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Patel A, Zhang M, Liao G, Karkache W, Montroy J, Fergusson DA, Khadaroo RG, Tran DTT, McIsaac DI, Lalu MM. A Systematic Review and Meta-Analysis Examining the Impact of Age on Perioperative Inflammatory Biomarkers. Anesth Analg 2021; 134:751-764. [PMID: 34962902 DOI: 10.1213/ane.0000000000005832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dysregulation of immune responses to surgical stress in older patients and those with frailty may manifest as differences in inflammatory biomarkers. We conducted a systematic review and meta-analysis to examine differences in perioperative inflammatory biomarkers between older and younger patients, and between patients with and without frailty. METHODS MEDLINE, Embase, Cochrane, and CINAHL databases were searched (Inception to June 23, 2020). Observational or experimental studies reporting the perioperative level or activity of biomarkers in surgical patients stratified by age or frailty status were included. The primary outcome was inflammatory biomarkers (grouped by window of ascertainment: pre-op; post-op: <12 hours, 12-24 hours, 1-3 days, 3 days to 1 week, and >1 week). Quality assessment was conducted using the Newcastle-Ottawa Scale. Inverse-variance, random-effects meta-analysis was conducted. RESULTS Forty-five studies (4263 patients) were included in the review, of which 36 were pooled for meta-analysis (28 noncardiac and 8 cardiac studies). Two studies investigated frailty as the exposure, while the remaining investigated age. In noncardiac studies, older patients had higher preoperative levels of interleukin (IL)-6 and C-reactive protein (CRP), lower preoperative levels of lymphocytes, and higher postoperative levels of IL-6 (<12 hours) and CRP (12-24 hours) than younger patients. In cardiac studies, older patients had higher preoperative levels of IL-6 and CRP and higher postoperative levels of IL-6 (<12 hours and >1 week). CONCLUSIONS Our findings demonstrate a paucity of frailty-specific studies; however, the presence of age-associated differences in the perioperative inflammatory response is consistent with age-associated states of chronic systemic inflammation and immunosenescence. Additional studies assessing frailty-specific changes in the systemic biologic response to surgery may inform the development of targeted interventions.
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Affiliation(s)
- Abhilasha Patel
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - MengQi Zhang
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary Liao
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wassim Karkache
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Dean A Fergusson
- From the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program.,Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rachel G Khadaroo
- Department of Surgery and Critical Care Medicine, University of Alberta, Walter C Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Diem T T Tran
- Clinical Epidemiology Program.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Daniel I McIsaac
- Clinical Epidemiology Program.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Manoj M Lalu
- Clinical Epidemiology Program.,Blueprint Translational Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Leibovici-Weissman Y, Mor E, Leshno M, Shlomai A. Patients' Age Rather Than Model of End-Stage Liver Disease Score Predicts Survival After Liver Transplantation. Dig Dis Sci 2017; 62:801-807. [PMID: 28054162 DOI: 10.1007/s10620-016-4423-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The model of end-stage liver disease (MELD) score is the standard tool for prioritizing patients awaiting liver transplantation. There is currently no definite high cutoff score reflecting disease severity that might exclude patients from transplantation. Furthermore, the age limit that used to disqualify patients from eligibility to transplantation was recently withdrawn in several countries. AIMS The aims of this study were to assess the effects of MELD score and age at time of transplantation on patients' short- and long-term survival. METHODS We conducted a retrospective single-center study on a cohort of patients transplanted for the first time due to non-fulminant liver failure. RESULTS Four hundred and seventeen patients (mean age 50.2 years, 63% males) who underwent liver transplantation for the first time were included. Both higher patients' and donors' age were significantly associated with increased long-term mortality (p = 0.007, 95% CI 1.006-1.038 for patient age, p = 0.02, 95% CI 1.002-1.023 for donor age). Patients' age remained significantly associated with survival at 1 year post-transplantation, as well. We found no association between higher MELD score at transplantation and long-term mortality (p = 0.189, 95% CI 0.99-1.051) irrespective of patients' age. Specifically, when patients were divided according to their MELD score at transplantation (MELD < 15, MELD 15-25 and MELD > 25), no significant differences in long-term survival were detected between these three subgroups. Results did not differ significantly in a subgroup analysis of patients without hepatocellular carcinoma at the time of transplantation. CONCLUSIONS Patients' and donors' age rather than patients' MELD score at transplantation determine survival following liver transplantation.
