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The utility of the model for end‐stage liver disease score: A reliable guide for liver transplant candidacy and, for select patients, simultaneous hospice referral
Author(s) -
Medici Valentina,
Rossaro Lorenzo,
Wegelin Jacob A.,
Kamboj Amit,
Nakai Junko,
Fisher Kelli,
Meyers Frederick J.
Publication year - 2008
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21398
Subject(s) - candidacy , medicine , liver transplantation , referral , liver disease , stage (stratigraphy) , model for end stage liver disease , intensive care medicine , general surgery , transplantation , family medicine , paleontology , politics , political science , law , biology
Patients with chronic liver disease are referred late to hospice or never referred. There are several barriers to timely referral. First, liver transplantation (LT) and hospice care have always been perceived as mutually exclusive. Yet the criteria for hospice referral and for LT are more similar than different (for example, advanced liver disease and imminent death). Second, physicians, patients, and families have not had a reliable metric to guide referral. However, many patients wait for transplantation but never receive an organ. We hypothesized that the Model for End‐Stage Liver Disease (MELD) score already in use to prioritize LT could be used in selected patients for concurrent hospice referral. Furthermore, we hypothesized that patients awaiting LT can receive hospice care and remain eligible for transplantation. Patients with advanced or end‐stage liver disease were referred to the University of California Davis Health System hospice program. We correlated the MELD score at admission to length of stay (LOS) in hospice. A total of 157 end‐stage liver disease patients were admitted to the hospice service. At the time of hospice admission the mean MELD score was 21 (range, 6‐45). The mean length of hospice stay was 38 days (range, 1‐329 days). A significant correlation was observed between hospice LOS and MELD score at hospice admission ( P < 0.01). Six patients were offered a liver graft while on the combined (LT and hospice) program. MELD can be used to guide clinician recommendation to families about hospice care, achieving one of the national benchmark goals of increasing hospice care duration beyond the current median of 2‐3 weeks. A higher MELD score might augment physician judgment as to hospice referral. Hospice care for selected patients may be an effective strategy to improve the care of end‐stage liver disease patients waiting for LT. Liver Transpl 14:1100–1106, 2008. © 2008 AASLD.