101
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Li X, Wu J, Mao W. Evaluation of the neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and red cell distribution width for the prediction of prognosis of patients with hepatitis B virus-related decompensated cirrhosis. J Clin Lab Anal 2020; 34:e23478. [PMID: 32666632 PMCID: PMC7676184 DOI: 10.1002/jcla.23478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background The development and progression of hepatitis B virus‐related decompensated cirrhosis (DeCi) is associated with inflammatory responses. The monocyte‐to‐lymphocyte ratio (MLR), neutrophil‐to‐lymphocyte ratio (NLR), and red cell distribution width (RDW) are well‐known inflammation markers. We aimed to assess the utility of these parameters for predicating the prognosis of patients with HBV‐DeCi. Methods We retrospectively recruited 174 patients diagnosed with HBV‐DeCi. Univariate and multivariate regression models were used to determine risk factors for mortality. Areas under the receiver operating characteristic curves were calculated to estimate and compare the predictive values of the three parameters. Hepatic function was evaluated using the Model for End‐Stage Liver Disease (MELD) score. Results The NLR, RDW, and MLR were found to be significantly higher in patients who did not survive compared with surviving patients. Moreover, these variables were all able to predict early poor outcomes in patients with HBV‐DeCi, with NLR exhibiting the highest accuracy. Furthermore, a combination of the NLR and MELD score was a more accurate prognostic marker for predicting mortality than either marker alone in such patients. Conclusions Hematological parameters can provide prognostic information for patients with HBV‐DeCi. Routine assessment of these parameters at admission may provide valuable data to complement other conventional measures for assessing disease condition in patients with HBV‐DeCi.
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Affiliation(s)
- XinKe Li
- Department of Radiation Oncology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - JianPing Wu
- Department of Clinical Laboratory, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - WeiLin Mao
- Department of Clinical Laboratory, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
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102
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Kidney Rejection Following Simultaneous Liver-kidney Transplantation. Transplant Direct 2020; 6:e569. [PMID: 32766424 PMCID: PMC7339316 DOI: 10.1097/txd.0000000000001004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022] Open
Abstract
Background. Donor-specific antibodies are reported to increase the risk of rejection and reduce allograft survival following simultaneous liver-kidney transplantation. Optimal immunosuppression regimens to reduce this risk and to treat rejection episodes are underinvestigated. Methods. Cohort analysis of the first 27 simultaneous liver-kidney transplant recipients, between 2014 and 2018 at our unit, is performed under a new risk stratification policy. Those with donor-specific antibodies to class II HLA with a mean fluorescence intensity >10 000 are considered high risk for antibody-mediated rejection (AMR). These patients received immunosuppression, which consisted of induction therapy, tacrolimus, mycophenolate mofetil, and prednisolone. All other patients are considered low risk and received tacrolimus and prednisolone alone. Results. Three patients were high risk for rejection, and 2 of these patients developed AMR, which was treated with plasma exchange and intravenous immunoglobulin. At 1 y, their estimated glomerular filtration rate (eGFR) were 50 and 59 mL/min. Two other patients developed AMR, which was similarly treated, and their 1-y eGFR was 31 and 50 mL/min. The overall histologically proven acute rejection rate within the first year was 33%, and median eGFR, for the 27 patients, at 1 y was 52 mL/min and at 2 y was 49 mL/min. Conclusions. This study confirms that there is a risk of AMR following simultaneous liver-kidney transplantation despite increased immunosuppression. This can be effectively treated with plasma exchange and intravenous immunoglobulin.
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103
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Ismail MS, Hassan M, Martinez-Camacho A, May SB, Goss JA, Kanwal F, Jalal PK. Retrospective analysis of long-term outcome 10 years after liver transplantation for Wilson disease: experience over three decades. Transpl Int 2020; 33:925-935. [PMID: 32314442 DOI: 10.1111/tri.13622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/23/2019] [Accepted: 04/14/2020] [Indexed: 01/23/2023]
Abstract
We evaluated long-term outcomes for patients with Wilson disease (WD) after liver transplantation (LT) and searched for risk factors for poor survival. Retrospective analysis of UNOS/OPTN data identified 156 pediatric and 515 adult cases of LT for WD between 1987 and 2016. Comparison cases were 10 442 pediatric and 104 874 adult non-WD transplant recipients. Survival was calculated using Kaplan-Meier analysis. Recipient, donor, and surgical variables were compared by Cox regression. Survival rates 3, 5, and 10 years after LT for adult WD patients (87.5%, 85.4%, and 80.5%, respectively) were significantly higher than those for non-WD patients (P < 0.001); survival rates for pediatric WD patients (90.5%, 89.7%, and 86.5%, respectively) did not differ significantly from non-WD patients. Graft survival in adult and pediatric patients followed similar trends. Regression analysis identified older age, female gender, and use of life support at the time of transplant as risk factors for decreased survival for adults with WD, and younger age, male gender, obesity, and high serum creatinine at the time of transplant as risk factors for poor survival in pediatric recipients with WD. Presentation with fulminant liver failure was not associated with survival in WD patients. No donor characteristic predicted poor survival. Long-term patient and graft survival after LT is excellent for both adult and pediatric WD patients.
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Affiliation(s)
- Mohamed Saleh Ismail
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA.,Department of Internal Medicine, Gastroenterology & Hepatology, Ain-Shams University, Cairo, Egypt
| | - Manal Hassan
- Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sarah B May
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - John A Goss
- Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, USA
| | - Fasiha Kanwal
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA
| | - Prasun K Jalal
- Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX, USA
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104
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Wiering L, Öllinger R, Kruppa J, Schoeneberg U, Dziodzio T, Jara M, Biebl M, Dargie R, Raschzok N, Schöning W, Eurich D, Schmelzle M, Sauer IM, Pratschke J, Ritschl PV. Hospitalization Before Liver Transplantation Predicts Posttransplant Patient Survival: A Propensity Score-Matched Analysis. Liver Transpl 2020; 26:628-639. [PMID: 32159923 DOI: 10.1002/lt.25748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 01/13/2023]
Abstract
In contrast to donor factors predicting outcomes of liver transplantation (LT), few suitable recipient parameters have been identified. To this end, we performed an in-depth analysis of hospitalization status and duration prior to LT as a potential risk factor for posttransplant outcome. The pretransplant hospitalization status of all patients undergoing LT between 2005 and 2016 at the Charité-Universitätsmedizin Berlin was analyzed retrospectively using propensity score matching. At the time of organ acceptance, 226 of 1134 (19.9%) recipients were hospitalized in an intensive care unit (ICU), 146 (12.9%) in a regular ward (RW) and 762 patients (67.2%) were at home. Hospitalized patients (RW and ICU) compared with patients from home showed a dramatically shorter 3-month survival (78.7% versus 94.4%), 1-year survival (66.3% versus 87.3%), and 3-year survival (61.7% versus 81.7%; all P < 0.001), whereas no significant difference was detected for 3-year survival between ICU and RW patients (61.5% versus 62.3%; P = 0.60). These results remained significant after propensity score matching. Furthermore, in ICU patients, but not in RW patients, survival correlated with days spent in the ICU before LT (1-year survival: 1-6 versus 7-14 days: 73.7% versus 60.5%, P = 0.04; 7-14 days versus >14 days, 60.5% versus 51.0%, P = 0.006). In conclusion, hospitalization status before transplantation is a valuable predictor of patient survival following LT.
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Affiliation(s)
- Leke Wiering
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen Kruppa
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Schoeneberg
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tomasz Dziodzio
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Maximillian Jara
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Biebl
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Richard Dargie
- Division of Emergency and Acute Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nathanael Raschzok
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Charité Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dennis Eurich
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul V Ritschl
- Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Charité Clinician Scientist Program, Berlin Institute of Health, Berlin, Germany
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105
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Parés A, Shiffman M, Vargas V, Invernizzi P, Malecha ES, Liberman A, MacConell L, Hirschfield G. Reduction and stabilization of bilirubin with obeticholic acid treatment in patients with primary biliary cholangitis. Liver Int 2020; 40:1121-1129. [PMID: 32145129 PMCID: PMC7317821 DOI: 10.1111/liv.14429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Total bilirubin is a predictor of survival in primary biliary cholangitis, with the main elevated component being direct bilirubin. The purpose of this post hoc analysis was to assess the efficacy and safety of obeticholic acid across quartiles of varying baseline levels of direct bilirubin in the phase 3, randomized, placebo-controlled Primary Biliary Cholangitis Obeticholic Acid International Study of Efficacy. METHODS This analysis assessed patients on the basis of their baseline direct bilirubin level (divided by quartile). Biochemistry and safety outcomes were evaluated within each quartile over time. RESULTS In the quartile with the highest baseline direct bilirubin (>5.47 µmol/L), there was a significant reduction in both direct and total bilirubin at Month 12 compared with placebo. Least squares mean (standard error) change from baseline in direct bilirubin at Month 12 was 4.17 (1.42) µmol/L for placebo, -3.48 (1.63) µmol/L for obeticholic acid 5-10 mg and -3.66 (1.51) µmol/L for obeticholic acid 10 mg (P < .0001, obeticholic acid vs placebo); the corresponding values for total bilirubin at Month 12 were 4.38 (1.55) µmol/L for placebo, -4.53 (1.83) µmol/L for obeticholic acid 5-10 mg and -5.06 (1.64) µmol/L for obeticholic acid 10 mg (P < .0001, obeticholic acid vs placebo). CONCLUSIONS Obeticholic acid treatment was associated with significant reductions in total and direct bilirubin, particularly in patients with high baseline direct bilirubin. Because raised direct bilirubin levels, even within the normal range, are predictive of survival in primary biliary cholangitis, these results suggest substantial benefits of obeticholic acid in at-risk patients.