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Affiliation(s)
- Yaara Leibovici-Weissman
- Department of Internal Medicine D, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Street, Petah-Tikva, 49100, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Eytan Mor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Transplantation, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Moshe Leshno
- Tel-Aviv University School of Management, Tel-Aviv University, Tel Aviv, Israel
| | - Amir Shlomai
- Department of Internal Medicine D, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Street, Petah-Tikva, 49100, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
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Cannon RM, Martin RCG, Callender GG, McMasters KM, Scoggins CR. Safety and efficacy of hepatectomy for colorectal metastases in the elderly. J Surg Oncol 2011; 104:804-8. [PMID: 21792943 DOI: 10.1002/jso.22042] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 07/05/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the safety and efficacy of hepatic metastasectomy in elderly patients with colorectal liver metastases (CLM). METHODS A retrospective review of a hepatobiliary database was performed on consecutive patients treated with metastasectomy for CLM. Patients were stratified by age (<70 years old vs. ≥70). Patient and tumor characteristics as well as operative factors were compared, as were morbidity, mortality, and length of stay. Logistic regression and Cox proportional hazards were used to evaluate the association of age and postoperative outcomes. RESULTS There were 59 elderly (median age 75) and 220 non-elderly (median age 58) patients analyzed over a 13 year period. The Charlson comorbidity index was higher in the elderly group (mean 4.7 vs. 4.4 P = 0.005). Postoperative morbidity and mortality were 52.5 and 0% vs. 48.2 and 4.1% in the elderly and non-elderly groups, respectively (P = 0.56 and P = 0.21). There were no differences in median DFS (21.8 months vs. 28.9 months; P = 0.157) or OS (36 months vs. 47.7 months; P = 0.070) between the elderly and non-elderly groups, respectively. CONCLUSIONS Age itself does not appear to be a significant contraindication to liver resection, including major hepatectomy, when patients are appropriately selected.
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Affiliation(s)
- Robert M Cannon
- Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Abstract
BACKGROUND The negative effects of increased donor age on liver transplantation became evident in deceased donor liver transplantation. In living donor liver transplantation (LDLT), the details remain unclear. METHODS Initially, 137 adult LDLT recipients from August 1996 to May 2005 were divided into two groups (donors <50 years of age: n=99, donors >or= 50 years of age: n=38) for the retrospective study. Then, 24 recipients who received LDLT from June 2005 to July 2006 were divided into two groups: group 1 (donors <50 years of age, n=14) and group 2 (donors >or= 50 years of age, n=10) and enrolled in the prospective study to analyze their clinical course and prognostic factors in the aged graft. RESULTS In the retrospective study, the younger donor group had significantly better survival than that of the aged donor group (P=0.015, Log rank test). In the prospective study, the postoperative graft functions showed that the serum total bilirubin levels were significantly lower in group 1 (P<0.02, by ANOVA analysis). The phosphorylated-Signal Transducer and Activator of Transcription3 expression at 4 hr after reperfusion (RT2) in group 2 was significantly lower than that in group 1. At RT2, the expressions were up-regulated in group 1, but were down-regulated in group 2. The serum 8-hydroxydeoxyguanosine value became significantly higher in group 1 two weeks after LDLT. CONCLUSIONS In the near term, Signal Transducer and Activator of Transcription3 gene induction during cold preservation may be of great use in improving the outcome of aged grafts in LDLT.
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Giovannini I, Chiarla C, Giuliante F, Vellone M, Ardito F, Nuzzo G. The relationship between albumin, other plasma proteins and variables, and age in the acute phase response after liver resection in man. Amino Acids 2006; 31:463-9. [PMID: 16583310 DOI: 10.1007/s00726-005-0287-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 10/27/2005] [Indexed: 12/20/2022]
Abstract
A large series of plasma albumin (ALB, g/dl) and simultaneous blood and clinical measurements were prospectively performed on 92 liver resection patients, and processed to assess the correlations between ALB, other plasma proteins, additional variables and clinical events. The measurements were performed preoperatively and at postoperative day 1, 3 and 7 in all patients, and subsequently only in those who developed complications or died. In patients who recovered normally ALB was 4.3 +/- 0.4 g/dl (mean +/- SD) preoperatively, 3.7 +/- 0.7 at day 1 and 3, and 3.9 +/- 0.4 at day 7. In patients with complications its decrease was more prolonged. In non-survivors it was 3.4 +/- 0.4 preoperatively, 3.0 +/- 0.4 at day 1, and then decreased further. Regression analysis showed direct correlations between ALB and pseudo-cholinesterase (CHE, U/l, nv 5300-13000), cholesterol (CHOL, mg/dl), iron binding capacity (IBC, mg/dl), prothrombin activity (PA, % of standard reference) and fibrinogen, an inverse correlation with blood urea nitrogen (BUN, mg/dl) for any given creatinine level (CREAT, mg/dl), and weaker direct correlations with hematocrit, other variables and dose of exogenous albumin. An inverse relationship found between ALB and age (AGE, years) became postoperatively (POSTOP) also a function of outcome, showing larger age-related decreases in ALB associated with complications (COMPL: sepsis, liver insufficiency) or death (DEATH). Main overall correlations: CHE = 287.4(2.014)(ALB), r = 0.73; CHOL = 16.5(1.610)(ALB) (1.001)(ALKPH), r = 0.71; IBC = 68.6(1.391)(ALB), r = 0.64; PA = 13.8 + 16.0(ALB), r = 0.51; BUN = 21.3 + 20.2(CREAT) - 6.2(ALB), r = 0.91; ALB = 5.0-0.013(AGE) - {0.5 + 0.003(AGE)( COMPL ) + 0.012(AGE)( DEATH )}( POSTOP ), r = 0.74 [p < 0.001 for each regression and each coefficient; ALKPH = alkaline phosphatase, U/l, nv 98-279, independent determinant of CHOL; discontinuous variables in italics label the change in regression slope or intercept associated with the corresponding condition]. These results suggest that altered albumin synthesis (or altered synthesis unable to compensate for albumin loss, catabolism or redistribution) is an important determinant of hypoalbuminemia after hepatectomy. The correlations with age and postoperative outcome support the concept that hypoalbuminemia is a marker of pathophysiologic frailty associated with increasing age, and amplified by the challenges of postoperative illness.
