Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 652
Filtrar
2.
BMJ Case Rep ; 13(7)2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32641442

RESUMO

We report on a patient with coronavirus disease 2019 (COVID-19) and decompensated cirrhosis who experienced a favourable outcome of severe immune thrombocytopaenic purpura (ITP) after administration of intravenous immunoglobulin and high-dose dexamethasone. The present case suggests that it is reasonable to evoke ITP in case of profound thrombocytopaenia in a patient with COVID-19.


Assuntos
Infecções por Coronavirus , Glucocorticoides/administração & dosagem , Imunoglobulinas Intravenosas/administração & dosagem , Cirrose Hepática Alcoólica , Obesidade , Pandemias , Pneumonia Viral , Púrpura Trombocitopênica Idiopática , Adulto , Betacoronavirus/isolamento & purificação , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Fatores Imunológicos/administração & dosagem , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/epidemiologia , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Oxigenoterapia/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Púrpura Trombocitopênica Idiopática/diagnóstico , Púrpura Trombocitopênica Idiopática/etiologia , Púrpura Trombocitopênica Idiopática/fisiopatologia , Púrpura Trombocitopênica Idiopática/terapia , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Liver Int ; 40(7): 1590-1593, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32369658

RESUMO

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly infectious viral disease that predominantly causes respiratory symptoms. Elevated liver enzymes have been reported during the course of disease and appear to be common. We present a 56-year-old woman with a history of decompensated alcoholic cirrhosis who presented with abdominal pain, fever and diarrhoea and was found to have acute on chronic liver failure secondary to SARS-CoV-2 infection. The patient was treated with empiric antibiotic and supportive care with subsequent improvement.


Assuntos
Insuficiência Hepática Crônica Agudizada/virologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/virologia , Cirrose Hepática Alcoólica/complicações , Pneumonia Viral/virologia , Insuficiência Hepática Crônica Agudizada/diagnóstico , Insuficiência Hepática Crônica Agudizada/terapia , Antibacterianos/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Hidratação , Interações Hospedeiro-Patógeno , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/terapia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Resultado do Tratamento
4.
Ann Agric Environ Med ; 27(1): 80-85, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32208584

RESUMO

INTRODUCTION: Liver cirrhosis is a chronic disease in which progressive fibrosis is noted. This process leads to changed architectonics of the liver parenchyma and the appearance of regenerative nodules, all of which are caused by pathological activation of the hepatic stellate cells. This process is enhanced on a molecular level by many cytokines, with platelet-derived growth factors (PDGFs) playing the key role. OBJECTIVE: The aim of the study was to assess serum concentrations of PDGFs active biodymers (PDGF-AA, PDGF-BB and PDGF-AB) in patients with alcoholic liver cirrhosis, and to correlate them with the stage of disease. MATERIAL AND METHODS: 64 patients with alcoholic cirrhosis and a control group of 16 healthy individuals were analysed. Liver cirrhosis was determined based on clinical image, history of the patients' alcohol consumption, laboratory findings and abdominal ultrasonography. The serum PDGF-AA, PDGF-BB and PDGF-AB concentrations were determined using ELISA kits. RESULTS: Serum concentration of PDGF-AA and PDGF-BB homodimers increases in patients with alcoholic liver cirrhosis (p=0.034 and p<0.0001, respectively), unlike the serum concentration of PDGF-AB heterodimer (p>0.05). When the stage of the disease increases, the concentrations of PDGF-AA and PGFD-BB in blood also oncrease. Furthermore, the serum level of both PDGF-AA and PDGF-BB correlates significantly with the severity of alcoholic liver cirrhosis (measured by Pugh-Child's scale), the correlation being stronger in the case of PDGF-BB levels than PDGF-AA (R=0.28; p=0.027 and R=0.26; p=0.038, respectively). CONCLUSIONS: The plasma levels of PDGF-AA and -BB may be indicators of alcohol-induced liver fibrosis process, and might be considered as future possible treatment targets, with PDGF-BB levels being an even better indicator than PDGF-AA levels.