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Affiliation(s)
- Albert Parés
- Hospital ClinicUniversity of BarcelonaIDIBAPSCIBERehdBarcelonaSpain
| | - Mitchell Shiffman
- Liver Institute of VirginiaBon Secours Mercy HealthNewport NewsVAUSA
| | - Victor Vargas
- Liver UnitHospital Vall d'HebronUniversitat Autònoma de BarcelonaCIBERehdBarcelonaSpain
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver DiseasesSan Gerardo HospitalDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | | | | | | | - Gideon Hirschfield
- Toronto Centre for Liver DiseaseToronto General Hospital and Department of MedicineUniversity of TorontoTorontoCanada
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106
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Nie Y, Wan SZ, Zhang Y, Liu C, Zhu X. Serum Urea Predicts Long-term Mortality in Hospitalized Patients with Decompensated Cirrhosis. HEPATITIS MONTHLY 2020; 20. [DOI: 10.5812/hepatmon.99497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 08/30/2023]
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107
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Amiri M, Toosi MN, Moazzami B, Jafarian A, Shahsavari H, Javaherian M, Dashti H, Fakhar N, Karimi M, Khani F. Factors Associated With Length of Hospital Stay Following Liver Transplant Surgery. EXP CLIN TRANSPLANT 2020; 18:313-319. [PMID: 32133943 DOI: 10.6002/ect.2019.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Length of stay is considered an important surrogate for transplant survival rate and resource utilization. Therefore, in the present study, our aim was to determine factors affecting length of hospital stay. MATERIALS AND METHODS We retrospectively analyzed records of patients who underwent liver transplant at the Tehran University of Medical Sciences Liver Transplantation Center from March 2014 to March 2016. RESULTS For our final analyses, there were 161 adult recipients, including 106 males (65.8%) and 55 females (34.1%). Univariate analyses showed that body mass index, Modelfor End-Stage Liver Disease score, duration of surgery, number of administered packed red blood cells and fibrinogen during surgery, reoperation, retransplant, bacterial infection, pleural effusion, ascites, renal failure that required dialysis, and wound infection were risk factors for length of hospital stay. After multivariate linear regression analysis, only body mass index (β = 0.016; P = .028), Model for End-Stage Liver Disease score (β = 0.017; P = .002), surgical duration (β = 0.002; P = .001), reoperation (β = 0.016; P < .001), presence of pleural effusion (β = 0.212; P = .042), and management of bacterial infection (β = 0.21; P = .03) and psychiatric problems after liver transplant (β = 0.213; P = .025) were independent risk factors for length of hospital stay. CONCLUSIONS The present study showed that multiple preoperative, intraoperative, and postoperative variables could have an impact on length of hospitalization. Therefore, methods for assessing these factors could improve patient outcomes and resource savings in liver transplant centers.
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Affiliation(s)
- Mahmoud Amiri
- >From the Department of Medical-Surgical Nursing, School of Nursing and Midwifery, University of Medical Sciences, Tehran, Iran
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108
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Cools KS, Moon AM, Burke LM, McGinty KA, Strassle PD, Gerber DA. Validation of the Liver Imaging Reporting and Data System Treatment Response Criteria After Thermal Ablation for Hepatocellular Carcinoma. Liver Transpl 2020; 26:203-214. [PMID: 31677319 PMCID: PMC6980979 DOI: 10.1002/lt.25673] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 10/26/2019] [Indexed: 12/17/2022]
Abstract
Single hepatocellular carcinoma (HCC) tumors can be successfully eradicated with thermal ablation (TA). We assessed the validity of the Liver Imaging Reporting and Data System Treatment Response (LR-TR) criteria with a retrospective analysis of a single-center database of patients with small HCC tumors (<3 cm in diameter) who underwent both laparoscopic TA and liver transplantation (LT) from 2004 to 2018. Postablation MRIs were assigned LR-TR categories (nonviable, equivocal, and viable) for ablated lesions and Liver Imaging Reporting and Data System (LI-RADS) categories (probable or definite HCC) for untreated lesions. Interpretations were compared with the histopathology of the post-LT explanted liver. There were 45 patients with 81 tumors (59 ablated and 22 untreated; mean size, 2.2 cm), and 23 (39%) of the ablated tumors had viable HCC on histopathology. The sensitivity/specificity of LR-TR categories (nonviable/equivocal versus viable) of ablated tumors was 30%/99%, with a positive predictive value (PPV)/negative predictive value (NPV) of 93%/69%. The sensitivity varied with residual tumor size. The sensitivity/specificity of LI-RADS 4 and 5 diagnostic criteria at detecting new HCC was 65%/94%, respectively, with a PPV/NPV of 85%/84%. The interrater reliability (IRR) was high for LR-TR categories (90% agreement, Cohen's ĸ = 0.75) and for LI-RADS LR-4 and LR-5 diagnostic categories (91% agreement, Cohen's ĸ = 0.80). In patients with HCC <3 cm in diameter, LR-TR criteria after TA had high IRR but low sensitivity, suggesting that the LR-TR categories are precise but inaccurate. The low sensitivity may be secondary to TA's disruption in the local blood flow of the tissue, which could affect the arterial enhancement phase on MRI. Additional investigation and new technologies may be necessary to improve imaging after ablation.
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Affiliation(s)
- Katherine S. Cools
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Andrew M. Moon
- Division of Gastroenterology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lauren M.B. Burke
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Katrina A. McGinty
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Paula D. Strassle
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC,Department of Epidemiology, University of North Carolina School of Public Health
| | - David A. Gerber
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC,Lineberger Cancer Center, University of North Carolina, Chapel Hill, NC
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109
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Wang XH, Jiang XM, Gao PX, Liu Q, Yuan JH, Chen SJ. Risk factors and prognostic analysis of acute-on-chronic liver failure of chronic hepatitis B after cessation of nucleos(t)ide analogs. Eur J Gastroenterol Hepatol 2020; 32:265-275. [PMID: 31789948 DOI: 10.1097/meg.0000000000001574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND To explore the risk factors and prognostic factors related to the acute-on-chronic liver failure (ACLF) occurrence and adverse outcome after withdrawal of nucleos(t)ide analogs (NAs) in chronic hepatitis B (CHB) patients. METHODS Hospitalized CHB patients with relapse after NAs withdrawal at our medical center were retrospectively included in the present study from January 2011 to May 2018. Logistic regression, Cox regression analysis, Kaplan-Meier log-rank test, and area under the receiver operating characteristic curves (AUROC) were used. RESULTS A total of 389 CHB patients (including 46 ACLF patients) were included. Their median age was 48.0 years; 315 patients were male and 74 were female. The age ≥30 years and HBVDNA ≤1000 copies at admission in logistic regression were the independent risk factors for ACLF after NAs withdrawal in CHB patients. In patients who developed ACLF, only the model of end-stage liver disease combining serum natrium concentration (MELD-Na) score and relapse after Lamivudine (LAM) cessation in the Cox multivariate regression analysis were independent predictors for 12-week mortality. The artificial liver support system (ALSS) showed no improvement in the 12-week survival of ACLF patients. We further defined 22.35 as the optimal cutoff value of MELD-Na score to predict 12-week mortality for ACLF patients, with the AUROC of 0.817, a sensitivity of 76.5%, and a specificity of 75.9%. CONCLUSION The age ≥30 years and HBVDNA ≤1000 copies at admission strongly correlate with occurrence of ACLF, and higher MELD-Na score and relapse after LAM withdrawal are closely related with 12-week mortality among patients with ACLF after NAs withdrawal.
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Affiliation(s)
- Xiao-Hua Wang
- Departments of Infectious Diseases and Liver diseases, Jinan Infectious Disease Hospital, Shandong University
| | - Xue-Mei Jiang
- Departments of Infectious Diseases and Liver diseases, Jinan Infectious Disease Hospital, Shandong University
| | | | - Qian Liu
- Departments of Infectious Diseases and Liver diseases, Jinan Infectious Disease Hospital, Shandong University
| | - Jun-Hua Yuan
- Department of Gastroenterology, Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Shi-Jun Chen
- Departments of Infectious Diseases and Liver diseases, Jinan Infectious Disease Hospital, Shandong University
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110
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Namba M, Hiramatsu A, Aikata H, Kodama K, Uchikawa S, Ohya K, Morio K, Fujino H, Nakahara T, Murakami E, Yamauchi M, Kawaoka T, Tsuge M, Imamura M, Chayama K. Management of refractory ascites attenuates muscle mass reduction and improves survival in patients with decompensated cirrhosis. J Gastroenterol 2020; 55:217-226. [PMID: 31485782 DOI: 10.1007/s00535-019-01623-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study investigated time-course changes in skeletal muscle volume per year with tolvaptan in patients with refractory ascites that was unresponsive to loop diuretics and aldosterone antagonists. METHODS This retrospective study included 42 patients who received tolvaptan for refractory ascites and/or hepatic edema and underwent computed tomography (CT) before and ≥ 3 months after initiating tolvaptan. The time-course changes in skeletal muscle index per year [ΔSMI (%)] was calculated as follows: ΔSMI (%) = (SMI at final CT scan - SMI at initial CT scan)/SMI at initial CT scan × 100/years between CT scans. RESULTS Eligible patients were 23 men and 19 women of median age of 71 years (range 21-94 years). The median follow-up period was 22.7 (range 3.5-54.6) months. ΔSMI (%) was significantly higher in the responders group than in the nonresponder group. Multivariate analysis showed the response to tolvaptan was an independent and significant factor associated with an increase in muscle mass [odds ratio (OR) 20.364; 95% CI 2.327-178.97; P = 0.006]. Overall survival with tolvaptan was significantly higher in the responder group than in the nonresponder group. Multivariate analysis showed that the response to tolvaptan treatment was a significant contributor to good prognosis (OR 3.884; 95% CI 1.264-11.931; P = 0.018). A significant negative correlation was observed between the dosage of furosemide and ΔSMI (%) (P = 0.014). CONCLUSIONS Treatment of refractory ascites with tolvaptan may attenuate the progression of sarcopenia and improve the prognosis in patients with decompensated cirrhosis.
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Affiliation(s)
- Maiko Namba
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Akira Hiramatsu
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Hiroshi Aikata
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kenichiro Kodama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Shinsuke Uchikawa
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuki Ohya
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kei Morio
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hatsue Fujino
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Takashi Nakahara
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Eisuke Murakami
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Masami Yamauchi
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Tomokazu Kawaoka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Masataka Tsuge
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Michio Imamura
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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111
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Qi ZL, Sun LY, Bai J, Zhuang HZ, Duan ML. Japanese encephalitis following liver transplantation: A rare case report. World J Clin Cases 2020; 8:337-342. [PMID: 32047783 PMCID: PMC7000955 DOI: 10.12998/wjcc.v8.i2.337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a serious public health concern with a high mortality rate in many Asian countries. For many years, JE virus (JEV) was considered the major cause of viral encephalitis in Asia. Although most JE cases are asymptomatic, the case fatality rate approaches 30%, and approximately 30%–50% of survivors have long-term neurological sequelae. To the best of our knowledge, JEV infection has never been reported following liver transplantation.
