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1.
Lucas Souto NACIF Wellington ANDRAUS Rafael Soares PINHEIRO Liliana DUCATTI Luciana BP HADDAD Luiz Carneiro D'ALBUQUERQUE 《Brazilian archives of digestive surgery》2014,27(2):145-147
Introduction
The hepatopulmonary syndrome has been acknowledged as an important vascular complication in lungs developing systemic hypoxemia in patients with cirrhosis and portal hypertension. Is formed by arterial oxygenation abnormalities induced from intrapulmonary vascular dilatations with liver disease. It is present in 4-32% of patients with cirrhosis. It increases mortality in the setting of cirrhosis and may influence the frequency and severity. Initially the hypoxemia responds to low-flow supplemental oxygen, but over time, the need for oxygen supplementation is necessary. The liver transplantation is the only effective therapeutic option for its resolution.Aim
To update clinical manifestation, diagnosis and treatment of this entity.Method
A literature review was performed on management of hepatopulmonary syndrome. The electronic search was held of the Medline-PubMed, in English crossing the headings "hepatopulmonary syndrome", "liver transplantation" and "surgery". The search was completed in September 2013.Results
Hepatopulmonary syndrome is classically defined by a widened alveolar-arterial oxygen gradient (AaPO2) on room air (>15 mmHg, or >20 mmHg in patients >64 years of age) with or without hypoxemia resulting from intrapulmonary vasodilatation in the presence of hepatic dysfunction or portal hypertension. Clinical manifestation, diagnosis, classification, treatments and outcomes are varied.Conclusion
The severity of hepatopulmonary syndrome is an important survival predictor and determine the improvement, the time and risks for liver transplantation. The liver transplantation still remains the only effective therapeutic. 相似文献2.
Andrew J. Benjamin Talia B. Baker Mark S. Talamonti Adam S. Bodzin Andrew B. Schneider David J. Winschester Kevin K. Roggin David J. Bentrem Nicholas R. Suss Marshall S. Baker 《Surgery》2018,163(3):582-586
Background
Studies comparing orthotopic liver transplantation to margin negative resection for patients with small unifocal hepatocellular carcinoma have not controlled for degree of cirrhosis.Methods
The National Cancer Database was used to identify patients with preserved liver function (Model for End-stage Liver Disease score ≤12) who underwent orthotopic liver transplantation or margin negative resection for American Joint Committee on Cancer stage I hepatocellular carcinoma lesions <3?cm between 2010 and 2013. Multivariable and Cox regression adjusting for age, demographics, comorbid disease burden, Model for End-stage Liver Disease score, tumor size, and operation were used to compare overall survival between cohorts.Results
In the study, 241 (53%) patients underwent orthotopic liver transplantation. In addition, 219 (47%) underwent margin negative resection. On multivariable regression, patients having a Charlson comorbidity score ≥2 were more likely to undergo orthotopic liver transplantation, (odds ratio 1.94, P?=?.03). African American patients (odds ratio 0.44, P?=?.02), and patients of advanced age (odds ratio 0.92, P?<?.001) were more likely to undergo margin negative resection. Patients undergoing orthotopic liver transplantation had longer overall survival than those undergoing margin negative resection (median OS not reached versus 67.6 months, P?<?.001). Multivariable Cox regression identified surgical procedure as the only independent determinant of survival with margin negative resection conferring a nearly 3-fold increased risk of death (hazard ratio 2.86, P?<?.001).Conclusion
Orthotopic liver transplantation offers a survival advantage relative to margin negative resection for patients with small unifocal hepatocellular carcinoma and preserved liver function. 相似文献3.
V. Bernal I. Pascual A. García-Gil I. Lacambra M.A. Simón 《Transplantation proceedings》2009,41(3):987-988
Background
The aim of this study was to assessed the correlation of N-terminal natriuretic peptide type B (NT-proBNP) with echocardiographic and hemodynamic indexes of right ventricular (RV) function and to evaluate the sensitivity and specificity of Doppler echocardiography in the diagnosis of portopulmonary hypertension.Methods
All patients underwent liver transplantation for cirrhosis. We obtained clinical data, NT-proBNP levels, echocardiography, and right heart hemodynamic measurements before transplantation.Results
Patients with pulmonary hypertension displayed significantly higher levels of NT-proBNP. They also showed higher model for End-stage Liver Disease scores and higher indices of RV overload on cardiac hemodynamics. The negative predictive value of echocardiography to identify pulmonary hypertension was 83%. A correlation was not observed between systolic pulmonary artery pressures measured by the two methods; however, NTproBNP showed a trend toward a significant correlation with mean pulmonary pressure as determined by hemodynamics (r = .3; P < .01).Conclusion
We concluded that NT-proBNP values showed significant correlations with pulmonary hypertension that could assist in a noninvasive diagnoseis for this group of patients. 相似文献4.
