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Kulkarni AV, Kumar K, Candia R, Arab JP, Tevethia HV, Premkumar M, Sharma M, Menon B, Rao GV, Reddy ND, Rao NP. Prophylactic Perioperative Terlipressin Therapy for Preventing Acute Kidney Injury in Living Donor Liver Transplant Recipients: A Systematic Review and Meta-Analysis. J Clin Exp Hepatol 2022; 12:417-427. [PMID: 35535072 PMCID: PMC9077193 DOI: 10.1016/j.jceh.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background Acute kidney injury (AKI) is common in the perioperative transplant period and is associated with poor outcomes. Few studies reported a reduction in AKI incidence with terlipressin therapy by counteracting the hemodynamic alterations occurring during liver transplantation. However, the effect of terlipressin on posttransplant outcomes has not been systematically reviewed. Methods A comprehensive search of electronic databases was performed. Studies reporting the use of terlipressin in the perioperative period of living donor liver transplantation were included. We expressed the dichotomous outcomes as risk ratio (RR, 95% confidence interval [CI]) using the random effects model. The primary aim was to assess the posttransplant risk of AKI. The secondary aims were to assess the need for renal replacement therapy (RRT), vasopressors, effect on hemodynamics, blood loss during surgery, hospital and intensive care unit (ICU) stay, and in-hospital mortality. Results A total of nine studies reporting 711 patients (309 patients in the terlipressin group and 402 in the control group) were included for analysis. Terlipressin was administered for a mean duration of 53.44 ± 28.61 h postsurgery. The risk of AKI was lower with terlipressin (0.6 [95% CI, 0.44-0.8]; P = 0.001). However, on sensitivity analysis including only four randomized controlled trials (I2 = 0; P = 0.54), the risk of AKI was similar in both the groups (0.7 [0.43-1.09]; P = 0.11). The need for RRT was similar in both the groups (0.75 [0.35-1.56]; P = 0.44). Terlipressin therapy reduced the need for another vasopressor (0.34 [0.25-0.47]; P < 0.001) with a concomitant rise in mean arterial pressure and systemic vascular resistance by 3.2 mm Hg (1.64-4.7; P < 0.001) and 77.64 dyne cm-1.sec-5 (21.27-134; P = 0.007), respectively. Blood loss, duration of hospital/ICU stay, and mortality were similar in both groups. Conclusions Perioperative terlipressin therapy has no clinically relevant benefit.
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Key Words
- AKI, acute kidney injury
- BMI, body mass index
- BUN, blood urea nitrogen
- C, control
- CI, confidence interval
- CNI, calcineurin inhibitors
- CTP, Child-Turcotte-Pugh score
- DDLT, deceased donor liver transplantation
- GRWR, graft-torecipient weight ratio
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HRS, hepatorenal syndrome
- ICU, intensive care unit
- LDLT, living donor liver transplantation
- MAP, mean arterial pressure
- MELD, model for end-stage liver disease
- NR, not reported
- PRBC, packed red blood cells
- RCT, randomized controlled trial
- RRT, renal replacement therapy
- SD, standard deviation
- SVR, systemic vascular resistance
- Tp, Terlipressin
- acute kidney injury
- hemodynamics
- mTORi, mammalian target of rapamycin inhibitors
- portal hypertension
- renal replacement therapy
- sCr, serum creatinine
- vasoconstrictors
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Affiliation(s)
- Anand V. Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India,Address for correspondence. Dr. Anand V.Kulkarni, Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India.
| | - Karan Kumar
- Department of Hepatology, Pacific Institute of Medical Sciences, Udaipur, India
| | - Roberto Candia
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Juan P. Arab
- Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Harsh V. Tevethia
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | | | - Mithun Sharma
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Balachandandran Menon
- Department of Hepatobiliary Surgery and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Guduru V. Rao
- Department of Hepatobiliary Surgery and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nageshwar D Reddy
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Nagaraja P. Rao
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
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Abstract
Background Melioidosis-related mycotic aneurysm (MA) is rare but a potentially life-threatening disease with high morbidity and mortality rate. Case presentation We report a case series of mycotic aneurysm caused by Burkholderia pseudomallei and the subsequent outcomes. Here, we illustrate their clinical characteristics, laboratory results, radiological findings, mode of therapies and clinical outcomes. Conclusion Melioidosis-associated MA may manifest in an atypical presentation. Its outcome is often lethal if antimicrobial therapy and surgical intervention are not offered promptly.