CASE SUMMARY We report a case of a woman who underwent liver transplantation for autoimmune liver disease but presented with fever and neurological symptoms 13 d after transplantation. Magnetic resonance imaging revealed JEV infection, and positive immunoglobulin M antibody to JEV in blood and cerebrospinal fluid confirmed JE. The patient was treated with antiviral agents, immune regulation, and organ function support. No neurological sequelae were present after 1 year of follow-up.
CONCLUSION Imaging and lumbar puncture examination should be performed as soon as possible in patients with fever and central nervous system symptoms after liver transplantation, and the possibility of atypical infection should be considered, which is helpful for early diagnosis and improved prognosis.
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Affiliation(s)
- Zhi-Li Qi
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Li-Ying Sun
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
- Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jing Bai
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Hai-Zhou Zhuang
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Mei-Li Duan
- Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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112
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Fagenson AM, Gleeson EM, Pitt HA, Lau KN. Albumin-Bilirubin Score vs Model for End-Stage Liver Disease in Predicting Post-Hepatectomy Outcomes. J Am Coll Surg 2020; 230:637-645. [PMID: 31954813 DOI: 10.1016/j.jamcollsurg.2019.12.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Albumin-Bilirubin score (ALBI) has been established to predict outcomes after hepatectomy. However, the relative value of ALBI and Model for End-Stage Liver Disease (MELD) in predicting post-hepatectomy liver failure and mortality has not been adequately evaluated. Therefore, the aim of this study was to validate and compare ALBI and MELD with respect to post-hepatectomy liver failure and mortality. STUDY DESIGN Patients undergoing major hepatectomy (≥3 segments) or partial hepatectomy (≤2 segments) were identified in the 2014 to 2017 American College of Surgeons NSQIP Procedure Targeted Participant Use File. Univariable and multivariable analyses were performed for 30-day post-hepatectomy liver failure (PHLF) and mortality. Predictive accuracy was assessed using a receiver operator characteristic curve and calculating the area under the curve (AUC). RESULTS For 13,783 patients, median ALBI was -2.6, and median MELD score was 6.9. Severe PHLF (grade B to C) and mortality rates were 2.9% and 1.8%, respectively. Multivariable analyses revealed ALBI grade 2/3 to be a stronger predictor than MELD ≥10 with respect to severe PHLF (odds ratio [OR] 2.30; 95% CI, 1.95 to 2.73; p < 0.001 vs OR 1.00; 95% CI, 0.78 to 1.23; p = 0.99) and mortality (OR 3.35; 95% CI, 2.49 to 4.52; p < 0.001 vs OR 1.73; 95% CI, 1.36 to 2.20; p < 0.001). ALBI also had better discrimination compared with MELD for severe PHLF (AUC 0.67 vs AUC 0.60) and mortality (AUC 0.70 vs AUC 0.58) in patients with hepatocellular carcinoma. CONCLUSIONS ALBI is a powerful predictor of PHLF and mortality. Compared with MELD, ALBI is more accurate, especially in patients with hepatocellular carcinoma.
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Affiliation(s)
| | - Elizabeth M Gleeson
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Henry A Pitt
- Department of Surgery, Temple University Hospital, Philadelphia, PA; Temple University Health System, Philadelphia, PA.
| | - Kwan N Lau
- Department of Surgery, Temple University Hospital, Philadelphia, PA
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113
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Liver Transplantation. THE CRITICALLY ILL CIRRHOTIC PATIENT 2020. [PMCID: PMC7122092 DOI: 10.1007/978-3-030-24490-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The field of liver transplantation has changed since the MELD scoring system became the most widely used donor allocation tool. Due to the MELD-based allocation system, sicker patients with higher MELD scores are being transplanted. Persistent organ donor shortages remain a challenging issue, and as a result, the wait-list mortality is a persistent problem for most of the regions. This chapter focuses on deceased donor and live donor liver transplantation in patients with complications of portal hypertension. Special attention will also be placed on donor-recipient matching, perioperative management of transplant patients, and the impact of hepatic hemodynamics on transplantation.
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114
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Geographic Disparities in Liver Allocation and Distribution in the United States: Where Are We Now? Transplant Proc 2019; 51:3205-3212. [PMID: 31732201 DOI: 10.1016/j.transproceed.2019.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/24/2019] [Accepted: 07/09/2019] [Indexed: 12/13/2022]
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115
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Zhou J, Mao W, Shen L, Huang H. Plasma D-dimer as a novel biomarker for predicting poor outcomes in HBV-related decompensated cirrhosis. Medicine (Baltimore) 2019; 98:e18527. [PMID: 31876748 PMCID: PMC6946568 DOI: 10.1097/md.0000000000018527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This study aim was to evaluate whether plasma D-dimer levels could serve as a novel prognostic biomarker for 1-month mortality in patients with HBV-related decompensated cirrhosis (HBV-DeCi).This was a retrospective study that enrolled 132 HBV-DeCi patients. Univariate and multivariate regression models were used to identify risk factors for mortality. The area under the receiver operating characteristic curve was calculated to estimate and compare the predictive values of different prognostic markers.In the present study, the plasma D-dimer levels were higher in the nonsurviving group than in the surviving group. Additionally, the D-dimer level was positively correlated with the model for end-stage liver disease (MELD) score. The results of multivariate analysis showed that both the MELD score and D-dimer level are independent predictors of 1-month mortality in HBV-DeCi patients (both P < .01).Plasma D-dimer can be considered a new additional prognostic marker for 1-month mortality in HBV-DeCi patients.
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Affiliation(s)
- Jing Zhou
- Department of Brain Surgery, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou
| | - WeiLin Mao
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang
- Key Laboratory of Digestive System Diseases of Shengzhou, Shengzhou People's Hospital, Shengzhou
| | - LiangJun Shen
- Department of Brain Surgery, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University, Shengzhou
| | - HongGuang Huang
- Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
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116
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Harumatsu T, Muraji T, Masuya R, Ohtani H, Nagai T, Yano K, Onishi S, Yamada K, Yamada W, Matsukubo M, Muto M, Kaji T, Ieiri S. Microvascular proliferation of the portal vein branches in the liver of biliary atresia patients at Kasai operation is associated with a better long-term clinical outcome. Pediatr Surg Int 2019; 35:1437-1441. [PMID: 31542827 DOI: 10.1007/s00383-019-04579-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 12/11/2022]
Abstract
AIM OF THE STUDY We previously showed an increased number of smaller portal vein (PV) branches in the portal areas of liver biopsy specimens of biliary atresia (BA) patients. We evaluated the correlation between this histopathological feature and the prognosis. PATIENTS AND METHODS Twenty-five consecutive patients with BA encountered between 2000 and 2012 were classified into three prognostic groups based on their postoperative outcomes: Excellent (n = 11) for native-liver survivors with a normal liver function, Good (n = 6) for native-liver survivors with liver dysfunction, and Poor (n = 8) for survivors after liver transplant or on a waiting list. Data from morphometrical analyses, including the fibrotic portal area, numbers of PVs, diameter and total area of PV branches, were statistically compared among the three groups. MAIN RESULTS The number of PV branches per unit area of the whole-liver specimen in the poor prognostic group was significantly lower than that in the excellent group (3.1 ± 0.6 vs. 5.2 ± 2.0/mm2, p = 0.03). There were no significant differences in the other parameters. CONCLUSIONS This is the first report on the relationships between morphometrically analyzed PV branches and the postoperative course in BA patients. The portal venous system is involved as the primary lesion in BA.
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Affiliation(s)
- Toshio Harumatsu
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Toshihiro Muraji
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.,Department of Pediatric Surgery, Kirishima Medical Center, Kagoshima, Japan
| | - Ryuta Masuya
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Haruo Ohtani
- Department of Pathology, Ibaraki Children's Hospital, Mito, Japan
| | - Taichiro Nagai
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.,Clinical Training Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Makoto Matsukubo
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.,Clinical Training Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima City, 890-8520, Japan.
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Georgiou A, Papatheodoridis GV, Alexopoulou A, Deutsch M, Vlachogiannakos I, Ioannidou P, Papageorgiou MV, Papadopoulos N, Yannakoulia M, Kontogianni MD. Validation of cutoffs for skeletal muscle mass index based on computed tomography analysis against dual energy X-ray absorptiometry in patients with cirrhosis: the KIRRHOS study. Ann Gastroenterol 2019; 33:80-86. [PMID: 31892802 PMCID: PMC6928470 DOI: 10.20524/aog.2019.0432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Accurate assessments of muscle mass in patients with cirrhosis are necessary in clinical practice. Computed tomography (CT) of the upper abdomen has been proposed as a useful method for quantifying muscle mass. Recently, Carey et al developed specific cutoffs for muscle wasting based on the skeletal muscle index at the L3 vertebra (L3-SMI) for cirrhotic patients. The aim of the present study was to assess the concurrent validity of the newly proposed cutoffs of Carey et al, along with others widely used in several clinical contexts, using dual energy X-ray absorptiometry (DXA) as the reference method. Methods: Data were evaluated from 97 Caucasian patients (59.8% male, 59.1±11.6 years old, 45.4% decompensated) with cirrhosis of various etiologies. Muscle mass was assessed using the appendicular lean mass index (ALMI) by DXA and the L3-SMI by CT. Low L3-SMI was defined in relation to 5 different cutoffs. Results: Low muscle mass prevalence was 13.4% according to ALMI and 26.8-45.4% according to the different cutoffs applied for L3-SMI. The Carey et al, Prado et al and Montano-Loza et al cutoffs showed similar sensitivity (all 69.2%) and specificity (79.8%, 76.2% and 75.0%, respectively) and high accuracy (78.4%, 75.3% and 74.2%). The Carey et al cutoffs showed the highest diagnostic validity against DXA the multivariate odds ratio adjusted for age, sex, body mass index category, disease etiology and model for end-stage liver disease score (95% confidence interval) was 5.88 (1.36-25.4), P=0.018. Conclusion: Compared to DXA, the cutoffs for identifying muscle wasting proposed by Carey et al were proven to be the most accurate.
