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1.
Zhonghua Wai Ke Za Zhi ; 58(3): 183-188, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187922

RESUMO

The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Hipertensão Portal/cirurgia , Cirrose Hepática/cirurgia , China , Humanos , Laparoscopia , Esplenectomia
2.
Medicine (Baltimore) ; 99(2): e18737, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914090

RESUMO

Portal vein thrombosis (PVT) might impair the prognosis of cirrhotic patients. However, formation of de novo PVT after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients without preexisting PVT was rarely reported. Moreover, it is not known whether warfarin is efficient in preventing de novo PVT after TIPS. The current study aimed to investigate retrospectively the incidence and location of de novo PVT, and preventive effects of warfarin on de novo PVT after TIPS for cirrhotic patients. Patients who received TIPS placement between March 1, 2015 and March 1, 2016 in our hospital were screened retrospectively. Patients without preexisting PVT before TIPS and those who were followed up for at least 12 months were included. There were 2 groups: 1 group received warfarin (warfarin group) post-TIPS, while another group (control group) did not receive prophylactic drug to prevent PVT. Their baseline characteristics and follow-up data were retrieved. The occurrence of PVT, adverse events due to warfarin, difference in stent patency and clinical complications such as stent dysfunction, hepatic encephalopathy, mortality, liver cancer, variceal bleeding, infection, and liver failure, and results of follow-up biochemical examination were compared. Eighty-three patients without preexisting PVT were included. There were 56 patients in the control group and 27 in the warfarin group. The incidence of PVT in the warfarin group was 14.8% (4/27), whereas the incidence in the control group was 42.9% (24/56, P = .013). The location of de novo PVT was mainly at left portal vein. Adverse events due to warfarin was mostly mild, such as hemorrhinia and gingival hemorrhage. No significant difference regarding to stent patency and clinical complications between the 2 groups was found. At 24-month after-TIPS, for the remaining patients in both groups, the total bilirubin was significantly increased while the red blood cell count was significantly decreased in control group compared with those in warfarin group (P < .05). PVT could commonly occur after TIPS in patients without preexisting PVT. Warfarin could prevent PVT in these patients, and might improve patient's liver function.


Assuntos
Cirrose Hepática/cirurgia , Veia Porta/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/efeitos adversos , Trombose/etiologia , Trombose/prevenção & controle , Varfarina/administração & dosagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Varfarina/efeitos adversos
3.
World J Gastroenterol ; 25(39): 6016-6024, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31660037

RESUMO

BACKGROUND: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been adopted by liver surgeons in recent years. However, high morbidity and mortality rates have limited the promotion of this technique. Some recent studies have suggested that ALPPS with a partial split can effectively induce the growth of future liver remnant (FLR) similar to a complete split with better postoperative safety profiles. However, some others have suggested that ALPPS can induce more rapid and adequate FLR growth, but with the same postoperative morbidity and mortality rates as in partial split of the liver parenchyma in ALPPS (p-ALPPS). AIM: To perform a systematic review and meta-analysis on ALPPS and p-ALPPS. METHODS: A systematic literature search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was performed for articles published until June 2019. Studies comparing the outcomes of p-ALPPS and ALPPS for a small FLR in consecutive patients were included. Our main endpoints were the morbidity, mortality, and FLR hypertrophy rates. We performed a subgroup analysis to evaluate patients with and without liver cirrhosis. We assessed pooled data using a random-effects model. RESULTS: Four studies met the inclusion criteria. Four studies reported data on morbidity and mortality, and two studies reported the FLR hypertrophy rate and one study involved patients with cirrhosis. In the non-cirrhotic group, p-ALPPS-treated patients had significantly lower morbidity and mortality rates than ALPPS-treated patients [odds ratio (OR) = 0.2; 95% confidence interval (CI): 0.07-0.57; P = 0.003 and OR = 0.16; 95%CI: 0.03-0.9; P = 0.04]. No significant difference in the FLR hypertrophy rate was observed between the two groups (P > 0.05). The total effects indicated no difference in the FLR hypertrophy rate or perioperative morbidity and mortality rates between the ALPPS and p-ALPPS groups. In contrast, ALPPS seemed to have a better outcome in the cirrhotic group. CONCLUSION: The findings of our study suggest that p-ALPPS is safer than ALPPS in patients without cirrhosis and exhibits the same rate of FLR hypertrophy.


