Apolipoprotein E polymorphism influences orthotopic liver transplantation outcomes in patients with hepatitis C virus-induced liver cirrhosis.

BACKGROUND: Hepatitis C virus (HCV) infection is responsible for a chronic liver inflammation, which may cause end-stage liver disease and hepatocellular carcinoma. Apolipoprotein E (protein: ApoE, gene: APOE), a key player in cholesterol metabolism, is mainly synthesized in the liver and APOE polymorphisms may influence HCV-induced liver damage. AIM: To determine whether APOE alleles affect outcomes in HCV-infected patients with liver cirrhosis following orthotopic liver transplantation (OLT). METHODS: This was a cohort study in which 179 patients, both genders and aged 34-70 years, were included before or after (up to 10 years follow-up) OLT. Liver injury severity was assessed using different criteria, including METAVIR and models for end-stage liver disease. APOE polymorphisms were analyzed by quantitative real-time polymerase chain reaction. RESULTS: The APOE3 allele was the most common (67.3%). In inflammation severity of biopsies from 89 OLT explants and 2 patients in pre-transplant, the degree of severe inflammation (A3F4, 0.0%) was significantly less frequent than in patients with minimal and moderate degree of inflammation (≤ A2F4, 16.2%) P = 0.048, in patients carrying the APOE4 allele when compared to non-APOE4. In addition, a significant difference was also found (≤ A2F4, 64.4% vs A3F4, 0.0%; P = 0.043) and (A1F4, 57.4% vs A3F4, 0.0%; P = 0.024) in APOE4 patients when compared to APOE3 carriers. The fibrosis degree of the liver graft in 8 of 91 patients and the lack of the E4 allele was associated with more moderate fibrosis (F2) (P = 0.006). CONCLUSION: Our results suggest that the E4 allele protects against progression of liver fibrosis and degree of inflammation in HCV-infected patients.

Hepatic steatosis assessment: a comparative study between surgeon evaluation and forward histopathologic findings.

CONTEXT: Liver transplantation is one of the last viable resources for patients with end-stage liver disease. Many strategies are been used to improve the number of available organs and overcome waiting list delay. However, hepatic steatosis is one of the mainly concerns when organs are consider to transplantation due to it is importance as a risk factor for primary dysfunction. Surgeons play an important role to decide each organ will be accept or decline and its righteous allocation. OBJECTIVE: Retrospectively evaluate the surgeon assessment of steatosis degree and its confrontation with further histopathologic findings. METHODS: We analyzed 117 patients underwent deceased liver transplantation for end-stage liver disease in University Hospital Walter Cantideo, Fortaleza, CE, Brazil. A matrix table was organized to estimate the categorical data observed. We clustered the subjects into mild (0%-30%) and moderate (30%-60%) steatosis degree under the clinical criteria of organ suitability for transplantation. We categorized the organs as suitable organ for transplant and as non-suitable organ for transplant. Evaluations between the two first assessments, before perfusion (pre-perfusion) vs biopsy findings and after perfusion vs biopsy findings observations were analyzed and also a comparison between pre-perfusion and after perfusion data was performed. RESULTS: On the first assessment, we obtained a 93% of agreement (n = 109) between the two evaluations. On the second assessment, we had an 8% (n = 9) of mistaken allocation. Comparing the observation before (pre-perfusion) and after (after perfusion), we obtained a strong agreement between the surgeons. CONCLUSIONS: Although our experienced surgeon team, we have wrongly evaluated feasible organs for transplantation. Nonetheless, our faulty percentage is low comparing to worldwide percentage.

Hepatic steatosis assessment

ContextLiver transplantation is one of the last viable resources for patients with end-stage liver disease. Many strategies are been used to improve the number of available organs and overcome waiting list delay. However, hepatic steatosis is one of the mainly concerns when organs are consider to transplantation due to it is importance as a risk factor for primary dysfunction. Surgeons play an important role to decide each organ will be accept or decline and its righteous allocation.ObjectiveRetrospectively evaluate the surgeon assessment of steatosis degree and its confrontation with further histopathologic findings.MethodsWe analyzed 117 patients underwent deceased liver transplantation for end-stage liver disease in University Hospital Walter Cantideo, Fortaleza, CE, Brazil. A matrix table was organized to estimate the categorical data observed. We clustered the subjects into mild (0%-30%) and moderate (30%-60%) steatosis degree under the clinical criteria of organ suitability for transplantation. We categorized the organs as suitable organ for transplant and as non-suitable organ for transplant. Evaluations between the two first assessments, before perfusion (pre-perfusion) vs biopsy findings and after perfusion vs biopsy findings observations were analyzed and also a comparison between pre-perfusion and after perfusion data was performed.ResultsOn the first assessment, we obtained a 93% of agreement (n = 109) between the two evaluations. On the second assessment, we had an 8% (n = 9) of mistaken allocation. Comparing the observation before (pre-perfusion) and after (after perfusion), we obtained a strong agreement between the surgeons.ConclusionsAlthough our experienced surgeon team, we have wrongly evaluated feasible organs for transplantation. Nonetheless, our faulty percentage is low comparing to worldwide percentage.

