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1.
Z Gastroenterol ; 58(1): 30-38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31931538

RESUMO

BACKGROUND: In order to reduce alcohol relapse after liver transplantation (LT), the German national guidelines for waiting-list maintenance and organ allocation demand a minimum 6-month period of alcohol abstinence pre-LT, confirmed by measuring urinary ethyl glucuronide (uEtG). METHODS: Between January 2015 and June 2016, uEtG was measured at least once in 339 cirrhotic patients with an indication for LT at the University Medical Center Mainz. uEtG was measured with an enzyme-linked immunosorbent assay (ELISA) screening test (cutoff value: 500 µg/L). For uEtG values ≥ 500 µg/L, liquid chromatography-mass spectrometry (LC-MS/MS) was performed as a confirmatory assay. Data were collected prospectively in a transplant database. RESULTS: Of the 339 potential liver transplant candidates, uEtG was negative in 86.4 %. Most patients were male (64.3 %), with an average age of 56.42 ±â€Š10.1 years. In the multivariate analysis, mean corpuscular volume (p = 0.001), urinary creatinine (p = 0.001), gamma-glutamyl transferase (p = 0.001), and hemoglobin (p = 0.003) were significantly associated with a positive uEtG test result. The sensitivity of the ELISA screening test was 100 % for uEtG values > 2000 µg/L, as confirmed by LC-MS/MS. CONCLUSION: uEtG is an effective parameter to reveal alcohol consumption by patients on the waiting list for LT. The sensitivity of the ELISA is excellent for uEtG values > 2000 µg/L, for which LC-MS/MS confirmation could be omitted.


Assuntos
Consumo de Bebidas Alcoólicas , Glucuronatos/urina , Cirrose Hepática Alcoólica/cirurgia , Cirrose Hepática Alcoólica/urina , Transplante de Fígado , Programas de Rastreamento/métodos , Idoso , Biomarcadores/urina , Cromatografia Líquida , Estudos de Coortes , Ensaio de Imunoadsorção Enzimática , Etanol/sangue , Etanol/urina , Feminino , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Espectrometria de Massas em Tandem , Listas de Espera
2.
Am Surg ; 85(9): 1025-1027, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638518

RESUMO

From 1991 to 2013, Mississippi was without liver transplant services. In 2013, a new liver transplant program was established at the University of Mississippi Medical Center. Here, we describe our experience with the first 150 transplants over a 4.5-year period. This study is a review of 147 patients who underwent the first 150 liver transplants at the University of Mississippi Medical Center between March 5, 2013, and January 4, 2018. There were no exclusion criteria for this study. Donor, recipient, and outcome variables were analyzed. Recipients were 46% female and 74% white. Age at the time of transplant was 57 [IQR 49-63]. BMI at transplant was 30 [IQR 25-35]. Thirty per cent of transplants were for alcoholic cirrhosis, 25% non-alcoholic steatohepatitis, 24% hepatitis C, and 12% cholestatic. Mean model for end-stage liver disease (MELD) at the time of transplant was 20 [95% confidence interval 19-21] and MELD-Na was 22 [95% confidence interval 20-23]. One-year patient- and graft survival were 89% and 87%, respectively, which were as expected based on Scientific Registry of Transplant Recipient reports after risk adjustment. The data published here verifies it is possible to establish a new liver transplant center in an underserved area previously lacking comprehensive liver care and to achieve results similar to other high-volume centers across the country.


Assuntos
Centros Médicos Acadêmicos , Transplante de Fígado , Índice de Massa Corporal , Colestase/cirurgia , Fígado Gorduroso/cirurgia , Feminino , Sobrevivência de Enxerto , Hepatite C/cirurgia , Humanos , Tempo de Internação , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/normas , Masculino , Pessoa de Meia-Idade , Mississippi , Complicações Pós-Operatórias , Desenvolvimento de Programas , Reoperação
3.
Dermatol Online J ; 25(6)2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31329388

RESUMO

We report cutaneous fluorescent in-situ hybridization (FISH) analysis as a useful test for earlier diagnostic confirmation in a case of acute graft-versus-host disease (GVHD) in a sex-mismatched liver transplant patient compared to the gold standard peripheral blood short tandem repeat chimerism analysis.


