Guidelines valuable, offer ‘concrete advice’
Approached for comment, Michael P. Curry, MD, Beth Israel Deaconess Medical Center, Boston, welcomed the guidelines, saying they are “very well written.”
He said there have been “a lot of changes in the field” since the 2011 guidelines. The current recommendations “provide concrete advice to all physicians on the appropriate assessment of patients with ALF,” he said.
Dr. Curry singled out the new recommendation on the early use of CRRT in patients with encephalopathy. He agreed on the need for gastroenterologists outside of transplant centers to make contact for potential transfer early.
“These are not patients who should, or could, be managed in a small community hospital or in a program that does not have a transplant center with which they work in close collaboration,” he said.
“So, identifying patients who are at highest risk of progressing is really important,” he said.
Dr. Curry hopes the guidelines will be shared widely by colleagues, but he is concerned that they are “not going to make it to some of these intensive care units in community, non-tertiary care centers.”
Nikolaos Pyrsopoulos, MD, PhD, MBA, Rutgers New Jersey Medical School, Newark, said the guidelines offer a “very comprehensive review of the literature.”
He said they are also a “very thorough evaluation of the quality of the evidence-based publications.”
It was “about time” that there was a set of guidelines of this quality, he added.
As for the recommendations, Dr. Pyrsopoulos believes that they will be “really valuable for the general gastroenterologist practicing in the community,” as well as for pathologists, to help them evaluate patients with ALF “as soon as possible, and in a standardized manner.”
He also emphasized the need for the rapid transfer of patients for transplant “when they are still lucid ... so we have the opportunity to discuss with and evaluate the patient.” This can be problematic in those who have been intubated and in patients with hepatic encephalopathy because they “become really confused.”
“The window of opportunity is closing very rapidly in some of these patients ... and morbidity and mortality is really pretty high” he said, so the transplant centers “appreciate when the referral is made to them earlier.”
No funding declared. No relevant financial relationships declared.
A version of this article first appeared on Medscape.com.
