopic liver transplantation (OLT) is the definitive treatment for end-stage liver disease (ESLD). Patients with high acuity ESLD are frequently denied life-saving OLT by transplant centers due to reported inferior outcomes. We sought to analyze the impact of a specialized transplant critical care model (TCCM) on patient access to OLT and survival outcomes in high acuity patients.

METHODS: From January 2009 to December 2016, 122 adults were wait-listed at our transplant center with laboratory Model for ESLD ≥35 or Status I. Outcomes in Era I (prior to TCCM) were compared to Era II (TCCM established October 1, 2012).

RESULTS: Era II (TCCM) led to a significant increase in patients' access to OLT. Frequency and need to seek OLT at another center dropped 4-fold in Era II. Compared to Era I, the majority of patients in Era II required intensive care unit management (22% vs 83%, P < .01) and renal replacement therapy (11% vs 70%, P < .01) prior to OLT. Despite a higher acuity of illness in Era II, 1-year patient survival was comparable (89% Era I, 80% Era II, P = .35).

CONCLUSION: Implementation of a specialized TCCM expanded OLT access to high acuity patients, reduced the need to seek higher level of care elsewhere, and achieved excellent short-term post-transplant survival outcomes.

Author List

Zimmerman MA, Selim M, Kim J, Saeian K, Cinquegrani MP, Connolly L, Woehlck HJ, Lauer KK, Hong JC

Authors

Lois A. Connolly MD Vice Chair, Professor in the Anesthesiology department at Medical College of Wisconsin
Kathryn K. Lauer MD Vice Chair, Professor in the Anesthesiology department at Medical College of Wisconsin
Kia Saeian MD Professor in the Medicine department at Medical College of Wisconsin
Motaz Selim MBBS, MSc, MD, PhD Assistant Professor in the Surgery department at Medical College of Wisconsin
Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Critical Care
End Stage Liver Disease
Female
Graft Survival
Humans
Intensive Care Units
Liver Transplantation
Male
Middle Aged
Patient Selection
Retrospective Studies
Treatment Outcome
jenkins-FCD Prod-399 190a069c593fb5498b7fcd942f44b7bc9cdc7ea1