Assuntos
Dermatite/patologia , Doença Enxerto-Hospedeiro/diagnóstico , Transplante de Fígado , Quimerismo , Dermatite/etiologia , Diagnóstico Precoce , Feminino , Doença Enxerto-Hospedeiro/complicações , Doença Enxerto-Hospedeiro/patologia , Humanos , Imunossupressores/uso terapêutico , Hibridização in Situ Fluorescente/métodos , Cirrose Hepática Alcoólica/cirurgia , Pessoa de Meia-Idade , Pancitopenia/etiologia , Reação em Cadeia da Polimerase , Linfócitos T/metabolismo
4.
Int J Mol Sci ; 20(14)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340446

RESUMO

Alcoholic liver disease (ALD) is a highly prevalent spectrum of pathologies caused by alcohol overconsumption. Morbidity and mortality related to ALD are increasing worldwide, thereby demanding strategies for early diagnosis and detection of ALD predisposition. A potential candidate as a marker for ALD susceptibility is the transcription factor nuclear factor erythroid-related factor 2 (Nrf2), codified by the nuclear factor erythroid 2-related factor 2 gene (NFE2L2). Nrf2 regulates expression of proteins that protect against oxidative stress and inflammation caused by alcohol overconsumption. Here, we assessed genetic variants of NFE2L2 for association with ALD. Specimens from patients diagnosed with cirrhosis caused by ALD were genotyped for three NFE2L2 single nucleotide polymorphisms (SNP) (SNPs: rs35652124, rs4893819, and rs6721961). Hematoxylin & eosin and immunohistochemistry were performed to determine the inflammatory score and Nrf2 expression, respectively. SNPs rs4893819 and rs6721961 were not specifically associated with ALD, but analysis of SNP rs35652124 suggested that this polymorphism predisposes to ALD. Furthermore, SNP rs35652124 was associated with a lower level of Nrf2 expression. Moreover, liver samples from ALD patients with this polymorphism displayed more severe inflammatory activity. Together, these findings provide evidence that the SNP rs35652124 variation in the Nrf2-encoding gene NFE2L2 is a potential genetic marker for susceptibility to ALD.


Assuntos
Predisposição Genética para Doença , Cirrose Hepática Alcoólica/genética , Fator 2 Relacionado a NF-E2/genética , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Adulto , Estudos de Casos e Controles , Etanol/farmacologia , Feminino , Expressão Gênica , Hepacivirus/crescimento & desenvolvimento , Hepacivirus/patogenicidade , Hepatite C/patologia , Hepatite C/virologia , Humanos , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática Alcoólica/metabolismo , Cirrose Hepática Alcoólica/patologia , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo
5.
Rev Med Liege ; 74(5-6): 332-335, 2019 05.
Artigo em Francês | MEDLINE | ID: mdl-31206276

RESUMO

In Belgium as in many other countries, alcohol is one of the leading causes of adult liver transplantation. Liver transplantation for terminal liver failure due to excessive alcohol intake raises clear ethical issues concerning the use of grafts to save patients suffering from a self-inflecting affection. Alcoholic liver disease is one of the best indications for liver transplantation, with excellent results in terms of length of survival and post transplantation quality of life, if this transplantation is proposed by a multidisciplinary team in a patient able to and helped by a supporting family and social environment.


