title: Region 11 MELD Na exception prospective study.
abstract: BACKGROUND
  Hyponatremia complicates cirrhosis and predicts short term mortality, including adverse outcomes before and after liver transplantation.
  
  
  METHODS
  From April 1, 2008, through April 2, 2010, all adult candidates for primary liver transplantation with cirrhosis, listed in Region 11 with hyponatremia, were eligible for sodium (Na) exception.
  
  
  RESULTS
  Patients with serum sodium (SNa) less than 130 mg/dL, measured two weeks apart and within 30 days of Model for End Stage Liver Disease (MELD) exception request, were given preapproved Na exception. MELD Na was calculated [MELD + 1.59 (135-SNa/30 days)]. MELD Na was capped at 22, and subject to standard adult recertification schedule. On data end of follow-up, December 28, 2010, 15,285 potential U.S. liver recipients met the inclusion criteria of true MELD between 6 and 22. In Region 11, 1,198 of total eligible liver recipients were listed. Sixty-two (5.2%) patients were eligible for Na exception (MELD Na); 823 patients (68.7%) were listed with standard MELD (SMELD); and 313 patients (26.1%) received HCC MELD exception. Ninety percent of MELD Na patients and 97% of HCC MELD patients were transplanted at end of follow up, compared to 49% of Region 11 standard MELD and 40% of U.S.A. standard MELD (USA MELD) patients (p < 0.001); with comparable dropout rates (6.5, 1.6, 6.9, 9% respectively; p = 0.2). MELD Na, HCC MELD, Region 11 SMELD, and USA MELD post-transplant six-month actual patient survivals were similar (92.9, 92.8, 92.2, and 93.9 %, respectively).
  
  
  CONCLUSIONS
  The Region 11 MELD Na exception prospective trial improved hyponatremic cirrhotic patient access to transplant equitably, and without compromising transplant efficacy.
authors.affiliation: Department of Surgery/Medicine, Virginia Commonwealth University, Medical College of Virginia Hospitals, Hume/Lee Transplant Ctr., Richmond Virginia, USA. rafisher@vcu.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Heuman
authors.forename: Ann M
authors.initials: AM
authors.lastname: Harper
authors.forename: Martha K
authors.initials: MK
authors.lastname: Behnke
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Smith
authors.forename: Mark W
authors.initials: MW
authors.lastname: Russo
authors.forename: Steven
authors.initials: S
authors.lastname: Zacks
authors.forename: John W
authors.initials: JW
authors.lastname: McGillicuddy
authors.forename: James
authors.initials: J
authors.lastname: Eason
authors.forename: Michael K
authors.initials: MK
authors.lastname: Porayko
authors.forename: Patrick
authors.initials: P
authors.lastname: Northup
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marvin
authors.forename: Johnathan
authors.initials: J
authors.lastname: Hundley
authors.forename: Satheesh
authors.initials: S
authors.lastname: Nair
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000601:surgery; D058625:End Stage Liver Disease / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D040841:Resource Allocation / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists
chemical_list: D012964:Sodium