Assuntos
Becaplermina/sangue , Cirrose Hepática Alcoólica/sangue , Cirrose Hepática Alcoólica/diagnóstico , Fator de Crescimento Derivado de Plaquetas/metabolismo , Adulto , Idoso , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Derivado de Plaquetas/análise , Índice de Gravidade de Doença
5.
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
7.
BMJ Case Rep ; 12(10)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653639

RESUMO

A 32-year-old man with alcoholic cirrhosis presented with worsening abdominal distension and jaundice. He was diagnosed with cirrhosis 2 years prior after a hospitalisation for acute liver failure, during which viral, autoimmune and metabolic workup was unrevealing. Heavy alcohol consumption was his only obvious risk factor for liver disease, so his decompensation was attributed to alcohol. At the present time, he was admitted with acute-on-chronic liver failure and acute renal failure. The severity of his presentation and the disproportionately mild elevation in alkaline phosphatase relative to his hyperbilirubinaemia prompted repeating a ceruloplasmin level, which, though previously normal, was now low, and eventually led to a diagnosis of Wilson disease (WD) with concomitant alcoholic liver disease. Clinicians must recognise limitations in ceruloplasmin and copper levels when screening for WD and maintain suspicion for WD in young patients, even if there is an already established aetiology of liver disease.


Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Degeneração Hepatolenticular/diagnóstico , Cirrose Hepática Alcoólica/diagnóstico , Adulto , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Ceruloplasmina/análise , Diagnóstico Diferencial , Degeneração Hepatolenticular/terapia , Humanos , Masculino , Troca Plasmática
8.
Rev Med Liege ; 74(10): 527-534, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31609556

RESUMO

We report here the case of a 62-year-old patient with Child-Pugh stage C ethylic cirrhosis associated with severe macrocytic anaemia, refractory to iterative transfusions and withdrawal. After a haemorrhagic, deficiency-related, or sideroblastic etiology was ruled out, haemolytic anaemia was suspected. A blood smear allowed diagnosis of haemolytic anaemia with acanthocytes. This offers the opportunity to discuss anaemia in patients with alcoholic cirrhosis, a frequent complication spanning a broad severity range and having the potential to be life-threatening. Its origin can be multifactorial : acute haemorrhage, dilution, haemolysis (here due to acanthocytosis), marrow insufficiency caused by direct alcohol toxicity, malnutrition, iron deficiency, vitamin B9 or B12 deficiency, chronic inflammation, splenic sequestration induced by portal hypertension...


Assuntos
Anemia Hemolítica , Anemia Macrocítica , Cirrose Hepática Alcoólica , Acantócitos , Anemia Hemolítica/complicações , Anemia Hemolítica/diagnóstico , Anemia Macrocítica/complicações , Anemia Macrocítica/diagnóstico , Transfusão de Sangue , Diagnóstico Diferencial , Humanos , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/diagnóstico , Pessoa de Meia-Idade
10.
Nihon Shokakibyo Gakkai Zasshi ; 116(7): 607-616, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31292323

RESUMO

Cirrhotic cardiomyopathy (CCM) is a chronic cardiac dysfunction in patients with cirrhosis and is characterized by altered diastolic relaxation, blunted contractile response to stress, and electrophysiological abnormalities;however, causes of CCM are unknown. Moreover, reduced cardiac afterload due to cirrhosis-related vasodilatation often masks cardiac insufficiency, whereas rapid hemodynamic overload reveals the presence of cirrhotic cardiomyopathy. Herein, we present the case of previously unrecognized cirrhotic cardiomyopathy that became overt with the development of severe acute cardiac failure. The rapidly worsening hepatic hydrothorax increased cardiac preload and intrathoracic pressure, which impaired cardiac filling. Furthermore, cardiac contractile function might have been worsened by hypoxia due to passive atelectasis and concomitant anemia.


Assuntos
Cardiomiopatias/diagnóstico , Insuficiência Cardíaca/diagnóstico , Hidrotórax/diagnóstico , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática , Cardiomiopatias/complicações , Insuficiência Cardíaca/complicações , Humanos , Hidrotórax/complicações , Cirrose Hepática Alcoólica/complicações
13.
Ann Hepatol ; 18(2): 397-401, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31029562

RESUMO

We report the case of a 53-year-old-man who developed human T-cell leukemia virus type-1-associated myelopathy (HAM) after ABO-incompatible liver transplantation for alcoholic liver cirrhosis. The living donor was seropositive for human T-cell leukemia virus type-1 (HTLV-1) and the recipient was seronegative for HTLV-1 before transplantation. After transplantation, the recipient developed steroid-resistant acute cellular rejection, which was successfully treated using anti-thymocyte globulin, and he was eventually discharged. He underwent spinal surgery twice after the transplantation for the treatment of cervical spondylosis that had been present for a period of 9 months before the transplantation. The surgery improved his gait impairment temporarily. However, his gait impairment progressed, and magnetic resonance imaging revealed multiple sites of myelopathy. He was diagnosed with HAM 16 months after the transplantation. Pulse steroid therapy (1000mg) was administered over a period of 3 days, and his limb paresis improved. Presently, steroid therapy is being continued, with a plan to eventually taper the dose, and he is being carefully followed up at our institution. Our case suggests that liver transplantation involving an HTLV-1-positive living donor carries the risk of virus transmission and short-term development of HAM after transplantation.


