Download PDF
Semin Liver Dis 2008; 28(1): 110-122
DOI: 10.1055/s-2008-1040325
© Thieme Medical Publishers

Assessment of Prognosis of Cirrhosis

François Durand1 , Dominique Valla1
  • 1Pôle des Maladies del' Appareil Digestif, Service d'Hépatologie, Université Paris VII, INSERM, U773, Centre de Recherche Biomédicale Bichat Beaujon CRB3, Hôpital Beaujon, Clichy, France
Further Information

Publication History

Publication Date:
22 February 2008 (online)

    Permissions and Reprints

ABSTRACT

Once patients with cirrhosis experience decompensation, early mortality risk increases sharply. Liver transplantation has transformed the prognosis of decompensated cirrhosis. Child-Pugh score has been the reference for many years for assessing the prognosis of cirrhosis. However, Child-Pugh score has important limitations among which is subjective interpretation of some of its variables, making it difficult to categorize patients according to their own disease severity. The model for end-stage liver disease (MELD) score, which was originally designed for assessing the prognosis of cirrhotic patients undergoing transjugular intrahepatic portosystemic shunt (TIPS), is a continuous score relying on three objective variables. Along with TIPS, MELD score proved to be a robust marker of early mortality across a wide spectrum of causes of cirrhosis, even though 10 to 20% of patients are still misclassified. MELD is especially useful for prioritizing candidates for transplantation according to a “sickest first” policy. However, MELD is not a universal prognostic marker of cirrhosis and several MELD exceptions require more specific approaches.

KEYWORDS

Cirrhosis - MELD score - Child score - portal hypertension - liver transplantation