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Key Words
- BA, Blood Agar
- CTA, Aortographic computed tomography
- EVAR, Endovascular repair
- MA, Mycotic aneurysm
- MAC, MacConkey Agar
- MALDI-TOF MS, Matrix-assisted laser desorption/ionisation mass spectrometry
- Melioidosis
- Mycotic aneurysm
- OS, Open surgery
- Outcome
- RRT, renal replacement therapy
- TEVAR, Thoracic endovascular aortic repair
- TMP/SMX, Trimethoprim/Sulfamethoxazole
- WCC, White blood cells, in cells/μL
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Affiliation(s)
- Tan Kok Tong
- Department of Internal Medicine, Queen Elizabeth Hospital II (QEH II) (Ministry of Health, Malaysia), Sabah, Malaysia
| | - Giri Shan
- Department of Internal Medicine, Queen Elizabeth Hospital II (QEH II) (Ministry of Health, Malaysia), Sabah, Malaysia
| | - Feona Joseph Sibangun
- Vascular Unit, Department of Surgery, QEH II (Ministry of Health, Malaysia), Malaysia
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Jiang DH, Roy DJ, Gu BJ, Hassett LC, McCoy RG. Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A State-of-the-Art Review. JACC Basic Transl Sci 2021; 6:796-811. [PMID: 34541421 PMCID: PMC8442719 DOI: 10.1016/j.jacbts.2021.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/22/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
The vast majority of patients (>99%) with severe acute respiratory syndrome coronavirus 2 survive immediate infection but remain at risk for persistent and/or delayed multisystem. This review of published reports through May 31, 2021, found that manifestations of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) affect between 33% and 98% of coronavirus disease 2019 survivors and comprise a wide range of symptoms and complications in the pulmonary, cardiovascular, neurologic, psychiatric, gastrointestinal, renal, endocrine, and musculoskeletal systems in both adult and pediatric populations. Additional complications are likely to emerge and be identified over time. Although data on PASC risk factors and vulnerable populations are scarce, evidence points to a disproportionate impact on racial/ethnic minorities, older patients, patients with preexisting conditions, and rural residents. Concerted efforts by researchers, health systems, public health agencies, payers, and governments are urgently needed to better understand and mitigate the long-term effects of PASC on individual and population health.
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Affiliation(s)
- David H. Jiang
- Division of Health Care Delivery and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Darius J. Roy
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Brett J. Gu
- School of Medicine, Yale University; New Haven, Connecticut, USA
| | | | - Rozalina G. McCoy
- Division of Health Care Delivery and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Reddy MS, Rajakumar A, Mathew JS, Venkatakrishnan L, Jothimani D, Sudhindran S, Jacob M, Narayanasamy K, Venugopal R, Mohanka R, Kaliamoorthy I, Varghese J, Panackel C, Mohamed Z, Vij M, Sachan D, Pillay V, Saigal S, Dhiman R, Soin AS, Gupta S, Wendon J, Rela M, Sarin SK. Liver Transplantation Society of India Guidelines for the Management of Acute Liver Injury Secondary to Yellow Phosphorus-Containing Rodenticide Poisoning Using the Modified Delphi Technique of Consensus Development. J Clin Exp Hepatol 2021; 11:475-483. [PMID: 34276154 PMCID: PMC8267358 DOI: 10.1016/j.jceh.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute liver failure caused by the ingestion of yellow phosphorus-containing rodenticide has been increasing in incidence over the last decade and is a common indication for emergency liver transplantation in Southern and Western India and other countries. Clear guidelines for its management are necessary, given its unpredictable course, potential for rapid deterioration and variation in clinical practice. METHODS A modified Delphi approach was used for developing consensus guidelines under the aegis of the Liver Transplantation Society of India. A detailed review of the published literature was performed. Recommendations for three areas of clinical practice, assessment and initial management, intensive care unit (ICU) management and liver transplantation, were developed. RESULTS The expert panel consisted of 16 clinicians, 3 nonclinical specialists and 5 senior advisory members from 11 centres. Thirty-one recommendations with regard to criteria for hospital admission and discharge, role of medical therapies, ICU management, evidence for extracorporeal therapies such as renal replacement therapy and therapeutic plasma exchange, early predictors of need for liver transplantation and perioperative care were developed based on published evidence and combined clinical experience. CONCLUSION Development of these guidelines should help standardise care for patients with yellow phosphorus poisoning and identify areas for collaborative research.
