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Clouse JW, Mangus RS, Vega CA, Cabrales AE, Bush WJ, Clouse IT, Ekser B, Mihaylov P, Kubal CA. Pleural Effusion and Malnutrition Are Associated With Worse Early Outcomes After Liver Transplant. Am Surg 2023; 89:5881-5890. [PMID: 37220891 DOI: 10.1177/00031348221126962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Pulmonary complications after liver transplantation (LT) have previously been associated with longer hospital stays and ventilator time, and higher mortality. This study reports the outcomes for a specific pulmonary complication, pleural effusion, in LT recipients. METHODS Records from a single transplant center were analyzed retrospectively for all adult LT patients. Patients with documented pleural effusion by radiographic imaging within 30 days pre- or post-transplant were considered as cases. Outcomes included length of hospital stay, discharge disposition, hospital readmission, discharge with home oxygen, and 1-year survival. RESULTS During the 4-year study period, 512 LTs were performed, with 107 patients (21%) developing a peri-transplant pleural effusion. In total, 49 patients (10%) had a pre-transplant effusion, 91 (18%) had a post-transplant effusion, and 32 (6%) had both. Characteristics associated with the presence of any pleural effusion included an increasing model for end-stage liver disease score, re-transplantation, diagnosis of alcoholic liver disease, low protein levels, and sarcopenia. Effusion patients had longer hospital stays (17 vs 9 days, P < .001) and higher likelihood of discharge to a care facility (48% vs 21%, P < .001). Ninety-day readmission occurred in 69% of effusion patients (vs 44%, P < .001). One-year patient survival with any effusion was 86% (vs 94%, P < .01). CONCLUSIONS Overall, 21% of recipients developed a clinically significant peri-transplant pleural effusion. Pleural effusion was associated with worse outcomes for all clinical measures. Risk factors for the development of pleural effusion included higher MELD score (>20), re-transplantation, alcoholic liver disease, and poor nutrition status, including poor muscle mass.
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Affiliation(s)
- Jared W Clouse
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard S Mangus
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carlos A Vega
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Arianna E Cabrales
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Weston J Bush
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Isaac T Clouse
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Burcin Ekser
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Plamen Mihaylov
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Mi H, Fang J, Wu S, Mao S, Jiang W, Tong J, Lu C. Comparison of Postoperative Hemorrhage Risk After Partial Liver Transplantation Versus Whole Liver Transplantation: A Single-Center Experience. Transplant Proc 2023; 55:2444-2449. [PMID: 37891019 DOI: 10.1016/j.transproceed.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 07/18/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND We aimed to identify risk factors associated with reoperation for postoperative intraperitoneal hemorrhage (PIH) after orthotopic liver transplantation and investigate if partial liver transplantation (PLT) increases the risk of PIH. METHODS We retrospectively analyzed the medical records of 304 consecutive recipients who underwent orthotopic liver transplantation at the Affiliated Lihuili Hospital, Ningbo University, from January 2016 to July 2022. Data were compared between recipients who experienced PIH requiring reoperation and those who did not. Subgroup propensity score matching analysis was performed to assess the impact of PLT on PIH risk. Neither prisoners nor participants who were coerced or paid were used in the study. RESULTS Among the 304 recipients, 22 (7.2%) underwent reoperation for PIH. Multivariate analysis revealed that the recipient Model for End-Stage Liver Disease (MELD) score (odds ratio = 1.066, 95% CI [1.025-1.109], P = .001) and volume of intraoperative packed red blood cell transfusion (odds ratio = 1.089, 95% CI [1.032-1.481], P = .002) were independent risk factors for PIH. No significant differences were observed in the risk of PIH between PLT and whole liver transplantation. CONCLUSION Preoperative MELD score and intraoperative packed red blood cell transfusion should be carefully considered to manage the risk of PIH in liver transplantation recipients. Partial liver transplantation, a crucial approach for addressing donor shortages, does not increase the risk of reoperation for PIH in recipients.
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Affiliation(s)
- Hongchao Mi
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Jiongze Fang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Shengdong Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Shuqi Mao
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Wei Jiang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Jingshu Tong
- School of Medicine, Ningbo University, Ningbo, China
| | - Caide Lu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China.
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Jayant K, Cotter TG, Reccia I, Virdis F, Podda M, Machairas N, Arasaradnam RP, Sabato DD, LaMattina JC, Barth RN, Witkowski P, Fung JJ. Comparing High- and Low-Model for End-Stage Liver Disease Living-Donor Liver Transplantation to Determine Clinical Efficacy: A Systematic Review and Meta-Analysis (CHALICE Study). J Clin Med 2023; 12:5795. [PMID: 37762738 PMCID: PMC10531849 DOI: 10.3390/jcm12185795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Various studies have demonstrated that low-Model for End-Stage Liver Disease (MELD) living-donor liver transplant (LDLT) recipients have better outcomes with improved patient survival than deceased-donor liver transplantation (DDLT) recipients. LDLT recipients gain the most from being transplanted at MELD <25-30; however, some existing data have outlined that LDLT may provide equivalent outcomes in high-MELD and low-MELD patients, although the term "high" MELD is arbitrarily defined in the literature and various cut-off scores are outlined between 20 and 30, although most commonly, the dividing threshold is 25. The aim of this meta-analysis was to compare LDLT in high-MELD with that in low-MELD recipients to determine patient survival and graft survival, as well as perioperative and postoperative complications. METHODS Following PROSPERO registration CRD-42021261501, a systematic database search was conducted for the published literature between 1990 and 2021 and yielded a total of 10 studies with 2183 LT recipients; 490 were HM-LDLT recipients and 1693 were LM-LDLT recipients. RESULTS Both groups had comparable mortality at 1, 3 and 5 years post-transplant (5-year HR 1.19; 95% CI 0.79-1.79; p-value 0.40) and graft survival (HR 1.08; 95% CI 0.72, 1.63; p-value 0.71). No differences were observed in the rates of major morbidity, hepatic artery thrombosis, biliary complications, intra-abdominal bleeding, wound infection and rejection; however, the HM-LDLT group had higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay. CONCLUSIONS The high-MELD LDLT group had similar patient and graft survival and morbidities to the low-MELD LDLT group, despite being at higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay. The data, primarily sourced from high-volume Asian centers, underscore the feasibility of living donations for liver allografts in high-MELD patients. Given the rising demand for liver allografts, it is sensible to incorporate these insights into U.S. transplant practices.