Robert Bachmann Jeannine Bachmann Jessica Lange Silvio Nadalin Alfred Königsrainer Ruth Ladurner 《The Journal of surgical research》2014
Background
Thrombocytopenia in patients with end-stage liver disease is a common disorder caused mainly by portal hypertension, low levels of thrombopoetin, and endotoxemia. The impact of immune-mediated heparin-induced thrombocytopenia type II (HIT type II) as a cause of thrombocytopenia after liver transplantation is not yet understood, with few literature citations reporting contradictory results. The aim of our study was to demonstrate the perioperative course of thrombocytopenia after liver transplantation and determine the occurrence of clinical HIT type II.Method
We retrospectively evaluated the medical records of 205 consecutive adult patients who underwent full-size liver transplantation between January 2006 and December 2010 due to end-stage or malignant liver disease. Preoperative platelet count, postoperative course of platelets, and clinical signs of HIT type II were analyzed.Results
A total of 155 (75.6%) of 205 patients had thrombocytopenia before transplantation, significantly influenced by Model of End-Stage Liver Disease score and liver cirrhosis. The platelet count exceeded 100,000/μL in most of the patients (n = 193) at a medium of 7 d. Regarding HIT II, there were four (1.95%) patients with a background of HIT type II.Conclusions
The incidence of HIT in patients with end-stage hepatic failure is, with about 1.95%, rare. For further reduction of HIT type II, the use of intravenous heparin should be avoided and the prophylactic anticoagulation should be performed with low-molecular-weight heparin after normalization of platelet count. 相似文献5.
A.C. del Pozo J.d.R. Martín M. Sturdevant K. Iyer T. Schiano S. Lerner J. Bromberg G. de Boccardo 《Transplantation proceedings》2009,41(5):1713-1716
Introduction
Hepatitis C (HCV) cirrhosis is the prevalent liver disease requiring liver transplantation in the United States. Candidates who also have end-stage renal disease, chronic renal disease stage 4, or prolonged hepatorenal syndrome are considered for combined liver and kidney transplantation (CLKT).Materials and methods
We performed a retrospective study of HCV(+) and HCV(−) CLKT patients with more than 12 months of follow-up and HCV(+) patients with isolated liver transplant (OLT) to compare the outcomes of various groups.Results
Since 1988, 2983 OLTs were performed at our institution including 58 CLKTs. Of these, 23 were HCV(+) subjects who were significantly older than HCV(−) CLKT patients. Race, pretransplant dialysis time, renal indication for CLKT, Model for End-stage Liver Disease score, donor age, liver and kidney rejection as well as occurrence of posttransplant hypertension were similar among HCV(+) and HCV(−) CLKT patients. Posttransplant diabetes was observed in 80% of the HCV(+) group and 30% of the HCV(−) group (P = .01). Renal function seemed to be better in HCV(−) when compared with HCV(+) subjects at 5 years (P = .09). Overall patient survival for HCV(+) CLKT, HCV(−) CLKT, and HCV(+) OLT groups at 1, 2, and 5 years were not significantly different (P = .6).Conclusion
HCV positivity should not exclude appropriate candidates for CLKT. 相似文献6.
L. Haddad K. Andrade L. Mendes L. Ducatti L.A. DAlbuquerque W. Andraus 《Transplantation proceedings》2017,49(2):330-337
Objective
To measure the association between readmission after liver transplantation and corresponding adverse drug reactions.Methods
A total of 48 patients undergoing liver transplantation were prospectively followed for 1 year. Of these, 23 were readmitted and evaluated by a pharmacist for causes of adverse drug reaction. The detection of adverse drug reactions was based on a combination of clinical interviews and physical and laboratory exams. Adverse reactions were defined in accordance with the Naranjo algorithm.Results
A total of 67.6% of all readmissions were related to adverse drug reactions, with tacrolimus accounting for 80% of the drug reactions. The most common cause of readmission was infection (48.6%), followed by procedure-related reasons (29.7%). Of all patients requiring admission, 39.1% had Model for End-stage Liver Disease (MELD) scores below 21 at the time of transplantation, 17.4% had MELD scores between 21 and 29, and 43.5% had MELD scores above 29. Most (66.7%) of those readmitted more than twice had MELD scores above 29.Conclusion
Adverse drug reactions related to immunosuppressants frequently lead to readmission among liver transplant patients, and in our series tacrolimus was the most frequently associated drug. 相似文献7.
