Survival after liver transplantation in patients with hepatic iron overload: the national hemochromatosis transplant registry

Microbial application in remediation of heavy metals: an overview

Heavy metal contamination poses a menacing threat to all living forms in the natural world due to its catastrophic consequences, contributing to environmental pollution. The need for human beings increasing each day along with anthropological activity is contributing directly to the destruction of the environment with the release of a large number of heavy metals into the food chain. These metals can be accumulated in the food chains and are very extremely toxic even at low concentrations. Heavy metals aggregation can deteriorate the healthy ecosystem of the water bodies as well. One of the major concerns is the diminution and administration of the heavy metals aggregating in marine water bodies and lakes. Heavy metals are not degradable and thus tend to remain in the environment for a prolonged time period. Heavy metal aggregation can demonstrate immediate repercussions such as DNA damage, inhibition of respiration and photosynthesis, and rapid reactive oxygen species generation. Conventional or standard chemical and physical methods for remediation of heavy metals are uneconomical and lead to the production of a large magnitude of chemical waste. This shifts the focus and interest towards the utilization of microbes in remediation of heavy metals from the environment which is eco-friendly and economical. To contend with heavy metals, microorganisms have a specific mechanism such as biotransformation, biosorption, and homeostasis. The microbial system is responsive to the toxicity that is created by the heavy metals which are easily water-soluble and available in the environment. The current review article describes the sources and effects of metal ions in the environment followed by bioremediation strategies followed in their remediation. Microbial approaches in remediation of metal ions from extraterrestrial materials are depicted in the paper.

Iron metabolism imbalance at the time of listing increases overall and infectious mortality after liver transplantation

BACKGROUND

Liver transplantation (LT) is the best treatment for patients with liver cancer or end stage cirrhosis, but it is still associated with a significant mortality. Therefore identifying factors associated with mortality could help improve patient management. The impact of iron metabolism, which could be a relevant therapeutic target, yield discrepant results in this setting. Previous studies suggest that increased serum ferritin is associated with higher mortality. Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered.

AIM

To assess the impact of pre-transplant iron metabolism parameters on post-transplant survival.

METHODS

From 2001 to 2011, 553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included. Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient. Serum ferritin (SF) and transferrin saturation (TS) were studied as continuous and categorical variable. Cox regression analysis was used to determine mortality risks factors. Follow-up data were obtained from the local and national database regarding causes of death.

RESULTS

At the end of a 95-mo median follow-up, 196 patients were dead, 38 of them because of infections. In multivariate analysis, overall mortality was significantly associated with TS > 75% [HR: 1.73 (1.14; 2.63)], SF < 100 µg/L [HR: 1.62 (1.12; 2.35)], hepatocellular carcinoma [HR: 1.58 (1.15; 2.26)], estimated glomerular filtration rate (CKD EPI Cystatin C) [HR: 0.99 (0.98; 0.99)], and packed red blood cell transfusion [HR: 1.05 (1.03; 1.08)]. Kaplan Meier curves show that patients with low SF (< 100 µg/L) or high SF (> 400 µg/L) have lower survival rates at 36 mo than patients with normal SF (P = 0.008 and P = 0.016 respectively). Patients with TS higher than 75% had higher mortality at 12 mo (91.4% ± 1.4% vs 84.6% ± 3.1%, P = 0.039). TS > 75% was significantly associated with infection related death [HR: 3.06 (1.13; 8.23)].

CONCLUSION

Our results show that iron metabolism imbalance (either deficiency or overload) is associated with post-transplant overall and infectious mortality. Impact of iron supplementation or depletion should be assessed in prospective study.