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Affiliation(s)
- I Giovannini
- Department of Surgery, Hepatobiliary Unit, and CNR-IASI Center for Pathophysiology of Shock, Catholic University of the Sacred Heart School of Medicine, Rome, Italy.
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Abstract
While major liver resections have become increasingly safe due to better understanding of anatomy and refinement of operative techniques, liver failure following partial hepatectomy still occurs from time to time and remains incompletely understood. Observationally, certain high-risk circumstances exist, namely, massive resection with small liver remnants, preexisting liver disease, and advancing age, where liver failure is more likely to happen. Upon review of available clinical and experimental studies, an interplay of factors such as impaired regeneration, oxidative stress, preferential triggering of apoptotic pathways, decreased oxygen availability, heightened energy-dependent metabolic demands, and energy-consuming inflammatory stimuli work to produce failing hepatocellular functions.
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Affiliation(s)
- Thomas S Helling
- Department of Surgery, University of Missouri at Kansas City, School of Medicine, Kansas City, MO, USA.
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Abstract
The shortage of organs has led centers to expand their criteria for the acceptance of marginal donors. The combination of multiple marginal factors seems to be additive on graft injury. In this review, the utility of various marginal donors in patients requiring liver transplantation will be described, including older donors, steatotic livers, non-heart-beating donors, donors with viral hepatitis, and donors with malignancies. The pathophysiology of the marginal donor will be discussed, along with strategies for minimizing the ischemia reperfusion injury experienced by these organs. Finally, new strategies for improving the function of the marginal/expanded donor liver will be reviewed.
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Affiliation(s)
- Ronald W Busuttil
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Transplant Center, Los Angeles, CA 90095, USA.
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Ikegami T, Nishizaki T, Yanaga K, Shimada M, Kishikawa K, Nomoto K, Uchiyama H, Sugimachi K. The impact of donor age on living donor liver transplantation. Transplantation 2000; 70:1703-7. [PMID: 11152100 DOI: 10.1097/00007890-200012270-00007] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The impact of the age of the donor on the outcome of living related liver transplantation is yet to be clarified. METHODS During October 14, 1996 and December 20, 1999, 34 living related liver transplantations were performed. Of these, 26 cases were performed using the extended left lobe graft, which were classified into three groups; younger donor group (group Y, donor age < 30, n = 7), middle-aged donor group (group M, 30 < or = donor age <50, n=13), and older donor group (group O, donor age < 50, n = 6). Early allograft function and regeneration were compared between these groups. RESULTS There was no difference in standard liver volume, and predicted or harvested graft size between the three groups. Although serum transaminase and total bilirubin levels within postoperative day 7 were not different between the groups, the prothrombin time on postoperative day 3 was significantly longer in group O than in group Y. One week after transplantation, group Y had significantly greater graft/standard liver volume ratio than group O, and greater graft volume than group M and O. One month after transplantation, however, there was no significant difference in such graft size parameters between the groups. Graft and patient survival were comparable between the three groups. CONCLUSION Although function and regeneration of the allografts from older donors in living donor liver transplantation is worse than those of their younger counterparts, the outcome is not affected by the age of the liver.
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Affiliation(s)
- T Ikegami
- Department of Surgery II, Kyushu University, Fukuoka, Japan
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Demirer S, Karadayi K, Simşek S, Erverdi N, Bumin C. Comparison of postoperative acute-phase reactants in patients who underwent laparoscopic v open cholecystectomy: a randomized study. J Laparoendosc Adv Surg Tech A 2000; 10:249-52. [PMID: 11071403 DOI: 10.1089/lap.2000.10.249] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We investigated the effect of laparoscopic v open cholecystectomy on acute-phase reactants. PATIENTS AND METHODS Fifty patients were randomized to laparoscopic (Group 1) and 50 to open (Group 2) cholecystectomy. Preoperative and postoperative values for acute-phase reactants (ceruloplasmin, fibrinogen, Westergren sedimentation rate, alpha-1-antitrypsin, haptoglobin, and C-reactive protein) in blood samples were compared. RESULTS Acute-phase reactants and length of hospitalization were significantly lower in patients who underwent a laparoscopic cholecystectomy than in those who underwent an open cholecystectomy. CONCLUSION Laparoscopic cholecystectomy appears associated with a less intense stress response and less tissue damage than open cholecystectomy.
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Affiliation(s)
- S Demirer
- Department of Surgery, Ankara University Medical School, Ibn-i Sina Hospital, Turkey.
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