Extracellular Histones H3 as a Prognostic Blood Marker for Delayed Liver Function Recovery After Donor Hepatectomy.

BACKGROUND: Early prediction of liver dysfunction after liver resection remains a challenge. We hypothesized that extracellular histone concentrations are a promising new biomarker for the detection of liver injury after donor hepatectomy. METHODS: This prospective study considered 93 living donors who underwent hepatectomy. Blood samples of donors were collected on postoperative day 1, and histone levels in the plasma samples of the patients were measured with total histone H3 sandwich ELISA kits. Among 86 right lobe donors, 23 (26.7%) were deemed to have a delayed liver function recovery according to the International Study Group of Liver Surgery's definition of posthepatectomy liver failure, whereas 63 (73.3%) were considered to have an adequate liver function recovery. RESULTS: The area under the receiver operating characteristic (ROC) curve for circulating histones in predicting persistent liver dysfunction was 0.618 ± 0.06 (95% confidence interval [CI], 0.501-0.735; P = .091). The cutoff point value obtained from the analysis of ROC curves was 0.895, with a sensitivity of 95.7% and a specificity of 32.9%, respectively, for examining a delayed liver function recovery (P = .015). The Fisher analysis significantly verified these results empirical influence function % 7.90 (95% CI, 3.91-11.90; P = .006). The univariate analysis determined that postoperative histones were identified as an independent risk factor of delayed liver function recovery (odds ratio, 10.8; 95% CI, 1.4-84.9; P = .024). CONCLUSIONS: The circulating histone negatively correlates with liver dysfunctions after donor hepatectomy and had the best value in predicting liver dysfunction within 24 hours after liver resection.

Differences in parents of pediatric liver transplantation and chronic liver disease patients.

BACKGROUND: With advancements in the treatment of chronic liver disease (CLD), including liver transplantation (LT), quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents. More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs. AIM: To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients. METHODS: During this survey, data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017 (LT group; n = 91) and parents of pediatric patients with chronic liver disease (CLD group; n = 94). Group comparisons were made based on the pediatric health-related quality of life (PedsQL) health care parent satisfaction scale, impact on family scale (IFS) and demographic characteristics. The PedsQL was administered to parents during a phone interview and the results were used to assess the health care-related satisfaction of parents. The IFS was used to assess the impact of the child's CLD status on the family. Demographic variables such as education level (elementary vs middle vs high vs university), monthly income (low vs middle vs high), and place of residence (village vs town vs city) were compared between CLD and LT parent groups. Finally, PedsQL and IFS results were also analyzed according to demographic variables. RESULTS: A total of 185 parents aged 19 to 65 years were included. There were statistically significant differences between the LT and CLD groups in terms of career (P < 0.001), monthly income (P = 0.016), and education level (P = 0.041). According to the PedsQL results, family inclusion, communication, technical skills, emotional needs, and overall satisfaction were significantly different between the groups; the LT group had consistently higher scores (P < 0.001). Additionally, scores for the IFS parameters of financial impact, familial-social impact, personal strain, and total impact were consistently higher for the LT group (P < 0.001). There were statistically significant relationships between education level, monthly income, and place of residence according to the IFS results but not the PedsQL results. There were inverse relationships between the difficulties that parents experience because of their child's health and education levels, monthly income, and place of residence. However, no relationship was found between education level, monthly income, or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results. CONCLUSION: Parents of children who underwent LT were very satisfied with the health care services provided to their children. However, they had more difficulties than parents of children with CLD.