HE PATOLOGY
were allocated onto the Euro transplant liver transplant waiting list between 2007 and 2018 using their MELD scores. These patients were followed from their first listing to the time of delisting or until 90 days after listing. As part of the study, each patient was reclassified retrospectively based on their MELD-Na score, allowing an estimation of the number of lives saved if MELD-Na allocation had been used. According to Dr. Ben Goudsmit from
Leiden University Medical Centre, who presented the study results, a large proportion (40%) of patients on the transplant waiting list had hyponatremia, and these patients had a three-fold increased risk of dying within 90 days of being listed. “We also found that, if the MELD-Na score had been used to prioritise patients instead of the MELD score, 26.3% of those who died within 90 days would have had a significantly higher chance of receiving a liver transplant,” he said. “This equates to a 4.9% reduction in 90-day waiting-list mortality.” The researchers believe that, since there is a shortage of liver grafts and the prevalence of cirrhosis is increasing globally, better prediction of mortality and improved prioritisation for liver transplantation are becoming increasingly important. “We believe that MELD-Na-based
allocation would help to prioritise patients on European liver transplant waiting lists and reduce the number of patients who die before they receive this life-saving treatment. The MELD score was a breakthrough in the field of liver transplantation, as it ensured equity in patients assessed and listed for a transplant. Over the years, it became apparent that the addition of Na to the original equation improved the classification of patients, and the MELD-Na was subsequently adopted in
Calls to tackle late diagnosis of liver disease
Liver disease is on the rise. Since 1970, deaths due to liver disease have increased by 400%. This is in stark contrast to other major killer diseases, such as heart disease and cancer, in which the number of deaths have either remained stable or decreased. In the UK, liver disease is the third leading cause of premature death and yet 90% of liver disease is preventable. In addition, three quarters of people are currently diagnosed at a late stage when it is too late for lifestyle changes or intervention
A new campaign has been launched to stop thousands of people with liver disease dying unnecessarily. One in four patients diagnosed in hospital with severe liver disease die within 60 days in England and Wales because of late diagnosis. The British Liver Trust is calling for much better awareness and proper treatment pathways to be put in place in primary care across the UK, and has launched a petition demanding these changes. The new campaign, Sound the Alarm on Liver Disease, is urging the Government to transform care for those with liver disease, and improve early diagnosis to save lives. The campaign is supported by the UK’s leading hepatologists and
clinicians, and is endorsed by the British Association for the Study of Liver Disease and British Society of Gastroenterologists. Professor Steven Ryder, medical advisor to the British Liver Trust, commented: “Currently three-quarters of people with liver disease are diagnosed very late in a hospital setting. At this stage, their condition is generally so advanced that there are few treatment options and transplantation is their only hope. Around a quarter of those patients die within 60 days. This has to stop. “The tragedy is that, in most cases, these deaths could have been avoided with earlier diagnosis. The liver is a remarkable organ and can often repair or reverse damage if steps to do this are taken in time. We know that the changes that we are asking for are possible as there are pockets of excellent care for liver patients in some parts of the UK, but provision is patchy and many areas do not have anything at all in place to ensure that people with liver disease are picked up early. Care for liver patients shouldn’t be a postcode lottery. We need to sound the alarm and demand earlier diagnosis for all liver patients throughout the UK today.” Sound the Alarm on Liver Disease is calling for three key changes to transform early diagnosis so that people with liver
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disease can be diagnosed at a much earlier stage and lives can be changed. By signing the petition, signatories will be calling for: l Every GP practice to have an agreed way of finding patients at risk, testing, following up and managing, and referring to secondary care when necessary.
l The NHS (over 40s) Health Check in England and other regular checks across the devolved nations to be routinely used to find those at risk of liver disease.
l Automated processes to be put in place in primary care to identify those at risk of liver disease, to include the correct blood tests and to manage appropriate follow-up.
Pamela Healy OBE, chief executive of the British Liver Trust, commented: “We know GPs have lots of different conditions to consider – however, by automating processes, we know that those at risk of liver disease can be easily flagged up and targeted for intervention.
“Since 1970, deaths due to liver disease have increased by 400%, and one in five of us are currently at risk of developing a liver condition. The clock is ticking – we can’t afford to wait any longer. We must take action today to save lives in the future.”
NOVEMBER 2020
the US in 2016,” explained Prof. Emmanuel Tsochatzis. “This study is an important step in introducing MELD-Na in the European liver transplant programmes, as it demonstrated an almost 5% improvement in 90-day waiting list mortality.”
Treatment of chronic hepatitis B virus Progress towards finding a cure for chronic hepatitis B virus (HBV) infection was also
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