Assuntos
Hepatectomia/métodos , Hepatomegalia/epidemiologia , Regeneração Hepática , Veia Porta/cirurgia , Complicações Pós-Operatórias/epidemiologia , Hepatectomia/efeitos adversos , Hepatomegalia/etiologia , Humanos , Ligadura/efeitos adversos , Ligadura/métodos , Fígado/irrigação sanguínea , Fígado/fisiologia , Fígado/cirurgia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Análise de Sobrevida , Resultado do Tratamento
4.
Transplant Proc ; 51(9): 3131-3135, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611120

RESUMO

Liver cirrhosis can cause splenic artery aneurysms (SAA) that pose a threat to patients undergoing liver transplantation. However, liver transplantation with multiple visceral artery aneurysms including giant SAA caused by arterial fragility has never been reported. We describe a 36-year-old man with decompensated liver cirrhosis due to Wilson disease that was complicated by giant SAA and multiple aneurysms in the bilateral renal arteries caused by fibromuscular dysplasia (FMD). The maximal diameter of the triple snowball-shaped SAA was 11 cm. We planned a 2-stage strategy consisting of a splenectomy with distal pancreatectomy to treat the SAA and subsequent living donor liver transplantation (LDLT) to address the liver cirrhosis. This strategy was selected to prevent fatal postoperative infectious complications caused by the potential development of pancreatic fistula during simultaneous procedures and to histopathologically diagnose the arterial lesion before LDLT to promote safe hepatic artery reconstruction. However, a postoperative pancreatic fistula did not develop after a splenectomy with distal pancreatectomy, and the pathologic findings of the artery indicated FMD. The patient underwent ABO-identical LDLT with a right lobe graft donated by his brother. Other than postoperative rupture of the aneurysm in the left renal artery requiring emergency interventional radiology, the patient has remained free of any other arterial complications and continues to do well at 2 years after LDLT.


Assuntos
Aneurisma/etiologia , Displasia Fibromuscular/complicações , Degeneração Hepatolenticular/complicações , Transplante de Fígado , Artéria Esplênica/patologia , Adulto , Aneurisma/cirurgia , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Doadores Vivos , Masculino , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Artéria Renal/patologia , Esplenectomia/efeitos adversos , Esplenectomia/métodos , Artéria Esplênica/cirurgia
5.
Ann Saudi Med ; 39(5): 337-344, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580715

RESUMO

BACKGROUND: Living donor liver transplantation (LDLT) has evolved into a widely accepted therapeutic option. Many different risk factors may affect early mortality after LDLT. OBJECTIVES: Analyze risk factors that can affect early (<6 months) mortality of patients after LDLT in a single center. DESIGN: Retrospective chart review of patients who underwent LDLT. SETTING: University hospital. PATIENTS AND METHODS: Adult cirrhotic patients who underwent LDLT were classified by early (first 6 months) or late mortality. A full pre, intra- and post-operative evaluation had been done on all patients including a full history, examination and investigations to identify risk factors that might affect mortality post-LDLT. MAIN OUTCOME MEASURES: Determination of pre-, intra- or postoperative factors that might affect recipient mortality post-LDLT. SAMPLE SIZE: 123. RESULTS: Pre-operative factors that increased early mortality in a univariate analysis were higher model for end-stage liver disease (MELD) scores, lower graft-recipient weigh ratio (GRWR), older donor age, and recurrent spontaneous bacterial peritonitis. Intraoperative factors included more transfusion units of blood, plasma, platelets and cryoprecipitate, a longer time for cold and warm ischemia, and a longer anhepatic phase among others. Postoperative factors included a longer ICU or hospital stay and abnormal postoperative laboratory data. In the final logistic regression model, the most significant factors were pre-operative GRWR, length of hospital stay, units of intraoperative blood transfusion, postoperative alanine aminotransferase, postoperative total leukocyte count, and MELD score. CONCLUSION: LDLT outcomes might be improved by attempting to resolve clinical factors that have been identified as contributors to early post-LDLT mortality. LIMITATIONS: More risk factors, such as those relevant to patient portal vein hemodynamics, should be included in an analysis of predictors of early mortality. CONFLICT OF INTEREST: None.