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Affiliation(s)
- Kumar Jayant
- Department of Surgery and Cancer, Hammersmith Hospital, Imperial College London, London W12 0TS, UK
- Department of General Surgery, Memorial Healthcare System, Pembroke Pines, FL 33028, USA
| | - Thomas G. Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Isabella Reccia
- General Surgery and Oncologic Unit, Policlinico ponte San Pietro, 24036 Bergamo, Italy;
| | - Francesco Virdis
- Dipartimento DEA-EAS Ospedale Niguarda Ca’ Granda Milano, 20162 Milano, Italy
| | - Mauro Podda
- Department of Surgery, Calgiari University Hospital, 09121 Calgiari, Italy
| | - Nikolaos Machairas
- 2nd Department of Propaedwutic Surgery, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | | | - Diego di Sabato
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA
| | - John C. LaMattina
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Rolf N. Barth
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA
| | - Piotr Witkowski
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA
| | - John J. Fung
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA
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Liu Y, Shu H, Wan P, Wang X, Xie H. Neutrophil extracellular traps predict postoperative pulmonary complications in paediatric patients undergoing parental liver transplantation. BMC Gastroenterol 2023; 23:237. [PMID: 37442949 DOI: 10.1186/s12876-023-02744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 03/25/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Parental liver transplantation (PLT) improves long-term survival rates in paediatric hepatic failure patients; however, the mechanism of PLT-induced postoperative pulmonary complications (PPCs) is unclear. METHODS A total of 133 paediatric patients undergoing PLT were included. Serum levels of NET components, including circulating free DNA (cfDNA), DNA-histone complex, and myeloperoxidase (MPO)-DNA complex, were detected. The occurrence of PPCs post-PLT, prolonged intensive care unit (ICU) stay and death within one year were recorded as the primary and secondary outcomes. RESULTS The overall rate of PPCs in the hospital was 47.4%. High levels of serum cfDNA, DNA-histone complexes and MPO-DNA complexes were associated with an increased risk of PPCs (for cfDNA, OR 2.24; for DNA-histone complex, OR 1.64; and for MPO-DNA, OR 1.94), prolonged ICU stay (OR 1.98, 4.26 and 3.69, respectively), and death within one year (OR 1.53, 2.65 and 1.85, respectively). The area under the curve of NET components for the prediction of PPCs was 0.843 for cfDNA, 0.813 for DNA-histone complexes, and 0.906 for MPO-DNA complexes. During the one-year follow-up, the death rate was higher in patients with PPCs than in patients without PPCs (14.3% vs. 2.9%, P = 0.001). CONCLUSIONS High serum levels of NET components are associated with an increased incidence of PPCs and death within one year in paediatric patients undergoing PLT. Serum levels of NET components serve as a biomarker for post-PLT PPCs and a prognostic indicator.
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Affiliation(s)
- Yaling Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road Suzhou, Jiangsu, China
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Huigang Shu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China
| | - Ping Wan
- Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaodong Wang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, China.
| | - Hong Xie
- Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road Suzhou, Jiangsu, China.
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Wang Y, Ning Z, Yang L, Wang T. Construction and validation of a pulmonary complication score for patients after liver transplantation. Clin Transplant 2023; 37:e14872. [PMID: 36444148 DOI: 10.1111/ctr.14872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Identification of preoperative risk factors associated with pulmonary complications may benefit high-risk patients from more intense surveillance and earlier interventions in liver transplantation (LT). Our study aimed to identify risk factors for predicting pulmonary complications in LT patients. MATERIALS AND METHODS The discovery data set enrolled 208 patients who underwent orthotopic LT while the validation data set included 117 patients. Clinical data were collected from medical history retrospectively and risk factors were determined by logistic regression analyses. The pulmonary complication score (PCS-LT) was established and validated for predicting pulmonary complications after LT. RESULTS In the discovery data set, 47 (22.6%) participants experienced pulmonary complications following LT. Four independent risk factors for pulmonary complications were identified by multivariate logistic regression analysis, including preoperative abnormal pulmonary function (OR = 4.743, p < .001), elevated lymphocyte count (OR = 2.336, p = .027), hypoproteinemia (OR = 2.635, p = .030), and hypokalemia (OR = 5.257, p = .003), and PCS-LT based on these factors was established. ROC analyses showed PCS-LT could predict PC in both the discovery data set (area under curve [AUC] .752, 95% confidence interval [CI] .687-.809) and the validation data set (AUC .754, 95% CI, .666-.829). The PCS-LT demonstrated superior predictive value (AUC .735, 95% CI, .703-.799) to APACHE II score (AUC .653, 95% CI, .599-.705) in the combined data set (p = .032). Meanwhile, PCS-LT > 1 was used as the cut-off value and has prognostic significance in LT patients. CONCLUSIONS The PCS-LT score, consisting of abnormal pulmonary function, elevated lymphocyte count, hypoproteinemia, and hypokalemia, could predict pulmonary complications after LT.
