Impact of a Multidisciplinary Team on Alcohol Recidivism and Survival After Liver Transplant for Alcoholic Disease.

BACKGROUND: Alcohol use disorders have a prevalence of 10% among the population of the United States and Europe and are one of the most frequent causes of liver cirrhosis in the Western world. Currently, alcohol-related liver cirrhosis represents one of the most frequent indications to liver transplant (LT), both as independent cause or associated with hepatitis C virus or hepatitis B virus infections. Starting from 2014, a multidisciplinary team involving surgeons, gastroenterologists, clinical toxicologists, psychiatrists, and psychologists was developed within the Modena Liver Transplant Center. METHODS: We retrospectively reviewed our prospectively maintained institutional database of liver transplants in order to identify cirrhotic patients eligible for LT with a diagnosis of alcohol use disorder. RESULTS: A total of 756 liver transplants were performed at Policlinico University Hospital, University of Modena, and Reggio Emilia, MO, Italy, between November 2000 and November 2017; 102 patients who underwent LT were considered eligible for inclusion in the study. CONCLUSIONS: The multidisciplinary approach, together with blood, urinary, and hair tests, allows identification of early recurrences and improves survival. Further studies are necessary to understand how multidisciplinary teams can change the 6-month rule in patient selection.

Indicators of Complex Care During the Consultation-Liaison Psychiatry Activity at the Transplant Center of the Policlinico Hospital, Modena.

OBJECTIVE: The objective of this study was to identify possible biopsychosocial predictors of organizational complexity in patients referred to the consultant psychiatrist for assessment before liver transplantation. METHODS: This was a case-control study. All psychiatric consultations performed before and after liver transplantation from January 1, 2008 to December 31, 2013 were included. Complexity was operationalized as "undergoing two or more psychiatric consultations". Controls were defined as patients who were assessed only once by the consultant. Cases were represented by patients who underwent two or more consultations. Statistical analysis was performed with STATA 13.1, using logistic regressions. RESULTS: In this study, 515 consultations were requested for 309 patients potentially eligible for liver transplantation. Controls were 209 (67.6%); cases were 100 (32.4%). Positive psychiatric history (odds ratio [OR] = 2.44; 95% confidence interval [CI], 1.43-4.16), viral or toxic (alcohol- or drug-related) liver disease (OR = 1.93; 95% CI, 1.09-3.42), use of psychotropic medications at the baseline (OR = 2.15; 95% CI, 1.14-4.07), and female gender (OR = 1.77; 95% CI, 1.01-3.11) were significantly associated with an increased probability of being cases. CONCLUSIONS: Positive psychiatric history, viral or toxic liver disease, use of psychotropic medications at the index referral, and female gender are possible biopsychosocial predictors of complexity in patients eligible for liver transplantation.

Actions of centrally administered neuropeptide Y on EEG activity in different rat strains and in different phases of their circadian cycle.

The effects of centrally administered neuropeptide Y (NPY) on the sleep-wakefulness cycle have been studied by analyzing its action in different strains of rats with or without spontaneous hypertension and during two different phases of the circadian cycle. Normal adult Sprague-Dawley (SD), Wistar-Kyoto (WKy) and spontaneous hypertensive (SH) rats were used. By means of EEG electrodes the recording of the fronto-parietal electrocorticogram and the electromyogram could be made. Stainless steel cannula were also implanted into the lateral ventricle. The effects of an intraventricular injection of NPY (1.25 nmol/rat) was compared with the effects of the vehicle (saline) alone. The EEG patterns were classified as desynchronized, mixed or synchronized. In the SD rats NPY produced behavioural signs of sedation and a significant reduction of synchronized EEG activity as well as significant increase of synchronized and mixed EEG activities in comparison with the saline treated rats. In the WKy rats NPY administration produced an increase of synchronized EEG activity during evening sessions. In SH rats NPY produced a significant increase of desynchronized EEG activity and a decrease in mixed EEG activity indicating an awakening effect of the peptide. In view of the NPY innervation of the locus ceruleus, it therefore seems possible that the neuronal and hormonal regulation of the locus ceruleus noradrenaline nerve cells is different in the two strains of rats. It also seems possible that the ability of NPY to increase wakefulness in hypertensive animals is related to abnormal changes in the alpha 2-adrenoreceptors taking place in SH rats.