Assuntos
Cirrose Hepática/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Adulto , Transfusão de Sangue/estatística & dados numéricos , Egito , Feminino , Humanos , Tempo de Internação , Transplante de Fígado/mortalidade , Masculino , Veia Porta , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto Jovem
6.
Medicine (Baltimore) ; 98(43): e17078, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651835

RESUMO

To investigate the feasibility, efficacy, and safety of laparoscopic totally extraperitoneal (TEP) repair in patients with inguinal hernia accompanied by liver cirrhosis.Between October 2015 and May 2018, 17 patients with liver cirrhosis who underwent TEP repair were included in this study. The baseline characteristics, perioperative data, and recurrence were retrospectively reviewed.Seventeen patients with a mean duration of 18.23 ± 16.80 months were enrolled. All TEP repairs were successful without conversion to trans-abdominal pre-peritoneal (TAPP) surgery or open repair, but 4 patients had peritoneum rupture during dissection. The mean operation time was 54.23 ±â€Š10.51 minutes for unilateral hernia and 101.25 ±â€Š13.77 minutes for bilateral hernias. We found 2 cases with contralateral inguinal hernia and 2 cases with obturator hernia during surgery. The rate of complication was 17.65% (3/17), 2 of 3 cases were Child-Turcotte-Pugh C with large ascites. During a follow-up of 19.29 ±â€Š9.01 months, no patients had recurrence and chronic pain, but 2 patients died because of the progression of underlying liver disease.Early and elective inguinal hernia repair is feasible and effective for patients with liver cirrhosis. TEP is a feasible and safe repair option for cirrhotic patients in experienced hands.


Assuntos
Ascite/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Cirrose Hepática/cirurgia , Abdome/cirurgia , Adulto , Idoso , Ascite/complicações , Conversão para Cirurgia Aberta/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Hérnia Inguinal/etiologia , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Peritônio/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
7.
An Acad Bras Cienc ; 91(3): e20190220, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31531535

RESUMO

Liver fibrosis is the final common pathway of chronic liver diseases, having cirrhosis as a possible progression, which has liver transplantation as the only effective treatment. Human amniotic membrane represents a potential strategy as a therapy for liver fibrosis, due to its anti-inflammatory, anti-fibrotic and immunomodulatory properties. The aim of this study was to evaluate amniotic membrane effects as a treatment for hepatic fibrosis induced in rats by bile duct ligation (BDL), verifying alterations between two different forms of amniotic membrane application, around all the lobes of the liver and around only one lobe of the liver. Two weeks after inducing fibrosis, an amniotic membrane fragment was applied to the surface of the liver, covering it either totally or partially. Four weeks later, the animals were euthanized and liver samples were collected. Histopathological and quantitative analyses demonstrated fibrosis severity decrease and an extremely significant reduction in the deposition of collagen in the groups treated with amniotic membrane, particularly when the amniotic membrane was applied in only one liver lobe. It is concluded that the amniotic membrane acted on the repair of liver fibrosis in both modes of application, with the application of the amniotic membrane around only one hepatic lobe being more effective in reducing the severity / extent of fibrosis.


Assuntos
Âmnio/transplante , Cirrose Hepática/cirurgia , Animais , Ductos Biliares/cirurgia , Colágeno/metabolismo , Modelos Animais de Doenças , Fígado/patologia , Cirrose Hepática/patologia , Masculino , Ratos , Ratos Wistar
8.
Transplant Proc ; 51(8): 2740-2744, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31563243

RESUMO

BACKGROUND: Refractory ascites is one of the major complications of liver transplant (LT) and is associated with increased morbidity and mortality. The aim of this study was to analyze the efficacy and safety of novel cell-free and concentrated ascites reinfusion therapy (KM-CART) for the treatment of refractory ascites during preoperative living donor liver transplant. METHODS: Forty KM-CART procedures were performed on 8 liver transplant candidates. We investigated the safety and efficacy of KM-CART in terms of the processed ascites, adverse events, laboratory data, and patient condition. RESULTS: By using KM-CART, an average of 12.5 L (range, 2.6-26.1 L) of ascites was filtered and concentrated to 0.5 L (range, 0.1-1.6 L) in 62 minutes (range, 8-187 minutes). Final products contained 21.5 g (range, 2.5-65.6 g) of albumin and 13.5 g (range, 1.5-61.8 g) of globulin. No endotoxin contamination was detected in the ascites. Although the incidence of adverse events was 35.0% (including fever, hypotension, bleeding, leg cramps, and nausea), all of these could be treated conservatively. Body weight and oral intake were significantly improved after KM-CART. Furthermore, the use of fresh frozen plasma for the LT recipients with KM-CART was significantly lower than that for patients without KM-CART. In addition, no patients lost their opportunity for LT because of adverse events due to KM-CART. CONCLUSIONS: Our findings show that KM-CART could be a promising option for the treatment of refractory ascites during the preoperative period of LT. This study provides the foundation for further large-scale prospective studies.