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Key Words
- ALF, acute liver failure
- ALI, acute liver injury
- DDLT, deceased donor liver transplantation
- ICU, intensive care unit
- INR, international normalised ratio
- KCC, Kings College Criteria
- LDLT, living donor liver transplantation
- LT, liver transplantation
- LTSI, Liver Transplantation Society of India
- MELD, model for end-stage liver disease
- RRT, renal replacement therapy
- TPE, therapeutic plasma exchange
- YP, yellow phosphorus
- acute liver failure
- consensus guidelines
- liver transplantation
- rat killer poison
- yellow phosphorus
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Affiliation(s)
- Mettu S. Reddy
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Center, Chennai, India
| | - Akila Rajakumar
- Department of Liver Anesthesia & Intensive Care, Dr Rela Institute & Medical Center, Chennai, India
| | - Johns S. Mathew
- Department of Liver Transplantation & Gastrointestinal Surgery, Amrita Hospitals, Kochi, India
| | | | - Dinesh Jothimani
- Department of Hepatology, Dr Rela Institute & Medical Center, Chennai, India
| | - S. Sudhindran
- Department of Liver Transplantation & Gastrointestinal Surgery, Amrita Hospitals, Kochi, India
| | - Mathew Jacob
- Multiorgan Transplantation & Hepatobiliary Surgery, Aster Medicity, Kochi, India
| | | | - Radhika Venugopal
- Department of Hepatology, Dr Rela Institute & Medical Center, Chennai, India
| | - Ravi Mohanka
- Department of Liver Transplantation & HPB Surgery, Global Hospital, Mumbai, India
| | - Ilankumaran Kaliamoorthy
- Department of Liver Anesthesia & Intensive Care, Dr Rela Institute & Medical Center, Chennai, India
| | - Joy Varghese
- Department of Hepatology & Liver Transplantation, Gleneagles Global Hospital & Health City, Chennai, India
| | - Charles Panackel
- Department of Hepatology & Liver Transplantation, Aster Medicity, Kochi, India
| | - Zubair Mohamed
- Department of Anesthesiology & Critical Care Medicine, Amrita Hospitals, Kochi, India
| | - Mukul Vij
- Department of Pathology & Laboratory Medicine, Dr Rela Institute & Medical Center, Chennai, India
| | - Deepti Sachan
- Department of Transfusion Medicine, Dr Rela Institute & Medical Center, Chennai, India
| | - V.V. Pillay
- Department of Forensic Medicine & Toxicology, Amrita Hospitals, Kochi, India
| | - Sanjiv Saigal
- Department of Hepatology & Liver Transplantation, Medanta Medicity, Gurgaon, India
| | - Radhakrishna Dhiman
- Department of Hepatology & Liver Transplantation, Post-graduate Institute of Medical Education & Research, Chandigarh, India
| | - Arvinder S. Soin
- Department of Liver Transplantation & Regenerative Medicine, Medanta Medicity, Gurgaon, India
| | - Subhash Gupta
- Centre for Liver & Biliary Sciences, Max Super Specialty Hospital, Saket, Delhi, India
| | - Julia Wendon
- Institute of Liver Studies, Kings College Hospital, London, UK
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Center, Chennai, India
| | - Shiv K. Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
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Kohsaka S, Okami S, Kanda E, Kashihara N, Yajima T. Cardiovascular and Renal Outcomes Associated With Hyperkalemia in Chronic Kidney Disease: A Hospital-Based Cohort Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:274-285. [PMID: 33997627 PMCID: PMC8105529 DOI: 10.1016/j.mayocpiqo.