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Affiliation(s)
- Ying Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenning Ning
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liuxiao Yang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
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Gad EH, Sallam AN, Soliman H, Ibrahim T, Salem TAH, Ali MAH, Al-Sayed Abd-same M, Ayoub I. Pediatric living donor liver transplantation (LDLT): Short- and long-term outcomes during sixteen years period at a single centre- A retrospective cohort study. Ann Med Surg (Lond) 2022; 79:103938. [PMID: 35860167 PMCID: PMC9289343 DOI: 10.1016/j.amsu.2022.103938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/05/2023] Open
Abstract
Background and objectives Pediatric living donor liver transplantation (LDLT) is an effective tool for managing pediatric patients with end-stage liver disease (ESLD) with good long-term graft and patient survival, especially after improvement in peri-operative care, surgical tools and techniques; however, the morbidity and mortality after such a procedure are still a challenging matter. The study aimed to analyze short-and long-term outcomes after pediatric LDLT in a single centre. Methods We retrospectively analyzed 67 pediatric patients who underwent LDLT in the period from April 2003 to July 2018. The overall male/female ratio was 40/27. Results Forty-one (61.2%) of patients had ≥1 early and/or late morbidities; the early (less than 3months) and late (≥3months) ones affected 36(53.7%) and 12(17.9%) of them respectively. The 16-year graft and patient survivals were 35(52.2%) while early and late mortalities were 23(34.3%) and 9(13.4%) respectively. Sepsis and chronic rejection were the most frequent causes of early and late mortalities respectively. Moreover, more packed RBCs transfusion units, bacterial infections, and pulmonary complications were independent predictors of poor patient survival. Conclusions More packed RBCs transfusion units intra-operatively, and post-liver transplant (LT) bacterial infection, sepsis, chronic rejection, as well as pulmonary complications had a negative insult on our patients' outcomes, so proper management of them is mandatory for improving outcomes after pediatric LDLT. More packed RBCs transfusion units intra-operatively had a negative insult on outcomes after paediatric LDLT. Bacterial infection and pulmonary complications led to poor outcomes after paediatric LDLT. Sepsis and chronic rejection led to post paediatric LDLT poor patient outcomes.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
- Corresponding author..
| | - Ahmed Nabil Sallam
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | - Hosam Soliman
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | - Tarek Ibrahim
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
| | | | | | | | - Islam Ayoub
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebeen Elkoum, Egypt
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Epidemiology and Prognostic Significance of Rapid Response System Activation in Patients Undergoing Liver Transplantation. J Clin Med 2021; 10:jcm10235680. [PMID: 34884382 PMCID: PMC8658097 DOI: 10.3390/jcm10235680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Patients undergoing liver transplantation have a high risk of perioperative clinical deterioration. The Rapid Response System is an intensive care unit-based approach for the early recognition and management of hospitalized patients identified as high-risk for clinical deterioration by a medical emergency team (MET). The etiology and prognostic significance of clinical deterioration events is poorly understood in liver transplant patients. We conducted a cohort study of 381 consecutive adult liver transplant recipients from a prospectively collected transplant database (2011–2017). Medical records identified patients who received MET activation pre- and post-transplantation. MET activation was recorded in 131 (34%) patients, with 266 MET activations in total. The commonest triggers for MET activation were tachypnea and hypotension pre-transplantation, and tachycardia post-transplantation. In multivariable analysis, female sex, increasing Model for End-Stage Liver Disease score and hepatorenal syndrome were independently associated with MET activation. The unplanned intensive care unit admission rate following MET activation was 24.1%. Inpatient mortality was 4.2% and did not differ by MET activation status; however, patients requiring MET activation had significantly longer intensive care unit and hospital length of stay and were more likely to require inpatient rehabilitation. In conclusion, liver transplant patients with perioperative complications requiring MET activation represent a high-risk group with increased morbidity and length of stay.
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Buggs J, LaGoy M, Ermekbaeva A, Rogers E, Nyce S, Patiño D, Kumar A, Kemmer N. Cost Utilization and the Use of Pulmonary Function Tests in Preoperative Liver Transplant Patients. Am Surg 2020; 86:996-1000. [PMID: 32762467 DOI: 10.1177/0003134820942159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pulmonary function tests (PFTs) are currently recommended for liver transplant candidates. We hypothesized that PFTs may not provide added clinical value to the evaluation of liver transplant patients. METHODS We conducted a retrospective cohort study of adult cadaveric liver transplants from 2012 to 2018. Abnormal PFTs were defined as restrictive disease of diffusing capacity of the lungs for carbon monoxide (DLCO) <80% or obstructive disease of ratio of forced expiratory volume in the first 1 second to the first vital capacity of the lungs (FEV1/FVC) <70%. RESULTS We analyzed data on 415 liver transplant patients (358 abnormal PFT results and 57 normal results). The liver transplant patients with abnormal PFTs had no difference in number of intensive care unit (ICU) days (P = .68), length of stay (P = .24), or intubation days (P = .33). There were no differences in pulmonary complications including pleural effusion (P = .30), hemo/pneumothorax (P = .74), pneumonia (P = .66), acute respiratory distress syndrome (P = .57), or pulmonary edema (P = .73). The significant finding between groups was a higher rate of reintubation in liver transplant patients with normal PFTs (P = .02). There was no difference in graft survival (P = .53) or patient survival (P = .42). DISCUSSION Abnormal PFTs, found in 86% of liver transplant patients, did not correlate with complications, graft failure, or mortality. PFTs contribute to the high cost of liver transplants but do not help predict which patients are at risk of postoperative complications.