Assuntos
Ascite/complicações , Ascite/cirurgia , Cirrose Hepática/complicações , Transplante de Fígado , Paracentese/métodos , Adulto , Idoso , Feminino , Humanos , Cirrose Hepática/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
Biosci Trends ; 13(4): 351-357, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527331

RESUMO

There is little information regarding the use of a combination of the albumin-bilirubin (ALBI) grade and the fibrosis-4 index (FIB-4) in predicting hepatocellular carcinoma (HCC) patient outcomes after liver resection. In this study, we aimed to analyze the predictive ability of a combination of the ALBI grade and the FIB-4 score (ALBI-FIB-4) for HCC patients within the Milan criteria after liver resection. The data of HCC patients within the Milan criteria who underwent liver resection between 2011 and 2019 at our center were reviewed (n = 544). Patients with an FIB-4 index > 3.25 were considered to have a high FIB-4 index and were given a score of 1, whereas patients with an FIB-4 index ≤ 3.25 were considered to have a low FIB-4 index and were given a score of 0. The ALBI-FIB-4 score was a summary score that combined the ALBI grade and the score based on the FIB-4 index. During the follow-up period, 279 patients experienced recurrence, and 175 patients died. Multivariate analysis showed that tumor size, the presence of multiple tumors, the presence of microvascular invasion and the ALBI-FIB-4 score were four independent risk factors for both postoperative recurrence-free survival (RFS) and overall survival (OS). The 5-year RFS of patients with high ALBI-FIB-4 scores of 1, 2, and 3 were 55.0%, 44.2% and 35.3%, respectively (p = 0.004). The 5-year OS rates of patients with high ALBI-FIB-4 scores of 1, 2, and 3 were 72.9%, 66.4% and 54.8%, respectively (p = 0.011). The ALBI-FIB-4 score may be a surrogate marker for predicting the prognosis of patients with HCC after liver resection. A high ALBI-FIB-4 score was associated with a high incidence of postoperative recurrence and mortality.


Assuntos
Bilirrubina/sangue , Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/diagnóstico , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/diagnóstico , Albumina Sérica/análise , Adulto , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/mortalidade , Intervalo Livre de Doença , Feminino , Fibrose , Seguimentos , Hepatectomia , Humanos , Incidência , Fígado/patologia , Fígado/cirurgia , Cirrose Hepática/mortalidade , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/sangue , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida
10.
World J Gastroenterol ; 25(33): 4814-4834, 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31543676

RESUMO

The intimate connection and the strict mutual cooperation between the gut and the liver realizes a functional entity called gut-liver axis. The integrity of intestinal barrier is crucial for the maintenance of liver homeostasis. In this mutual relationship, the liver acts as a second firewall towards potentially harmful substances translocated from the gut, and is, in turn, is implicated in the regulation of the barrier. Increasing evidence has highlighted the relevance of increased intestinal permeability and consequent bacterial translocation in the development of liver damage. In particular, in patients with non-alcoholic fatty liver disease recent hypotheses are considering intestinal permeability impairment, diet and gut dysbiosis as the primary pathogenic trigger. In advanced liver disease, intestinal permeability is enhanced by portal hypertension. The clinical consequence is an increased bacterial translocation that further worsens liver damage. Furthermore, this pathogenic mechanism is implicated in most of liver cirrhosis complications, such as spontaneous bacterial peritonitis, hepatorenal syndrome, portal vein thrombosis, hepatic encephalopathy, and hepatocellular carcinoma. After liver transplantation, the decrease in portal pressure should determine beneficial effects on the gut-liver axis, although are incompletely understood data on the modifications of the intestinal permeability and gut microbiota composition are still lacking. How the modulation of the intestinal permeability could prevent the initiation and progression of liver disease is still an uncovered area, which deserves further attention.


Assuntos
Hipertensão Portal/etiologia , Mucosa Intestinal/metabolismo , Cirrose Hepática/etiologia , Transplante de Fígado , Hepatopatia Gordurosa não Alcoólica/etiologia , Translocação Bacteriana , Progressão da Doença , Disbiose/complicações , Disbiose/patologia , Humanos , Hipertensão Portal/patologia , Hipertensão Portal/cirurgia , Mucosa Intestinal/patologia , Fígado/metabolismo , Fígado/patologia , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Hepatopatia Gordurosa não Alcoólica/patologia , Permeabilidade , Resultado do Tratamento
11.
Gastroenterology ; 157(6): 1630-1645.e6, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31560893