Assuntos
Alcoolismo , Cirrose Hepática Alcoólica , Hepatopatias Alcoólicas , Transplante de Fígado , Adulto , Bélgica , Humanos , Cirrose Hepática Alcoólica/cirurgia , Qualidade de Vida , Recidiva
6.
JAMA Netw Open ; 2(6): e196412, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31251379

RESUMO

Importance: Changes in the characteristics of patients with cirrhosis are likely to affect future outcomes and are important to understand in planning for the care of this population. Objective: To identify changes in demographic and clinical characteristics and outcomes in patients with newly diagnosed cirrhosis. Design, Setting, and Participants: A retrospective cohort study of patients with a new diagnosis of cirrhosis was conducted using the Indiana Network for Patient Care, a large statewide regional health information exchange, between 2004 and 2014. Patients with at least 1 year of continuous follow-up before the cirrhosis diagnosis were followed up through August 1, 2015. The analysis was conducted from December 2018 to January 2019. Exposures: Age, cause of cirrhosis, and year of diagnosis. Main Outcomes and Measures: Overall rates for mortality, liver transplant, hepatocellular carcinoma, and hepatic decompensation (composite of ascites, hepatic encephalopathy, or variceal bleeding). Results: A total of 9261 patients with newly diagnosed cirrhosis were identified (mean [SD] age, 57.9 [12.6] years; 5109 [55.2%] male). A 69% increase in new diagnoses occurred over the course of the study period (620 in 2004 vs 1045 in 2014). The proportion of those younger than 40 years increased by 0.20% per year (95% CI, 0.04% to 0.36%; P for trend = .02), and the proportion of those aged 65 years and older increased by 0.81% per year (95% CI, 0.51% to 1.11%; P for trend < .001). The proportion of patients with alcoholic cirrhosis increased by 0.80% per year (95% CI, 0.49% to 1.12%), and the proportion with nonalcoholic steatohepatitis increased by 0.59% per year (95% CI, 0.30% to 0.87%), whereas the proportion with viral hepatitis decreased by 1.36% per year (95% CI, -1.68% to -1.03%) (P < .001 for all). In patients younger than 40 years, 40 to 64 years, and 65 years and older, mortality rates were 6.4 (95% CI, 5.4 to 7.6), 9.9 (95% CI, 9.5 to 10.4), and 16.2 (95% CI, 15.2 to 17.2) per 100 person-years, respectively (P < .001). Mortality rates decreased during the study period (11.9 [95% CI, 10.7-13.1] per 100 person-years in 2004 vs 10.0 [95% CI, 8.1-12.2] per 100 person-years in 2014; annual adjusted hazard ratio, 0.87 [95% CI, 0.86 to 0.88]) and were lower in those with alcoholic cirrhosis compared with patients with viral hepatitis (adjusted hazard ratio, 0.89 [95% CI, 0.80 to 0.98]). Rates of hepatocellular carcinoma were low in patients younger than 40 years (0.5 [95% CI, 0.2 to 0.9] per 100 person-years). Liver transplant rates were low throughout the study period (0.3 [95% CI, 0.3-0.4] per 100 person-years). In patients with compensated cirrhosis, rates of hepatic decompensation were lower in patients younger than 40 years (adjusted subhazard ratio 0.78; 95% CI, 0.62 to 0.99) and in patients with nonalcoholic steatohepatitis (adjusted subhazard ratio, 0.51; 95% CI, 0.43 to 0.60). Conclusions and Relevance: The population of patients with newly diagnosed cirrhosis in Indiana has experienced changes in the age distribution and cause of cirrhosis, with decreasing mortality rates. These findings support investment in the prevention and treatment of alcoholic liver disease and nonalcoholic steatohepatitis, particularly in younger and older patients. Additional study is needed to identify the reasons for decreasing mortality rates.