REFERENCES

  • 1 Ginès P, Quintero E, Arroyo V et al.. Compensated cirrhosis: natural history and prognostic factors.  Hepatology. 1987;  7 122-128
    CrossrefPubMedGoogle Scholar
  • 2 D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies.  J Hepatol. 2006;  44 217-231
    CrossrefPubMedGoogle Scholar
  • 3 Child C G. Surgery and portal hypertension. In: Child CG The Liver and Portal Hypertension. Philadelphia, PA; WB Saunders 1964: 50-72
    Google Scholar
  • 4 Durand F, Valla D. Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD.  J Hepatol. 2005;  42(suppl) S100-S107
    CrossrefPubMedGoogle Scholar
  • 5 Pugh R N, Murray-Lyon I M, Dawson J L, Pietroni M C, Williams R. Transection of the oesophagus for bleeding oesophageal varices.  Br J Surg. 1973;  60 646-649
    CrossrefPubMedGoogle Scholar
  • 6 Fleck A, Raines G, Hawker F et al.. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury.  Lancet. 1985;  1 781-784
    PubMedGoogle Scholar
  • 7 Henriksen J H, Parving H H, Christiansen L et al.. Increased transvascular escape rate of albumin during experimental portal and hepatic venous hypertension in the pig: relation to findings in patients with cirrhosis of the liver.  Scand J Clin Lab Invest. 1981;  41 289-299
    PubMedGoogle Scholar
  • 8 Moseley R H. Sepsis and cholestasis.  Clin Liver Dis. 2004;  8 83-94
    CrossrefPubMedGoogle Scholar
  • 9 Plessier A, Denninger M H, Consigny Y et al.. Coagulation disorders in patients with cirrhosis and severe sepsis.  Liver Int. 2003;  23 440-448
    CrossrefPubMedGoogle Scholar
  • 10 Fernandez-Esparrach G, Sanchez-Fueyo A, Ginès P et al.. A prognostic model for predicting survival in cirrhosis with ascites.  J Hepatol. 2001;  34 46-52
    PubMedGoogle Scholar
  • 11 Merkel C, Bolognesi M, Sacerdoti D et al.. The hemodynamic response to medical treatment of portal hypertension as a predictor of clinical effectiveness in the primary prophylaxis of variceal bleeding in cirrhosis.  Hepatology. 2000;  32 930-934
    CrossrefPubMedGoogle Scholar
  • 12 Gluud C, Henriksen J H, Nielsen G. Prognostic indicators in alcoholic cirrhotic men.  Hepatology. 1988;  8 222-227
    PubMedGoogle Scholar
  • 13 Planas R, Balleste B, Alvarez M A et al.. Natural history of decompensated hepatitis C virus-related cirrhosis: a study of 200 patients.  J Hepatol. 2004;  40 823-830
    CrossrefPubMedGoogle Scholar
  • 14 van Dam G M, Gips C H, Reisman Y et al.. Major clinical events, signs and severity assessment scores related to actual survival in patients who died from primary biliary cirrhosis: a long-term historical cohort study.  Hepatogastroenterology. 1999;  46 108-115
    PubMedGoogle Scholar
  • 15 Shetty K, Rybicki L, Carey W D. The Child-Pugh classification as a prognostic indicator for survival in primary sclerosing cholangitis.  Hepatology. 1997;  25 1049-1053
    CrossrefPubMedGoogle Scholar
  • 16 Zeitoun G, Escolano S, Hadengue A et al.. Outcome of Budd-Chiari syndrome: a multivariate analysis of factors related to survival including surgical portosystemic shunting.  Hepatology. 1999;  30 84-89
    CrossrefPubMedGoogle Scholar
  • 17 Bruix J, Sherman M. Management of hepatocellular carcinoma.  Hepatology. 2005;  42 1208-1236
    CrossrefPubMedGoogle Scholar
  • 18 Friedman L S. The risk of surgery in patients with liver disease.  Hepatology. 1999;  29 1617-1623
    CrossrefPubMedGoogle Scholar
  • 19 Testa R, Valente U, Risso D et al.. Can the MEGX test and serum bile acids improve the prognostic ability of Child-Pugh's score in liver cirrhosis?.  Eur J Gastroenterol Hepatol. 1999;  11 559-563
    PubMedGoogle Scholar
  • 20 Merkel C, Bolognesi M, Bellon S et al.. Aminopyrine breath test in the prognostic evaluation of patients with cirrhosis.  Gut. 1992;  33 836-842
    CrossrefPubMedGoogle Scholar