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Affiliation(s)
- Alexandra Georgiou
- Department of Dietetics Nutrition and School of Health Education Sciences and Harokopio University (Georgiou Alexandra Yannakoulia Mary Meropi D. Kontogianni) Gastroenterology
| | - Georgios V Papatheodoridis
- Department of Medical School of National and Kapodistrian Athens University of Laiko General Hospital of Athens (Papatheodoridis Georgios V. Vlachogiannakos Ioannis Ioannidou Panagiota Maria-Vasiliki Papageorgiou)
| | - Alexandra Alexopoulou
- 2nd Department Medicine of Internal Medical School of National and Kapodistrian Athens University of Hippokration General Athens Hospital of Athens Greece (Alexopoulou Alexandra Melanie Deutsch)
| | - Melanie Deutsch
- 2nd Department Medicine of Internal Medical School of National and Kapodistrian Athens University of Hippokration General Athens Hospital of Athens Greece (Alexopoulou Alexandra Melanie Deutsch)
| | - Ioannis Vlachogiannakos
- Department of Medical School of National and Kapodistrian Athens University of Laiko General Hospital of Athens (Papatheodoridis Georgios V. Vlachogiannakos Ioannis Ioannidou Panagiota Maria-Vasiliki Papageorgiou)
| | - Panagiota Ioannidou
- Department of Medical School of National and Kapodistrian Athens University of Laiko General Hospital of Athens (Papatheodoridis Georgios V. Vlachogiannakos Ioannis Ioannidou Panagiota Maria-Vasiliki Papageorgiou)
| | - Maria-Vasiliki Papageorgiou
- Department of Medical School of National and Kapodistrian Athens University of Laiko General Hospital of Athens (Papatheodoridis Georgios V. Vlachogiannakos Ioannis Ioannidou Panagiota Maria-Vasiliki Papageorgiou)
| | - Nikolaos Papadopoulos
- 1st Department Medicine of Internal Army Share Fund Hospital of Athens (Nikolaos Papadopoulos) Athens Greece
| | - Mary Yannakoulia
- Department of Dietetics Nutrition and School of Health Education Sciences and Harokopio University (Georgiou Alexandra Yannakoulia Mary Meropi D. Kontogianni) Gastroenterology
| | - Meropi D Kontogianni
- Department of Dietetics Nutrition and School of Health Education Sciences and Harokopio University (Georgiou Alexandra Yannakoulia Mary Meropi D. Kontogianni) Gastroenterology
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Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study. Br J Nutr 2019; 122:1368-1376. [DOI: 10.1017/s0007114519002277] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractMalnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5–54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.
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119
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Abstract
Ascites occurs in up to 70% of patients during the natural history of cirrhosis. Management of uncomplicated ascites includes sodium restriction and diuretic therapy, whereas that for refractory ascites (RA) is regular large-volume paracentesis with transjugular intrahepatic portosystemic shunt being offered in appropriate patients. Renal impairment occurs in up to 50% of patients with RA with type 1 hepatorenal syndrome (HRS) being most severe. Liver transplant remains the definitive treatment of eligible candidates with HRS, whereas combined liver and kidney transplant should be considered in patients requiring dialysis for more than 4 to 6 weeks or those with underlying chronic kidney disease.
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120
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Shorter Height Is Associated With Lower Probability of Liver Transplantation in Patients With Hepatocellular Carcinoma. Transplantation 2019; 104:988-995. [PMID: 31577670 DOI: 10.1097/tp.0000000000002975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The effect of height and sex on liver transplantation (LT) for hepatocellular carcinoma (HCC) remains unclear. METHODS Using United Network for Organ Sharing (UNOS) data, 14 844 HCC patients listed for LT from 2005 to 2015 were identified. Cumulative incidence of waitlist events (LT and dropout for death or too sick) were calculated and modeled using Fine and Gray competing risk regression. RESULTS Short (SWR), mid (MWR), and long (LWR) UNOS wait regions comprised 25%, 42%, and 33% of the cohort. Three-year cumulative incidence of LT was lower in shorter height patients (≤150, 151-165, and >185 cm; 70.8%, 76.7%, and 83.5%; P < 0.001) and women (78.2% versus 79.8%; P < 0.001). On multivariable analysis, shorter height (≤150, 151-165 cm, hazard ratio [HR] versus >185 cm) was associated with lower probability of LT (0.81 and 0.89; P = 0.02) and greater dropout (HR 1.99 and 1.43; P < 0.001). Female sex was not associated with LT overall, but a significant sex and wait region interaction (P = 0.006) identified lower LT probability for women in MWR (HR versus men, 0.91; P = 0.02). CONCLUSIONS Despite uniform HCC Model for End-Stage Liver Disease exception across height and sex, shorter patients and females in MWR have lower probability of LT. Consideration should be given to awarding additional Model for End-Stage Liver Disease exception points to these patients.
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121
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Maheshwari A, Bajpai M, Patidar GK. Effects of therapeutic plasma exchange on liver function test and coagulation parameters in acute liver failure patients. Hematol Transfus Cell Ther 2019; 42:125-128. [PMID: 31387798 PMCID: PMC7248502 DOI: 10.1016/j.htct.2019.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 01/26/2023] Open
Abstract
Background Currently the treatment of choice for critical liver failure is liver transplantation. Liver failure is treated conservatively until a matching liver donor becomes available. The therapeutic plasma exchange (TPE) plays an important role as a bridge to transplantation by removing accumulated toxins from patient plasma, as well as restoring the coagulation profile. Method This was a retrospective study on critically ill liver disease patients who underwent TPE from January 2012 to September 2015. The data were collected for the analyses of coagulation parameters, liver function tests, renal function tests, model for end-stage liver disease (MELD) scores, mortality, and hospital stay. Results In the study duration, a total of 45 patients with critical liver disease underwent therapeutic plasma exchange. The TPE resulted in a statistically significant reduction in the bilirubin level, aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time (PT), international normalized ratio (INR), serum ferritin level and MELD scores. Higher MELD scores in both pre- and post-TPE were associated with higher mortality during the hospital stay. Conclusion The TPE is safe and well-tolerated, and it improves coagulation profile and liver function tests in critically ill liver disease patients, but the overall survival remains low.
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Affiliation(s)
| | - Meenu Bajpai
- Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
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122
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Serum Tumor Necrosis Factor-α Is Inversely Associated With the Psoas Muscle Index in Both Male and Female Patients Scheduled for Living Donor Liver Transplantation. Transplant Proc 2019; 51:1874-1879. [PMID: 31262437 DOI: 10.1016/j.transproceed.2019.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/09/2019] [Accepted: 03/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients on a waiting list for liver transplantation frequently show core muscle wasting, referred to as sarcopenia, which results in poor prognosis. To date, there has been a lack of research on the association between inflammation mediators, including cytokines, and loss of core muscle mass in cirrhotic patients scheduled for living donor liver transplantation (LDLT). METHODS Cytokines in serum, such as interleukin (IL)-2, IL-6, IL-10, IL-12, IL-17, interferon-γ, and tumor necrosis factor (TNF)-α, were retrospectively investigated in 234 LDLT patients 1 day before surgery. The psoas muscle area was measured using abdominal computed tomography within 1 month before surgery and used to calculate the psoas muscle index (PMI = psoas muscle area/height2). The study population was classified into 2 groups according to the interquartile range of PMI: a non-sarcopenia group (> 25th quartile) and a sarcopenia group (≤ 25th quartile) in each sex. RESULTS In both sexes, IL-10 and TNF-α levels were significantly higher in the sarcopenia group than the non-sarcopenia group. In a univariate analysis, male patients showed that serum IL-10 and TNF-α levels were potentially associated with sarcopenia. Serum TNF-α was independently associated with sarcopenia in a multivariate analysis. In female patients, TNF-α was significantly associated with sarcopenia in both univariate and multivariate analyses. Male patients with a PMI ≤ 25th quartile had significantly higher TNF-α levels than those in other quartile ranges, and female patients with a PMI ≤ 25th quartile had a significantly higher TNF-α level than those with a PMI > 75th quartile. CONCLUSIONS Serum levels of TNF-α are inversely associated with skeletal muscle wasting in both male and female patients scheduled for LDLT.
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123
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Moreno Gonzales M, Sanchez W, Taner T. Liver transplantation: When to say yes or no? Based on a case report. TRANSPLANTATION REPORTS 2019. [DOI: 10.1016/j.tpr.2019.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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124
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Kalisvaart M, Schlegel A, Trivedi PJ, Roberts K, Mirza DF, Perera T, Isaac JI, Ferguson J, de Jonge J, Muiesan P. Chronic Kidney Disease After Liver Transplantation: Impact of Extended Criteria Grafts. Liver Transpl 2019; 25:922-933. [PMID: 30947384 DOI: 10.1002/lt.25468] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/03/2019] [Indexed: 12/13/2022]
Abstract
The use of extended criteria donor (ECD) grafts has been associated with acute kidney injury (AKI) after liver transplantation. However, the relation between graft quality and development of chronic kidney disease (CKD) remains unknown. Therefore, the aim of this study was to analyze the impact of ECD grafts for CKD after liver transplantation. All patients (2007-2015) transplanted for end-stage liver disease at our center were assessed. Longterm kidney function was divided into 4 groups: no CKD (estimated glomerular filtration rate [eGFR], ≥60 mL/minute/1.73 m2 ), mild CKD (eGFR, 30-59 mL/minute/1.73 m2 ), severe CKD (eGFR, 15-29 mL/minute/1.73 m2 ), and end-stage renal disease (ESRD). Marginal donation after brain death (DBD) grafts (donor age, >70 years; body mass index, >35 kg/m2 ; cold storage, >12 hours) and donation after circulatory death (DCD) grafts were considered ECD grafts. Overall, 926 patients were included, and 43% received an ECD graft (15% marginal DBD; 28% DCD). After 5 years, 35% developed CKD; severe CKD and ESRD occurred in only 2% and 1%, respectively. CKD rates were comparable for all 3 graft groups (standard group, 36%; marginal DBD group, 29%; DCD group, 35%; standard versus marginal DBD groups, P = 0.16; standard versus DCD group, P = 0.80). None of the ECD criteria were identified as independent risk factors in a Cox regression model for CKD. Risk factors included recipient age, female sex, and preoperative kidney function. Furthermore, recipients who had severe acute kidney injury (AKI; Kidney Disease: Improving Global Outcomes stages 2 and 3) had a 1.8-fold increased risk for CKD. Longterm kidney function of recipients with severe AKI depended on the recovery of kidney function in the first postoperative week. In conclusion, there is no direct relation between the use of ECD grafts and CKD after liver transplantation. However, caution should be taken in recipients who experience severe AKI, regardless of graft type.
