The effect of taurine supplementation on delirium post liver transplantation: A randomized controlled trial.

BACKGROUND & AIMS: Delirium is a prevalent complication of liver transplantation (LT). It may enhance the risk of morbidity and mortality. Taurine is considered to have antioxidant and neuroprotective activities. The aim of this study was to evaluate taurine supplementation effect on post-LT delirium. METHODS: Patients older than 18 years old who had received LT in Abu-Ali Sina transplantation center in Shiraz, Iran from September 2020 to June 2021, were enrolled in this double-blinded randomized clinical trial. Exclusion criteria was known hypersensitivity to taurine, pregnancy or breast-feeding and death within 72 h post-LT. Patients were randomly divided into two groups, each received 2 g/day placebo or taurine from the first day post-LT for 30 days. Delirium was assessed using Confusion Assessment Method-Intensive Care Unit (CAM-ICU). Mortality and rejection rates and length of Intensive Transplantation Unit (ITU) and hospital stays were evaluated within one month after transplantation. RESULTS: Two hundred and seven patients were divided into two groups. Twenty-eight and 23 patients were excluded due to their refuse to participate in the study and death within 72 h post-LT, respectively. Delirium rate within the first month was 23.08% and was significantly lower in taurine group (9.46%) compared with placebo (35.36%, P = 0.012). Length of ITU stay was significantly higher among delirious patients (P = 0.015) in this analysis. CONCLUSION: we reached to the result that taurine can prevent post-LT delirium, dramatically. Placebo receiving and longer stay in ITU were the only independent risk factors in this trial. REGISTRATION NUMBER OF CLINICAL TRIAL: The study was registered at the Iranian Registry of Clinical Trials (IRCT20200312046755N1; http://www.irct.ir/).

Lessons learned from successful autologous gastrointestinal reconstruction in patients with intestinal failure: a case series.

BACKGROUND: Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body's inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. CASE PRESENTATION: Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. DISCUSSION AND CONCLUSIONS: As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.