Survival analysis of obese patients undergoing liver transplantation

INTRODUCTION: The influence of preoperative obesity in liver transplanted patients remains undetermined. OBJECTIVE: To analyze the survival of obese patients undergoing liver transplantation. METHODS: We calculated the body mass index (BMI; kg/m2) of 244 liver transplantation patients. All transplantations were performed from September 1991 to December 2006. The patients were divided according to the BMI values: nonobese (NO) patients (BMI<30) and obese (O) patients (BMI>30). Pre- and postoperative data were used. The following statistical tests were employed: Student's t test, Kaplan-Meier survival, and Cox-Mantel tests. RESULTS: Group O was composed of 38 individuals (15.3%) with BMI of 33.1, and the BMI of NO was 24. Group O showed an average age of 50.1 years and group NO, 45.5 years (P<.05). Group O postoperative creatinine was higher (P=.001). Both groups had similar MELD scores with an average of 17.5+/-5.9. According to the Child-Pugh classification, group NO included 140 (69.6%) B and 61 (30.3%) C patients; group O, 8 (21%) B and 30 (79%) C patients. There were no significant differences between the groups when comparing cold and warm ischemia times, surgical times, intensive care stay, or blood requirements. The actuarial survivals after 1 and 5 years were 61.3% and 51% for group O and 68% and 47% for NO group (P>.05). A Cox proportional hazard analysis showed that the survival time in this study was related to red blood cell transfusions, recipient sodium, MELD score, donor sodium, and age. Recipient age was a main factor in multiple regression analysis for obese patients in this study. CONCLUSION: There was no significant difference between O and NO for the 1-year and long-term survivals, but older patients displayed lower survival times.     

Profile of cadaveric liver donors of the OPO-UNICAMP From 2002 to 2006

INTRODUCTION: Four decades after the first successful liver transplantation, the organ donation shortage challenges the scientific community to create various new strategies. OBJECTIVES: We sought to analyze the profile of registered cadaveric liver donors for an Organ Procurement Organization (OPO) during the period of 2002 through 2006. METHODS: This retrospective analysis of 122 deceased donors in the OPO-Unicamp corresponded to the period of 2002 through 2006. RESULTS: Men were identified as 57.14% of donors and the overall average age was 32.88 years with 16.53% over 50 years of age. Analyzing the causes of brain death, cerebral trauma (CET) was responsible for 46.22% and cerebral vascular accidents, 33.61%. The percentage of use of vasoactive drugs was 88.43%. Observing the donors' backgrounds, we observed that 11.90% had alcoholism, 1.23% drug addiction and 27.78% infection. We verified cardiac arrest in 9.43%. In accordance with the expanded criteria of donation, 89.26% of donors fulfilled some of the criteria: 73.55%, one criterion; 14.05%, two; 1.65%, three; and no donor fulfilled 4 or 5. CONCLUSION: The donor profile in our unit is a young man with CET and who fulfills at least one expanded donation criterion. Finally, to increase the number of donors, the use of vasoactive drugs (89.26%), cardiopulmonary resuscitation (9.43%), and infection (27.78%) were not considered reasons to discard the liver.     

Immunoexpression of Heat Shock Protein 70, Glypican 3, Glutamine Synthetase,and Beta-Catenin in Hepatocellular Carcinoma After Liver Transplantation: Association Between Positive Glypican 3 and Beta-Catenin With the Presence of Larger Nodules

Background

Hepatocellular carcinoma (HCC) is the 6th leading cause of cancer worldwide. Its recurrence ranges from 6% to 26%. In the literature, many factors are associated with higher risk of recurrence, without a clear definition of the best method that could predict this highly lethal event.

Liver regeneration following partial hepatectomy is improved by enhancing the HGF/Met axis and Akt and Erk pathways after low-power laser irradiation in rats

A simple, easy, and safe procedure aiming to improve liver regeneration could be of great clinical benefit in critical situations such as major hepatectomy, trauma, or hemorrhage. Low-power laser irradiation (LPLI) has come into a wide range of use in clinical practice by inducing regeneration in healthy and injured tissues. However, the effect of LPLI on the process of liver regeneration, especially those related to the molecular mechanisms, is not fully understood. Thus, the aim of the present study was to investigate the main molecular mechanisms involved in liver regeneration of partially hepatectomized rats exposed to LPLI. We used Wistar male rats, which had their remaining liver irradiated or not with LPLI (wavelength of 632.8 nm and fluence of 65 mW/cm²) for 15 min after a 70 % hepatectomy. We subsequently investigated hepatocyte growth factor (HGF), Met, Akt, and Erk 1/2 signaling pathways through protein expression and phosphorylation analyses along with cell proliferation (proliferating cell nuclear antigen (PCNA) and Ki-67) using immunoblotting and histological studies. Our results show that LPLI can improve liver regeneration as shown by increased HGF protein expression and the phosphorylation levels of Met, Akt, and Erk 1/2 accompanied by higher levels of the PCNA and Ki-67 protein in the remnant livers. In summary, our results suggest that LPLI may play a clinical role as a simple, fast, and easy-to-perform strategy in order to enhance the liver regenerative capacity of a small liver remnant after hepatectomy.     