Introduction
The present study compared the functional capacity of the grafts by evaluating changes in lactate and PT after reperfusion among deceased donor liver transplantation (DDLT) versus living donor liver transplantation (LDLT).Methods
We performed a retrospective analysis of primary adult liver transplantations (45 and 77 recipients in DDLT and LDLT, respectively) between January 2007 and December 2009. Lactate was recorded from 5 minutes after reperfusion of graft (R0) to intensive care unit admission (P0). PT expressed in international normalized ratio (INR) was recorded from R0 to postoperative day (POD) 5. These values were compared between two groups.Results
The cold ischemia time (CIT), Child-Turcotte-Pugh score, Model for End-stage Liver Disease score, INR, and graft-to-recipient weight ratio were greater in the recipients of DDLT versus LDLT. Lactate and INR at R0 were similar between the two groups, but, the values showed a faster recovery from 1 hour after reperfusion until P0 for lactate and until POD 5 for INR among DDLT recipients. The fresh frozen plasma requirements during corresponding periods were similar between the two groups.Conclusion
The functional capacity of the graft measured by changes in lactate and PT after reperfusion showed faster recovery among DDLT versus LDLT recipients despite poorer graft quality (longer CIT) and the recipients' preoperative medical conditions-higher MELD and CTP scores. 相似文献8.
S. Hwang C.-S. AhnK.-H. Kim D.-B. MoonT.-Y. Ha G.-W. SongD.-H. Jung G.-C. ParkJ.-M. Namgoong C.-S. ParkH.-W. Park Y.-H. ParkS.-H. Kang B.-H. JungS.-G. Lee 《Transplantation proceedings》2013
Background
Since the establishment of the Korean Network for Organ Sharing (KONOS) in 2000, thousands of patients have been enrolled on the waiting list, but only a small proportion have received a deceased donor liver transplantation. This report on waiting list mortality in Korea based on data from a single institution.Methods
The 1772 patients enrolled on the waiting list between February 2000 and December 2011 either have not yet received at the time of analysis or have died before receiving an organ. Survival information was obtained in February 2012 by reviewing medical records or by telephone. We excluded patients who died immediately after enrollment or after retransplantation.Results
Primary diagnoses of those awaiting transplantation were hepatitis B virus-associated cirrhosis (63.7%), alcoholic liver disease (14.3%), hepatitis C virus-associated cirrhosis (13.8%), and acute liver failure due to other causes (8.1%). The priority status of patients on the waiting list was KONOS status 1 (highest priority) in 3.8%, status 2A in 3.9%, status 2B in 41.9%, status 3 to 7 (lowest priority) in 50.5%. Their median survival periods were 1, 1, 18, and 59 months, respectively. The mean Child-Pugh score was 8.5 ± 2.5 and Model for End-stage Liver Disease (MELD) score 18.1 ± 9.8.Conclusions
Patients with high MELD scores or hepatocellular carcinoma succumbed soon after being entered on to the waiting list. By increasing organ donation rates and developing a risk-based allocation system, it should be possible to reduce mortality among patients on organ waiting lists. 相似文献9.
