e-GLR Score Predicts Early Graft Loss in Adult Live-Donor Liver Transplantation.

Objective: This study aimed to analyze risk factors and develop a predictive model for early allograft loss due to early graft dysfunction (EGD) in adult live-donor liver transplantation (LDLT). Methods: Data of patients who underwent LDLT from 2011 to 2019 were reviewed for EGD, associated factors, and outcomes. A homogeneous group of 387 patients was analyzed: random cohort A (n = 274) for primary analysis and random cohort B (n = 113) for validation. Results: Of 274 recipients, 92 (33.6%) developed EGD. The risk of graft loss within 90 days was 29.3% and 7.1% in those with and without EGD, respectively (P < 0.001). Multivariate logistic regression analysis determined donor age (P = 0.045), estimated (e) graft weight (P = 0.001), and the model for end-stage liver disease (MELD) score (0.001) as independent predictors of early graft loss due to EGD. Regression coefficients of these factors were employed to formulate the risk model: Predicted (P) early graft loss risk (e-GLR) score = 10 × [(donor age × 0.052) + (e-Graft weight × 1.681) + (MELD × 0.145)] - 8.606 (e-Graft weight = 0, if e-Graft weight ≥640 g and e-Graft weight = 1, and if e-Graft weight < 640 g). Internal cross-validation revealed a high predictive value (C-statistic = 0.858). Conclusions: Our novel risk score can efficiently predict early allograft loss following graft dysfunction, which enables donor-recipient matching, evaluation, and prognostication simply and reliably in adult LDLT.

Cystic artery pseudoaneurysm-a rare complication of acute cholecystitis: review of literature.

OBJECTIVE: To acquaint with the presentation and management of the cystic artery aneurysm by enriching the reviewed literature with our own experience. BACKGROUND: Cystic artery pseudoaneurysm is an uncommon entity with varied clinical presentation. Inflammation and trauma are associated with most of the cases. Limited experience with the condition challenges the management of individual cases. MATERIALS AND METHODS: We retrieved all the reported cases of cystic artery pseudoaneurysm, published up to December 2019, from the PubMed database and excluded those arising as postoperative complications. A total of 59 cases were analyzed, and we also included our experience of managing a case of cystic artery pseudoaneurysm. RESULTS: Abdominal pain (77.9%) was the most common presentation followed by upper GI bleed (64.4%), while 19 patients (32.2%) had presented with classic Quincke's Triad. Most of the cases were diagnosed following the rupture of the pseudoaneurysm (n = 49, 83.05%). Fifteen patients presented with shock. Hyperbilirubinemia (59.3%) and anemia (55.9%) were the commonest laboratory findings. Although CT angiogram remains the investigation of choice, a conventional angiogram is the gold standard and sufficed as the definitive management in 20 cases. Cholecystectomy formed the definitive management in the rest of the cases. We successfully managed a middle-aged female patient of cystic artery aneurysm with xanthogranulomatous cholecystitis by open cholecystectomy. CONCLUSION: Cystic artery pseudoaneurysms are amenable to successful management with careful evaluation and timely cholecystectomy or angioembolization or a combination of both.

Evaluation of Epworth Sleepiness Scale to Predict Obstructive Sleep Apnea in Morbidly Obese Patients and Increasing Its Utility.

INTRODUCTION: Studies have shown that Epworth sleepiness scale (ESS) is not a good tool to predict obstructive sleep apnea (OSA). However, data regarding the accuracy of ESS in the prediction of OSA among morbidly obese patients are scarce. METHODS: The study involved a retrospective review of the charts of the consecutive patients who underwent bariatric surgery at a tertiary care teaching hospital. All the patients underwent polysomnography (PSG) and undertook the ESS questionnaire. The sensitivity and specificity of ESS were calculated based on its correlation with the PSG findings. Furthermore, a new score was devised to improve the utility of ESS to predict OSA. RESULTS: A total of 232 consecutive patients from January 2014 to July 2017 were included in the study. The mean age and body mass index (BMI) were 40.5 ± 11.8 years and 47.6 ± 7.3 kg/m2, respectively. Among the 162 patients who had an ESS <10, 57.4% had moderate-to-severe OSA. The sensitivity of ESS to predict moderate-to-severe OSA was found to be 38.8% and the positive predictive value was 84.2% (positive likelihood ratio 2.82, 95% confidence interval = 1.57-5.06). A predictive score was identified as 0.031Age (years) +0.039BMI (kg/m2) + 0.038ESS + Gender (1 for male, 0 for female). The score had a sensitivity of 80% at a cutoff of 3.3. CONCLUSIONS: Among the morbidly obese, ESS is a poor predictor of OSA. Its utility as a tool for prediction of moderate-to-severe OSA can be improved by use of a new formula incorporating age, gender, and BMI beside ESS.