Assuntos
Cirrose Hepática/mortalidade , Adulto , Distribuição por Idade , Idoso , Ascite/mortalidade , Carcinoma Hepatocelular/mortalidade , Varizes Esofágicas e Gástricas/mortalidade , Feminino , Hemorragia Gastrointestinal/mortalidade , Encefalopatia Hepática/mortalidade , Humanos , Indiana/epidemiologia , Cirrose Hepática/cirurgia , Cirrose Hepática Alcoólica/mortalidade , Cirrose Hepática Alcoólica/cirurgia , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/mortalidade , Transplante de Fígado/estatística & dados numéricos , Transplante de Fígado/tendências , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Hepatopatia Gordurosa não Alcoólica/mortalidade , Hepatopatia Gordurosa não Alcoólica/cirurgia , Prognóstico , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 98(19): e15212, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083154

RESUMO

RATIONALE: In living-donor liver transplantation (LDLT), the right lobe graft is commonly utilized to prevent small-for-size syndrome, despite the considerable donor morbidity. Conversely, the feasibility of the left lobe graft and the right posterior section graft in smaller-sized recipients is now commonly employed with comparable outcomes to right lobe grafts. The efficacy of the right anterior section graft has rarely been reported. PATIENT CONCERNS: A 56-year-old man, a heavy alcoholic beverage drinker for 20 years, presented in the emergency department with massive ascites and lethargy. He was previously admitted twice due to bleeding esophageal varices. DIAGNOSIS: He was diagnosed with hepatic encephalopathy coma due to alcoholic liver cirrhosis. The Child-Turcotte-Pugh score was 11 (class C), and the Model for End-stage Liver Disease score was 21.62. INTERVENTION: A LDTL was offered to the patient as the best treatment option available. The patient's 26-year-old son was found to be the only donor-compatible candidate for the LDTL.Preoperatively, the right lobe of the donor occupied 76.2% of the total liver volume exposing the donor to a small residual liver volume. The right posterior section and left lobe volumes were insufficient, providing a graft-to-recipient weight ratio of 0.42% and 0.38%, respectively. However, the right anterior section could fulfill an acceptable GRWR of 0.83%. Thus, a living donor right anterior sectionectomy was performed. OUTCOMES: Clinical signs and symptoms and liver function improved following anterior section graft transplantation without complications. LESSON: The procurement of anterior section graft is technically feasible in selected patients, especially in high-volume liver centers.


Assuntos
Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Doadores Vivos , Adulto , Alcoolismo/complicações , Família , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Cirrose Hepática Alcoólica/diagnóstico por imagem , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade
8.
J Infect Chemother ; 25(10): 816-819, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31003955

RESUMO

We report a case of necrotizing skin infection caused by Yokenella regensburgei in an immunosuppressed patient with orthotopic liver transplantation. Initial bacterial culture identification was suggestive of Hafnia alvei. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed identification of Y. regensburgei. Necrotizing fasciitis is potentially fatal and requires aggressive management, including early diagnosis, appropriate antibiotic selection, and operative debridement.


Assuntos
Enterobacteriaceae/isolamento & purificação , Fasciite Necrosante/microbiologia , Hospedeiro Imunocomprometido , Pele/lesões , Ferimentos e Lesões/microbiologia , Amputação , Antibacterianos/uso terapêutico , Desbridamento , Enterobacteriaceae/imunologia , Fasciite Necrosante/imunologia , Fasciite Necrosante/terapia , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Perna (Membro) , Cirrose Hepática Alcoólica/imunologia , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/efeitos adversos , Pessoa de Meia-Idade , Pele/microbiologia , Pele/patologia , Resultado do Tratamento , Ferimentos e Lesões/imunologia , Ferimentos e Lesões/terapia
9.
Transplant Proc ; 51(1): 187-189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30736972

RESUMO

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.


Assuntos
Alcoolismo/diagnóstico , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Seleção de Pacientes , Adulto , Abstinência de Álcool , Feminino , Humanos , Itália , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Reincidência , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
10.
Psychosomatics ; 60(1): 56-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30122643