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Affiliation(s)
- Jacentha Buggs
- Department of Transplant Surgery, Tampa General Medical Group, Tampa, FL, USA
| | - Madeleine LaGoy
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | - Ebonie Rogers
- 7829 Office of Clinical Research, Tampa General Hospital, Tampa, FL, USA
| | - Samantha Nyce
- Pre-medical Studies, University of Tampa, Tampa, FL, USA
| | - Diego Patiño
- Pre-medical Studies, University of Tampa, Tampa, FL, USA
| | - Ambuj Kumar
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Nyingi Kemmer
- Department of Transplant Hepatology, Tampa General Medical Group, Tampa, FL, USA
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Model for End-Stage Liver Disease (MELD) Score Among Patients Qualified For Lung Transplantation With End-Stage Lung Diseases With Particular Consideration of Median Pulmonary Artery Pressure. Transplant Proc 2020; 52:2128-2132. [PMID: 32553508 DOI: 10.1016/j.transproceed.2020.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Model for End-Stage Liver Disease (MELD) score is used to assess the severity of chronic liver disease. It is implemented in transplantology in the process of qualification for urgent liver transplant. The aim of our study was to assess the liver function of patients qualified for lung transplant using MELD score, taking under consideration mean pulmonary artery pressure as an important risk factor of death. METHODS The study group consisted of 123 patients qualified for lung transplant in Silesian Center for Heart Diseases between 2004 and 2017. Data relevant for MELD score calculations and medial pulmonary artery pressure were acquired from medical records. RESULTS The average MELD score among patients qualified for lung transplant was 8.24 points, and mean pulmonary pressure (mPAP) was 35.02 mm Hg. Patients with idiopathic pulmonary artery hypertension acquired the highest MELD and highest mPAP results (13.1 points and 57.7 mm Hg, respectively). Patients with idiopathic pulmonary fibrosis presented higher mean MELD-Na score among those with pulmonary arterial hypertension than those without pulmonary arterial hypertension (36.59 mm Hg; 7.74 points vs 18 mm Hg; 6.5 points). There is strong positive correlation between MELD-Na and mPAP among patients who underwent lung transplant because of idiopathic pulmonary fibrosis. CONCLUSIONS This is the first study in the worldwide literature assessing MELD-Na as a predictor of survival among patients qualified for lung transplant and those who already are recipients. Further studies regarding this issue are required as authors will explore this issue in the future.
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10
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Lui JK, Spaho L, Hakimian S, Devine M, Bui R, Touray S, Holzwanger E, Patel B, Ellis D, Fridlyand S, Ogunsua AA, Mahboub P, Daly JS, Bozorgzadeh A, Kopec SE. Pleural Effusions Following Liver Transplantation: A Single-Center Experience. J Intensive Care Med 2020; 36:862-872. [PMID: 32527176 DOI: 10.1177/0885066620932448] [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] [Indexed: 12/15/2022]
Abstract
INTRODUCTION This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. METHODS A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. RESULTS In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. CONCLUSIONS In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.
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Affiliation(s)
- Justin K Lui
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Lidia Spaho
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Shahrad Hakimian
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Gastroenterology, 164186University of Massachusetts Medical School, Worcester, MA USA
| | - Michael Devine
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Rosa Bui
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Sunkaru Touray
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA.,Carlsbad Medical Center, NM, USA
| | - Erik Holzwanger
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Boskey Patel
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Daniel Ellis
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Svetlana Fridlyand
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA
| | - Adedotun A Ogunsua
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Cardiology, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Paria Mahboub
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Jennifer S Daly
- Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, 12259Boston University School of Medicine, MA, USA.,Division of Infectious Diseases, 3354University of Massachusetts Medical School, Worcester, MA, USA
| | - Adel Bozorgzadeh
- Division of Transplant Surgery, 12262University of Massachusetts Medical School, Worcester, MA, USA
| | - Scott E Kopec
- Department of Medicine, 164186University of Massachusetts Medical School, Worcester, MA, USA.,Division of Pulmonary, Allergy & Critical Care Medicine, 164186University of Massachusetts Medical School, Worcester, MA USA
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11
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Complications Following Liver Transplant at a Teaching Hospital. Transplant Proc 2020; 52:1354-1359. [PMID: 32507486 DOI: 10.1016/j.transproceed.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/26/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study is to analyze the liver transplant complications in a reference transplant hospital in southern Brazil. METHODS The researchers used a cross-sectional, quantitative, exploratory, and descriptive study, conducted using 103 medical records of patients who underwent liver transplantation from 2011 to 2018. Data were analyzed through median, mean, and standard deviation, and the Kruskal-Wallis test was used. RESULTS There was a higher proportion of men (70.9%), with a mean age of 53.3 years, who had hepatitis C (43.7%). The indication for the procedure was hepatocellular carcinoma (34%). The most frequent complications included pulmonary (26.7%), graft-related complications such as rejection (21.1%), and viral infections (14.4%). In addition, infectious complications, such as pneumonia (45%) and septicemia (29%), occurred. The main causes of death were septic shock (15.6%) and multiple organ failure (21.9%). There was statistical significance between the recipient's age and the Model for End-Stage Liver Disease value at the time of transplantation for the development of complications. CONCLUSIONS The data from the present study provide important information about liver transplant. These data may enable the team to propose strategies for practice improvements, which will certainly offer better living conditions and transplant survival.
