Can joint analysis of postoperative MELD, base excess and blood lactate levels be used as an index of postoperative outcome for patients submitted to liver transplantation?

Fluorescence spectroscopy for clinical transplantation liver grafts monitoring: possibilities offered by 408 nm excitation

PURPOSE

Fluorescence spectroscopy techniques have been investigated aiming to reduce the invasiveness of methods for investigation of tissue. In transplantation procedures, it may offer the possibility of a complementary technique for the monitoring of liver grafts' conditions prior to and during the transplantation procedure stages involving cold perfusion. The objective of this study was to evaluate fluorescence spectroscopy under violet light excitation (408 nm) for the monitoring of clinical hypothermic liver transplantation procedures.

METHODS

Organ grafts were monitored from before the removal of the donor's body to 1 h after the implant into the receptor's body. Fluorescence spectroscopy was assessed over five stages within these transplant stages.

RESULTS

The study provided evidence of a correlation between fluorescence information collected during liver grafts transplantation and the survival of patients.

CONCLUSIONS

Fluorescence spectroscopy can become a tool to monitor transplantation grafts, providing objective information for the final decision of surgeons to use organs.

Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection

BACKGROUND/AIM

Infections are one of the most important causes of mortality and morbidity after liver transplantation as in all transplantations. Infectious complications are known to be among the preventable causes with appropriate diagnosis and treatment. So early prediction of the risk of infections will provide an effective approach to determine the local antimicrobial resistance and prevention of specific risk factors. The aim of this study was to deterimne whether specific markers are useful or not to deterimne a suspected infection in patients that have undergone liver transplantation.

PATIENTS AND METHODS

The study included 65 patients with liver transplantation admitted to emergency room with suspicion of infection. These patient's CRP, procalsitonin (PCT), lactate, SAA and IL-6 levels were initially measured in the emergency department. The patients were classified to three categories according to culture results; culture-negative, culture-positive and control group. Studying parameters were investigated according to whether the culture was positive or negative in these patients.

RESULTS

CRP, PCT, lactate, SAA and IL-6 levels were significanlty high in patients with suspected infeciton when compared to the control group (p<0.05). CRP, PCT and IL-6 levels were higher in the culture-positive group than in the culture-negative group and there was a significant variation (p<0.05). When suspecting an infection evaluating the parameters CRP, PCT and IL-6 was very meaningfull (p<0.05).

CONCLUSION

We can use CRP, PCT, lactate, SAA and IL-6 parameters to identify presence of infection at the liver transplantation patients admitted to the emergency department with suspected infection. If CRP, PCT and IL-6 levels are significantly high we can guess the patient's positive culture.

Postoperative Meld-Lactate and Isolated Lactate Values As Outcome Predictors Following Orthotopic Liver Transplantation

The Model for End Stage Liver (MELD) score is validated to predict pretransplant mortality. However, as a predictor of postoperative outcomes, its utility has proven inconsistent. Recently developed MELD-Lactate models better predict 30-day survival as compared with the MELD and MELD-Sodium scores. We compared the MELD-Lactate, original MELD, and MELD-Sodium formulae and the initial postoperative lactate as predictors of 30-day and in-hospital mortality following liver transplantation.Adult patients (n = 989) undergoing orthotopic liver transplant between 2002 to 2013 were included. In addition to the previous models, the first postoperative lactate value and a newly derived Mount Sinai MELD-Lactate score and associated c-statistics were compared.The Mount Sinai MELD-Lactate model yielded the highest c-statistic value (0.749), followed by the original MELD-Lactate (0.740), initial lactate value (0.729), postoperative MELD (0.653), and MELD-Sodium (0.641) models in predicting survival at 30 days following liver transplantation. For in-hospital mortality, the original MELD-Lactate model had slightly higher c-statistic (0.739) compared with the Mount Sinai MELD-Lactate model (0.734). Despite the distribution differences in the MELD-Lactate models, the model validation results, both from cross-validation and bootstrap methods, were similar.Postoperative MELD-Lactate and isolated postoperative lactate values were moderately predictive of 30-day and in-hospital mortality following liver transplantation in this patient cohort.

Effect of hyperbaric hepatic hyperoxia on the liver of rats submitted to intermittent ischemia/reperfusion injury

PURPOSE

To determine the effect of hyperbaric hyperoxia as hepatic preconditioning on hepatocellular integrity in rats submitted to intermittent hepatic ischemia/reperfusion injury.

METHODS

Twenty male Wistar rats were divided into 4 groups (SHAM, I/R, HBO-I/R and CONTROL). The surgical technique consisted of total clamping of the hepatic pedicle for 15 min, followed by reperfusion for 5 min, performed twice. The application of hyperbaric oxygen (HBO) was carried out in a collective chamber (simultaneous exposure of 4 rats) pressurized directly with oxygen at 2 ATA for 60 min. Tissue malondialdehyde (MDA) levels were determined and blood samples were collected for the determination of serum AST and ALT levels. Data were analyzed statistically by the Mann-Whitney test, with the level of significance set at p < 0.05.

RESULTS

A statistically significant difference in MDA (p< 0.05) was observed between control and HBO-I/R, but not between control and I/R. Regarding AST, there was a difference between control and I/R and HBO-I/R. Analysis of ALT revealed a significant difference between control and I/R (p<0.05) and between I/R and HBO-I/R, with no difference between control and HBO-IR.

CONCLUSION

Hyperoxic preconditioning proved to be favorable regarding alanine transaminase, but not aspartate aminotranserase or malondialdehyde levels.

A new formula as a predictive score of post-liver transplantation outcome: postoperative MELD-lactate

INTRODUCTION

Liver transplantation (OLT) involves a 5% to 10% 30-day mortality rate. Multiple scores have been used as predictors of early postoperative mortality, such as the original Model for End-stage Liver Disease (MELD) and MELD sodium. Investigations have been conducted over the last 5 years to find new predictors of early post-OLT mortality.

OBJECTIVE

The aim of this study was to develop a new mathematical model to predict the individual chance of 30-day mortality after OLT.

METHODS

The study was conducted on 58 patients submitted to OLT at the University Hospital, between October 2008 and March 2012. The 29 latest survivor and 29 latest nonsurvivor cases were selected. Arterial blood sodium, lactate, international normalized ratio, total bilirubin, and creatinine values were determined 1 hour after the end of surgery. The MELD original equation, MELD sodium, and new MELD lactate were also elaborated. The results were analyzed by the Mann-Whitney and Wilcoxon tests. The level of significance was set at .05.

RESULTS

The new formula elaborated was as follows: MELD lactate = 5.68 × loge (lactate) + 0.64 × (Original MELD) + 2.68. The MELD lactate values were significantly higher than the MELD sodium and original MELD values (P < .05). The area under the receiver operating characteristic curve of MELD lactate in predicting the outcome of patients submitted to OLT was 0.80, as opposed to 0.71 for the original MELD and 0.72 for MELD sodium (P < .05).

CONCLUSION

The postoperative MELD lactate score proved to be more specific and sensitive than the original MELD and MELD sodium as a predictive model of the outcome of patients submitted to OLT.