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To examine the association between hyperkalemia and long-term cardiovascular and renal outcomes in patients with chronic kidney disease. Patients and Methods An observational retrospective cohort study was performed using a Japanese hospital claims registry, Medical Data Vision (April 1, 2008, to September 30, 2018). Of 1,208,894 patients with at least 1 potassium measurement, 167,465 patients with chronic kidney disease were selected based on International Classification of Diseases, Tenth Revision codes or estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Hyperkalemia was defined as at least 2 potassium measurements of 5.1 mmol/L or greater within 12 months. Normokalemic controls were patients without a record of potassium levels of 5.1 mmol/L or greater and 3.5 mmol/L or less. Changes in eGFRs and hazard ratios of death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction were assessed between propensity score–matched hyperkalemic patients and normokalemic controls. Results Of 16,133 hyperkalemic patients and 11,898 normokalemic controls eligible for analyses, 5859 (36.3%) patients and 5859 (49.2%) controls were selected after propensity score matching. The mean follow-up period was 3.5 years. The 3-year eGFR change in patients and controls was −5.75 and −1.79 mL/min/1.73 m2, respectively. Overall, hyperkalemic patients had higher risks for death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction than controls, with hazard ratios of 4.40 (95% CI, 3.74 to 5.18), 1.95 (95% CI, 1.59 to 2.39), 5.09 (95% CI, 4.17 to 6.21), and 7.54 (95% CI, 5.73 to 9.91), respectively. Conclusion Hyperkalemia was associated with significant risks for mortality and adverse clinical outcomes, with more rapid decline of renal function. These findings underscore the significance of hyperkalemia as a predisposition to future adverse events in patients with chronic kidney disease.
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Key Words
- ACEi, angiotensin-converting enzyme inhibitor
- ARB, angiotensin receptor blocker
- CKD, chronic kidney disease
- DM, diabetes mellitus
- HDL, high-density lipoprotein
- HF, heart failure
- ICD-10, International Classification of Diseases, Tenth Revision
- LDL, low-density lipoprotein
- MDV, Medical Data Vision
- MRA, mineralocorticoid receptor antagonist
- PS, propensity score
- RAASi, renin-angiotensin-aldosterone system inhibitor
- RRT, renal replacement therapy
- S-K, serum potassium
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Suguru Okami
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshitaka Yajima
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
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Abstract
Acute kidney injury (AKI) is a relatively common condition, encountered in everyday paediatric clinical practice. It is an important cause of morbidity and mortality in children both inside and outside intensive care units. It is associated with prolonged hospital stay and progression to chronic kidney disease. The burden of AKI is particularly high in low- and middle-income countries where rural areas and smaller cities in the countryside predominate. Most of these areas suffer from poverty, poor sanitation, water quality and hygiene, lack of education and poor access to health care. AKI is preventable if it is detected sufficiently early and managed promptly. Improved nephrology services and the availability of cost-effective dialysis facilities in resource-limited settings should reduce morbidity and save many children's lives.
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Affiliation(s)
- Mohamed B Abdelraheem
- a Al Jalila Children's Speciality Hospital , Dubai , United Arab Emirates.,b Department of Paediatrics , University of Khartoum , Khartoum , Sudan
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