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Ducatti L, Haddad LBP, Meyer A, Nacif LS, Arantes RM, Martino RB, Rocha-Santos V, Waisberg DR, Pinheiro RS, D Albuquerque LAC, Andraus W. CIRRHOTIC PATIENTS WITH ACUTE KIDNEY INJURY (AKI) HAVE HIGHER MORTALITY AFTER ABDOMINAL HERNIA SURGERY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1622. [PMID: 35019134 PMCID: PMC8735160 DOI: 10.1590/0102-672020210002e1622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of abdominal hernia in cirrhotic patients is as higher as 20%; in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in cirrhotic postoperative period (PO) is acute kidney injury (AKI). AIM To analyze the renal function of cirrhotic patients undergoing to hernia surgery and evaluate the factors related to AKI. METHODS Follow-up of 174 cirrhotic patients who underwent hernia surgery. Laboratory tests including the renal function were collected in the PO.AKI was defined based on the consensus of the ascite´s club. They were divided into two groups: with (AKI PO) and without AKI . RESULTS All 174 patients were enrolled and AKI occurred in 58 (34.9%). In the AKI PO group, 74.1% had emergency surgery, whereas in the group without AKI PO it was only 34.6%.In the group with AKI PO, 90.4% presented complications, whereas in the group without AKI PO they occurred only in 29.9%. Variables age, baseline MELD, baseline creatinine, creatinine in immediate postoperative (POI), AKI and the presence of ascites were statistically significant for survival. CONCLUSIONS There is association between AKI PO and emergency surgery and, also, between AKI PO and complications after surgery. The factors related to higher occurrence were initial MELD, basal Cr, Cr POI. The patients with postoperative AKI had a higher rate of complications and higher mortality.
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Affiliation(s)
- Liliana Ducatti
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Luciana B P Haddad
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Alberto Meyer
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Lucas S Nacif
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Rubens M Arantes
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Rodrigo B Martino
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Vinicius Rocha-Santos
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Daniel R Waisberg
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Rafael S Pinheiro
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Luiz A C D Albuquerque
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
| | - Wellington Andraus
- Department of Gastroenterology, University Hospital, School of Medicine, University of São Paulo - USP, São Paulo, SP, Brazil
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Bianco G, Pascale MM, Frongillo F, Nure E, Agnes S, Spoletini G. Transjugular portosystemic shunt for early-onset refractory ascites after liver transplantation. Hepatobiliary Pancreat Dis Int 2021; 20:90-93. [PMID: 32967815 DOI: 10.1016/j.hbpd.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Bianco
- General Surgery and Liver Transplant Unit, Fondazione IRCCS - Policlinico Universitario "A. Gemelli", Rome 00168, Italy
| | - Marco Maria Pascale
- General Surgery and Liver Transplant Unit, Fondazione IRCCS - Policlinico Universitario "A. Gemelli", Rome 00168, Italy.
| | - Francesco Frongillo
- General Surgery and Liver Transplant Unit, Fondazione IRCCS - Policlinico Universitario "A. Gemelli", Rome 00168, Italy
| | - Erida Nure
- General Surgery and Liver Transplant Unit, Fondazione IRCCS - Policlinico Universitario "A. Gemelli", Rome 00168, Italy
| | - Salvatore Agnes
- General Surgery and Liver Transplant Unit, Fondazione IRCCS - Policlinico Universitario "A. Gemelli", Rome 00168, Italy
| | - Gabriele Spoletini
- General Surgery and Liver Transplant Unit, Fondazione IRCCS - Policlinico Universitario "A. Gemelli", Rome 00168, Italy
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Allegretti AS, Ortiz G, Cui J, Wenger J, Bhan I, Chung RT, Thadhani RI, Irani Z. Changes in Kidney Function After Transjugular Intrahepatic Portosystemic Shunts Versus Large-Volume Paracentesis in Cirrhosis: A Matched Cohort Analysis. Am J Kidney Dis 2016; 68:381-91. [PMID: 26994685 DOI: 10.1053/j.ajkd.2016.02.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/11/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with cirrhosis and refractory ascites have physiologic and hormonal dysregulation that contributes to decreased kidney function. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) can reverse these changes and potentially improve kidney function. We sought to evaluate change in estimated glomerular filtration rate (eGFR) following TIPS placement. STUDY DESIGN Retrospective, matched cohort analysis. SETTINGS & PARTICIPANTS Patients who underwent first-time TIPS placement for refractory ascites in 1995 to 2014. Frequency matching was used to generate a comparator group of patients with cirrhosis and ascites treated with serial large-volume paracentesis (LVP) in a 1:1 fashion. PREDICTOR TIPS placement compared to serial LVP. OUTCOME Change in eGFR over 90 days' follow-up. MEASUREMENTS Multivariable regression stratified by baseline eGFR<60 versus ≥60mL/min/1.73m(2); analysis of effect modification between TIPS placement and baseline eGFR. RESULTS 276 participants (TIPS, n=138; serial LVP, n=138) were analyzed. After 90 