ABSTRACT
BACKGROUND Long-term patient survival after intestinal transplantation (IT) remains low compared with other organ transplants despite years of advancement in clinical experience. While patients with extremely high or low body mass index (BMI) are often considered ineligible for IT, the impact of BMI on post-transplant IT survival remains understudied. MATERIAL AND METHODS Using the United Network for Organ Sharing Standard Transplant database, we conducted a retrospective cohort study on patients who underwent IT between April 11, 1994, and September 29, 2021. We assessed the association of recipient and donor BMI at transplant with post-transplant mortality using Kaplan-Meier survival curves and univariate and multivariate Cox regression analyses. RESULTS A total of 1541 patients were included in our final sample. Of these patients, 806 were females (52.5%) and most were in the normal-weight BMI subgroup (54.2%). Obese class II (mean; 36.8±10.92 years) and underweight patients (mean; 37.6±13.37 years) were significantly younger than patients in other BMI categories. The adjusted multivariate model demonstrated an increased risk of mortality in underweight IT recipients compared to normal-weight IT recipients (aHR=1.25, 95% confidence interval [CI], 1.02-1.54; P=0.032).There was no significant association between donor BMI categories and survival in IT recipients. CONCLUSIONS Recipient BMI below normal is associated with an increased risk of mortality after intestinal transplantation and represents a potentially modifiable patient characteristic to improve survival outcomes.
Subject(s)
Body Mass Index , Intestines , Humans , Female , Male , Adult , Retrospective Studies , Intestines/transplantation , Middle Aged , Databases, Factual , Tissue Donors , Tissue and Organ Procurement , Organ Transplantation/mortality , Survival Rate , Transplant Recipients , United States/epidemiologyABSTRACT
OBJECTIVES: The Asian American (AsA) population is at high risk for poor oral health outcomes and remains an underserved and understudied community. Low oral health literacy could explain poor oral health behaviours, practices and outcomes in this population. The aims were as follows: (i) provide a scoping review of oral health literacy, knowledge, practice and beliefs among AsA individuals residing in the United States; (ii) identify any instruments or tools translated into participants' language and (iii) determine whether the translated instruments had been assessed for validity and reliability. METHODS: The current study used a scoping review framework based on PRISMA-ScR that included rigorous eligibility criteria, search strategy, independent selection process with adjudication, and standardized reporting of outcomes. The search was conducted on March 14, 2022, and updated on February 25, 2023 and February 13, 2024, in the following databases: Ovid MEDLINE, Embase, Web of Science and CINAHL. Peer-reviewed original research on oral health literacy, knowledge, awareness, practice, and beliefs related to oral health care in AsA subgroups published in English were included. Two reviewers independently assessed whether titles and abstracts should be included for review, with discrepancies adjudicated by a third reviewer. Data extracted from articles used a standard template that included study design, and measurement tools of oral health, knowledge, awareness, practice and beliefs, as well as results and conclusions of the publication. In addition, the template captured whether the translated and original measurement tools were assessed for reliability and validity. RESULTS: Of the 367 papers identified, 10 studies that met eligibility criteria were included in the final review. Of these, four studies used previously validated tools to assess oral health measurements in AsA. Only five of the studies translated the tools into the participants' native language. Although AsA exhibited lower oral health literacy than Whites but higher than Hispanics and African Americans, none of the translated tools were assessed for reliability and validity. Acculturation and country of birth were factors influencing oral health behaviours related to good oral health practice and utilization, with AsA born in the United States exhibiting higher oral health utilization than those born in their country of origin. Oral health beliefs played a significant role in dental care utilization among AsA populations. CONCLUSIONS: The scoping review on oral health in Asian American communities identifies a significant research gap, particularly in the lack of validated tools for assessing oral health literacy, which varies across ethnic groups. It notes that AsA generally have lower oral health literacy compared to Whites, but higher than Hispanics and African Americans. AsA born in the United States shows better oral health practices, influenced by acculturation and birth country. The findings emphasize the need for more thorough and culturally adapted research methods to address oral health disparities in this diverse group.