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Affiliation(s)
- Marit Kalisvaart
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom.,Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andrea Schlegel
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Palak J Trivedi
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Keith Roberts
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Darius F Mirza
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - Thamara Perera
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - John I Isaac
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
| | - James Ferguson
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom.,National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, United Kingdom
| | - Jeroen de Jonge
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Paolo Muiesan
- The Liver Unit, Queen Elizabeth University Hospital Birmingham, Birmingham, United Kingdom
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Hasanin AS, Mahmoud FM, Soliman HM. Factors affecting acid base status during hepatectomy in cirrhotic patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ashraf S. Hasanin
- Department of Anesthesia & ICU, National Liver Institute, Menoufia University, Egypt
| | - Fatma M.A. Mahmoud
- Department of Anesthesia & ICU, National Liver Institute, Menoufia University, Egypt
| | - Hossam M. Soliman
- Department of Hepatobiliary Surgery & Liver Transplantation, National Liver Institute, Menoufia University, Egypt
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126
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Lee J, Lee JG, Jung I, Joo DJ, Kim SI, Kim MS. Development of a Korean Liver Allocation System using Model for End Stage Liver Disease Scores: A Nationwide, Multicenter study. Sci Rep 2019; 9:7495. [PMID: 31097768 PMCID: PMC6522508 DOI: 10.1038/s41598-019-43965-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 05/01/2019] [Indexed: 02/08/2023] Open
Abstract
The previous Korean liver allocation system was based on Child-Turcotte-Pugh scores, but increasing numbers of deceased donors created a pressing need to develop an equitable, objective allocation system based on model for end-stage liver disease scores (MELD scores). A nationwide, multicenter, retrospective cohort study of candidates registered for liver transplantation from January 2009 to December 2011 was conducted at 11 transplant centers. Classification and regression tree (CART) analysis was used to stratify MELD score ranges according to waitlist survival. Of the 2702 patients that registered for liver transplantation, 2248 chronic liver disease patients were eligible. CART analysis indicated several MELD scores significantly predicted waitlist survival. The 90-day waitlist survival rates of patients with MELD scores of 31-40, 21-30, and ≤20 were 16.2%, 64.1%, and 95.9%, respectively (P < 0.001). Furthermore, the 14-day waitlist survival rates of severely ill patients (MELD 31-40, n = 240) with MELD scores of 31-37 (n = 140) and 38-40 (n = 100) were 64% and 43.4%, respectively (P = 0.001). Among patients with MELD > 20, presence of HCC did not affect waitlist survival (P = 0.405). Considering the lack of donor organs and geographic disparities in Korea, we proposed the use of a national broader sharing of liver for the sickest patients (MELD ≥ 38) to reduce waitlist mortality. HCC patients with MELD ≤ 20 need additional MELD points to allow them equitable access to transplantation. Based on these results, the Korean Network for Organ Sharing implemented the MELD allocation system in 2016.
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Affiliation(s)
- Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Advisory Committee on Improving Liver Allocation, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Inkyung Jung
- Department of Biostatistics and Medical Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soon Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- The Advisory Committee on Improving Liver Allocation, Seoul, Republic of Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
- The Advisory Committee on Improving Liver Allocation, Seoul, Republic of Korea.
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Healthy Body Weights With Corticosteroid-free Immunosuppression Is the Best Predictor of Cardiovascular Health in Children After Liver Transplantation. J Pediatr Gastroenterol Nutr 2019; 68:713-719. [PMID: 30676521 DOI: 10.1097/mpg.0000000000002271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Cardiometabolic dysregulation (CMD) influences morbidity and mortality risk in adults post-liver transplantation (LTx). CMD is reported in 10% to 25% of pediatric LTx recipients, but no information regarding the longitudinal expression of CMD is available. The study objective was to examine the longitudinal expression of CMD and associations with body composition and growth in children post-LTx. METHODS A retrospective review was conducted in youth (34 F/30 M) who underwent LTx between 1994 and 2015 at the Stollery Children's Hospital. Primary outcomes included serum markers of CMD (insulin, glucose, hemoglobin A1C [A1C], homeostasis model assessment for insulin resistance [abnormal >3], lipid panel triglycerides, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol) and systolic/diastolic blood pressure (BP: absolute/z scores). RESULTS Mean (±SD) age, weight z, height z, body mass index z was 9.7 ± 3.4 years (3.5-17.9), 0.26 ± 1.03, 0.017 ± 1.2, and 0.41 ± 1.05, respectively. The majority of children had percentage fat mass, percentage fat-free mass within normal reference ranges. Systolic/diastolic BP was within healthy references ranges in 83.1% and 93.5% of children, respectively. Serum insulin (83.4%) and high-density lipoprotein-cholesterol (43.9%) concentrations were low, with abnormal findings of other laboratory markers found in <5% of participants. Abnormal findings for metabolic parameters were independent of weight z, body mass index z, fat mass, and corticosteroids but were positively related to child's age (>9.7 years) and fat-free mass (total, arms). Insulin levels decreased significantly in the first 4 years post-LTx, but no changes in lipid panel, A1C and glucose were noted over 10 years. CONCLUSIONS Pediatric LTx recipients with healthy body weights and corticosteroid-free immunosuppression have a low expression of CMD over 10 years.
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Neong SF, Adebayo D, Wong F. An update on the pathogenesis and clinical management of cirrhosis with refractory ascites. Expert Rev Gastroenterol Hepatol 2019; 13:293-305. [PMID: 30791777 DOI: 10.1080/17474124.2018.1555469] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ascites commonly complicates cirrhosis, becoming refractory to treatment with diuretics and sodium restriction in approximately 10% of patients. Pathogenesis of refractory ascites (RA) is multifactorial, the common final pathway being renal hypoperfusion and avid sodium retention. Refractory ascites has a negative prognostic implication in the natural history of cirrhosis. Management of RA include sodium restriction and regular large volume paracentesis (LVP) with albumin infusions, preventing paracentesis-induced circulatory dysfunction. In appropriate setting, transjugular intrahepatic porto-systemic shunt (TIPS) can be considered. Ascites clearance with TIPS can lead to nutritional improvement, avoiding sarcopenia. Liver transplantation (LT) remains the definitive treatment for eligible candidates. Areas covered: Our review summarizes current updates on pathogenesis and clinical management of RA including potential future therapeutic options such as the automated slow-flow ascites pump, chronic outpatient albumin infusion and cell-free and concentrated ascites reinfusion therapy. Expert commentary: Standard of care in patients with RA include LVP with albumin replacement and prompt referral for LT where indicated. Other novel therapeutic options on the horizon include automated low-flow ascites pump and cell-free, concentrated albumin reinfusion therapy.
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Affiliation(s)
- Shuet Fong Neong
- a Division of Gastroenterology, Department of Medicine, Toronto General Hospital , University of Toronto , Toronto , Ontario , Canada
| | - Danielle Adebayo
- a Division of Gastroenterology, Department of Medicine, Toronto General Hospital , University of Toronto , Toronto , Ontario , Canada
| | - Florence Wong
- a Division of Gastroenterology, Department of Medicine, Toronto General Hospital , University of Toronto , Toronto , Ontario , Canada
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129
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Zhang QK, Wang ML. Value of Model for End-Stage Liver Disease-Serum Sodium Scores in Predicting Complication Severity Grades After Liver Transplantation for Acute-on-chronic Liver Failure. Transplant Proc 2019; 51:833-841. [DOI: 10.1016/j.transproceed.2019.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023]
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130
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Freeman AJ, Sellers ZM, Mazariegos G, Kelly A, Saiman L, Mallory G, Ling SC, Narkewicz MR, Leung DH. A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis-Associated Liver Disease. Liver Transpl 2019; 25:640-657. [PMID: 30697907 DOI: 10.1002/lt.25421] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/09/2019] [Indexed: 12/16/2022]
Abstract
Approximately 5%-10% of patients with cystic fibrosis (CF) will develop advanced liver disease with portal hypertension, representing the third leading cause of death among patients with CF. Cystic fibrosis with advanced liver disease and portal hypertension (CFLD) represents the most significant risk to patient mortality, second only to pulmonary or lung transplant complications in patients with CF. Currently, there is no medical therapy to treat or reverse CFLD. Liver transplantation (LT) in patients with CFLD with portal hypertension confers a significant survival advantage over those who do not receive LT, although the timing in which to optimize this benefit is unclear. Despite the value and efficacy of LT in selected patients with CFLD, established clinical criteria outlining indications and timing for LT as well as disease-specific transplant considerations are notably absent. The goal of this comprehensive and multidisciplinary report is to present recommendations on the unique CF-specific pre- and post-LT management issues clinicians should consider and will face.
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Affiliation(s)
- A Jay Freeman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Healthcare of Atlanta, Atlanta, GA
| | - Zachary M Sellers
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA
| | - George Mazariegos
- Department of Surgery and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Andrea Kelly
- Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, Philadelphia, PA.,Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Medical Center, New York, NY.,Division of Pediatric Infectious Diseases, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - George Mallory
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.,Divisions of Pediatric Pulmonary Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Simon C Ling
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Toronto, Ontario, Canada
| | - Michael R Narkewicz
- Digestive Health Institute, Children's Hospital of Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Daniel H Leung
- Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.,Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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The ability of the new ALBI scoring in predicting mortality, complications and prognostic comparison among cirrhotics. GASTROENTEROLOGY REVIEW 2019; 14:250-257. [PMID: 31988671 PMCID: PMC6983760 DOI: 10.5114/pg.2019.83872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/26/2019] [Indexed: 02/08/2023]
Abstract
Introduction Albumin-bilirubin (ALBI) is a newly devised scoring system for prognostication of liver cirrhosis. The ALBI has recently been validated and found superior to Child-Turcotte-Pugh score (CTP) and Model for End stage Liver Disease (MELD) in assessing severity of liver disease. Aim To determine the ALBI score's mortality prediction among cirrhotics, associated complications and to compare its prognostic proficiency to that of MELD and CTP. Material and methods The diagnostic accuracy of CTP, MELD and ALBI scores for mortality in hospitalized cirrhotic patients was determined by receiver operating characteristic curve (ROC) analysis. The areas under the ROC curve were calculated, with confidence intervals (CI) of 95%. The best cut-off values were ascertained with the greatest specificity and sensitivity. Results The study showed overall in-hospital mortality of 25.5%. Median CTP score was 10.2 (IQR = 3) and area under curve (AUC) was 0.842 (95% CI: 0.817-0.868, p < 0.001) with sensitivity of 75.0% and specificity of 79.2%. Median MELD score was 20.9 (IQR = 7.2) and AUC was 0.836 (95% CI: 0.810-0.863, p < 0.001) with sensitivity of 76.6% and specificity of 76.7%. Median ALBI score was -1.1 (IQR = 1.0), and AUC of ALBI was 0.852 (95% CI: 0.826-0.879, p < 0.001) with sensitivity and specificity of 78.1%. Conclusions The objective prognostication and easy utilization of ALBI make it a useful alternative to MELD and CTP and therefore favour its applicability in clinical practice. Further validations in large prospective cohorts are needed for prognostic value of ALBI in cirrhosis and its complications.