  • 21 Albers I, Hartmann H, Bircher J, Creutzfeldt W. Superiority of the Child-Pugh classification to quantitative liver function tests for assessing prognosis of liver cirrhosis.  Scand J Gastroenterol. 1989;  24 269-276
    CrossrefPubMedGoogle Scholar
  • 22 Merkel C, Bolognesi M, Finucci G F et al.. Indocyanine green intrinsic hepatic clearance as a prognostic index of survival in patients with cirrhosis.  J Hepatol. 1989;  9 16-22
    CrossrefPubMedGoogle Scholar
  • 23 Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi).  Hepatology. 1996;  23 1041-1046
    CrossrefPubMedGoogle Scholar
  • 24 Malinchoc M, Kamath P S, Gordon F D et al.. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts.  Hepatology. 2000;  31 864-871
    CrossrefPubMedGoogle Scholar
  • 25 Salerno F, Borroni G, Moser P et al.. Prognostic value of the galactose test in predicting survival of patients with cirrhosis evaluated for liver transplantation: a prospective multicenter Italian study. AISF Group for the Study of Liver Transplantation. Associazione Italiana per lo Studio del Fegato.  J Hepatol. 1996;  25 474-480
    CrossrefPubMedGoogle Scholar
  • 26 Zoli M, Iervese T, Merkel C et al.. Prognostic significance of portal hemodynamics in patients with compensated cirrhosis.  J Hepatol. 1993;  17 56-61
    CrossrefPubMedGoogle Scholar
  • 27 Freeman Jr R B, Edwards E B. Liver transplant waiting time does not correlate with waiting list mortality: implications for liver allocation policy.  Liver Transpl. 2000;  6 543-552
    CrossrefPubMedGoogle Scholar
  • 28 Kamath P S, Wiesner R H, Malinchoc M et al.. A model to predict survival in patients with end-stage liver disease.  Hepatology. 2001;  33 464-470
    CrossrefPubMedGoogle Scholar
  • 29 Wiesner R, Edwards E, Freeman R et al.. Model for end-stage liver disease (MELD) and allocation of donor livers.  Gastroenterology. 2003;  124 91-96
    CrossrefPubMedGoogle Scholar
  • 30 Freeman R B, Wiesner R H, Edwards E et al.. Results of the first year of the new liver allocation plan.  Liver Transpl. 2004;  10 7-15
    CrossrefPubMedGoogle Scholar
  • 31 Angermayr B, Cejna M, Karnel F et al.. Child-Pugh versus MELD score in predicting survival in patients undergoing transjugular intrahepatic portosystemic shunt.  Gut. 2003;  52 879-885
    CrossrefPubMedGoogle Scholar
  • 32 Schepke M, Roth F, Fimmers R et al.. Comparison of MELD, Child-Pugh, and Emory model for the prediction of survival in patients undergoing transjugular intrahepatic portosystemic shunting.  Am J Gastroenterol. 2003;  98 1167-1174
    CrossrefPubMedGoogle Scholar
  • 33 Said A, Williams J, Holden J et al.. Model for end-stage liver disease score predicts mortality across a broad spectrum of liver disease.  J Hepatol. 2004;  40 897-903
    CrossrefPubMedGoogle Scholar
  • 34 Chalasani N, Kahi C, Francois F et al.. Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding.  Hepatology. 2002;  35 1282-1284
    CrossrefPubMedGoogle Scholar
  • 35 Evans L T, Kim W R, Poterucha J J, Kamath P S. Spontaneous bacterial peritonitis in asymptomatic outpatients with cirrhotic ascites.  Hepatology. 2003;  37 897-901
    CrossrefPubMedGoogle Scholar
  • 36 Alessandria C, Ozdogan O, Guevara M et al.. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation.  Hepatology. 2005;  41 1282-1289
    CrossrefPubMedGoogle Scholar
  • 37 Botta F, Giannini E, Romagnoli P et al.. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study.  Gut. 2003;  52 134-139
    CrossrefPubMedGoogle Scholar
  • 38 Trotter J F, Olson J, Lefkowitz J et al.. Changes in international normalized ratio (INR) and model for end-stage liver disease (MELD) based on selection of clinical laboratory.  Am J Transplant. 2007;  7 1624-1628
    CrossrefPubMedGoogle Scholar
  • 39 Cholongitas E, Marelli L, Kerry A et al.. Different methods of creatinine measurement significantly affect MELD scores.  Liver Transpl. 2007;  13 523-529
