학술논문
When Is a Critically Ill Cirrhotic Patient Too Sick to Transplant? Development of Consensus Criteria by a Multidisciplinary Panel of 35 International Experts.
Document Type
article
Author
Weiss, Emmanuel; Saner, Fuat; Asrani, Sumeet K; Biancofiore, Gianni; Blasi, Annabel; Lerut, Jan; Durand, François; Fernandez, Javier; Findlay, James Y; Fondevila, Constantino; Francoz, Claire; Gustot, Thierry; Jaber, Samir; Karvellas, Constantine; Kronish, Kate; Laleman, Wim; Laterre, Pierre François; Levesque, Eric; Mandell, M Susan; Mc Phail, Mark; Muiesan, Paolo; Olson, Jody C; Olthoff, Kim; Daniele Pinna, Antonio; Reiberger, Thomas; Reyntjens, Koen; Saliba, Faouzi; Scatton, Olivier; Simpson, Kenneth J; Soubrane, Olivier; Subramanian, Ram M; Tacke, Frank; Tomescu, Dana; Xia, Victor; Wagener, Gebhard; Paugam-Burtz, Catherine
Source
Transplantation. 105(3)
Subject
Language
Abstract
BackgroundCritically ill cirrhotic patients are increasingly transplanted, but there is no consensus about futile liver transplantation (LT). Therefore, the decision to delay or deny LT is often extensively debated. These debates arise from different opinions of futility among transplant team members. This study aims to achieve a multinational and multidisciplinary consensus on the definition of futility in LT and to develop well-articulated criteria for not proceeding with LT due to futility.MethodsThirty-five international experts from anesthesiology/intensive care, hepatology, and transplant surgery were surveyed using the Delphi method. More than 70% of similar answers to a question were necessary to define agreement.ResultsThe panel recommended patient and graft survival at 1 year after LT to define futility. Severe frailty and persistent fever or 1 μg/kg per minute and a serum lactate level >9 mmol/L.ConclusionsOur expert panel provides a consensus on the definition of futile LT and on specific criteria for postponing or denying LT. A framework that may facilitate the decision if a patient is too sick for transplant is presented.