Premium
Use of model for end‐stage liver disease exception points for early liver transplantation and successful reversal of hepatic myelopathy with a review of the literature
Author(s) -
Caldwell Cary,
Werdiger Norman,
Jakab Sofia,
Schilsky Michael,
Arvelakis Antonios,
Kulkarni Sanjay,
Emre Sukru
Publication year - 2010
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.22077
Subject(s) - medicine , liver transplantation , model for end stage liver disease , myelopathy , liver disease , transplantation , intensive care medicine , surgery , gastroenterology , spinal cord , psychiatry
Hepatic myelopathy (HM) is a rarely reported disorder characterized by progressive spastic paraparesis due to impaired corticospinal tract function in the setting of cirrhosis or portosystemic shunting. HM has not to date been recognized as a Model for End‐Stage Liver Disease (MELD) exception for transplantation. Outcomes for a small number of patients from Europe and Asia who have undergone liver transplantation (LT) for HM suggest a potential neurological benefit, especially with earlier transplantation. We report the first use of MELD exception points for the condition of HM to enable early LT resulting in the reversal of marked spastic paraparesis. Our patient, whose myelopathy had markedly progressed without further hepatic decompensation, underwent LT 14 months after the diagnosis of HM with an adjusted MELD score of 30, which was granted as a United Network for Organ Sharing exception. After LT, there was significant neurological improvement as the patient progressed from wheelchair dependency to full ambulation. We reviewed the literature of other HM patients who had undergone LT. With our patient, there were in all 15 reported cases of LT in individuals with HM. LT can lead to a marked improvement in HM, particularly in the earlier clinical stages of the disorder. Early LT can be accomplished, as in our case, by the submission of an appeal for a MELD upgrade. Liver Transpl 16:818–826, 2010. © 2010 AASLD.