Socioeconomic status does not affect the outcome of liver transplantation

The outcome of liver transplantation is dependent on many factors. It was suggested that racial disparities in outcome may be related to differences in socioeconomic status (SES). In this retrospective study, we analyzed the effect of SES on graft and patient survival. Two hundred seventy-six adult patients who underwent liver transplantation at our institution from July 1988 to June 2001 were included in the analysis. Educational and occupation statuses were coded using established criteria (Hollingshead Index of Social Status [HI]). SES then was calculated using the HI formula: SES = education level × 3 + occupation × 5, and categorized into four groups: group 1, score less than 29 (n = 71); group 2, score of 29 to 42 (n = 82); group 3, score of 42 to 53 (n = 69); and group 4, score greater than 53 (n = 54). Kaplan-Meier analysis was used for graft and patient survival, and Cox regression analysis was used to determine the effect of confounding factors. Demographics of all four groups were similar. One-, 2-, and 5-year graft and patient survival did not differ significantly across groups by Kaplan-Meier and Cox regression survival analysis. In conclusion, SES did not predict graft and patient survival after liver transplantation. (Liver Transpl 2002;8:1133-1137.)     

Evidence that cyclosporine does not affect the metabolism of prednisolone after renal transplantation

The following investigation was performed to establish whether renal transplant patients treated with cyclosporine and prednisone have a decreased prednisolone catabolism and/or an increased systemic availability of oral prednisone when compared with patients treated with azathioprine and prednisone. Therefore we assessed, by HPLC and equilibrium dialysis, the total concentrations of prednisolone and prednisone and the unbound concentrations of prednisolone in plasma samples collected over 24 hr, and the 24-hr urinary excretion of prednisolone, prednisone, and 6 beta-hydroxyprednisolone after an i.v. dose of prednisolone and an equal oral dose of prednisone in 25 renal transplant patients on cyclosporine and in 25 patients on azathioprine and prednisone one month after transplantation. The metabolic clearance, the renal clearance, the volume of distribution, and the systemic availability of total and unbound prednisolone were identical in patients with and without cyclosporine. The apparent activities of the oxidoreductases involved in the biotransformation of prednisone into prednisolone and vice-versa were not affected by cyclosporine therapy. The fractional urinary excretions of 6 beta-hydroxyprednisolone increased with increasing metabolic clearance rate of prednisolone (r = 0.50, P less than 0.001). This relationship was not modulated by cyclosporine, indicating that cyclosporine does not affect the activity of the microsomal P-450-dependent 6 beta-hydroxylase. Thus, early after transplantation, patients on cyclosporine have a normal metabolism of prednisolone.     

Greater travel time to a liver transplant center does not adversely affect clinical outcomes.

The effect of patient travel time to a transplant center on outcomes is unknown. We compared outcomes between patients living >3 hours (Group A) vs. 90 days to list, listing, survival while listed, transplantation, and posttransplantation survival. Covariates included Model for End-Stage Liver Disease (MELD) score, hepatocellular carcinoma (HCC), alcoholic liver disease, insurance type, and psychosocial score. There were 38 (23%) patients in Group A and 128 (77%) in Group B. Median MELD scores were 14.5 (range, 6-36) for Group A and 14.0 (range, 7-32) for Group B (p = 0.20). Groups were similar for age, gender, diagnosis, psychosocial score, insurance, and HCC variables. Group A was not independently associated with >90 days to list (odds ratio, 0.98; 95% confidence interval [CI], 0.4-2.4). Kaplan-Meier cumulative probabilities for listing, transplantation, and 1-yr posttransplantation survival were similar (A vs. B: 0.77 vs. 0.83, 0.70 vs. 0.69, and 0.85 vs. 0.86, respectively; all p values >0.05). Being in Group A remained insignificant in terms of probability of listing, transplantation, and posttransplantation survival by Cox proportional hazard modeling. Survival on the list was significantly better for Group A (A: 1.0, B: 0.55; p = 0.02). Fewer patients at high MELD score in Group A and referral biases may explain this difference. In conclusion, after entering evaluation, patients living >3 hours away from a transplant center have comparable outcomes to those living closer.     

Compromised visceral circulation does not affect the outcome of colorectal surgery

Purpose

Anastomotic leakage is a serious complication after colorectal surgery, and many risk factors for this problem have so far been identified. The aim of this study was to assess the association between visceral arterial occlusive disease and anastomotic leakage.

Methods

The preoperative abdominal computed tomography scans from all consecutive patients who underwent colorectal surgery with anastomosis in 2010 were retrospectively analyzed.

Results

A total of 242 patients were included, with a median age of 65 years (interquartile range 55–74). Anastomotic leakage occurred in 14 % of cases (n = 34). The mortality rate was 3 % (n = 8). There was no association between atherosclerosis of the visceral or iliac arteries and anastomotic leakage. There was also no association between right-sided or left-sided resections and total occlusion of the superior or inferior mesenteric artery, respectively.

Conclusion

Asymptomatic visceral artery occlusive disease is not a risk factor for anastomotic leakage after colorectal surgery, and additional radiological imaging or percutaneous transluminal angioplasty for occluded visceral vessels is not indicated prior to colorectal surgery.     