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Matsuo Y, Nomi T, Hokuto D, Yoshikawa T, Kamitani N, Sho M. Pulmonary complications after laparoscopic liver resection. Surg Endosc 2020; 35:1659-1666. [DOI: 10.1007/s00464-020-07549-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/04/2020] [Indexed: 01/13/2023]
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Wiering L, Sponholz F, Brandl A, Dziodzio T, Jara M, Dargie R, Eurich D, Schmelzle M, Sauer IM, Aigner F, Kotsch K, Pratschke J, Öllinger R, Ritschl PV. Perioperative Pleural Drainage in Liver Transplantation: A Retrospective Analysis from a High-Volume Liver Transplant Center. Ann Transplant 2020; 25:e918456. [PMID: 31949125 PMCID: PMC6988474 DOI: 10.12659/aot.918456] [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] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pleural effusions represent a common complication after liver transplantation (LT) and chest drain (CD) placement is frequently necessary. MATERIAL AND METHODS In this retrospective cohort study, adult LT recipients between 2009 and 2016 were analyzed for pleural effusion formation and its treatment within the first 10 postoperative days. The aim of the study was to compare different settings of CD placement with regard to intervention-related complications. RESULTS Overall, 597 patients met the inclusion criteria, of which 361 patients (60.5%) received at least 1 CD within the study period. Patients with a MELD >25 were more frequently affected (75.7% versus 56.0%, P<0.001). Typically, CDs were placed in the intensive care unit (ICU) (66.8%) or in the operating room (14.1% during LT, 11.5% in the context of reoperations). In total, 97.0% of the patients received a right-sided CD, presumably caused by local irritations. Approximately one-third (35.4%) of ICU-patients required pre-interventional optimization of coagulation. Of the 361 patients receiving a CD, 15 patients (4.2%) suffered a post-interventional hemorrhage and 6 patients (1.4%) had a pneumothorax requiring further treatment. Less complications were observed when the CD was performed in the operating room compared to the ICU: 1 out 127 patients (0.8%) versus 20 out of 332 patients (6.0%); P=0.016. CONCLUSIONS CD placement occurring in the operating room was associated with fewer complications in contrast to placement occurring in the ICU. Planned CD placement in the course of surgery might be favorable in high-risk patients.
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Affiliation(s)
- Leke Wiering
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Sponholz
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Brandl
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tomasz Dziodzio
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Maximilian Jara
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Richard Dargie
- Division of Emergency and Acute Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dennis Eurich
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Aigner
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Katja Kotsch
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Paul Viktor Ritschl
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,BIH Charité Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
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Impact of early remote organ dysfunction on long-term survival after liver transplantation. Clin Res Hepatol Gastroenterol 2019; 43:730-737. [PMID: 30954392 DOI: 10.1016/j.clinre.2019.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Attention is focused on graft function although extrahepatic organ dysfunction often occurs. Renal failure, cardiovascular events and sepsis have individually shown a significant impact on short- and long-term outcomes. The aim of the study was to identify how extrahepatic organ dysfunction (EROD) and allograft dysfunction (EAD) may be associated and their relative impact on long-term survival. METHODS A retrospective study was conducted in a unicentric cohort of 294 patients transplanted between 2009 and 2014. The composite endpoint EROD was defined as requirement during the hospitalization of de novo renal replacement therapy, reintubation/ventilation > 7 days or cardiovascular event. Donor and recipient characteristics were evaluated as predictive of EROD in uni- and multivariate analysis. Main endpoint was overall survival evaluated by Kaplan-Meier method. RESULTS EROD occurred in 91 patients (31%) among whom 42 also experienced EAD (46%). Predicting factors associated with EROD were IL6 level (P = 0.002) and lab-MELD (P < 0.001). Only patients experiencing both EAD and EROD had a worse survival (P = 0.001). In patients without EAD, time to normalization of bilirubin and INR were longer in patients with EROD compared to those without EROD (P = 0.002 and P = 0.008 respectively). CONCLUSIONS The composite endpoint described as early remote organ dysfunction could be used as a predictive factor after transplantation and should be included in future studies together with early allograft dysfunction. Identifying patients in whom EROD and EAD occur together or one after the other could help to better predict long-term outcomes.