ABSTRACT
BACKGROUND: Hepatic hydrothorax is a challenging complication of end-stage liver disease, and.patients with this complication can receive model for end-stage liver disease (MELD) exception points if they meet specific criteria as defined by United Network for Organ Sharing (UNOS). This research aimed to analyze the effect of receiving MELD exception points for hepatic hydrothorax on posttransplant mortality, using a national transplant database. METHODS: Patients >18â years in the UNOS database awaiting liver transplant between 2012 and 2023 were identified based on their petition for MELD exception points. Using a 1:â 1 propensity score-matched analysis, 302 patients who received MELD exception points for hepatic hydrothorax were compared with 302 patients who did not receive MELD exception points.Demographic, clinical and laboratory values were compared. The primary outcome was posttransplant mortality. Multivariate logistic regression controlled for potential confounders. RESULTS: No significant difference was observed in mean age (58.20 vs 57.62â years), mean initial MELD score (16.93 vs 16.54), or mean Child-Pugh score (9.77 vs 9.74) in patients with hepatic hydrothorax receiving MELD exception points versus their matched cohort who did not recieve exception points. The proportion of males was slightly higher among patients who received MELD exception points (57.6% males vs 53.6% males). A majority of patients in both groups had Child-Pugh grade C (>56%). Patients receiving MELD exception points for hepatic hydrothorax had a statistically significant 44% decrease in the odds of posttransplant death compared to those who did not (OR 0.56; 95% CI 0.37-0.88; P â =â 0.01). Among the combined cohort, each year increase in age resulted in a 3.9% increase in mortality (OR 1.04; 95% CI 1.01-1.07; P â =â 0.005), and every one-unit increase in serum creatinine resulted in a 40% increase in mortality (OR 1.40; 95% CI 1.03-1.92; P â =â 0.03). CONCLUSION: Receiving MELD exception points for hepatic hydrothorax is associated with a significant reduction in the odds of posttransplant mortality. These findings underscore the importance of MELD exception points for hepatic hydrothorax among patients with decompensated cirrhosis, potentially improving patient prioritization for liver transplantation and influencing clinical decision-making.
Subject(s)
End Stage Liver Disease , Hydrothorax , Liver Transplantation , Propensity Score , Humans , Hydrothorax/etiology , Hydrothorax/mortality , Male , Female , Middle Aged , Liver Transplantation/mortality , End Stage Liver Disease/surgery , End Stage Liver Disease/mortality , End Stage Liver Disease/complications , Treatment Outcome , Retrospective Studies , Risk Factors , Databases, Factual , Logistic Models , Aged , United States/epidemiology , Severity of Illness Index , Multivariate Analysis , Time Factors , Waiting Lists/mortality , Adult , Risk AssessmentABSTRACT
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the global population, with a significant risk of advancing to liver cirrhosis and hepatocellular carcinoma. The roles of ammonia and glutamine in MASLD's pathogenesis are increasingly recognized, prompting this systematic review. This systematic review was conducted through a meticulous search of literature on December 21, 2023, across five major databases, focusing on studies that addressed the relationship between ammonia or glutamine and MASLD. The quality of the included studies was evaluated using CASP checklists. This study is officially registered in the PROSPERO database (CRD42023495619) and was conducted without external funding or sponsorship. Following PRISMA guidelines, 13 studies were included in this review. The studies were conducted globally, with varying sample sizes and study designs. The appraisal indicated a mainly low bias, confirming the reliability of the evidence. Glutamine's involvement in MASLD emerged as multifaceted, with its metabolic role being critical for liver function and disease progression. Variable expressions of glutamine synthetase and glutaminase enzymes highlight metabolic complexity whereas ammonia's impact through urea cycle dysfunction suggests avenues for therapeutic intervention. However, human clinical trials are lacking. This review emphasizes the necessity of glutamine and ammonia in understanding MASLD and identifies potential therapeutic targets. The current evidence, while robust, points to the need for human studies to corroborate preclinical findings. A personalized approach to treatment, informed by metabolic differences in MASLD patients, is advocated, alongside future large-scale clinical trials for a deeper exploration into these metabolic pathways.