I. Loria M. Giusto V. Giannelli S. Di Menna S.G. Corradini M. Rossi M. Merli 《Transplantation proceedings》2010,42(4):1191-2845
Background
An important complication of chronic liver disease is osteodystrophy, which includes osteoporosis and the much rarer osteomalacia. Both conditions are associated with significant morbidity through fractures resulting in pain, deformity, and immobility. Liver transplantation may further deteriorate bone metabolism. The aim of the present study was to investigate the frequency and severity of hepatic osteodystrophy among patients with liver cirrhosis who were referred for liver transplantation. We also evaluated modifications in bone metabolism after liver transplantation.Materials and methods
We recruited 35 consecutive patients with chronic liver disease who were undergoing assessment for transplantation over a 1-year period. Bone mass in the total skeleton and proximal hip was evaluated using a dual-energy X-ray absorptiometry device (Lunar Prodigy Advance, GE Healthcare, USA). According to World Health Organization recommendations, osteoporosis was defined as a T score < −2.5 and osteopenia as T score between −1 and −2.5.Results
We enrolled in the study 35 patients, including 8 females and 27 males of overall mean age of 57 ± 7, who showed a viral etiology (57%) or alcohol etiology (28%), Child-Pugh 8.7 ± 2.3. The overall prevalence of osteodystrophy was 40% (26% osteopenia and 14% osteoporosis). No difference was evident according to gender, severity of liver disease (Child-Pugh, Model for End-stage Liver Disease), or origin of liver disease. A subgroup of 10 transplanted patients reached 3-month follow-up, showing total body T score with a significant decrease after 3 months while femoral T scores tended to decrease insignificantly.Conclusions
This study revealed a high prevalence of low bone mineral density among cirrhotic patients before liver transplantation. We suggest that both bone mineral density and biochemical examinations should be considered to be routine tests to identify the status of bone mass and bone metabolism among recipients prior to liver transplantation. 相似文献10.
Y. Oya Y. Sugawara M. Honda D. Yoshii K. Isono S. Hayashida H. Yamamoto Y. Inomata 《Transplantation proceedings》2017,49(5):1123-1125
Background
Progressive familial intrahepatic cholestasis type 1 (PFIC1) is an inherited disease characterized by cholestatic features. We report two patients with PFIC1 who underwent liver retransplantation.Case Report
One patient was a 3-year-old female who underwent liver transplantation for PFIC1. She presented with severe diarrhea and fatty liver, and went into liver failure. She therefore underwent liver retransplantation and external biliary diversion 8 years after the initial liver transplantation. The explanted liver was histologically diagnosed with chronic rejection. Her intractable diarrhea stopped after the retransplantation. She was diagnosed with a fatty liver 8 months after the retransplantation and died 4 years after retransplantation due to bleeding from an ileostomy. The other patient was a 3-year-old male. This patient underwent liver retransplantation due to liver cirrhosis caused by steatohepatitis 9 years after the initial liver transplantation. The biliary tract was not diverted. He also experienced severe diarrhea after the retransplantation and requires home parenteral nutrition due to an eating disorder.Conclusions
Liver transplantation is the only treatment to resolve life-threatening issues due to PFIC1, but requires further improvement as a therapeutic modality. 相似文献11.
R.P. Duarte A.C. Sentanin A.M.O. da Silva R.M. Tonella G.L. Duarte L.S.R. Ratti I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):829-831
Introduction
Liver disease induces many organic and metabolic changes, leading to malnutrition and weight and muscular function loss. Surface electromyography is an easily applicable, noninvasive study, through which the magnitudes of the peaks on the charts depict voluntary muscle activity.Aim
To evaluate the diaphragmatic surface electromyography of postoperative liver transplantation subjects.Methods
Subjects were patients who underwent liver transplantation and extubation in the Clinical Hospital of State University of Campinas. Electromyography data were collected with support pressure of ≤10 cm H2O, Glasgow Coma Scale = 11, and minimum dosages of vasoactive drugs, and data were collected again 30 minutes after extubation. Signal collection was performed with sEMG System Brazil SAS1000V3 electromyograph and electrode stickers. Statistical analysis was performed using R software.Results
The average time of surgery was 345.36 ± 125.62 minutes. Time from spontaneous mode until extubation was 417.14 ± 362.97 minutes. The RMS (root mean square) values of the right and left domes in spontaneous mode with minimal ventilation parameters were 26.68 ± 10.92 and 26.55 ± 10.53, respectively, and the RMS values after extubation were 31.93 ± 18.69 to 34.62 ± 13.55, for right and left domes. The last calculated pretransplant Model for End-stage Liver Disease score averaged 19.64 ± 8.41.Conclusion
There were significant differences between the RMS of the diaphragm domes under mechanical ventilation and after extubation, showing lower effectiveness of the diaphragm muscle against resistance, without the aid of positive pressure and the existing overload of the left dome. 相似文献12.