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Impact of Regional Organ Sharing and Allocation in the UK Northern Liver Alliance on Waiting Time to Liver Transplantation and Waitlist Survival. Transplantation 2019; 103:2304-2311. [PMID: 30830042 DOI: 10.1097/tp.0000000000002687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United Kingdom, liver transplantation (LT) is undertaken in 7 supraregional centers. Until March 2018, liver grafts were offered to a center and allocated to a patient on their elective waiting list (WL) based on unit prioritization. Patients in Newcastle, Leeds, and Edinburgh with a United Kingdom Model for End-Stage Liver Disease (UKELD) score ≥62 were registered on a common WL and prioritized for deceased-donor liver allocation. This was known as the Northern Liver Alliance (NLA) "top-band scheme." Organs were shared between the 3 centers, with a "payback" scheme ensuring no patient in any center was disadvantaged. We investigated whether the NLA had improved WL survival and waiting time (WT) to transplantation. METHODS Data for this study were obtained from the UK Transplant Registry maintained by National Health Service Blood and Transplant. This study was based on adult patients registered for first elective liver transplant between April 2013 and December 2016. Non-NLA centers were controls. The Kaplan-Meier method was used to estimate WL survival and median WT to transplant, with the log-rank test used to make comparisons; a Bonferroni correction was applied post hoc to determine pairwise differences. RESULTS WT was significantly lower at NLA centers compared with non-NLA centers for top-band patients (23 versus 99 days, P < 0.001). However, WL survival was not significantly different for top-band patients (P > 0.999) comparing NLA with non-NLA centers. WL survival for nontop-band patients was no different (P > 0.999) comparing NLA with non-NLA centers. CONCLUSIONS The NLA achieved its aim, providing earlier transplantation to patients with the greatest need. Nontop-band patients did not experience inferior survival.
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Serum Cystatin C Predicts Mortality in HBV-Related Decompensated Cirrhosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7272045. [PMID: 30949507 PMCID: PMC6425319 DOI: 10.1155/2019/7272045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/20/2019] [Accepted: 02/05/2019] [Indexed: 01/06/2023]
Abstract
Background Some studies have reported that renal dysfunction is associated with poor prognosis in cirrhotic patients. Serum cystatin C (CysC) is an accurate biomarker for early renal dysfunction. This study aimed to assess the prognostic value of serum CysC levels in patients with hepatitis B virus-related decompensated cirrhosis (HBV-DeCi). Methods This retrospective study included 75 subjects who had been diagnosed with HBV-DeCi. The association between serum CysC and prognosis was estimated by receiver operating characteristic curve analysis and a multivariable logistic regression model. Results Serum CysC levels were higher in nonsurvivors than in survivors and were positively correlated with model for end-stage liver disease (MELD) scores. In multivariate analysis, CysC and the MELD score were independent prognostic factors in all HBV-DeCi patients. However, only serum CysC was an independent factor predicting mortality in patients with normal creatinine levels. Conclusions These data suggest that high serum CysC levels can be considered an independent biomarker of 3-month mortality in patients with HBV-DeCi.
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Kartoun U. Toward an accelerated adoption of data-driven findings in medicine : Research, skepticism, and the need to speed up public visibility of data-driven findings. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:153-157. [PMID: 29882052 DOI: 10.1007/s11019-018-9845-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To accelerate the adoption of a new method with a high potential to replace or extend an existing, presumably less accurate, medical scoring system, evaluation should begin days after the new concept is presented publicly, not years or even decades later. Metaphorically speaking, as chameleons capable of quickly changing colors to help their bodies adjust to changes in temperature or light, health-care decision makers should be capable of more quickly evaluating new data-driven insights and tools and should integrate the highest performing ones into national and international care systems. Doing so is essential, because it will truly save the lives of many individuals.
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Affiliation(s)
- Uri Kartoun
- Center for Computational Health, IBM Research, Cambridge, MA, USA.
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135
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Correlation Between MELD and UNa/K Ratio in Predicting Renal Dysfunction in Cirrhotic Patients. J Transl Int Med 2019; 6:181-184. [PMID: 30637205 PMCID: PMC6326034 DOI: 10.2478/jtim-2018-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background Renal dysfunction is one of the dreaded complications of cirrhosis. MELD is a validated chronic liver disease (CLD) severity scoring system. Urinary (U) Na/K ratio closely correlates with renal dysfunction in terms of low GFR in cirrhotic patients. Patients and Methods All consecutive patients with decompensated cirrhosis between the age of 18 to 70 years, of either gender, presenting in the outpatients’ department of Sindh Institute of Urology and Transplantation, Karachi, from June 2015 to June 2017 were included. The MELD score was calculated and the UNa/K ratio less than 1 was taken as surrogate marker of renal dysfunction. Statistical analysis was performed by SPSS (version 20.0). Results A total of 71 patients were enrolled. The mean age was 43.79 years and majority were male (67.6%). The most common cause of liver cirrhosis was HCV, found in 42 (59.2%) patients. The mean CTP score was 10.48 ± 2.069 (range: 6–14) with majority of the patients following in class C, that is, 48 (67.6%). Mean MELD score was 21.75 ± 8.96 (range: 8–43). In 57 patients (80.3%), MELD score was > 15.The mean serum creatinine and mean serum sodium were 1.5 ± 1.1 mg/dl (range: 0.37–5.3) and 133.79 ± 6.9 mmol/L (range: 112–152), respectively. Mean urinary sodium and urinary potassium were 38.60 ± 46.64 mmol/L (range: 5–181) and 38.15 ± 23.9 mmol/L (range: 4.3–112), respectively. In majority of study population, UNa/K ratio was below 1, that is, in 52 patients (73.2%). Statistically significant correlation was documented between MELD score and UNa/K ratio (ɤ = 0.34, P = 0.004). Conclusion The inverse correlation between MELD scores and UNa/K ratio indicates that patients with CLD and higher MELD scores might have renal dysfunction. This finding however should be corroborated by large scale studies.
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Abstract
Ascites, a common complication of liver cirrhosis, eventually becomes refractory to diuretic therapy and sodium restriction in ∼10% of patients. Multiple pathogenetic factors are involved in the development of refractory ascites, which ultimately lead to renal hypoperfusion and avid sodium retention. Therefore, renal dysfunction commonly accompanies refractory ascites. Management includes continuation of sodium restriction, which needs frequent reviews for adherence; and regular large volume paracentesis of 5 L or more with albumin infusions to prevent the development of paracentesis-induced circulatory dysfunction. In the appropriate patients with reasonable liver reserve, the insertion of a transjugular intrahepatic portosystemic stent shunt (TIPS) can be considered, especially if the patient is relatively young and has no previous hepatic encephalopathy or anatomical contraindications, and no past history of renal or cardiopulmonary disease. Response to TIPS with ascites clearance can lead to nutritional improvement. Devices such as an automated low-flow ascites pump may be available in the future for ascites treatment. Patients with refractory ascites and poor liver function and/or renal dysfunction, should be referred for liver transplant, as this will eliminate the portal hypertension and liver dysfunction. Renal dysfunction prior to liver transplant largely improves after transplant without affecting post-transplant survival.
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Affiliation(s)
- Danielle Adebayo
- Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. These authors contributed equally: Danielle Adebayo, Shuet Fong Neong
| | - Shuet Fong Neong
- Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. These authors contributed equally: Danielle Adebayo, Shuet Fong Neong
| | - Florence Wong
- Division of Gastroenterology, Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. These authors contributed equally: Danielle Adebayo, Shuet Fong Neong
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137
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Wu SL, Zheng YX, Tian ZW, Chen MS, Tan HZ. Scoring systems for prediction of mortality in decompensated liver cirrhosis: A meta-analysis of test accuracy. World J Clin Cases 2018; 6:995-1006. [PMID: 30568954 PMCID: PMC6288518 DOI: 10.12998/wjcc.v6.i15.995] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/08/2018] [Accepted: 11/14/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the accuracy of the scoring systems Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease score (MELD), MELD-Na, and MELD to Serum Sodium ratio (MESO) to predict the mortality in decompensated liver cirrhosis. METHODS The PubMed, Web of Science, Cochrane Library, EMBASE, and Ovid databases were systematically searched from inception to September 2018 for relevant articles, and we evaluated the quality of the included studies. The accuracy of scoring systems was analyzed with Stata 12 and MetaDiSc 1.4. RESULTS Sixteen studies involving 2337 patients were included. The pooled areas under the summary receiver operating characteristic curves (AUROCs) of CTP, MELD, MELD-Na, and MESO to predict mortality were 0.81, 0.78, 0.85, and 0.86, respectively. Within 3 mo, the AUROCs of CTP, MELD, and MELD-Na in predicting mortality were 0.78, 0.76, and 0.89, respectively. The AUROCs of CTP, MELD, and MELD-Na at 3 mo were 0.86, 0.78, and 0.86, respectively. The AUROCs of CTP, MELD, and MELD-Na at 6 mo were 0.91, 0.83, and 0.90, respectively. The AUROCs of CTP, MELD, and MELD-Na at 12 mo were 0.72, 0.75 and 0.84, respectively. In cirrhotic patients with bleeding, the AUROCs of CTP and MELD were 0.76 and 0.88, respectively. CONCLUSION MESO has the highest AUROC in all assessed scoring systems. Considering the different time points, MELD-Na has good accuracy in predicting the mortality of decompensated liver cirrhosis. Compared to CTP, MELD is better in predicting variceal bleeding.