Prior dialysis does not affect the outcome of pediatric renal transplantation

The effect of pretransplantation dialysis treatment was examined retrospectively in 70 children less than 6 years old receiving a primary renal transplant at the University of Minnesota. Patient and graft survivals were compared at 1, 2 and 3 years and there were no significant differences between patients who received only hemodialysis (group 1), only peritoneal dialysis (group 2), or no prior dialysis (group 3). All patients received deliberate blood transfusions before transplantation and children at risk for recurrent diseases were excluded from the analyses. No grafts were lost due to perioperative thrombosis. Also, treatment with cyclosporine A did not significantly influence the outcomes. In this series, the choice to proceed directly to renal transplantation without an interposed interval of dialysis imposes no penalty in terms of patient or graft survival. Likewise, when dialysis was required, the dialysis mode selected exerted no clear effect on the outcome of transplantation.     

On-site coagulation monitoring does not affect hemostatic outcome after cardiac surgery

BACKGROUND: Rapid coagulation tests are now available for monitoring of bleeding patients after cardiac surgery. As inappropriate blood use in these patients may be due to lack of timely coagulation data, we studied the effect of an algorithm with on-line coagulation monitoring on transfusions in these patients. METHODS: Prospectively, patients bleeding (>1.5 ml kg(-1) 15 min(-1)) after cardiac surgery were randomly assigned to two groups: in group A (n=28), hemostatic treatment during the immediate recovery period (1 h after surgery) was based on an algorithm with on-site hemostasis monitoring, whereas during the same period group B patients (n=30) were managed solely according to the clinician's judgement; laboratory tests other than activated clotting time after heparin neutralization were prohibited. RESULTS: Cumulative chest tube drainage up to 16 h and total transfusion requirements did not differ between the groups. Using a platelet transfusion trigger of 100x10(9)/l, significantly more patients received platelets during the immediate recovery period in the algorithm group than in the control group (14 vs. 3 patients, P=0.001). Desmopressin acetate was administered more often in group A than in group B (8 vs. 2 patients, P=0.04). CONCLUSIONS: Algorithm-based therapy increased utilization of hemostatic interventions during the immediate recovery period without any obvious benefit to the hemostatic outcome. Re-evaluation of the platelet transfusion trigger seems warranted.     

Increasing age does not affect good outcome after lumbar disc replacement

From 1992 to 1998 fifteen Link-Charite SB III disc prostheses were implanted into 14 patients. The main indication was degenerative lumbar disc disease with segmental instability. With a mean follow-up of 48 months (18–68 months); 12 patients had a good (10) or fair (2) outcome regarding pain relief, return to employment and level of general physical activity. In contrast to previous publications we felt that age over 45 years did not appear to adversely affect the outcome.

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Résumé  De 1992 a 1998 quinze prothe`ses discales LINK-CHARITE III ont été posées chez quatorze patients avec une dégéneration lombaire. Avec un suivi post-operatoire de 48 mois (18 – 68 mois); douze patients ont bien récupéré en ce qui concerne l’analgesie ainsi que la retour au travail et aux activites physiques générales. Nous ne trouvont pas que l’age plus de 45 ans affectait les resultats.

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Accepted: 21 November 1999     

Combined liver and pancreas procurement with Belzer-UW solution

Graft availability remains the major limitation to organ transplantation. Belzer-UW solution has been used for multiple organ procurement in 20 consecutive donors. Belzer-UW solution was used for both aortic in situ flush and ex vivo cold storage. From 20 donors, a total of 20 pancreatic grafts, 20 livers, 39 kidneys, and 10 hearts were procured. Mean preservation time was 14.2 hours for the pancreas, 16 hours for the kidney transplanted with the pancreas, 13.8 hours for the liver, and 29.9 hours for the isolated kidneys, which were machine perfused. Graft survival of the organs transplanted at the University of Wisconsin was 100% for kidney and pancreas, 93.3% for the isolated kidney, and 78.5% for the liver. When the organs referred to other centers were included, 84 of 89 procured organs were functioning at 1 month. It is concluded that multiorgan procurement with Belzer-UW solution yields excellent graft function for all abdominal organs.     

High MELD score does not adversely affect outcome of living donor liver transplantation: Experience in 1000 recipients

In countries where deceased organ donation is scarce, there is a big gap between demand and supply of organs and living donor liver transplantation (LDLT) plays an important role in meeting this unmet need. This study was conducted to analyze the effect of pretransplant Model for End‐stage Liver Disease (MELD) score on outcomes following LDLT. The outcome of 1000 patients who underwent LDLT from July 2010 to March 2015 was analyzed retrospectively. Patients were grouped into low MELD<25 and high MELD ≥25 score to compare short‐term outcomes. Cumulative overall survival rates were calculated using Kaplan‐Meier methods. A total of 849 recipients were in low MELD group (Mean MELD=16.90±9.2) and 151 were in high MELD group (Mean MELD=28.77±7.2). No significant difference in etiology of CLD was observed between groups except for a higher prevalence of hepatitis C virus (29.6% vs 19.9%, P=.01) in low MELD patients. No significant difference was observed in 1‐year survival (88.5% vs 84.1%, P=.12) between the groups. The multivariate analysis showed that pretransplant MELD score does not predict survival of recipients. Pretransplant high MELD score does not adversely affect outcomes after LDLT. In view of shortage of deceased organs, LDLT can be a good option in high MELD recipients.