Un nouvel index pour évaluer le vieillissement artériel indépendamment de la pression artérielle : pOpscore®

AimPulse wave velocity does not correlate to age in the upper limb but in the aorta and lower limb. We studied the link between ageing and pulse wave transit time (PWtt) indexes at the toe and finger.Patients and methodsMeasurements were performed in 300 patients in occupational medicine and primary care after 5 minutes supine rest using the device studied (pOpmètre^®, Axelife SAS, France). It measures transit time between R-ECG and finger or toe pulse signal (ttf or ttt respectively). We define as follows three indexes: difference between transit times: Dtf = ttt ? ttf; pulse wave velocity PWVft = k*subjects height/Dtf (m/s); and the pOpscore^® as the ratio of toe PWV/fingerPWV.ResultsOf the 300 tested patients, 147 were analysed using univariate correlation: age (P < 10^?4), SBP (P < 10^?4), DBP (P < 0.02) and BMI (P < 0.04) correlated to Dtf, PWVtf and pOpscore^®. Using stepwise regression analysis with Age, BMI, SBP, DBP, MBP: Dtf was dependent with age (P < 10^?4) and SBP (P < 0.01); PWVtf with age (P < 0.0001), SBP (P < 0.01) and DBP (P < 0.05); pOpscore^® was dependent only to age (P < 10^?4).ConclusionIn this study, in contrast with the other vascular indexes studied dependent to age and blood pressure, pOpscore^® was dependent only to ageing. pOpmètre^® is a promising technique for routine determination of arterial stiffness and pOpscore^® appears to be appropriate to study the structural vascular ageing in outpatient.     

Race and Association With Disease Manifestations and Mortality in Scleroderma: A 20-Year Experience at the Johns Hopkins Scleroderma Center and Review of the Literature

Experience suggests that African Americans may express autoimmune disease differently than other racial groups. In the context of systemic sclerosis (scleroderma), we sought to determine whether race was related to a more adverse expression of disease. Between January 1, 1990, and December 31, 2009, a total of 409 African American and 1808 white patients with scleroderma were evaluated at a single university medical center. While the distribution by sex was virtually identical in both groups, at 82% female, African American patients presented to the center at a younger mean age than white patients (47 vs. 53 yr; p < 0.001). Two-thirds of white patients manifested the limited cutaneous subset of disease, whereas the majority of African American patients manifested the diffuse cutaneous subset (p < 0.001). The proportion seropositive for anticentromere antibody was nearly 3-fold greater among white patients, at 34%, compared to African American patients (12%; p < 0.001). Nearly a third of African American (31%) patients had autoantibodies to topoisomerase, compared to 19% of white patients (p = 0.001). Notably, African American patients experienced an increase in prevalence of cardiac (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3–2.2), renal (OR, 1.6; 95% CI, 1.2–2.1), digital ischemia (OR, 1.5; 95% CI, 1.4–2.2), muscle (OR, 1.7; 95% CI, 1.3–2.3), and restrictive lung (OR, 6.9; 95% CI, 5.1–9.4) disease. Overall, 700 (32%) patients died (159 African American; 541 white). The cumulative incidence of mortality at 10 years was 43% among African American patients compared to 35% among white patients (log-rank p = 0.0011). Compared to white patients, African American patients experienced an 80% increase in risk of mortality (relative risk [RR], 1.8; 95% CI, 1.4–2.2), after adjustment for age at disease onset and disease duration. Further adjustment by sex, disease subtype, and scleroderma-specific autoantibody status, and for the socioeconomic measures of educational attainment and health insurance status, diminished these risk estimates (RR, 1.3; 95% CI, 1.0–1.6). The heightened risk of mortality persisted in strata defined by age at disease onset, diffuse cutaneous disease, anticentromere seropositivity, decade of care at the center, and among women. These findings support the notion that race is related to a distinct phenotypic profile in scleroderma, and a more unfavorable prognosis among African Americans, warranting heightened diagnostic evaluation and vigilant care of these patients. Further, we provide a chronologic review of the literature regarding race, organ system involvement, and mortality in scleroderma; we furnish synopses of relevant reports, and summarize findings.