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Affiliation(s)
- Shi-Lan Wu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410000, Hunan Province, China
| | - Yi-Xiang Zheng
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha 410000, Hunan Province, China
| | - Zheng-Wen Tian
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410000, Hunan Province, China
| | - Meng-Shi Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410000, Hunan Province, China
| | - Hong-Zhuan Tan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410000, Hunan Province, China
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138
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Ferre-Aracil C, Lledó JL, Aguilera L, Garcia-Paredes A, Rodríguez-Santiago E, Graus J, García-González M, Nuño J, López-Buenadicha A, López-Hervás P, Rodríguez-Gandía M, Gea F, Albillos A. Current allocation policy is favorable for patients with hepatocellular carcinoma waiting for liver transplantation. Dig Liver Dis 2018; 50:1345-1350. [PMID: 29807872 DOI: 10.1016/j.dld.2018.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/04/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with hepatocellular carcinoma (HCC) are a growing population of the transplantation waiting list (WL) for orthotopic liver transplantation (OLT). There is no consensus to prioritize these patients while on the WL. AIMS To assess whether patients with HCC were more prioritized than non-HCC patients based on their WL survival as primary outcome. METHODS Restrospective cohort study including patients listed for elective OLT from January 2013 to January 2016. RESULTS 165 patients with cirrhosis were listed for OLT: 64 in the HCC group (38.78%) and 101 in the non-HCC group (61.22%). Outcomes (HCC vs. non-HCC) were: OLT in 75.51% vs. 64.37%; death or dropout due to worsening in 20.41% vs. 27.59%, and delisting because of improvement in 4.08% vs. 8.05%. HCC patients had a significantly higher WL survival rate (HR = 0.45; 95% CI: 0.21-0.96); lower MELD score at transplantation (21 [20-24] vs. 24 [20-30]; p = 0.021); higher delta-MELD - the difference between MELD at transplantation and MELD at listing time - (3 [2-6] vs. 0 [0-5]; p = 0.024) and longer waiting time until OLT (143 [70-233] vs. 67 [21-164] days; p = 0.008). CONCLUSION Despite having to wait longer, patients with HCC showed higher WL survival than non-HCC patients.
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Affiliation(s)
- Carlos Ferre-Aracil
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - José-Luis Lledó
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Lara Aguilera
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Ana Garcia-Paredes
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Enrique Rodríguez-Santiago
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Javier Graus
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Miguel García-González
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Javier Nuño
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Adolfo López-Buenadicha
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Pedro López-Hervás
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Miguel Rodríguez-Gandía
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Francisco Gea
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain
| | - Agustín Albillos
- Departments of Gastroenterology and General Surgery, Liver Transplantation Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERHD-Instituto de Salud Carlos III, Universidad de Alcalá, Madrid, Spain.
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139
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Mahmud N, Gadsden MM, Goldberg DS. Is the Pediatric End-stage Liver Disease Score Truly a Detriment to Pediatric Liver Allocation? JAMA Pediatr 2018; 172:1013-1015. [PMID: 30242354 PMCID: PMC6309193 DOI: 10.1001/jamapediatrics.2018.2886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nadim Mahmud
- Division of Gastroenterology, Department of Medicine, Perelman
School of Medicine, University of Pennsylvania, Philadelphia
| | - Melissa M. Gadsden
- Department of Medicine, Perelman School of Medicine, University of
Pennsylvania, Philadelphia
| | - David S. Goldberg
- Division of Gastroenterology, Department of Medicine, Perelman
School of Medicine, University of Pennsylvania, Philadelphia,Clinical Center for Clinical Epidemiology and Biostatistics,
University of Pennsylvania, Philadelphia
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140
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Hypoalbuminemia is Associated With Significantly Higher Liver Transplant Waitlist Mortality and Lower Probability of Receiving Liver Transplant. J Clin Gastroenterol 2018; 52:913-917. [PMID: 29356783 DOI: 10.1097/mcg.0000000000000984] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
GOALS To evaluate the predictive value of hypoalbuminemia on liver transplant (LT) waitlist survival and probability of receiving LT among adults with end-stage liver disease (ESLD). BACKGROUND Growing evidence reports on the negative prognostic value of hypoalbuminemia among ESLD patients awaiting LT. METHODS Using 2003 to 2015 United Network for Organ Sharing data, we retrospectively evaluated the impact of mild-moderate (2.5 to 3.4 g/dL) and severe hypoalbuminemia (<2.5 g/dL) on waitlist survival and probability of receiving LT among US adults awaiting LT. Outcomes were stratified by liver disease etiology and presence of hepatocellular carcinoma (HCC), and evaluated using Kaplan-Meier and multivariate Cox proportional hazards models. RESULTS Among 128,450 adults listed for LT, 27.1% had normal albumin (≥3.5 g/dL), 53.7% mild-moderate hypoalbuminemia (2.5 to 3.4 g/dL), and 19.2% severe hypoalbuminemia (<2.5 g/dL) at time of listing. Patients with severe hypoalbuminemia had significantly lower 1-year waitlist survival compared with those with normal albumin (80.4% vs. 95.2%; P<0.001). On multivariate regression, severity of hypoalbuminemia was associated with increasing waitlist mortality, even after correcting for model for end stage liver disease-sodium and HCC [albumin, 2.5 to 3.4 g/dL: hazard ratio (HR), 1.81; 95% confidence interval (CI), 1.62-2.01; P<0.001; <2.5 g/dL: HR, 2.46; 95% CI, 2.20-2.76; P<0.001]. Patients with hypoalbuminemia had significantly lower probability of receiving LT compared with those with normal albumin (albumin <2.5 g/dL: HR, 0.80; 95% CI, 0.78-0.83; P<0.001). CONCLUSIONS ESLD patients with hypoalbuminemia have lower probability of LT despite significantly higher waitlist mortality compared with patients with normal albumin. If validated by further studies, incorporation of albumin into prognostication systems may improve the performance of US donor organ allocation systems.
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141
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Kang SH, Jeong WK, Baik SK, Cha SH, Kim MY. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle 2018; 9:860-870. [PMID: 30371017 PMCID: PMC6204582 DOI: 10.1002/jcsm.12333] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sarcopenia has been reported as a prognostic factor. We evaluated the impact of sarcopenia to the conventional prognostic factors [Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, hepatic venous pressure gradient (HVPG)] in cirrhosis. METHODS Overall, 452 patients with cirrhosis were stratified by MELD score (low < 15, high ≥ 15), CTP class, and HVPG [non-clinically significant portal hypertension (CSPH), 6-9 mmHg; CSPH, 10-19 mmHg; extremely severe PH, ≥20 mmHg]. L3 skeletal muscle index as marker of sarcopenia was subdivided into quartiles (47.01-52.25-58.22 cm2 /m2 ). RESULTS Among the patients, 42% (190/452) presented with sarcopenia. During a median follow-up period of 21.2 months, sarcopenia was associated with mortality (adjusted hazard ratio = 2.253, P < 0.001) and specifically with compensated and early decompensated stages of cirrhosis, but not with advanced decompensated stages; low (P < 0.001) and high (P = 0.095) MELD scores; CTP classes A (P = 0.034), B (P < 0.001), and C (P = 0.205); and non-CSPH (P = 0.018), CSPH (P < 0.001), and extremely severe PH (P = 0.846). In quartiles of sarcopenia, MELD score, CTP class, and HVPG were independent predictors of mortality in non-sarcopenia, but not in severe sarcopenia (MELD, P = 0.182; CTP, P = 0.187; HVPG, P = 0.077). CONCLUSIONS Sarcopenia is associated with mortality in compensated and early decompensated cirrhosis, and existing conventional prognostic factors had limited value in severe sarcopenia. Therefore, incorporating sarcopenia in the conventional prognostic factors had added value, particularly in compensated and early decompensated cirrhosis. Subclassification of prognostic factors according to sarcopenia may help to better assess the prognosis of cirrhosis.
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Affiliation(s)
- Seong Hee Kang
- Department of Internal MedicineYonsei University Wonju College of MedicineWonjuKorea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging ScienceSungkyunkwan University School of MedicineSeoulKorea
| | - Soon Koo Baik
- Department of Internal MedicineYonsei University Wonju College of MedicineWonjuKorea
- Cell Therapy and Tissue Engineering CenterYonsei University Wonju College of MedicineWonjuKorea
- Institute of Evidence Based MedicineYonsei University Wonju College of MedicineWonjuKorea
| | - Seung Hwan Cha
- Department of RadiologyYonsei University Wonju College of MedicineWonjuKorea
| | - Moon Young Kim
- Department of Internal MedicineYonsei University Wonju College of MedicineWonjuKorea
- Cell Therapy and Tissue Engineering CenterYonsei University Wonju College of MedicineWonjuKorea
- Institute of Evidence Based MedicineYonsei University Wonju College of MedicineWonjuKorea
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142
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Locklear CT, Golabi P, Gerber L, Younossi ZM. Exercise as an intervention for patients with end-stage liver disease: Systematic review. Medicine (Baltimore) 2018; 97:e12774. [PMID: 30334965 PMCID: PMC6211898 DOI: 10.1097/md.0000000000012774] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Various etiologies of chronic liver disease often result in cirrhosis. Beside obvious liver-related complications, cirrhosis also leads to loss of muscle mass and decreased exercise capacity. In this study, our aim was to conduct a systematic review of literature to investigate the efficacy of exercise interventions in patients with cirrhosis. METHOD PubMed was used to perform the literature search. The mesh terms used were the following: (liver (and) cirrhosis (and) exercise or (exercise therapy)). The following terms were excluded: Non-alcoholic fatty liver disease (NAFLD). The search was limited to the English language and human research. The initial search was conducted on December 6, 2016 and re-reviewed May 2017. RESULTS Seven studies met selection criteria. Training interventions ranged between 4 and 14 weeks in duration with an exercise frequency of 3 to 5 days per week. Most studies demonstrated an increase in maximal oxygen consumption using gas exchange techniques. Two of 3 studies demonstrated increased distance covered in the 6-minute walk test. One study showed a clinically significant decrease in hepatic venous pressure gradient, while another showed a transient increase only during exercise. There were no adverse effects of the exercise program reported. CONCLUSIONS Exercise in selected patients with cirrhosis can have potential benefit in endurance and functional outcome measures without adverse effect from exercise.