Takeda K Tanaka K Kumamoto T Morioka D Endo I Togo S Shimada H 《Transplantation proceedings》2010,42(9):3858-3861
A 27-year-old Japanese man underwent liver transplantation because of uncompensated cirrhosis due to Dorfman-Chanarin syndrome (DCS). At birth, the patient displayed ichthyosis and liver dysfunction. Moreover, mental retardation appeared and intracytoplasmic vacuoles were observed within peripheral blood neutrophils. A fatty liver was also noticed, leading to the diagnosis of DCS. When he was referred to our hospital, his American Society of Anesthesiologists score was 3. The findings of computed tomography showed liver atrophy, splenomegaly, and ascites. The Child-Pugh score was B, and the Model for End-stage Liver Disease score was 14. The pathophysiology was DCS with uncompensated liver cirrhosis. Therefore, living donor liver transplantation (LDLT) was performed from the patient's brother. The histological appearance of the resected liver revealed macrovesicular steatosis in most hepatocytes with excess fibrous tissue in the portal areas. These findings were compatible with nonalcoholic steatohepatitis. Although the patient's mental retardation and characteristic appearance have not improved, good liver function has been maintained since LDLT. An outpatient protocol liver biopsy performed at 12 months after LDLT did not show recurrence of macrovesicular steatosis. 相似文献
13.
Álamo JM Bernal C Barrera L Marín LM Suárez G Serrano J Gómez MA Padillo FJ 《Transplantation proceedings》2011,43(6):2230-2232
Objective
The objective of this study was to evaluate long-term survival, histological diagnoses, and mobility of patients with cryptogenic cirrhosis (CC) treated with orthotopic liver transplantation (OLT).Patients and Methods
We performed a retrospective analysis of 35 patients who underwent transplantation with CC among 800 OLT patients. There were no differences in gender, mean age of 47 years, average MELD (Model for End-stage Liver Disease) of 16, and hepatocellular carcinoma incidence (8%).Results
In 28.6% of patients, the diagnosis of CC was wrong. There was no incidence of an acute rejection episode and a low incidence of complications, although the postoperative mortality rate was 20%, of chronic rejection was 25%, and recurrence of disease was 4%. Cumulative at 3-, 5-, and 10-year survivals were lower than the other OLT. Survival was lower in patients receiving suboptimal grafts.Conclusions
One of 3 patients who underwent transplantation for CC had a specific etiologic diagnosis. The chronic rejection rate and postoperative mortality rate were higher than other etiologies, and survivals at 5, 10, and 15 years were lower than other OLT. 相似文献14.
Suarez Artacho G Barrera Pulido L Alamo Martinez JM Serrano Diez-Canedo J Bernal Bellido C Marín Gomez LM Padillo Ruiz J Gómez Bravo MA 《Transplantation proceedings》2010,42(8):3156-3158
Objective
The objective of the present study was to analyze the incidence of portal vein thrombosis (PVT), comparing morbidity and mortality rates among those affected with and those free of this complication. In the PVT group, we also analyzed mortality related to partial (PPVT) and total (TPVT) thrombosis.Methods
We undertook a retrospective study of orthotopic liver transplantations from deceased donors in 617 recipients from January 1991 until October 2008. Recipients were classified according to whether they had PVT. In all cases, we considered age, sex, Model for End-stage Liver Disease score, Child-Pugh score, indication for transplantation, type of thrombosis, surgical technique blood product transfusion, and survival rate.Results
There were 48 patients with PVT (7.78%) among 670 transplantations in 617 recipients in our institution. Concerning the type of thrombosis, 28 (58.3%) were partial and 20 (41.7%) total with complete occlusion of the portal vein lumen.Conclusion
PVT in liver transplant candidates is a rare event (7.8%) that entails greater difficulty in the procedure, expressed as a longer operative time, greater consumption of blood products, and complex surgical techniques. The prognosis for these patients depends on the type of thrombosis: patients with TPVT showed a higher mortality, whereas those with PPVT had survival rates comparable to those of candidates with a permeable portal vein. 相似文献15.