RESUMO

BACKGROUND: Liver transplant candidates undergo psychosocial assessment as a component of their pretransplant evaluation. Global psychosocial assessment scales, including the Psychosocial Assessment of Candidates for Transplantation (PACT), capture and quantify these psychiatric and social variables. OBJECTIVE: Our primary aim was to assess for an association between global PACT score and survival in liver transplant recipients. METHODS: This retrospective cohort study examined records of all liver recipients at one U.S. Transplant Center from 2000 to 2012 with outcomes monitoring until 07/01/2016. We investigated for associations between the following variables and mortality: PACT score, age, gender, marital status, race, alcoholic liver disease (ALD), and body mass index (BMI). Statistical methods included Student's t-test, Wilcoxon rank sum test, chi-square, Fisher's exact test, Kaplan-Meier curve, and Cox proportional hazard models. RESULTS: Of 1040 liver recipients, 538 had a documented PACT score. Among these, PACT score was not associated with mortality. In women, a lower PACT score was associated with mortality (p = 0.003) even after adjustments for age, marital status, and BMI. Women with ALD had a 2-fold increased hazard of death (p = 0.012). Increasing age was associated with increased risk of death for the cohort as a whole (p = 0.019) and for men (p = 0.014). In men, being married and BMI were marginally protective (p = 0.10 and p = 0.13, respectively). CONCLUSIONS: Transplant psychosocial screening scales, specifically the PACT, identify psychosocial burden and may predict post-transplant outcomes in certain populations. In female liver recipients, lower PACT scores and ALD were associated with a greater risk of post-transplant mortality.


Assuntos
Cirrose Hepática Alcoólica/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Saúde Mental , Mortalidade , Apoio Social , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estimativa de Kaplan-Meier , Estilo de Vida , Cirrose Hepática/cirurgia , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Psicologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Transplantation ; 103(1): 113-121, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29985186

RESUMO

BACKGROUND: Patients with nonalcoholic steatohepatitis (NASH) cirrhosis have excellent postliver transplant survival despite having many comorbidities. We hypothesized that this could be due to a selection bias. METHODS: We analyzed the United Network for Organ Sharing data from 2002 to 2016 and compared postliver transplant survival of NASH (n = 7935) patients with cryptogenic cirrhosis (CC) (n = 6087), alcoholic cirrhosis (AC) (n = 16 810), and autoimmune hepatitis cirrhosis (AIH) (n = 2734). RESULTS: By 3 years of listing, the cumulative incidence (CI) of death or deterioration was 29% for NASH, 28% for CC and AC, and 24% for AIH, but when adjusted for risk factors, the CI was similar for NASH and AIH. The factors that increased the risk of waiting list removal due to death/deterioration were poor performance status, encephalopathy, diabetes, high Model for End-stage Liver Disease, Hispanic race, older age and a low serum albumin. Most patients were transplanted within the first year (median, 2 months; interquartile range, 1-7 months) of listing and by 5 years, the unadjusted CI of transplantation was 54% for NASH, 52% for CC, 51% for AIH, and 48% for AC. The adjusted CI of transplantation within 2 months of listing was higher for AC (subhazard ratio [SHR], 1.17), AIH (SHR, 1.17), and CC (SHR, 1.13) when compared with NASH, but after 2 months, adjusted transplantation rates decreased in AC (SHR, 0.6), AIH (SHR, 0.78), and CC (SHR, 0.95). The negative predictors of receiving a transplant were dialysis, female sex, nonwhite race, high albumin, and creatinine. CONCLUSIONS: Patients with NASH cirrhosis are not disadvantaged by higher waitlist removal or lower transplantation rates.


Assuntos
Hepatite Autoimune/cirurgia , Cirrose Hepática Alcoólica/cirurgia , Cirrose Hepática/cirurgia , Transplante de Fígado , Hepatopatia Gordurosa não Alcoólica/cirurgia , Listas de Espera/mortalidade , Adulto , Idoso , Comorbidade , Feminino , Nível de Saúde , Hepatite Autoimune/diagnóstico , Hepatite Autoimune/mortalidade , Humanos , Incidência , Cirrose Hepática/diagnóstico , Cirrose Hepática/mortalidade , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/mortalidade , Transplante de Fígado/efeitos adversos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
12.
Transplant Proc ; 50(10): 3988-3994, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30471833

