A. Purpose: MELD may not adequately assess the risks for clinical complications in listed Primary Sclerosing Cholangitis (PSC) patients compared to a disease severity index (DSI) based on dual cholate clearances and shunt.
B. Methods: 42 PSC patients were studied and 10 were listed for liver transplant (LT). Oral cholate-2,2,4,4-d4 is taken up by enteric bile salt transporters directly into the portal vein and its clearance defines Portal Hepatic Filtration Rate (HFR). IV cholate-24-13C clearance defines Systemic HFR. Labeled cholate clearances were determined from 5 serum samples using an LCMS method validated to FDA guidelines for accuracy and precision. The ratio of Systemic to Portal HFR measures the portal-systemic SHUNT. A DSI is calculated as A(SHUNT) B(LOGe Portal HFR) + C, with scores ranging from ∼10 for healthy controls to ∼50 for patients with the most severe liver dysfunction.
C. Results: PSC patients had significantly lower Portal HFR and higher SHUNT and DSI relative to healthy controls, whose values were established in earlier studies (Table 1, values are mean±SEM). Listed PSC patients had significantly lower Portal HFR and higher SHUNT, DSI, and MELD relative to those not listed. Within the listed group, those with varices had significantly lower Portal HFR and higher SHUNT and DSI relative to those without varices while their mean MELD score was insignificantly higher. Two of the varices patients received LTs. Patient A had a MELD of only 20 but exhibited the lowest Portal HFR and highest DSI measured and required an emergency LT within 1 month. Patient B had a MELD of only 17 but had the highest SHUNT measured and received a live donor LT.
D. Conclusions: A DSI based on cholate testing can differentiate PSC patients from healthy controls; listed PSC patients from those not listed for LT; and listed patients with varices from those without varices. The results with varices and the 2 LT patients suggest that a cholate test based DSI may be superior to MELD in assessing the risks for complications and priority for LT in PSC.
Everson, G.: Other, HepQuant, LLC, LLC Manager.
To cite this abstract in AMA style:Helmke S, Wallack A, Herman A, Isberg H, Lauriski S, Everson G. Disease Severity Index Based on Dual Cholate Clearances and Shunt Identifies Primary Sclerosing Cholangitis Waiting List Patients at Risk for Clinical Complications, A [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/disease-severity-index-based-on-dual-cholate-clearances-and-shunt-identifies-primary-sclerosing-cholangitis-waiting-list-patients-at-risk-for-clinical-complications-a/. Accessed December 5, 2019.
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