The Utilization of Palliative Care Services in Patients with Cirrhosis who have been Denied Liver Transplantation: A Single Center Retrospective Review

Ann Hepatol. 2017 May-Jun;16(3):395-401. doi: 10.5604/16652681.1235482.

Abstract

Introduction and aim: Utilization of palliative care services in patients dying of end-stage liver disease (ESLD) is understudied. We performed a retrospective review of palliative care services among patients with ESLD unsuitable for liver transplantation (LT) at a tertiary care center.

Material and methods: Deceased ESLD patients considered unsuitable for LT from 2007-2012 were identified. Patients were excluded if they received a transplant, had an incomplete workup, were lost to follow up or whose condition improved so LT was not needed. Of the 1,175 patients reviewed, 116 met inclusion criteria.

Results: Forty patients (34.4%) received an inpatient palliative care (PC) consultation and forty-one patients (35.3%) were referred directly to hospice. Thirty-three patients (28.4%) transitioned to comfort measures without PC consultation (median survival < 1 day). The median interval between LT denial and PC consultation or hospice was 28 days. Median survival after PC consult or hospice referral was 15 days. In conclusion, in a single center retrospective review of ESLD patients, palliative care services, when utilized, were for care at the very end of life. Without consultation, aggressive interventions continued until hours before death. We propose that ESLD patients could benefit from PC consultation at time of LT evaluation or based on MELD scores.

MeSH terms

  • Adult
  • Aged
  • Delivery of Health Care, Integrated / statistics & numerical data*
  • End Stage Liver Disease / diagnosis
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / therapy*
  • Female
  • Health Resources / statistics & numerical data*
  • Hospice Care / statistics & numerical data
  • Humans
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / therapy*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Palliative Care / statistics & numerical data*
  • Patient Admission
  • Quality of Life
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Terminal Care / statistics & numerical data*
  • Tertiary Care Centers
  • Time Factors
  • Time-to-Treatment / statistics & numerical data
  • Treatment Outcome
  • Wisconsin
  • Young Adult