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BACKGROUND: The average age of recipients and donors of liver transplantation (LT) is increasing. Although there has been a change in the indications for LT over the years, data regarding the trends and outcomes of LT in the older population is limited. AIM: To assess the clinical characteristics, age-related trends, and outcomes of LT among the older population in the United States. METHODS: We analyzed data from the United Network for Organ Sharing database between 1987-2019. The sample was split into younger group (18-64 years old) and older group (≥ 65 years old). RESULTS: Between 1987-2019, 155758 LT were performed in the United States. During this period there was a rise in median age of the recipients and percentage of LT recipients who were older than 65 years increased (P < 0.05) with the highest incidence of LT among older population seen in 2019 (1920, 23%). Common primary etiologies of liver disease leading to LT in older patients when compared to the younger group, were non-alcoholic steatohepatitis (16.4% vs 5.9%), hepatocellular carcinoma (14.9% vs 6.9%), acute liver failure (2.5% vs 5.2%), hepatitis C cirrhosis (HCV) (19.2 % vs 25.6%) and acute alcoholic hepatitis (0.13% vs 0.35%). In older recipient group female sex and Asian race were higher, while model for end-stage liver disease (MELD) score and rates of preoperative mechanical ventilation were lower (P < 0.01). Median age of donor, female sex, body mass index (BMI), donor HCV positive status, and donor risk index (DRI) were significantly higher in older group (P < 0.01). In univariable analysis, there was no difference in post-transplant length of hospitalization, one-year, three-year and five-year graft survivals between the two groups. In multivariable Cox-Hazard regression analysis, older group had an increased risk of graft failure during the five-year post-transplant period (hazard ratio: 1.27, P < 0.001). Other risk factors for graft failure among recipients were male sex, African American race, re-transplantation, presence of diabetes, mechanical ventilation at the time of LT, higher MELD score, presence of portal vein thrombosis, HCV positive status, and higher DRI. CONCLUSION: While there is a higher risk of graft failure in older recipient population, age alone should not be a contraindication for LT. Careful selection of donors and recipients along with optimal management of risk factors during the postoperative period are necessary to maximize the transplant outcomes in this population.
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INTRODUCTION: Using direct peritoneal resuscitation (DPR) as an adjunct when managing patients undergoing damage control laparotomy (DCL) shows promising results. We report our initial experience in utilizing DPR when managing patients who underwent DCL for emergent surgery at the index operation. MATERIALS AND METHODS: We prospectively collected data on 37 patients between August 2020 to October 2021 who underwent DCL with open abdomens after the index operation and utilized DPR. DPR was performed using peritoneal lavage with DIANEAL PD-2-D 2.5% Ca 3.5 mEq/L at a rate of 400ml/hour. Patients' physiological scores and clinical outcomes were evaluated. RESULTS: 86% required DCL and DPR due to septic abdomen/bowel ischemia. The median (interquartile range [IQR]) age was 62 years (53-70); 62% were male, and median (IQR) body mass index was 30.0kg/m2 (25.5-38.4). On DPR initiation, median (IQR) APACHE-IV score was 48 (33-64) and median (IQR) Acute Physiology Score (APS) was 31 (18-54). After initiation, median (IQR) APACHE-IV score and median (IQR) APS were 39 (21-62) and 19 (11-56), respectively, and both showed significant improvement in survivors (p<0.05). Median (IQR) DPR duration was four days (2-8) and primary abdominal closure was achieved in 30 patients (81%). There were eight mortalities (21.6%) within 30 days postoperatively, of which seven were within 3-24 days due to uncontrolled sepsis/multiple organ failure. The most frequent complication was surgical-site infection recorded in 12 patients (32%). Twenty-four patients (67%) were discharged home/transferred to a rehab center/nursing home. CONCLUSION: DPR application showed significant improvement of APACHE-IV score and APS in patients with peritonitis/septic abdomen.
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INTRODUCTION: Rhabdomyolysis is a condition where muscle damage leads to the leakage of intracellular contents such as myoglobin and creatine kinase. These leak into systemic circulation and can cause detrimental effects. Due to the detrimental effect of rhabdomyolysis on patient mortality and potential complications, identifying factors that affect patient mortality in those with rhabdomyolysis could provide valuable insight in early management strategies and potentially benefit patient outcomes. OBJECTIVE: The goal of this study was to identify independent predictors of in-hospital mortality in non-elderly adult patients who underwent emergency admission due to rhabdomyolysis. MATERIALS AND METHODS: A retrospective cohort study was done by analyzing 27,688 non-elderly adult patients (18-64 years) with rhabdomyolysis who underwent emergency admission using the National Inpatient Sample (NIS) during 2005-2014. Factors such as demographic information, clinical course, and comorbidities were collected to identify predictors of in-hospital mortality. Chi square and student's t-tests were utilized to evaluate various group differences on categorical and continuous variables. Backward logistic regression analyses were performed to examine factors that could affect patient mortality. RESULTS: A total number of 27,688 non-elderly adult patients (age 18-64 years) were included, of which, 20,137 patients were male (72.8%) with a mean (SD) age of 40.60 (13.34) years, and 7,551 patients were female (27.3%) with a mean (SD) age of 45.63 (13.20) years. Multivariable backward logistic regression analysis was performed to evaluate the associations between mortality and different variables in our patient sample. Out of different factors, respiratory diseases, cardiac disease, and genitourinary system disease demonstrated the most significant association with mortality, shown by odds ratios of 3.67, 3.59, and 3.08, respectively. Additionally, patient age, history of surgical procedure, bacterial infection (other than tuberculosis), and cerebrovascular diseases were also positively associated with mortality. Their respective odds ratios were 1.03, 2.14, 2.13, and 2.66. CONCLUSION: Each additional year in age leads to 3% increased odds of mortality in non-elderly adult patients who are emergently admitted with rhabdomyolysis.
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Infection with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2/Covid-19) has been correlated with micro and macrovascular thrombosis. Reports have discussed localized thrombosis leading to ischemia, we report a case of diffuse systemic thromboembolism resulting in limb ischemia and organ damage from Covid-19 despite prompt anticoagulation. A 60-year-old unvaccinated male with a history of asthma, diabetes mellitus and coronary artery disease, presented with shortness of breath and right lower extremity pain. The patient was found to be Covid-19 Delta variant positive. CTA and transthoracic echocardiogram showed diffuse thromboembolic disease affecting the left ventricle, right kidney and bilateral lower extremities.
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The mir-34/449 family consists of six homologous miRNAs at three genomic loci. Redundancy of miR-34/449 miRNAs and their dominant expression in multiciliated epithelia suggest a functional significance in ciliogenesis. Here we report that mice deficient for all miR-34/449 miRNAs exhibited postnatal mortality, infertility and strong respiratory dysfunction caused by defective mucociliary clearance. In both mouse and Xenopus, miR-34/449-deficient multiciliated cells (MCCs) exhibited a significant decrease in cilia length and number, due to defective basal body maturation and apical docking. The effect of miR-34/449 on ciliogenesis was mediated, at least in part, by post-transcriptional repression of Cp110, a centriolar protein suppressing cilia assembly. Consistent with this, cp110 knockdown in miR-34/449-deficient MCCs restored ciliogenesis by rescuing basal body maturation and docking. Altogether, our findings elucidate conserved cellular and molecular mechanisms through which miR-34/449 regulate motile ciliogenesis.