    CrossrefPubMedGoogle Scholar
  • 40 Sanyal A J, Genning C, Reddy K R et al.. The North American Study for the Treatment of Refractory Ascites.  Gastroenterology. 2003;  124 634-641
    CrossrefPubMedGoogle Scholar
  • 41 Heuman D M, Abou-Assi S G, Habib A et al.. Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death.  Hepatology. 2004;  40 802-810
    CrossrefPubMedGoogle Scholar
  • 42 Albillos A, Colombato L A, Groszmann R J. Vasodilatation and sodium retention in prehepatic portal hypertension.  Gastroenterology. 1992;  102 931-935
    PubMedGoogle Scholar
  • 43 Biggins S W, Rodriguez H J, Bacchetti P et al.. Serum sodium predicts mortality in patients listed for liver transplantation.  Hepatology. 2005;  41 32-39
    CrossrefPubMedGoogle Scholar
  • 44 Biggins S W, Kim W R, Terrault N A et al.. Evidence-based incorporation of serum sodium concentration into MELD.  Gastroenterology. 2006;  130 1652-1660
    CrossrefPubMedGoogle Scholar
  • 45 Londono M C, Cardenas A, Guevara M et al.. MELD score and serum sodium in the prediction of survival of patients with cirrhosis awaiting liver transplantation.  Gut. 2007;  56 1283-1290
    CrossrefPubMedGoogle Scholar
  • 46 Ginès P, Arroyo V, Quintero E et al.. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites: results of a randomized study.  Gastroenterology. 1987;  93 234-241
    PubMedGoogle Scholar
  • 47 Francoz C, Belghiti J, Vilgrain V et al.. Splanchnic vein thrombosis in candidates for liver transplantation: usefulness of screening and anticoagulation.  Gut. 2005;  54 691-697
    CrossrefPubMedGoogle Scholar
  • 48 Heuman D M, Mihas A A, Habib A et al.. MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy.  Liver Transpl. 2007;  13 30-37
    CrossrefPubMedGoogle Scholar
  • 49 Merion R M, Wolfe R A, Dykstra D M et al.. Longitudinal assessment of mortality risk among candidates for liver transplantation.  Liver Transpl. 2003;  9 12-18
    CrossrefPubMedGoogle Scholar
  • 50 Bambha K, Kim W R, Kremers W K et al.. Predicting survival among patients listed for liver transplantation: an assessment of serial MELD measurements.  Am J Transplant. 2004;  4 1798-1804
    CrossrefPubMedGoogle Scholar
  • 51 Mathurin P, Mendenhall C L, Carithers Jr R L et al.. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH.  J Hepatol. 2002;  36 480-487
    CrossrefPubMedGoogle Scholar
  • 52 Carithers Jr R L, Herlong H F, Diehl A M et al.. Methylprednisolone therapy in patients with severe alcoholic hepatitis: a randomized multicenter trial.  Ann Intern Med. 1989;  110 685-690
    CrossrefPubMedGoogle Scholar
  • 53 Forrest E H, Evans C D, Stewart S et al.. Analysis of factors predictive of mortality in alcoholic hepatitis and derivation and validation of the Glasgow alcoholic hepatitis score.  Gut. 2005;  54 1174-1179
    CrossrefPubMedGoogle Scholar
  • 54 Mathurin P, Abdelnour M, Ramond M J et al.. Early change in bilirubin levels is an important prognostic factor in severe alcoholic hepatitis treated with prednisolone.  Hepatology. 2003;  38 1363-1369
    PubMedGoogle Scholar
  • 55 Dunn W, Jamil L H, Brown L S et al.. MELD accurately predicts mortality in patients with alcoholic hepatitis.  Hepatology. 2005;  41 353-358
    CrossrefPubMedGoogle Scholar
  • 56 Srikureja W, Kyulo N L, Runyon B A, Hu K Q. MELD score is a better prognostic model than Child-Turcotte-Pugh score or Discriminant Function score in patients with alcoholic hepatitis.  J Hepatol. 2005;  42 700-706
    CrossrefPubMedGoogle Scholar
  • 57 Louvet A, Naveau S, Abdelnour M et al.. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids.  Hepatology. 2007;  45 1348-1354
    CrossrefPubMedGoogle Scholar
  • 58 Fontana R J, Hann H W, Perrillo R P et al.. Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy.  Gastroenterology. 2002;  123 719-727
    CrossrefPubMedGoogle Scholar
