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

Valentina Medici, Lorenzo Rossaro, Jacob A. Wegelin, Amit Kamboj, Junko Nakai, Kelli Fisher, Frederick J Meyers

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1100-1106
Number of pages7
JournalLiver Transplantation
Volume14
Issue number8
DOIs
StatePublished - Aug 2008

Fingerprint

End Stage Liver Disease
Hospices
Hospice Care
Referral and Consultation
Transplants
Liver Transplantation
Liver
Length of Stay
Liver Diseases
Transplantation
Benchmarking
Family Physicians
Chronic Disease
Physicians

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

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. / Medici, Valentina; Rossaro, Lorenzo; Wegelin, Jacob A.; Kamboj, Amit; Nakai, Junko; Fisher, Kelli; Meyers, Frederick J.

In: Liver Transplantation, Vol. 14, No. 8, 08.2008, p. 1100-1106.

Research output: Contribution to journalArticle

@article{6692f58d5b63489b8000d70e5d123831,
title = "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",
abstract = "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.",
author = "Valentina Medici and Lorenzo Rossaro and Wegelin, {Jacob A.} and Amit Kamboj and Junko Nakai and Kelli Fisher and Meyers, {Frederick J}",
year = "2008",
month = "8",
doi = "10.1002/lt.21398",
language = "English (US)",
volume = "14",
pages = "1100--1106",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "8",

}

TY - JOUR

T1 - The utility of the model for end-stage liver disease score

T2 - A reliable guide for liver transplant candidacy and, for select patients, simultaneous hospice referral

AU - Medici, Valentina

AU - Rossaro, Lorenzo

AU - Wegelin, Jacob A.

AU - Kamboj, Amit

AU - Nakai, Junko

AU - Fisher, Kelli

AU - Meyers, Frederick J

PY - 2008/8

Y1 - 2008/8

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=49649118226&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=49649118226&partnerID=8YFLogxK

U2 - 10.1002/lt.21398

DO - 10.1002/lt.21398

M3 - Article

C2 - 18668666

AN - SCOPUS:49649118226

VL - 14

SP - 1100

EP - 1106

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 8

ER -