RESUMO

BACKGROUND: Combined liver and kidney transplant is a very complex surgery. To date, there has been no report on the intraoperative management of patients with impaired cardiac function undergoing simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors. CASE REPORT: A 60-year-old man underwent simultaneous ABO-compatible liver and ABO-incompatible kidney transplant from 2 living donors because of IgA nephropathy and alcoholic liver cirrhosis. The preoperative cardiac findings revealed continuous aggravation, shown by large left atrial enlargement, severe left ventricular hypertrophy, a very prolonged QT interval, and a calcified left anterior descending coronary artery. Severe hypotension with very weak pulsation and severe bradycardia developed, with an irregular junctional rhythm noted immediately after the liver graft was reperfused. Although epinephrine was administered as a rescue drug, hemodynamics did not improve, and central venous pressure and mean pulmonary arterial pressure increased to potentially fatal levels. Emergency phlebotomy via the central line was performed. Thereafter, hypotension and bradycardia recovered gradually as the central venous pressure and mean pulmonary arterial pressure decreased. The irregular junctional rhythm returned to a sinus rhythm, but the QTc interval was slightly more prolonged. Because of poor cardiac capacity, the volume and rate of fluid infusion were increased aggressively to maintain appropriate kidney graft perfusion after confirming vigorous urine production of the graft. CONCLUSIONS: A heart with impaired function due to both end-stage liver and kidney diseases may be less able to withstand surgical stress. Further study on cardiac dysfunction will be helpful for the management of patients undergoing complex transplant surgery.


Assuntos
Cardiopatias/complicações , Transplante de Rim/métodos , Transplante de Fígado/métodos , Sistema ABO de Grupos Sanguíneos , Incompatibilidade de Grupos Sanguíneos , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/cirurgia , Humanos , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade
13.
Langenbecks Arch Surg ; 403(7): 825-836, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30349998

RESUMO

PURPOSE: This review investigated survival and alcoholic relapse following liver transplantation (LT) in patients with severe acute alcoholic hepatitis (AH) without 6 months of alcohol abstinence. METHODS: All studies comparing acute AH patients undergoing LT with a control group were included. CENTRAL, MEDLINE, and Web of Science databases were searched. Survival benefits or odds ratios (OR) and 95% confidence intervals (CI) were assessed by meta-analyses using a random effects model. The study was registered in PROSPERO (CRD42017057971). According to the search results, two separate meta-analyses were performed: meta-analysis A compared early LT with medical therapy alone in patients with severe AH that were not responding to medical therapy and meta-analysis B compared LT outcome in patients with AH and chronic alcoholic cirrhosis (AC). RESULTS: The search yielded 2232 articles. Eight studies were included in the two meta-analyses-two studies in meta-analysis A and six studies in meta-analysis B. The two studies (n = 70) included in meta-analysis A revealed that 1-year patient survival was significantly higher in the LT group compared with the medical therapy-alone group (survival benefit, 15.88; 95% CI, 3.98-63.35; p < 0.0001). The six studies in meta-analysis B (including 1091 patients) showed that 1-year (survival benefit, 1.65; 95% CI, 0.95-2.89; p = 0.08), 3-year (survival benefit, 1.31; 95% CI, 0.79-2.18; p = 0.30), and 5-year survival (survival benefit, 1.54; 95% CI, 0.92-2.56; p = 0.10) were not significantly different between AH and AC groups. There was no significant difference in the rate of alcohol relapse between the groups (OR, 1.26; 95% CI, 0.53-2.96; p = 0.60). CONCLUSIONS: Early LT is a life-saving treatment for AH patients that do not respond to medical therapy. The chance of alcohol relapse after LT is not increased in selected patients.