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Aykota MR, Sari T, Yilmaz S, Mete A, Carti E, Gokakin AK. Evaluation of the first liver transplantations in our transplant center experience. TRANSPLANTATION REPORTS 2019. [DOI: 10.1016/j.tpr.2019.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Zhu M, Wang J, Wang Q, Xie K, Wang M, Qian C, Deng Y, Han L, Gao Y, Ni Z, Xia Q, Gu L. The Incidence and Risk Factors of Low Oxygenation After Orthotropic Liver Transplantation. Ann Transplant 2019; 24:139-146. [PMID: 30858349 PMCID: PMC6429984 DOI: 10.12659/aot.913716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background This study was designed to observe incidence and risk factors of low oxygenation after orthotropic liver transplantation (OLT). Material/Methods We retrospectively evaluated all adult patients who underwent living-donor OLT between January 1, 2017 and December 31, 2017. Postoperative low oxygenation was defined as PaO2/FiO2 <300 mmHg within 24 hours after surgery. Early acute kidney injury (AKI) after OLT was also defined when AKI was happened with 24 hours after operative. Results A total of 301 patients, aged 50.35±10.29 years were enrolled. Of these patients, 100 patients (33.2%) suffered postoperative low oxygenation (PaO2/FiO2=251.80±35.84). Compared with the normal oxygenation group, body mass index (BMI) (24.48±3.53 versus 23.1±3.27 kg/m2, P=0.001), preoperative hemoglobin (115.79±29.27 versus 111.52±29.80 g/L, P=0.033), preoperative MELD (22.25±6.54 versus 20.24±5.74, P=0.008), and intraoperative urinary volume (1.25 [0.76, 1.89] versus 2.04 [1.49, 3.68] mL/kg/h, P=0.003) were higher in low oxygenation group. There were more cases of earlier AKIs that occurred after OLT in low oxygenation patients than that in normal group (47% versus 23.4%, P<0.001). Logistic analysis showed that the preoperative BMI (hazard ration [HR]=1.107, [1.010, 1.212], P=0.029) and early AKI after OLT (HR=2.115, [1.161, 3.855], P=0.014) were independent risk factors for postoperative low oxygenation. Conclusions The incidence of postoperative low oxygenation after liver transplantation in adults was 33.2%. BMI and early AKI after OLT were correlated with postoperative hypoxemia.
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Affiliation(s)
- Mingli Zhu
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Jiemin Wang
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Qiaoling Wang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Kewei Xie
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Minzhou Wang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Cheng Qian
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Yuxiao Deng
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Longzhi Han
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Yuan Gao
- Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Leyi Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (mainland)
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López-de-Andrés A, Perez-Farinos N, de Miguel-Díez J, Hernández-Barrera V, Jiménez-Trujillo I, Méndez-Bailón M, de Miguel-Yanes JM, Jiménez-García R. Type 2 diabetes and postoperative pneumonia: An observational, population-based study using the Spanish Hospital Discharge Database, 2001-2015. PLoS One 2019; 14:e0211230. [PMID: 30726277 PMCID: PMC6364970 DOI: 10.1371/journal.pone.0211230] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose We analyzed temporal trends, demographic and clinical characteristics and hospital mortality rates of postoperative pneumonia among type 2 diabetes mellitus (T2DM) patients in Spain from 2001 to 2015. We also compared the incidence, comorbidities and mortality between patients with and without T2DM suffering from postoperative pneumonia. Finally, we analyzed the factors involved in the prediction of in-hospital mortality among patients suffering postoperative pneumonia. Methods We used the Spanish National Hospital Discharge Database for the period 2001–2015. We analyzed patients aged 40 years or over who had been hospitalized for a surgical procedure and suffered pneumonia or ventilator-associated pneumonia during their hospital admission. We compared patients with and without T2DM. The main outcome measures were the type of surgical procedure, the presence of a comorbidity, the type of isolated pathogens, admission to the emergency room (ER) and in-hospital mortality (IHM). Results We selected 117,665 hospitalized patients who suffered postoperative pneumonia (16.9% with T2DM). After multivariable adjustment, T2DM patients had a 21% higher incidence of postoperative pneumonia than nondiabetic patients (IRR 1.21, 95% CI 1.03–1.42). The IHM was approximately 31% in both groups. Predictors of IHM included age, the presence of comorbidities, treatment with a pleural drainage tube, dialysis, blood transfusion, mechanical ventilation and admission to the ER. From 2001 to 2015, the IHM decreased significantly in both populations. Suffering from T2DM was not a predictor of IHM (OR 0.99, 95% CI 0.96–1.03) in our investigation. Conclusions T2DM patients have a higher incidence of postoperative pneumonia than those without this disease. The IHM decreased from 2001 to 2015, regardless of T2DM status. T2DM did not predict a higher IHM after suffering from postoperative pneumonia.
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Affiliation(s)
- Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Napoleon Perez-Farinos
- Public Health and Psychiatry Department, Faculty of Medicine, Universidad de Malaga, Malaga, Spain
- * E-mail:
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - José M. de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit. Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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N-Acetylcysteine inhalation improves pulmonary function in patients received liver transplantation. Biosci Rep 2018; 38:BSR20180858. [PMID: 30217943 PMCID: PMC6165840 DOI: 10.1042/bsr20180858] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/02/2018] [Accepted: 09/12/2018] [Indexed: 02/08/2023] Open
Abstract
Postoperative pulmonary complications (PPCs) following orthotopic liver transplantation (OLT) are associated with high morbidity and mortality rates. The effect of N-acetylcysteine (NAC) inhalation on the incidence of PPCs and the outcomes of patients undergoing OLT is unknown. This prospective randomized controlled clinical trial was conducted to investigate the effect of NAC inhalation during OLT on PPCs. Sixty patients were randomly assigned to the NAC group (n = 30) or the control group (n = 30) to receive inhaled NAC or sterilized water, respectively, for 30 min before surgery and 3 h after reperfusion. The incidence of early PPCs and outcomes including survival rate were assessed. Biomarkers including tumor necrosis factor (TNF)-α, interleukin (IL)-8, Clara cell secretory protein (CC16), intercellular adhesion molecule (ICAM)-1, and superoxide dismutase (SOD) were measured in exhaled breath condensate (EBC) at T1 (before surgery) and T2 (at the end of operation) as well as in serum at T1, T2, T3 (12 h after operation), and T4 (24 h after operation). A total of 42 patients (20 in the NAC group and 22 in the control group) were enrolled in the final analysis. Atomization inhaled NAC significantly reduced the incidence of PPCs after OLT. The levels of TNF-α, IL-8, CC16, and ICAM-1 in EBC were significantly lower, and SOD activity was higher, at T2 in the NAC group; similar data were found in serum at T2, T3, and T4. In summary, perioperative NAC inhalation may reduce the incidence of PPCs and improve patient outcomes after OLT.
