It is also very important to honor the ethical, moral, and religious values of society.
Organ and tissue transplantation is successful only if everyone involved in the process, including physicians and medical institutions, respect and consider the best interests of the patients. Surgeons are also confronted by ethical issues for example, should transplantation be offered to the severely ill alcoholic patient in the terminal stage who has not adhered to recommendations regarding abstinence, and whose only hope of cure is a liver transplant. There is much controversy regarding the length of the abstinence period and the optimal time for transplantation. Patients need to abstain from alcohol for at least 6 months, and only then can they be presented to the surgical team for the transplant preparation.
, among the various prognostic scores used to assess mortality in alcoholic cirrhosis, the CTP score is a very reliable indicator.Īlcoholic cirrhosis is essentially a disease of addiction which, in many cases, is very difficult to control and treat, hence the importance of monitoring and evaluating the patient. There is much diversity among patients with alcoholic liver disease and it is therefore advantageous to include a large number of potential indicators in the scoring system used to determine prognosis. Recently, the MELD score was remodeled by the inclusion of the serum sodium in the calculation of the numerical value. The MELD score has been shown to be a valid, independent predictor of short-term as well as the long-term survival of patients with end-stage liver disease. In February 2002, the organ allocation system for liver transplantation in the USA started to base its prioritization technique on the MELD score. In 2003, the CTP score was remodeled by the inclusion of the serum creatinine level in the formula, which has improved its predictive accuracy and justified the wider use of the CTP score in day-to-day clinical practice. The most important prognostic scores are the Child-Turcotte-Pugh (CTP) score, developed in 1973 by Pugh's modification of the Child-Turcotte score, and the Model for End-Stage Liver Disease (MELD) score, which was originally developed to predict 3-month survival in cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt. In clinical practice, a number of scoring systems are also used to estimate prognosis. The best indicators of prognosis are the histological findings on liver biopsy poor prognostic features include zone 3 fibrosis, perivenular fibrosis, and alcoholic hepatitis. At that stage, both in alcoholic cirrhosis and in alcoholic hepatitis, mortality is the highest within the 1-year follow-up, while with active alcoholic patients it can be measured in weeks. In the later stages of disease, when signs of decompensation such as persistent ascites and jaundice are dominant features, abstinence has less influence on prognosis. The 5-year survival is about 60% in patients who abstain versus 40% in those who continue to consume alcohol. Prognosis is also reported to be worse in women. Prognosis in alcoholic liver cirrhosis is better than in cirrhosis due to other etiologies, but much depends on the patient's ability to abstain from alcohol consumption, socioeconomic factors, and the availability of family support. Results: The updated MELD score had the highest predictive value (3.29) among the tested scores (95% CI: 2.26-4.78). Their discriminatory ability was evaluated using receiver operating characteristic (ROC) curve analysis. Cox regression analysis was used to assess the ability of each of the scores for predicting mortality in patients with alcoholic cirrhosis. For each patient, prognostic scores were calculated these included the Child-Turcotte-Pugh score (CTP score), CTP creatinine-modified I score, CTP creatinine-modified II score, Model for End-Stage Liver Disease (MELD score), MELD model for end-stage liver disease sodium-modified score, Integrated MELD score, updated MELD score, United Kingdom MELD, and the MELD score remodeled by serum sodium index (MESO index). Material and Methods: In this prospective study, 126 patients were enrolled and followed up for 29 months. Objective: To identify the prognostic score that is the best predictor of outcome in patients hospitalized with decompensated liver cirrhosis.
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