Assuntos
Abstinência de Álcool , Hepatite Alcoólica/mortalidade , Hepatite Alcoólica/cirurgia , Transplante de Fígado/métodos , Doença Aguda , Feminino , Sobrevivência de Enxerto , Hepatite Alcoólica/diagnóstico , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/mortalidade , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/mortalidade , Masculino , Prognóstico , Recidiva , Medição de Risco , Análise de Sobrevida , Fatores de Tempo
14.
Acta Gastroenterol Belg ; 81(3): 427-429, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30350533

RESUMO

Cytomegalovirus (CMV) reactivation is a common complication after liver transplantation. In patients with CMV infection, indicated by a positive CMV DNA titer, the presence of any clinical symptom is termed CMV disease. The most common organ affected in CMV disease is the gastrointestinal tract, causing esophagitis, gastritis, enteritis or colitis. CMV infection of the pleura and pericard has been reported in immunocompromised patients, but is rarely seen following liver transplantation.We report a case of a 59-year-old male who developed CMV pleuropericarditis after liver transplantation. Initial ganciclovir treatment did not improve the patient's symptoms and therapy was switched to Foscarnet which ultimately resulted in resolution of infection. However, a few weeks after Foscarnet cessation, the patient again developed bilateral pleural effusion. Ultimate biochemical and clinical response was achieved with IV ganciclovir treatment. The patient was discharged from the hospital with oral Valganciclovir for 3 weeks and has since remained relapse free for >1 year.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Transplante de Fígado , Pericardite/diagnóstico , Pleurisia/diagnóstico , Antivirais/uso terapêutico , Infecções por Citomegalovirus/etiologia , Infecções por Citomegalovirus/terapia , Drenagem , Ganciclovir/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Cirrose Hepática Alcoólica/cirurgia , Masculino , Pessoa de Meia-Idade , Pericardiocentese , Pericardite/etiologia , Pericardite/terapia , Pleurisia/tratamento farmacológico , Pleurisia/etiologia , Toracentese , Tomografia Computadorizada por Raios X
17.
Medicine (Baltimore) ; 97(24): e11076, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29901618

RESUMO

RATIONALE: Hepatic vein occlusive disease (HVOD) is a rare complication after liver transplantation, which is characterized by nonthrombotic, fibrous obliteration of the small centrilobular hepatic veins by connective tissue and centrilobular necrosis in zone 3 of the acini. HVOD after solid organ transplantation has been reported; recently, most of these reports with limited cases have documented that acute cell rejection and immunosuppressive agents are the major causative factors. HVOD is relatively a rare complication of liver transplantation with the incidence of approximately 2%. PATIENT CONCERNS: A 59-year-old male patient with alcoholic liver cirrhosis underwent liver transplantation in our center. He suffered ascites, renal impairment 3 months after the surgery while liver enzymes were in normal range. DIAGNOSES: Imagining and pathology showed no evidence of rejection or vessels complications. HVOD was diagnosed with pathology biopsy. INTERVENTIONS: Tacrolimus was withdrawn and the progression of HVOD was reversed. OUTCOMES: Now, this patient has been followed up for 6 months after discharge with normal liver graft function. LESSONS: The use of tacrolimus in patients after liver transplantation may cause HVOD. Patients with jaundice, body weight gain, and refractory ascites should be strongly suspected of tacrolimus related HVOD.


Assuntos
Hepatopatia Veno-Oclusiva/patologia , Imunossupressores/efeitos adversos , Transplante de Fígado/efeitos adversos , Tacrolimo/efeitos adversos , Rejeição de Enxerto , Veias Hepáticas/patologia , Humanos , Fígado/patologia , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler
18.
Alcohol Alcohol ; 53(5): 511-517, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-29912265