days, eGFRs increased significantly after TIPS placement in participants with baseline eGFRs<60mL/min/1.73m(2) compared to treatment with serial LVP (21 [95% CI, 13-29] mL/min/1.73m(2); P<0.001) and was no different in those with eGFRs≥60mL/min/1.73m(2) (1 [95% CI, -9 to 12] mL/min/1.73m(2); P=0.8). There was significant effect modification between TIPS status and baseline eGFR (P=0.001) in a model that included all participants. LIMITATIONS Outcomes restricted by clinically recorded data; clinically important differences may still exist between the TIPS and LVP cohorts despite good statistical matching. CONCLUSIONS TIPS placement was associated with significant improvement in kidney function. This was most prominent in participants with baseline eGFRs<60mL/min/1.73m(2). Prospective studies of TIPS use in populations with eGFRs<60mL/min/1.73m(2) are needed to evaluate these findings.
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Affiliation(s)
- Andrew S Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA.
| | - Guillermo Ortiz
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jie Cui
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Julia Wenger
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ishir Bhan
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Raymond T Chung
- Liver Center and Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ravi I Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Zubin Irani
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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Waits S, Wojcik BM, Cai S, Mathur AK, Englesbe MJ. Portal vein thrombosis and outcomes for pediatric liver transplant candidates and recipients in the United States. Liver Transpl 2011; 17:1066-72. [PMID: 21744467 PMCID: PMC3162124 DOI: 10.1002/lt.22371] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The effect of occlusive portal vein thrombosis (PVT) on the mortality of pediatric liver transplant candidates and recipients is poorly defined. Using standard multivariate techniques, we studied the relationship between PVT and waiting-list and posttransplant survival rates with data from the Scientific Registry of Transplant Recipients (September 2001 to December 2007). In all, 5087 liver transplant candidates and 3630 liver transplant recipients were evaluated during the period. PVT was found in 1.4% of the liver transplant candidates (n = 70) and in 3.7% of the liver transplant recipients (n = 136). PVT was not associated with increased wait-list mortality [hazard ratio (HR) = 1.1, 95% confidence interval (CI) = 0.5-2.4, P = 0.77]. Conversely, PVT patients had a significantly lower unadjusted survival rate in the posttransplant period (P = 0.01). PVT was independently associated with increased posttransplant mortality in multivariate models (30-day survival: HR = 2.9, 95% CI = 1.6-5.3, P = 0.001; overall survival: HR = 1.7, 95% CI = 1.1-2.4, P = 0.01). The presence of PVT in pediatric liver candidates was not associated with increased wait-list mortality but was clearly associated with posttransplant mortality, especially in the immediate postoperative period.
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Affiliation(s)
- Seth Waits
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | | | - Shijie Cai
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Amit K. Mathur
- Department of Surgery, University of Michigan, Ann Arbor, MI
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Abstract
SummaryChronic liver disease is increasingly prevalent and, as the population ages, geriatricians will see an increasing burden. We present an overview of the investigation and management of older adults with chronic parenchymal liver disease and highlight the potential roles of transjugular intrahepatic portosytemic shunts and orthotopic liver transplantation.
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Al-Holou S, Mathur AK, Ranney D, Kubus J, Englesbe MJ. Survival among children with portal vein thrombosis and end-stage liver disease. Pediatr Transplant 2010; 14:132-7. [PMID: 19413719 DOI: 10.1111/j.1399-3046.2009.01175.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Occlusive PVT concurrent with chronic liver disease is a common clinical entity among pediatric patients referred for transplantation. The natural history of PVT is unknown. Our aim was to determine, using a retrospective cohort design, if children under 13 yr with chronic liver disease and concomitant PVT have an increased mortality risk prior to and after transplantation. A total of 203 patients were included in the study. Nearly 10% of the population had PVT (n = 19); 63.2% of PVT patients (5.9% of total cohort) underwent liver transplantation (n = 12). PVT patients tended to be younger than non-PVT patients at evaluation (1.94 +/- 3.51 vs. 3.79 +/- 4.11, p = 0.059). Clinical and demographic factors were similar between the two groups. Regarding survival, four PVT patients died, of which two had undergone transplantation. Kaplan-Meier analyses indicated that PVT and non-PVT patients had similar survival from the time of evaluation, on the waiting list, and after transplant. Although limited by sample size, our study suggests that a diagnosis of PVT does not increase the mortality risk for children waiting for a liver transplant. Further study is needed to discern variations in mortality risk that may occur in the pediatric chronic liver disease population with PVT.
