Predicting outcomes post liver transplantation in patients with primary biliary cirrhosis and primary sclerosing cholangitis.

摘要

Orthotopic liver transplantation (OLT) is used in management of end-stage primary biliary cirrhosis (PBC) and primary sclerosing cholangitis. Current allocation procedures assign organs to those patients rated with the most advanced disease and who will suffer the highest mortality if a transplant is not performed. However, waiting until the patient's status is terminal before attempting transplantation has a negative impact upon postoperative outcome. The research problem is the critical need for a reliable prognostic tool to identify the best candidates for OLT.; Prognostic models emerged in the 1980s through research efforts that addressed the natural history of PBC and PSC to assist in timing of OLT. The prognostic model "A Model to Predict the Outcome of Liver Transplantation in Patients with PBC and PSC", commonly referred to as the 1997 Mayo model (Ricci et al., 1997) was used in this study. The purpose of the study was to test whether the 1997 Mayo model is effective in predicting post-OLT outcomes for PBC and PSC patients. The 1997 Mayo model included four variables, age, Child-Pugh score, United Network for Organ Sharing (UNOS) status, and renal failure that were found to be valid in predicting post-OLT outcomes.; An extensive literature review from 1983 to 2000 supports that contributions of independent PBC and PSC studies have led to the development of the 1997 Mayo model. In this study, a retrospective chart audit, (1990 to 2000), was conducted on 30 patients with PBC and PSC who underwent OLT. Post-OLT outcomes were determined after the data underwent application of the 1997 Mayo model.; The results of the study validated that the 1997 Mayo model is a useful tool in predicting post-OLT outcomes. It is the hope of this study that the findings will support use of the 1997 Mayo model in timing of OLT. In conclusion, the 1997 Mayo model is an easily-obtainable and clinically applicable tool. Since this study is an initial scholarly endeavor for nursing, the potential for future research efforts and the improvement in the standard of care for PBC and PSC patients is noteworthy.