RESUMO

Aims: Liver transplantation is the only curative treatment available for patients with end-stage alcoholic liver disease. As different studies showed a significant association between leptin plasma levels, gene methylation patterns and the extent of craving in alcohol-dependent patients, we investigated the effect of liver transplantation on leptin expression and promoter methylation. Short Summary: The present study shows that in alcohol-dependent patients with liver cirrhosis leptin is significantly higher before liver transplantation and decreases significantly after transplantation. Alcohol-dependent patients on the waiting list had significantly higher leptin promoter methylation values than patients who underwent liver transplantation for other reasons than alcoholic liver disease. Methods: Only plasma of 118 and peripheral blood mononuclear cells of 121 patients were used: healthy controls (C, n = 24/22), alcohol-dependent patients without ethyltoxic liver cirrhosis (AD, n = 24/22), patients after liver transplantation for other reasons than ethyltoxic liver cirrhosis (C-Tx, n = 18/21), alcohol-dependent patients suffering from ethyltoxic liver cirrhosis on the transplantation waiting list (Pre-Tx, n = 30/28) and patients with prior ethyltoxic liver cirrhosis after liver transplantation (Post-Tx, n = 22/28). Results: Leptin protein was significantly elevated in the pre-transplantation cohort when compared to post-transplantation and alcohol-dependent cohorts. Furthermore, leptin promoter methylation was higher in ethyltoxic patients before transplantation compared to non-ethyltoxic patients after transplantation, but not when compared to ethyltoxic patients after transplantation. C-Tx had lower methylation values than all other groups except for Post-Tx. Conclusions: Our study outlines the role of leptin protein levels as a marker for AD-related liver damage, contrasting it from AD without severe liver damage. With regard to the results of the methylation analysis, inflammation of the liver appears to cause mechanisms of leptin regulation to deviate from transcriptional regulation. Our data also suggest that leptin regulation is altered in ethyltoxic liver disease when compared to liver cirrhosis caused by other pathologies.


Assuntos
Alcoolismo/sangue , Alcoolismo/cirurgia , Leptina/biossíntese , Cirrose Hepática Alcoólica/sangue , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/tendências , Adulto , Idoso , Biomarcadores/sangue , Pesquisa Biomédica/tendências , Feminino , Previsões , Expressão Gênica , Humanos , Leptina/genética , Masculino , Metilação , Pessoa de Meia-Idade
19.
Z Gastroenterol ; 56(6): 561-568, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29890557

RESUMO

BACKGROUND: Recurrent ascitic decompensation is a frequent complication of advanced alcoholic liver disease. Ascites can be controlled by transjugular intrahepatic portosystemic shunt (TIPS) implantation, but specific pre-procedural outcome predictors are not well established. Liver and spleen stiffness measurement (LSM, SSM) correlate with outcome of compensated liver disease, but data for decompensated cirrhosis disease are scarce. Therefore, the predictive value of LSM and SSM was evaluated in patients with refractory ascites treated with TIPS insertion or receiving conservative therapy. MATERIAL AND METHODS: Patients with alcoholic liver cirrhosis and recurrent or refractory ascites were stratified according to TIPS eligibility. LSM was prospectively assessed by transient elastography (TE, XL probe) and point shear wave elastography (pSWE). pSWE was also used for SSM. The primary study endpoint was transplant-free survival after 12 months. In addition, correlation of LSM and SSM with TIPS complications was analyzed. RESULTS: 43 patients (16 % female, age 55.5 [28.6 - 79.6] years) were recruited, n = 20 underwent TIPS and n = 23 were treated with repeated paracenteses only. 15 patients died and five underwent liver transplantation during follow-up. LSM and SSM at baseline did not predict the patients' outcome in the TIPS cohort and in patients with conservative therapy. SSM was increased in two cases with spontaneous TIPS occlusion and declined after revision. CONCLUSION: LSM and SSM cannot be recommended for risk stratification in cirrhotic patients with refractory ascites. SSM may be useful in monitoring TIPS function during follow-up.


Assuntos
Elasticidade , Cirrose Hepática Alcoólica , Cirrose Hepática , Paracentese , Derivação Portossistêmica Transjugular Intra-Hepática , Adulto , Idoso , Ascite , Feminino , Humanos , Cirrose Hepática Alcoólica/mortalidade , Cirrose Hepática Alcoólica/cirurgia , Masculino , Pessoa de Meia-Idade , Paracentese/efeitos adversos , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Valor Preditivo dos Testes , Baço , Resultado do Tratamento
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