K. Dudek O. Kornasiewicz P. Remiszewski K. Kobry B. Ziarkiewicz-Wrblewska B. Grnicka K. Zieniewicz M. Krawczyk 《Transplantation proceedings》2009,41(8):3135-3137
Introduction
Orthotopic liver transplantation (OLT) is a well-established treatment for cirrhotic patients with hepatocellular carcinoma (HCC) who meet the Milan criteria. The aim of this study was to identify predictors of survival among 65 patients with HCC in cirrhotic livers who underwent liver transplantation (OLT).Methods
From January 2001 to December 2008, we performed 655 OLT in 615 patients. HCC was diagnosed in 58 patients before OLT and in 65 by histological examination of the explanted livers; 74% of the patients met Milan criteria by histological examination.Results
The median follow-up was 27 months (range = 1-96). We analyzed patient age and gender, etiology of liver disease, Child score at transplantation, rejection episodes, tumor number/size, vascular invasion, and differentiation grade. There was no significant difference in survival among patients grouped according to the Model for End-stage Liver Disease staging system for HCC. The 5-year survival of patients with low differentiated (G3) HCC was significantly worse than that of those with moderately differentiated (G2) or well-differentiated (G1) HCC: 50%, 81%, and 86% respectively, (P < .01). Patients with microvascular invasion displayed a worse 5-year survival than those without vascular invasion (42% vs 80%; P < .01).Conclusions
The analysis indicated that the histological grade of the tumors and evidences of microscopic vascular invasion were the most useful predictive factors for overall survival among patients with cirrhosis after liver transplantation for HCC. 相似文献16.
Lucas Souto NACIF Wellington ANDRAUS Rodrigo Bronze MARTINO Vinicius Rocha SANTOS Rafael Soares PINHEIRO Luciana BP HADDAD Luiz Carneiro D'ALBUQUERQUE 《Brazilian archives of digestive surgery》2014,27(3):201-203
Background
Liver transplantation is performed at large transplant centers worldwide as a therapeutic intervention for patients with end-stage liver diseases.Aim
To analyze the outcomes and incidence of liver transplantation performed at the University of São Paulo and to compare those with the State of São Paulo before and after adoption of the Model for End-Stage Liver Disease (MELD) score.Method
Evaluation of the number of liver transplantations before and after adoption of the MELD score. Mean values and standard deviations were used to analyze normally distributed variables. The incidence results were compared with those of the State of São Paulo.Results
There was a high prevalence of male patients, with a predominance of middle-aged. The main indication for liver transplantation was hepatitis C cirrhosis. The mean and median survival rates and overall survival over ten and five years were similar between the groups (p>0.05). The MELD score increased over the course of the study period for patients who underwent liver transplantation (p>0.05). There were an increased number of liver transplants after adoption of the MELD score at this institution and in the State of São Paulo (p<0.001).Conclusion
The adoption of the MELD score led to increase the number of liver transplants performed in São Paulo. 相似文献17.
L.C. Casadaban M.G. Gabra A. Parvinian J. Minocha M.G. Knuttinen J.T. Bui R.C. Gaba 《Transplantation proceedings》2014
Purpose
To assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) creation on Model for End-stage Liver Disease (MELD) score temporal progression in patients with liver cirrhosis.Materials and methods
In this single-institution retrospective study, 256 consecutive patients who underwent TIPS creation between 1999 and 2013 were identified for potential investigation. Inclusion criteria for analysis consisted of at least 6 months of post-TIPS clinical follow-up with available lab values at 1, 3, 6, and, if available, 12 months post-TIPS for MELD score calculation. Patients who were lost to follow-up or expired within 6 months, lacked sufficient lab follow-up, or underwent liver transplantation within 6 months of TIPS were excluded from the study cohort. Within-patient variance in MELD score was assessed using repeated-measures analysis of variance.Results
Sixty-six patients met criteria for study inclusion. TIPS were created for variceal hemorrhage (n = 26) or ascites, hydrothorax, or portal vein thrombosis (n = 40). Hemodynamic success rate was 97% (64/66) and median portosystemic pressure gradient reduction was 13 mm Hg. Median baseline MELD score was 14 (range 7–26). Low MELD scores (≤10, n = 16) increased in sequential scores over 1-year follow-up (median increase +3.5), intermediate MELD scores (11–18, n = 34) showed general stability in successive scores over 1-year follow-up (median increase +1), and high MELD scores (≥19, n = 16) decreased in serial scores over 1-year follow-up (median decrease −4); these trends are compatible with published MELD progression tendencies in cirrhotic patients without TIPS. However, the MELD score changes were not statistically significant (P = .172) on within-subject comparison.Conclusions
Among patients with liver cirrhosis who recover from the procedure, TIPS creation does not alter the natural MELD score evolution during intermediate term follow-up, and as such does not significantly alter liver transplant candidacy. 相似文献18.