Assuntos
Sistema ABO de Grupos Sanguíneos , Anticorpos Antivirais/sangue , Incompatibilidade de Grupos Sanguíneos , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/efeitos adversos , Doadores Vivos , Paraparesia Espástica Tropical/transmissão , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Cirrose Hepática Alcoólica/diagnóstico , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/imunologia , Paraparesia Espástica Tropical/terapia , Paraparesia Espástica Tropical/virologia , Medição de Risco , Fatores de Tempo , Resultado do Tratamento
14.
J Cancer Res Ther ; 15(1): 255-257, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30880788

RESUMO

This case report demonstrates successful concurrent chemoradiotherapy for esophageal cancer without severe adverse events in a patient with cirrhotic disease. A 63-year-old Japanese male with alcoholic liver cirrhosis was referred to our hospital for treatment of superficial esophageal cancer. Endoscopic submucosal dissection was performed and the patient was diagnosed as having squamous cell carcinoma of the esophagus that was pathologically staged as pT1bN0M0. When a superficial tumor involves the submucosa, esophagectomy is usually recommended. However, the patient was at high risk of perioperative morbidity and mortality because of impaired liver function. As an alternative to esophagectomy, the patient received concurrent chemoradiotherapy, comprising nedaplatin 64 mg/m2 on days 1 and 34 and S-1 80 mg/body orally on days 1-14 and 34-47 with concurrent radiotherapy of 50 Gy in daily fractions of 2 Gy. He has shown no signs of recurrence in the 30 months since his treatment.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/terapia , Cirrose Hepática Alcoólica/patologia , Quimiorradioterapia/métodos , Progressão da Doença , Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/diagnóstico por imagem , Carcinoma de Células Escamosas do Esôfago/complicações , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Esofagectomia , Esofagoscopia , Humanos , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/diagnóstico , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/uso terapêutico , Planejamento da Radioterapia Assistida por Computador , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Liver Transpl ; 25(5): 706-711, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30882995

RESUMO

Alcohol-associated liver disease (ALD) can be coded in United Network for Organ Sharing (UNOS) as either alcoholic cirrhosis or alcoholic hepatitis (AH), without having specific criteria to assign either diagnosis. In this multicenter American Consortium of Early Liver Transplantation for Alcoholic Hepatitis (ACCELERATE-AH) study, we sought to assess the concordance of the clinician diagnosis of AH at liver transplantation (LT) listing versus UNOS data entry of AH as listing diagnosis. In a prior study, consecutive early LT recipients transplanted for AH between 2012 and 2017 were identified by chart review at 10 ACCELERATE-AH sites. In this current study, these same LT recipients were identified in the UNOS database. The primary UNOS diagnostic code was evaluated for concordance with the chart-review assignment of AH. In cases where the primary listing diagnosis in UNOS was not AH, we determined the reason for alternate classification. Among 124 ACCELERATE-AH LT recipients with a chart-review diagnosis of AH, only 43/124 (35%) had AH as listing diagnosis in UNOS; 80 (64%) were listed as alcoholic cirrhosis, and 1 (1%) as fulminant hepatic necrosis. Of the 81 patients missing AH as a UNOS listing diagnosis code, the reasons for alternate classification were 44 (54%) due to a lack of awareness of a separate diagnosis code for AH; 13 (16%) due to concomitant clinical diagnosis of AH and alcoholic cirrhosis in the chart; 12 (15%) due to clinical uncertainty regarding the diagnosis of AH versus acute decompensated alcoholic cirrhosis; and 12 (15%) due to a data entry error. In conclusion, in a large cohort of LT recipients with AH, only 35% were documented as such in UNOS. Increased education and awareness for those performing UNOS data entry, the establishment of specific criteria to define AH in the UNOS database, and the ability to document dates of alcohol use would allow future research on ALD to be more informative.