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Prieto Amorin J, Lopez M, Rando K, Castelli J, Medina Presentado J. Early Bacterial Pneumonia After Hepatic Transplantation: Epidemiologic Profile. Transplant Proc 2018; 50:503-508. [PMID: 29579836 DOI: 10.1016/j.transproceed.2017.11.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/11/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postoperative pulmonary complications are major cause of morbidity and mortality in patients receiving liver transplantation (LT), particularly bacterial pneumonia occurring within the first 100 days after transplantation. Our aim in this study was to determine the incidence, microorganisms involved, associated factors, and morbidity of bacterial pneumonia presenting in the first 100 days posttransplant. METHODS We performed a cohort study in which patients receiving liver transplantation were included prospectively in our national database (Database of Infections in Transplantation of Solid Organs). The study period was from July 14, 2009 to July 24, 2015. RESULTS One hundred six patients were transplanted during the 6-year period. We documented 9 bacterial pneumonia cases with an incidence of 8.5 per 100 patients; 2 patients had hospital-acquired pneumonia (HAP) and 7 had ventilator-associated pneumonia (VAP). In 4 of the 9 bacterial pneumonia cases, patients presented with bacteremia. Eleven microorganisms were isolated these 9 patients. Microbiologic diagnosis methods included 5 cases of alveolar bronchoalveolar lavage (BAL), 1 case of BAL and pleural fluid puncture, 1 case of pleural fluid puncture, and 1 case through sputum study. Of the 11 isolated organisms, 9 corresponded to Gram-negative bacilli (GNB): Klebsiella spp, n = 3; Acinetobacter baumannii, n = 4; Morganella morganii, n = 1; and Pseudomonas aeruginosa, n = 1. Regarding the resistance profile, 7 presented with a multiresistance profile (MDR) and extreme resistance (XDR). Univariate analysis identified the Model for End-Stage Liver Disease (MELD) pretransplant score as a factor associated with developing pneumonia (P < .001, 95% confidence interval [CI] 2.872-10.167), and early extubation, before 8 hours posttransplant, as a protective factor (P = .008; relative risk [RR] 0.124; 95% CI 0 .041-0.377). Hospital stay was longer in patients with pneumonia compared to those without pneumonia (P < .0001, 95% CI 17.79-43.11 days). There was also an increased risk of death in patients with pneumonia (RR 17.963; 95% CI 5106-63,195). CONCLUSIONS Early bacterial pneumonia after hepatic transplantation is associated with higher morbidity and mortality. At our center, 4 of 9 patients had bacteremia. GNB cases with MDR and XDR profiles are predominant. Early extubation is a protective factor.
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Affiliation(s)
- J Prieto Amorin
- Programa Nacional de Trasplante Hepático, Unidad Bi-Institucional de Enfermedades Hepáticas Compleja (Hospital Militar, Hospital de Clínicas), Cátedra de Enfermedades Infecciosas, Facultad de Medicina Montevideo, UdeLaR, Montevideo, Uruguay.
| | - M Lopez
- Programa Nacional de Trasplante Hepático, Unidad Bi-Institucional de Enfermedades Hepáticas Compleja (Hospital Militar, Hospital de Clínicas), Cátedra de Enfermedades Infecciosas, Facultad de Medicina Montevideo, UdeLaR, Montevideo, Uruguay
| | - K Rando
- Programa Nacional de Trasplante Hepático, Unidad Bi-Institucional de Enfermedades Hepáticas Compleja (Hospital Militar, Hospital de Clínicas), Cátedra de Enfermedades Infecciosas, Facultad de Medicina Montevideo, UdeLaR, Montevideo, Uruguay
| | - J Castelli
- Programa Nacional de Trasplante Hepático, Unidad Bi-Institucional de Enfermedades Hepáticas Compleja (Hospital Militar, Hospital de Clínicas), Cátedra de Enfermedades Infecciosas, Facultad de Medicina Montevideo, UdeLaR, Montevideo, Uruguay
| | - J Medina Presentado
- Programa Nacional de Trasplante Hepático, Unidad Bi-Institucional de Enfermedades Hepáticas Compleja (Hospital Militar, Hospital de Clínicas), Cátedra de Enfermedades Infecciosas, Facultad de Medicina Montevideo, UdeLaR, Montevideo, Uruguay
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de Miguel-Díez J, López-de-Andrés A, Hernández-Barrera V, Jiménez-Trujillo I, Méndez-Bailón M, de Miguel-Yanes JM, Jiménez-García R. Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015. Eur J Intern Med 2018; 53:66-72. [PMID: 29452729 DOI: 10.1016/j.ejim.2018.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/29/2018] [Accepted: 02/10/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD. METHODS We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database. RESULTS We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68-2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p < 0.05). Factors independently associated with IHM, among COPD and non-COPD patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88-0.95). CONCLUSIONS The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD.