ContextoO transplante ortotópico de fígado é considerado um dos últimos recursos terapêuticos viáveis para os pacientes hepatopatas, em estágio terminal da doença. Muitas estratégias têm sido usadas para aumentar o número de órgãos disponíveis e diminuir a demora em lista de espera. No entanto, a presença de esteatose hepática é uma das principais limitações quanto ao uso de órgãos para transplante, devido a sua importância como relevante fator de risco para disfunção primária pós-transplante. Neste cenário, a avaliação do órgão pelo cirurgião, no momento da captação no doador, é de grande importância para a correta alocação do mesmo.ObjetivoAvaliar retrospectivamente o grau de esteatose estabelecido pelo cirurgião e confrontar estes dados com os achados histopatológicos da biopsia.MétodosAnalisaram-se 117 pacientes hepatopatas terminais sub-metidos ao transplante de fígado no Hospital Universitário Walter Cantídeo, Fortaleza, CE. Uma tabela matriz foi organizada para avaliação dos dados categóricos observados. Os indivíduos foram classificados quanto ao grau de esteatose apresentado pelo órgão: leve (0%-30%) e moderada (30%-60%) e agrupados sob os critérios clínicos de adequação de órgãos para transplante. Os órgãos foram descritos como adequado para transplante de órgãos e como não adequado para transplante de órgãos. As avaliações entre as duas primeiras situações, antes da perfusão vs biopsia e após a perfusão vs biopsia foram analisadas; bem como realizada comparação entre as duas situações de perfusão (antes e após).ResultadosNa primeira avaliação, obtiveram-se 93% de concordância (n = 109) entre as duas observações, mostrando grande grau de concordância entre as classificações do órgão antes da perfusão e na biopsia. Na segunda avaliação, obteve-se um grau de discordância de 8%, levando a erros de alocação em nove situações. Na comparação entre as avaliações realizadas entre antes e após a perfusão, obteve-se forte concordância através do índice kappa entre os espectadores.ConclusõesEmbora a equipe deste estudo seja constituída de cirurgiões experientes, em alguns casos os mesmos, foram induzidos a erros de alocação. No entanto o percentual encontra-se bastante abaixo da média mundial.

HEPATIC STEATOSIS ASSESSMENT: a comparative study between surgeon evaluation and forward histopathologic findings

Context Liver transplantation is one of the last viable resources for patients with end-stage liver disease. Many strategies are been used to improve the number of available organs and overcome waiting list delay. However, hepatic steatosis is one of the mainly concerns when organs are consider to transplantation due to it is importance as a risk factor for primary dysfunction. Surgeons play an important role to decide each organ will be accept or decline and its righteous allocation. Objective Retrospectively evaluate the surgeon assessment of steatosis degree and its confrontation with further histopathologic findings. Methods We analyzed 117 patients underwent deceased liver transplantation for end-stage liver disease in University Hospital Walter Cantideo, Fortaleza, CE, Brazil. A matrix table was organized to estimate the categorical data observed. We clustered the subjects into mild (0%–30%) and moderate (30%-60%) steatosis degree under the clinical criteria of organ suitability for transplantation. We categorized the organs as suitable organ for transplant and as non-suitable organ for transplant. Evaluations between the two first assessments, before perfusion (pre-perfusion) vs biopsy findings and after perfusion vs biopsy findings observations were analyzed and also a comparison between pre-perfusion and after perfusion data was performed. Results On the first assessment, we obtained a 93% of agreement (n = 109) between the two evaluations. On the second assessment, we had an 8% (n = 9) of mistaken allocation. Comparing the observation before (pre-perfusion) and after (after perfusion), we obtained a strong agreement between the surgeons. Conclusions Although our experienced surgeon team, we have wrongly evaluated feasible organs for transplantation. Nonetheless, our faulty percentage is low comparing to worldwide percentage. .

Contexto O transplante ortotópico de fígado é considerado um dos últimos recursos terapêuticos viáveis para os pacientes hepatopatas, em estágio terminal da doença. Muitas estratégias têm sido usadas para aumentar o número de órgãos disponíveis e diminuir a demora em lista de espera. No entanto, a presença de esteatose hepática é uma das principais limitações quanto ao uso de órgãos para transplante, devido a sua importância como relevante fator de risco para disfunção primária pós-transplante. Neste cenário, a avaliação do órgão pelo cirurgião, no momento da captação no doador, é de grande importância para a correta alocação do mesmo. Objetivo Avaliar retrospectivamente o grau de esteatose estabelecido pelo cirurgião e confrontar estes dados com os achados histopatológicos da biopsia. Métodos Analisaram-se 117 pacientes hepatopatas terminais sub-metidos ao transplante de fígado no Hospital Universitário Walter Cantídeo, Fortaleza, CE. Uma tabela matriz foi organizada para avaliação dos dados categóricos observados. Os indivíduos foram classificados quanto ao grau de esteatose apresentado pelo órgão: leve (0%-30%) e moderada (30%-60%) e agrupados sob os critérios clínicos de adequação de órgãos para transplante. Os órgãos foram descritos como adequado para transplante de órgãos e como não adequado para transplante de órgãos. As avaliações entre as duas primeiras situações, antes da perfusão vs biopsia e após a perfusão vs biopsia foram analisadas; bem como realizada comparação entre as duas situações de perfusão (antes ...