Assuntos
Codificação Clínica/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Hepatite Alcoólica/cirurgia , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/estatística & dados numéricos , Adulto , Erros de Diagnóstico , Feminino , Hepatite Alcoólica/diagnóstico , Hepatite Alcoólica/epidemiologia , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/epidemiologia , Transplante de Fígado/normas , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
Liver Int ; 39(1): 168-176, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30188604

RESUMO

BACKGROUND & AIMS: Familial aggregation of metabolic traits in NAFLD is well documented. However, relevance of these traits in alcoholic cirrhosis is not well studied. We aimed to explore the association of family history of metabolic traits with age at diagnosis, severity and complications of alcoholic cirrhosis. METHODS: In a cross-sectional study, all consecutive patients with alcoholic cirrhosis presenting to our tertiary care centre were included. Family and personal history, demographic characteristics, medical history, anthropometric measurements and laboratory data were recorded. The amount and duration of alcohol consumption were also carefully recorded. RESULTS: Out of 1084 alcoholic cirrhotics (age 48.5 ± 10.1 years, all males), family history for metabolic traits was documented in 688 (63.5%) patients. These patients had younger age at diagnosis, increased incidence of jaundice, ascites, variceal bleed and hepatic encephalopathy with consequently higher MELD and CTP score. These patients developed cirrhosis despite shorter median duration (13 years, IQR 7-20 vs 21, IQR 18-25) and lesser amount of alcohol consumption (74 g/d, IQR 24-96 vs 144, IQR 100-148). Patients with both family and personal history of metabolic traits had a higher risk by 3.3 times (95% CI 2.2-4.8) of an early age at diagnosis, 13.2 times (95% CI 8.7-20.1) of progression to cirrhosis with lesser amount of alcohol consumption and 4.6 times (95% CI 3.1-6.9) with lesser duration of alcohol consumption. CONCLUSIONS: Positive family and personal history of metabolic traits predispose to alcoholic cirrhosis with an earlier age at onset and more severity despite lesser exposure to alcohol.


Assuntos
Cirrose Hepática Alcoólica/complicações , Anamnese , Síndrome Metabólica/complicações , Hepatopatia Gordurosa não Alcoólica/complicações , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Ascite/etiologia , Estudos Transversais , Progressão da Doença , Feminino , Predisposição Genética para Doença , Encefalopatia Hepática/complicações , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Índice de Gravidade de Doença , Centros de Atenção Terciária
17.
Clin Liver Dis ; 23(1): 115-126, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30454826

RESUMO

Alcohol-associated cirrhosis (AC) contributes up to 50% of the overall cirrhosis burden in the United States. AC is typically a comorbid condition in association with alcohol-use disorder. AC is often coexistent with other conditions. Several noninvasive methods are available to assist in recognizing the presence of AC. The natural history of AC is governed by the patients continued drinking or abstinence. All treatment starts with abstinence. After decompensation, the progression to acute-on-chronic liver failure heralds death. When patients who have deteriorated are declined liver transplant, palliative care should be considered.


Assuntos
Cirrose Hepática Alcoólica , Abstinência de Álcool , Alcoolismo/epidemiologia , Carcinoma Hepatocelular , Causas de Morte , Fumar Cigarros/epidemiologia , Comorbidade , Gerenciamento Clínico , Progressão da Doença , Hemocromatose/epidemiologia , Hepatite B Crônica/epidemiologia , Hepatite C Crônica/epidemiologia , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/epidemiologia , Cirrose Hepática Alcoólica/metabolismo , Cirrose Hepática Alcoólica/terapia , Neoplasias Hepáticas , Transplante de Fígado , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Cuidados Paliativos
19.
Exp Clin Transplant ; 17(3): 355-362, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-29957165

RESUMO

OBJECTIVES: The aim of this study was to analyze alcoholic cirrhosis in women who were to undergo liver transplant, including their biochemical and clinical characteristics, main complications, survival rates, and main causes of death compared with men with alcoholic cirrhosis. MATERIALS AND METHODS: Our study included 400 patients with alcoholic cirrhosis, which we divided according to sex and viral infections. Biochemical parameters and the presence and degree of ascites and encephalopathy, liver function status, and liver rejection and survival rates were analyzed from 1 to 10 years and the main cause of death at 10 years. RESULTS: Patients with nonviral alcoholic cirrhosis and liver transplant had significantly better survival rates (84.1%) at 1 year versus those with viral alcoholic cirrhosis (74.5%; P = .036). Men with nonviral alcoholic cirrhosis (14%) and women with hepatitis C virus (29%) had the lowest short-term survival rates. In long-term survival analysis, the lowest rate was observed in women with nonviral alcoholic cirrhosis (26.1%), and the highest rate was observed in women with hepatitis C virus (42.9%). Liver graft failure was one of the main causes of death in male patients (19.5%). CONCLUSIONS: Women with alcoholic cirrhosis showed a higher rate of ascites and encephalopathy but lower liver graft rejection than men with alcoholic cirrhosis. Survival rates were similar between men and women, although slightly lower in women who had hepatitis C virus.


Assuntos
Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado , Causas de Morte , Feminino , Humanos , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Taxa de Sobrevida
20.
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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...