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Affiliation(s)
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Lynn Gerber
- Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
| | - Zobair M. Younossi
- Center For Liver Disease, Department of Medicine, Inova Fairfax Hospital
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, United States
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143
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Lee HA, Cho EY, Kim TH, Lee Y, Suh SJ, Jung YK, Kim JH, An H, Seo YS, Kim DS, Yim HJ, Yeon JE, Byun KS, Um SH. Risk Factors for Dropout From the Liver Transplant Waiting List of Hepatocellular Carcinoma Patients Under Locoregional Treatment. Transplant Proc 2018; 50:3521-3526. [PMID: 30577230 DOI: 10.1016/j.transproceed.2018.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/29/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND In new organ allocation policy, patients with hepatocellular carcinoma (HCC) experience a 6-month delay in being granted Model for End-Stage Liver Disease exception points. However, it may not be fair for patients at risk of early progression of HCC. METHODS All patients who were diagnosed as United Network for Organ Sharing (UNOS) stage 1 or 2 of HCC between January 2004 and December 2012 were included. Patients who received surgical resection or liver transplant (LT) as a primary treatment and who did not receive any treatment for HCC were excluded. Patients with baseline Model for End-Stage Liver Disease score ≥22 were also excluded because they have a higher chance of receiving LT. Patients who developed extrahepatic progression within 1 year were considered as high-risk for early recurrence after LT. RESULTS A total of 586 patients were included. Mean (SD) age was 59.9 (10.3) years and 409 patients (69.8%) were men. The cumulative incidence of estimated dropout was 8.9% at 6 months; size of the maximum nodule (≥3 cm) and nonachievement of complete response were independent factors. Extrahepatic progression developed in 16 patients (2.7%) within 1 year; size of the maximum nodule (4 cm) and alpha-fetoprotein level (>100 ng/mL) were independent predictors. CONCLUSIONS The estimated dropout rate from the waiting list within 6 months was 8.9%. Advantage points might be needed for patients with maximum nodule size ≥3 cm or those with noncomplete response. However, in patients with maximum nodule size ≥4 cm or alpha-fetoprotein level >100 ng/mL, caution is needed.
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Affiliation(s)
- H A Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - E Y Cho
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - T H Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Y Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - S J Suh
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Y K Jung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - J H Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - H An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Y S Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
| | - D-S Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - H J Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
| | - J E Yeon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - K S Byun
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - S H Um
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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144
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Habibollahi P, Hunt S, Bitterman T, Gade TP, Soulen MC, Nadolski G. Definitive locoregional therapy (LRT) versus bridging LRT and liver transplantation with wait-and-not-treat approach for very early stage hepatocellular carcinoma. Diagn Interv Radiol 2018; 24:213-218. [PMID: 30091712 DOI: 10.5152/dir.2018.17418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Since the change in the United Network for Organ Sharing (UNOS) policy excluding patients with very early stage hepatocellular carcinoma (veHCC, single tumor nodule <2 cm) from receiving Model for End-stage Liver Disease (MELD) exception points, patients eligible to receive liver transplantation (LT) who fall in this category are commonly treated with locoregional therapy (LRT) after progression to UNOS T2 stage (1 nodule of 2-5 cm or up to 3 nodules, none above 3 cm). The aim of the current study is to compare the outcomes of patients treated with bridging LRT and LT with wait-and-not-treat approach with patients treated with definitive LRT. METHODS A retrospective study has been performed on patients with veHCC evaluated in multidisciplinary liver tumor clinic of a large academic center between 2004-2011. Patients eligible for LT were assigned to the wait-and-not-treat group while patients who were not eligible were assigned to the definitive LRT group. Tumor size, time to treatment, severity of liver disease, recurrence and survival from time of detection were reviewed and recorded. RESULTS A total of 19 patients were identified and treated with definitive LRT while 57 patients were treated with bridging LRT prior to LT after disease progression to T2 stage. Patients in the definitive LRT group were older (70.4±10.2 years vs. 58.7±5.9 years, P < 0.001) and had more comorbid conditions compared with the wait-and-not-treat group. Mean survival for definitive LRT group at the end of 5 years was 34.3±6.0 months with a median of 30.3 months (95% CI, 5.7-55.0 months) compared with 48.7±2.6 months for the wait-and-not-treat group, respectively (median not reached). The 3- and 5-year survival rates were 53.3% and 33.3% for the definitive LRT group compared with 78.9% and 68.4% for the patients in the wait-and-not-treat group. Survival rate at the end of 5 years was significantly better for the wait-and-not-treat group (P = 0.013). CONCLUSION Based on the findings of current retrospective study, treating veHCC (UNOS T1 stage) patients listed for LT with bridging LRT after disease progression to T2 stage appears to be safe and effective with high 5-year survival rates.
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Affiliation(s)
| | - Stephen Hunt
- PIGI Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Therese Bitterman
- Department of Hepatology and Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Terence P Gade
- PIGI Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Nadolski
- PIGI Laboratory, University of Pennsylvania, Philadelphia, PA, USA
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145
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Gorial FI, Hassan AM. Diagnostic Performance of Red Cell Distribution Width in Adult Iraqi Patients with Ankylosing Spondylitis. ARTHRITIS 2018; 2018:2904694. [PMID: 30174952 PMCID: PMC6098932 DOI: 10.1155/2018/2904694] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is a chronic, progressive inflammatory rheumatic disease that leads to structural damage, functional impairment, and decrease in the quality of life. Red cell distribution width (RDW) is a part of the complete blood count (CBC) and estimates erythrocyte variability. OBJECTIVE To analyse RDW in patients with AS and to evaluate the relationships with acute phase reactants (APRs) and disease activity index. PATIENTS AND METHODS A total of 100 patients with AS (78 males and 22 females) were diagnosed according to the modified New York classification criteria for AS and 146 (99 males: 47 females) healthy individuals matched in age and sex as controls enrolled in the study. Demographic data, disease activity scores using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), medical history, C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), and complete blood count (CBC) were measured. RESULTS The mean age for patients and controls was 38.0 ± 9.0 and 35.8 ± 9.0 years, respectively (p=0.057). RDW was significantly higher in patients with AS compared with controls (14.133 ± 1.613 versus 12.299 ± 1.031, p < 0.001). There was a direct correlation of RDW with both ESR and CRP (P < 0.001); RDW had r=0.38 for C-reactive protein (CRP) and r=0.413 for ESR. Also BASDAI was directly correlated with RDW (r=0.326 p<0.001). RDW was a valid measure to differentiate between patients with AS and controls (AUC=0,84, p<0.001) and at optimum cut-off value>13% has highest accuracy (78.9%) with very good sensitivity test (81%) and NPV (85.6%) as well as good specificity (77.4%) and PPV (71.1%). CONCLUSION RDW was higher in AS patients compared with controls and was directly correlated with ESR, CRP, and BASDAI. RDW was a valid simple measure with good accuracy to differentiate between patients with AS and controls.
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Affiliation(s)
- Faiq I. Gorial
- Rheumatology Unit, Department of Medicine, Collage of Medicine, University of Bagdad, Iraq
| | - Ali M. Hassan
- Baghdad Teaching Hospital, Rheumatology Unit, Baghdad, Iraq
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146
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Mager DR, Hager A, Ooi PH, Siminoski K, Gilmour SM, Yap JY. Persistence of Sarcopenia After Pediatric Liver Transplantation Is Associated With Poorer Growth and Recurrent Hospital Admissions. JPEN J Parenter Enteral Nutr 2018; 43:271-280. [DOI: 10.1002/jpen.1414] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/04/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Diana R. Mager
- Department of Agricultural, Food & Nutritional SciencesUniversity of Alberta Edmonton Alberta Canada
- Department of PediatricsUniversity of Alberta Edmonton Alberta Canada
| | - Amber Hager
- Department of Agricultural, Food & Nutritional SciencesUniversity of Alberta Edmonton Alberta Canada
| | - Poh Hwa Ooi
- Department of Agricultural, Food & Nutritional SciencesUniversity of Alberta Edmonton Alberta Canada
| | | | - Susan M. Gilmour
- Department of PediatricsUniversity of Alberta Edmonton Alberta Canada
- Division of Pediatric Gastroenterology & Nutrition/Transplant ServicesThe Stollery Children's Hospital, Alberta Health Services Edmonton Alberta Canada
| | - Jason Y.K. Yap
- Department of PediatricsUniversity of Alberta Edmonton Alberta Canada
- Division of Pediatric Gastroenterology & Nutrition/Transplant ServicesThe Stollery Children's Hospital, Alberta Health Services Edmonton Alberta Canada
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147
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Complications after Living Donor Hepatectomy: Analysis of 176 Cases at a Single Center. J Am Coll Surg 2018; 227:24-36. [DOI: 10.1016/j.jamcollsurg.2018.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/31/2018] [Accepted: 03/05/2018] [Indexed: 02/06/2023]
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148
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149
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Mitchell E, Loomes KM, Squires RH, Goldberg D. Variability in acceptance of organ offers by pediatric transplant centers and its impact on wait-list mortality. Liver Transpl 2018; 24:803-809. [PMID: 29506323 DOI: 10.1002/lt.25048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
Recent data have suggested that pediatric patients wait-listed for a liver transplantation frequently have liver offers declined. However, factors associated with liver offer decisions and center-level variability in practice patterns have not been explored. We evaluated United Network for Organ Sharing data on all match runs from May 1, 2007 to December 31, 2015 in which the liver was offered to ≥1 pediatric patient; the transplant recipient was ranked in the first 40 positions for the organ offer; and the donor was brain-dead and <50 years of age. We used multilevel mixed effects models to evaluate factors associated with organ offer acceptance, among-center variability, and the association between center-level acceptance and wait-list mortality. There were 4088 unique pediatric patients during the study period, comprising 27,094 match runs. Initial Model for End-Stage Liver Disease or Pediatric End-Stage Liver Disease score, history of exception points, recipient region, rank on match run, and geographic share type were all associated with probability of offer acceptance. There was significant among-center variation (P < 0.001) in adjusted liver offer acceptance rates, accounting for donor, recipient, and match-related factors (adjusted acceptance rates: median, 8.9%; range, 5.1%-14.6%). Center-level acceptance rates were associated with wait-list mortality, with a >10% increase in the risk of wait-list mortality for every 1% decrease in a center's adjusted liver offer acceptance rate (odds ratio, 1.10; 95% confidence interval, 1.01-1.19). In conclusion, there is significant among-center variability in liver offer acceptance rates for pediatric patients that is not explained by donor and recipient factors. A center's liver acceptance behavior significantly impacts whether a pediatric patient will be transplanted or die on the waiting list. Liver Transplantation 24 803-809 2018 AASLD.
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Affiliation(s)
- Ellen Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kathleen M Loomes
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert H Squires
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
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150
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Johnson MW, Zarrinpar A, Thomas EM, Andreoni KA. Liver Transplantation for Hepatoma: Raising the Bar. CURRENT TRANSPLANTATION REPORTS 2018. [DOI: 10.1007/s40472-018-0191-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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