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Affiliation(s)
- Shaza Al-Holou
- Division of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0331, USA
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Englesbe MJ, Kubus J, Muhammad W, Sonnenday CJ, Welling T, Punch JD, Lynch RJ, Marrero JA, Pelletier SJ. Portal vein thrombosis and survival in patients with cirrhosis. Liver Transpl 2010; 16:83-90. [PMID: 20035521 DOI: 10.1002/lt.21941] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The effects of occlusive portal vein thrombosis (PVT) on the survival of patients with cirrhosis are unknown. This was a retrospective cohort study at a single center. The main exposure variable was the presence of occlusive PVT. The primary outcome measure was time-dependent mortality. A total of 3295 patients were analyzed, and 148 (4.5%) had PVT. Variables independently predictive of mortality from the time of liver transplant evaluation included age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.01-1.03], Model for End-Stage Liver Disease (MELD) score (HR, 1.10; 95% CI, 1.08-1.11), hepatitis C (HR, 1.44; 95% CI, 1.24-1.68), and PVT (HR, 2.61; 95% CI, 1.97-3.51). Variables independently associated with the risk of mortality from the time of liver transplant listing included age (HR, 1.02; 95% CI, 1.01-1.03), transplantation (HR, 0.65; 95% CI, 0.50-0.81), MELD (HR, 1.08; 95% CI, 1.06-1.10), hepatitis C (HR, 1.50; 95% CI, 1.18-1.90), and PVT (1.99; 95% CI, 1.25-3.16). The presence of occlusive PVT at the time of liver transplantation was associated with an increased risk of death at 30 days (odds ratio, 7.39; 95% CI, 2.39-22.83). In conclusion, patients with cirrhosis complicated by PVT have an increased risk of death.
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Affiliation(s)
- Michael J Englesbe
- Division of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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Sohda T, Iwata K, Irie M, Takeyama Y, Nakane H, Morihara D, Kitamura Y, Yokoyama M, Shakado S, Watanabe H, Sakisaka S. Characteristic Genotypes of Vascular Endothelial Growth Factor are Susceptible to Ascites in Patients with Cirrhosis. J Int Med Res 2009; 37:841-6. [DOI: 10.1177/147323000903700328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study was designed to investigate whether different vascular endothelial growth factor (VEGF) genotypes are associated with ascites formation in cirrhotic patients. Seventy cirrhotic patients were included in the study: 25 cirrhotic patients with ascites and 45 cirrhotic patients without ascites. Patient characteristics were investigated and compared between the two groups. With regard to VEGF genotype, 42 patients were C/C and 28 patients were T/T or C/T. The genotypes T/T or C/T were observed in 23 cases (51%) among the non-ascites group, but in only five cases (20%) among the ascites group. Serum levels of albumin and creatinine, and the VEGF genotypes were significantly different between the two groups. Multiple regression analysis showed that serum levels of creatinine and the VEGF genotypes were significantly correlated with ascites formation. Thus, it can be concluded that VEGF genotyping might be a valuable susceptibility marker for ascites formation in cirrhotic patients.
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Affiliation(s)
- T Sohda
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - K Iwata
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - M Irie
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Y Takeyama
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - H Nakane
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - D Morihara
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Y Kitamura
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - M Yokoyama
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - S Shakado
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - H Watanabe
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - S Sakisaka
- Department of Gastroenterology and Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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[Medical therapy of complications in liver cirrhosis]. Internist (Berl) 2007; 48:1349-57. [PMID: 17992496 DOI: 10.1007/s00108-007-1965-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with liver cirrhosis bear a considerable risk of a variety of complications that involve virtually all organ systems. They can be addressed with a wide spectrum of drugs for acute interventions as well as for prophylactic purposes. At the same time treatment of the underlying disease, the identification and treatment of triggering factors and the possibility of liver transplantation should be kept in mind.
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