  • 59 Schiff E, Lai C L, Hadziyannis S et al.. Adefovir dipivoxil for wait-listed and post-liver transplantation patients with lamivudine-resistant hepatitis B: final long-term results.  Liver Transpl. 2007;  13 349-360
    CrossrefPubMedGoogle Scholar
  • 60 Bruno S, Stroffolini T, Colombo M et al.. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: a retrospective study.  Hepatology. 2007;  45 579-587
    CrossrefPubMedGoogle Scholar
  • 61 Dickson E R, Grambsch P M, Fleming T R et al.. Prognosis in primary biliary cirrhosis: model for decision making.  Hepatology. 1989;  10 1-7
    PubMedGoogle Scholar
  • 62 Grambsch P M, Dickson E R, Kaplan M et al.. Extramural cross-validation of the Mayo primary biliary cirrhosis survival model establishes its generalizability.  Hepatology. 1989;  10 846-850
    PubMedGoogle Scholar
  • 63 Christensen E, Gunson B, Neuberger J. Optimal timing of liver transplantation for patients with primary biliary cirrhosis: use of prognostic modelling.  J Hepatol. 1999;  30 285-292
    CrossrefPubMedGoogle Scholar
  • 64 Kim W R, Poterucha J J, Wiesner R H et al.. The relative role of the Child-Pugh classification and the Mayo natural history model in the assessment of survival in patients with primary sclerosing cholangitis.  Hepatology. 1999;  29 1643-1648
    CrossrefPubMedGoogle Scholar
  • 65 Northup P G, Wanamaker R C, Lee V D et al.. Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis.  Ann Surg. 2005;  242 244-251
    CrossrefPubMedGoogle Scholar
  • 66 Ziser A, Plevak D J, Wiesner R H et al.. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery.  Anesthesiology. 1999;  90 42-53
    CrossrefPubMedGoogle Scholar
  • 67 Durand F. Risk scores in cirrhotic patients: from non-transplant surgery to transplantation and back.  J Hepatol. 2006;  44 620-621
    CrossrefPubMedGoogle Scholar
  • 68 Balzan S, Belghiti J, Farges O et al.. The “50-50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy.  Ann Surg. 2005;  242 824-828 discussion 828-829
    CrossrefPubMedGoogle Scholar
  • 69 Wehler M, Kokoska J, Reulbach U et al.. Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems.  Hepatology. 2001;  34 255-261
    CrossrefPubMedGoogle Scholar
  • 70 Dhainaut J F, Laterre P F, Janes J M et al.. Drotrecogin alfa (activated) in the treatment of severe sepsis patients with multiple-organ dysfunction: data from the PROWESS trial.  Intensive Care Med. 2003;  29 894-903
    PubMedGoogle Scholar
  • 71 Knaus W A, Draper E A, Wagner D P, Zimmerman J E. APACHE II: a severity of disease classification system.  Crit Care Med. 1985;  13 818-829
    CrossrefPubMedGoogle Scholar
  • 72 Vincent J L, Moreno R, Takala J et al.. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.  Intensive Care Med. 1996;  22 707-710
    CrossrefPubMedGoogle Scholar
  • 73 Cholongitas E, Marelli L, Shusang V et al.. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation.  Liver Transpl. 2006;  12 1049-1061
    CrossrefPubMedGoogle Scholar
  • 74 Desai N M, Mange K C, Crawford M D et al.. Predicting outcome after liver transplantation: utility of the model for end-stage liver disease and a newly derived discrimination function.  Transplantation. 2004;  77 99-106
    CrossrefPubMedGoogle Scholar
  • 75 Jacob M, Copley L P, Lewsey J D et al.. Pretransplant MELD score and post liver transplantation survival in the UK and Ireland.  Liver Transpl. 2004;  10 903-907
    CrossrefPubMedGoogle Scholar
  • 76 Freeman R B, Edwards E B, Harper A M. Waiting list removal rates among patients with chronic and malignant liver diseases.  Am J Transplant. 2006;  6 1416-1421
    CrossrefPubMedGoogle Scholar
  • 77 Merion R M, Schaubel D E, Dykstra D M et al.. The survival benefit of liver transplantation.  Am J Transplant. 2005;  5 307-313
    CrossrefPubMedGoogle Scholar
  • 78 Christensen E. Prognostic models in chronic liver disease: validity, usefulness and future role.  J Hepatol. 1997;  26 1414-1424
