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Markers of increased waiting list mortality in children with chronic liver failure

The most recent issue of Hepatology finds that ascites and serum sodium are markers of increased waiting list mortality in children with chronic liver failure.

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Ascites is the most common complication of cirrhosis and in adults it is associated with 50% mortality at 5 years if patients do not receive a liver transplant.

The occurrence of hyponatremia in these patients has been associated with increased mortality on the waiting list.

The importance of serum sodium levels and the presence of ascites in the pediatric setting remain to be clarified.

Dr Renata Pugliese and colleagues from Brazil performed a retrospective analysis of pediatric patients with cirrhosis on the transplant list between 2000 and 2012.

The team's primary objective was to evaluate the association of pre-transplant variables with mortality within 90 days following the inclusion of patients on the waiting list.

In all, 522 patients were included in the study.

40% of the children presented ascites
Hepatology

The research team found that 66% of patients were under 1 year of age, and 40% of the children presented ascites.

The team noted that total bilirubin, international normalized ratio, serum sodium levels, ascites, and categorized age were independently associated with risk of death in 90 days.

The researchers reported that malnutrition and serum albumin were not included in the final model.

Dr Pugliese's team concludes, "The presence of ascites and serum sodium levels are important variables associated with decreased patient survival while candidates wait for a liver graft."

"Multicenter studies are necessary to validate these findings in order to improve current allocation policies based on the PELD score."

Hepatology 2014: 59(5): 1964–1971
07 May 2014

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