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Affiliation(s)
- Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Li X, Chen C, Wei X, Zhu Q, Yao W, Yuan D, Luo G, Cai J, Hei Z. Retrospective Comparative Study on Postoperative Pulmonary Complications After Orthotopic Liver Transplantation Using the Melbourne Group Scale (MGS-2) Diagnostic Criteria. Ann Transplant 2018; 23:377-386. [PMID: 29853713 PMCID: PMC6248093 DOI: 10.12659/aot.907883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Postoperative pulmonary complications (PPCs) after orthotopic liver transplantation (OLT) are associated with poor postoperative survival. However, there are no standard criteria for diagnosis of PPCs. This retrospective study aimed to explore the reliability of the Melbourne Group Scale version 2 (MGS-2) for determining PPCs after OLT. Material/Methods A total of 121 patients were divided into 3 groups. In the PPC and non-PPC groups, PPCs were determined to be present or absent in accordance with both the MGS-2 and the conventional broad criteria for diagnosis of PPCs; in the potential-PPC group, PPCs were determined to be present only in accordance with the conventional broad criteria. The perioperative risk factors for PPCs and prognosis of patients in potential-PPC group were all compared with non-PPC groups and PPC groups. Results The preoperative characteristics of patients in the potential-PPC group were similar to those in non-PPC group. The length of intensive care unit stay (2.26±0.22 vs. 4.75±0.47 days; P=0.017), duration of hospitalization (33.33±1.70 vs. 48.78±2.53 days; P<0.001), and treatment cost (28.01±1.78 vs. 38.35±1.85×10 000 yuan; P=0.018) were significantly less in the potential-PPC group than in the PPC group. Furthermore, in accordance with the MGS-2 criteria for diagnosis of PPCs, patients with PPCs showed poorer overall survival rates than those without (P=0.038). Conclusions The MGS-2 appears to be a more suitable and reliable tool for diagnosis of PPCs and to identify the post-OLT patients with poorer perioperative characteristics and prognosis.
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Affiliation(s)
- Xiaoyun Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Chaojin Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Xiaoxia Wei
- Department of Anesthesiology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China (mainland)
| | - Qianqian Zhu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Nanning, Guangxi, China (mainland)
| | - Weifeng Yao
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Dongdong Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Gangjian Luo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Jun Cai
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
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Abstract
Chronic liver disease has been associated with pulmonary dysfunction both before and after liver transplantation. Post-liver transplantation pulmonary complications can affect both morbidity and mortality often necessitating intensive care during the immediate postoperative period. The major pulmonary complications include pneumonia, pleural effusions, pulmonary edema, and atelectasis. Poor clinical outcomes have been known to be associated with age, severity of liver dysfunction, and preexisting lung disease as well as perioperative events related to fluid balance, particularly transfusion and fluid volumes. Delineating each and every one of these pulmonary complications and their associated risk factors becomes paramount in guiding specific therapeutic strategies.
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Predictive Value of Intraoperative Troponin I Elevation in Pediatric Living Donor Liver Transplant Recipients With Biliary Atresia. Transplantation 2017; 101:2385-2390. [PMID: 28319568 DOI: 10.1097/tp.0000000000001732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pediatric living donor liver transplantation is associated with slight alteration in cardiac enzymes without ongoing acute cardiac injury, but available information about the significance of these changes is limited. The aims of this study were to analyze the link between the anomalies of intraoperative serum cardiac troponin I (cTnI) and acute lung injury during the first week after liver transplantation. METHODS In this retrospective study, 123 children suffering from biliary atresia were enrolled. Several perioperative variables, particularly cTnI before operation and at 30 minutes of neohepatic phase were recorded. Sixty-four recipients were divided into high cTnI group (≥0.07 ng/mL) and 59 recipients composed normal cTnI group (<0.07 ng/mL). The clinical data between 2 groups were compared and the association between serum cTnI level and acute lung injury after living donor liver transplantation were evaluated by univariate and multivariate logistic regression analyses. RESULTS The percentage of acute lung injury after pediatric living donor liver transplantation among high cTnI group and normal cTnI group was 34.3% and 11.9%, respectively. Intratransplant cTnI ≥ 0.07 ng/mL (odds ratio [OR], 3.475; 95% confidence interval [CI], 1.114-10.842) was the risk factors for acute lung injury after transplantation. The value of cTnI showed the close correlation with preoperative bilirubin (OR, 1.005; 95% CI, 1.002-1.008) and pretransplant albumin (OR, 0.915; 95% CI, 0.849-0.986). CONCLUSIONS Intraoperative cTnI elevation was the significant prognostic risk factor in acute lung injury after pediatric living-donor liver transplantation for children with biliary atresia. And the value of cTnI was associated with preoperative bilirubin and albumin level.
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Murata M, Kato TS, Kuwaki K, Yamamoto T, Dohi S, Amano A. Preoperative hepatic dysfunction could predict postoperative mortality and morbidity in patients undergoing cardiac surgery: Utilization of the MELD scoring system. Int J Cardiol 2016; 203:682-9. [DOI: 10.1016/j.ijcard.2015.10.181] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/19/2015] [Accepted: 10/24/2015] [Indexed: 01/29/2023]
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