Boin IF Capel C Ataide EC Cardoso AR Caruy CA Stucchi RS 《Transplantation proceedings》2010,42(10):4119-4122
Introduction
Predicting the prognosis of hepatic cirrhosis is the most accurate method to achieve a fair allocation among the liver transplant waiting list thereby reducing overall mortality rates.Aim
To study the survival rates of recipients who undergo liver transplantation in association with hyponatremia rates.Methods
This retrospective study used a prospectively collected database. The characteristics of liver donors and recipients were: age (years), Model for End-stage Liver Disease (MELD), MELD Na score, recipient body mass index (kg/m2), warm ischemia time (minutes), cold ischemia time (minutes), intensive care unit time (days), hemocomponents transfused, recipient glycemia (mg/dL) and serum sodium (mEq/L), Child-Pugh-Turcotte classification (points), and survival time (months). We analyzed all 318 consecutive liver transplantations from February 1994 to May 2010 divided into two groups: A (Na > 130 mEq/L) and B (Na ≤ 130 mEq/L). The Kaplan-Meier method was used to evaluate survival rate and the Cox regression test to identify predictive factors.Results
Hyponatremic patients displayed shorter survival (P = .04). The Cox regression for survival time showed that patients with low serum sodium values (group B) had: Child-Pugh scores with 1.13% plus risk of death for each point; cold ischemia time with 1.001% less risk of death for each minute; glycemia with 0.6% for each mg/dL; 0.66% use of cell-saver; plus a risk of death for each 100 mL plus 1.02% risk of death for each year of donor age.Conclusion
Hyponatremic cirrhotic patients show more advanced stages of disease compared to normonatremic cirrhotics. They usually display metabolic or cirrhotic decompensation and comorbidities. When these symptoms were associated with the use of extended criteria donors, increased cold ischemia time, and intraoperative bleeding, we observed lower survival rates. 相似文献19.
R.B. Martino D.R. Waisberg A.P.M. Dias V.B.S. Inoue R.M. Arantes L.B.P. Haddad W. Andraus L.D. Lopes F.H.F. Galv?o A.T.W. Song L.A.C. DAlbuquerque 《Transplantation proceedings》2018,50(3):758-761
Background
The Model for End-Stage Liver Disease (MELD) system reliably predicts mortality in cirrhotic patients. However, the etiology of liver disease and presence of portal vein thrombosis are not directly taken into account in MELD score. Its impact on the outcomes of patients on the waiting list is still unclear. The aim of this study was to investigate mortality and access to transplantation regarding etiology of liver disease and portal vein thrombosis (PVT).Methods
A total of 465 adult patients on the liver waiting list from August 2015 to August 2016 were followed up until August 2017. Patients were divided into groups according to the etiology of liver disease and presence of PVT.Results
The most frequent etiologies were hepatitis C (26.88%), alcoholic cirrhosis (26.02%) and cryptogenic cirrhosis (10.75%). Death while on the waiting list occurred in 168 patients (36.1%) and was more frequent in nonalcoholic steatohepatitis (NASH, 65.4%) and alcoholic cirrhosis (41.3%). A total of 142 (30.5%) patients underwent transplantation and viral, autoimmune, and biliary diseases showed higher proportion of transplantation (36.3%, 53.8%, and 34%, respectively; P < .01). Mean delta-MELD at the study endpoint was higher in patients with autoimmune hepatitis, biliary diseases, and NASH (8.3 ± 7.2, 8.3 ± 9.1, and 7.5 ± 9.1, respectively; P < .01). A total 77 patients (16.7%) presented PVT. There was no significant difference in outcomes between patients with and without PVT.Conclusions
Patients with NASH and alcoholic liver disease had higher mortality while on the waiting list, whereas patients with viral and autoimmune hepatitis had higher transplantation rate. Outcomes were not influenced by PVT. 相似文献20.
Wibaux C Legroux-Gerot I Dharancy S Boleslawski E Declerck N Canva V Mathurin P Pruvot FR Cortet B 《Joint, bone, spine : revue du rhumatisme》2011,78(4):387-391
Osteoporosis is common in liver transplant recipients as a result of both iatrogenic factors and preexisting hepatic osteodystrophy.