    CrossrefPubMedGoogle Scholar
  • 79 Valla D C. Gastrointestinal hemorrhage: what kind of surveillance is needed for drug treatment [in French]?.  Gastroenterol Clin Biol. 2004;  28 B242-B255
    PubMedGoogle Scholar
  • 80 Vorobioff J, Groszmann R J, Picabea E et al.. Prognostic value of hepatic venous pressure gradient measurements in alcoholic cirrhosis: a 10-year prospective study.  Gastroenterology. 1996;  111 701-709
    CrossrefPubMedGoogle Scholar
  • 81 Ripoll C, Groszmann R, Garcia-Tsao G et al.. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis.  Gastroenterology. 2007;  133 481-488
    CrossrefPubMedGoogle Scholar
  • 82 Abraldes J G, Tarantino I, Turnes J et al.. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis.  Hepatology. 2003;  37 902-908
    CrossrefPubMedGoogle Scholar
  • 83 D'Amico G, Garcia-Pagan J C, Luca A, Bosch J. Hepatic vein pressure gradient reduction and prevention of variceal bleeding in cirrhosis: a systematic review.  Gastroenterology. 2006;  131 1611-1624
    CrossrefPubMedGoogle Scholar
  • 84 Gunsar F, Raimondo M L, Jones S et al.. Nutritional status and prognosis in cirrhotic patients.  Aliment Pharmacol Ther. 2006;  24 563-572
    CrossrefPubMedGoogle Scholar
  • 85 Alvares-da-Silva M R, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients.  Nutrition. 2005;  21 113-117
    CrossrefPubMedGoogle Scholar
  • 86 Abad-Lacruz A, Cabre E, Gonzalez-Huix F et al.. Routine tests of renal function, alcoholism, and nutrition improve the prognostic accuracy of Child-Pugh score in nonbleeding advanced cirrhotics.  Am J Gastroenterol. 1993;  88 382-387
    PubMedGoogle Scholar
  • 87 Bianchi G, Marchesini G, Zoli M et al.. Prognostic significance of diabetes in patients with cirrhosis.  Hepatology. 1994;  20 119-125
    CrossrefPubMedGoogle Scholar
  • 88 Moreau R, Delègue P, Pessione F et al.. Clinical characteristics and outcome of patients with cirrhosis and refractory ascites.  Liver Int. 2004;  24 457-464
    CrossrefPubMedGoogle Scholar
  • 89 Nishida T, Tsuji S, Tsujii M et al.. Oral glucose tolerance test predicts prognosis of patients with liver cirrhosis.  Am J Gastroenterol. 2006;  101 70-75
    CrossrefPubMedGoogle Scholar
  • 90 Kwon S Y, Kim S S, Kwon O S et al.. Prognostic significance of glycaemic control in patients with HBV- and HCV-related cirrhosis and diabetes mellitus.  Diabet Med. 2005;  22 1530-1535
    CrossrefPubMedGoogle Scholar
  • 91 Holstein A, Hinze S, Thiessen E et al.. Clinical implications of hepatogenous diabetes in liver cirrhosis.  J Gastroenterol Hepatol. 2002;  17 677-681
    CrossrefPubMedGoogle Scholar
  • 92 Durand F, Belghiti J, Troisi R et al.. Living donor liver transplantation in high-risk vs. low-risk patients: optimization using statistical models.  Liver Transpl. 2006;  12 231-239
    CrossrefPubMedGoogle Scholar
  • 93 Sarasin F P, Majno P E, Llovet J M et al.. Living donor liver transplantation for early hepatocellular carcinoma: a life-expectancy and cost-effectiveness perspective.  Hepatology. 2001;  33 1073-1079
    CrossrefPubMedGoogle Scholar
  • 94 Salomon J A, Weinstein M C, Hammitt J K, Goldie S J. Cost-effectiveness of treatment for chronic hepatitis C infection in an evolving patient population.  JAMA. 2003;  290 228-237
    CrossrefPubMedGoogle Scholar
  • 95 de Franchis R. Evolving consensus in portal hypertension: report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension.  J Hepatol. 2005;  43 167-176
    CrossrefPubMedGoogle Scholar
  • 96 Kim W R, Wiesner R H, Therneau T M et al.. Optimal timing of liver transplantation for primary biliary cirrhosis.  Hepatology. 1998;  28 33-38
    CrossrefPubMedGoogle Scholar

François DurandM.D. 

Service d'Hépatologie, Hôpital Beaujon, 100 Boulevard du Général Leclerc

92110 Clichy, France

Email: francois.durand@bjn.aphp.fr

      >