Assessment of patients with chronic liver disease qualifying for liver transplant

ABSTRACT

To determine the frequency, etiology and pattern of patients with chronic liver disease at a tertiary care hospital qualifying for a liver transplant. Cross-sectional Study Military Hospital Rawalpindi from December 2008 to May 2009. Study included all patients of Chronic Liver Disease, admitted in medical wards. Diagnosis was made on the basis of clinical and ultrasonographic findings suggestive of chronic liver disease. Etiology was identified by serological tests [ELISA or PCR] and immunological tests. Metabolic screening was done for Wilson's disease and haemochromatosis. HCC was diagnosed and staged by biopsy and CT scan. After taking informed consent, detailed medical history, physical examination and required biochemical tests were carried out. All patients of age 12 years and above were evaluated according to Model for End Stage Liver Disease [MELD] and those below 12 years of age were evaluated by Pediatric End Stage Liver Disease [PELD]. Milan's Criteria was used for hepatocellular carcinoma and Mayo risk scores [MRS] for patients with Primary Biliary Cirrhosis and Primary Sclerosing Cholangits. A total of 212 patients suffering from chronic liver disease were included. Out of these, 164 [77.4%] were suffering from chronic hepatitis C, 16 [7.5%] from chronic hepatitis B, 2 [0.9%] from autoimmune hepatitis, 2 [0.9%] from hepatocelluar carcinoma, 1 [0.5%] from alcoholic hepatitis, 2 [0.9%] from Wilson's disease, 1 [0.5%] from haemochromatosis and 24 [11.3%] were Cryptogenic. All these patients were evaluated for liver transplant according to the appropriate criterion. Out of 212 patients, 43 [20.3%] patients had MELD/PELD Score of patients were in the range of 11-18, 44 [20.8%] patients in range of 19-24, 31 [14.6%] patients were in range of 25-35 and 02 [0.9%] patients were >/=36 [79.71]. Patients with MELD/PELD score more than 10 are considered for liver transplant but the MELD/PELD score at which a patient will realistically receive a liver varies by region and organ demand as defined by the number of candidates on the waiting list and their blood type. High frequency of patients of chronic liver disease in our setup qualify for a liver transplant. It provides preliminary data for the need of liver transplant centers in our region