RESUMO

BACKGROUND & AIMS: Intratumor heterogeneity and divergent clonal lineages within and among primary and recurrent hepatocellular carcinomas (HCCs) produce challenges to patient management. We investigated genetic and epigenetic variations within liver tumors, among hepatic lesions, and between primary and relapsing tumors. METHODS: Tumor and matched nontumor liver specimens were collected from 113 patients who underwent partial hepatectomy for primary or recurrent HCC at 2 hospitals in Hong Kong. We performed whole-genome, whole-exome, or targeted capture sequencing analyses of 356 HCC specimens collected from multiple tumor regions and matched initial and recurrent tumors. We performed parallel DNA methylation profiling analyses of 95 specimens. Genomes and epigenomes of nontumor tissues that contained areas of cirrhosis or fibrosis were analyzed. We developed liver cancer cell lines that endogenously expressed a mutant form of TP53 (R249S) or overexpressed mutant forms of STAT3 (D170Y, K348E, and Y640F) or JAK1 (S703I and L910P) and tested the abilities of pharmacologic agents to reduce activity. Cells were analyzed by immunoblotting and chromatin immunoprecipitation with quantitative polymerase chain reaction. RESULTS: We determined the monoclonal origins of individual tumors using a single sample collection approach that captured more than 90% of mutations that are detected in all regions of tumors. Phylogenetic and phylo-epigenetic analyses revealed interactions and codependence between the genomic and epigenomic features of HCCs. Methylation analysis revealed a field effect in cirrhotic liver tissues that predisposes them to tumor development. Comparisons of genetic features revealed that 52% of recurrent HCCs derive from the clonal lineage of the initial tumor. The clonal origin if recurrent HCCs allowed construction of a temporal map of genetic alterations that associated with tumor recurrence. Activation of JAK signaling to STAT was a characteristic of HCC progression via mutations that associate with response to drug sensitivity. The combination of a mutation that increases the function of TP53 and the 17p chromosome deletion might provide liver cancer cells with a replicative advantage. Chromatin immunoprecipitation analysis of TP53 with the R249S substitution revealed its interaction with genes that encode chromatin regulators (MLL1 and MLL2). We validated MLL1 and MLL2 as direct targets of TP53R249S and affirmed their association in the Cancer Genome Atlas dataset. The MLL-complex antagonists MI-2-2 (inhibitor of protein interaction) and OICR-9492 (inhibitor of activity) specifically inhibited proliferation of HCC cells that express TP53R249S at nanomolar concentrations. CONCLUSIONS: We performed a systematic evaluation of intra- and intertumor genetic heterogeneity in HCC samples and identified genetic and epigenetic changes that associate with tumor progression and recurrence. We identified chromatin regulators that are upregulated by mutant TP53 in HCC cells and inhibitors that reduce proliferation of these cells. DNA methylation patterns in cirrhotic or fibrotic liver tissues might be used to identify those at risk of HCC development.


Assuntos
Carcinoma Hepatocelular/genética , Cirrose Hepática/genética , Neoplasias Hepáticas/genética , Recidiva Local de Neoplasia/genética , Adulto , Idoso , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/genética , Metilação de DNA , Proteínas de Ligação a DNA/antagonistas & inibidores , Proteínas de Ligação a DNA/metabolismo , Epigênese Genética , Feminino , Seguimentos , Mutação com Ganho de Função , Heterogeneidade Genética , Hepatectomia , Histona-Lisina N-Metiltransferase/antagonistas & inibidores , Histona-Lisina N-Metiltransferase/metabolismo , Hong Kong , Humanos , Fígado/patologia , Fígado/cirurgia , Cirrose Hepática/patologia , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Proteína de Leucina Linfoide-Mieloide/antagonistas & inibidores , Proteína de Leucina Linfoide-Mieloide/metabolismo , Proteínas de Neoplasias/antagonistas & inibidores , Proteínas de Neoplasias/metabolismo , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Proteína Supressora de Tumor p53/genética , Sequenciamento Completo do Genoma
12.
World J Gastroenterol ; 25(28): 3798-3807, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391774

RESUMO

BACKGROUND: Cirrhosis is a major risk factor for the development of hepatocellular carcinoma (HCC). Portal vein thrombosis is not uncommon after splenectomy in cirrhotic patients, and many such patients take oral anticoagulants including aspirin. However, the long-term impact of postoperative aspirin on cirrhotic patients after splenectomy remains unknown. AIM: The main purpose of this study was to investigate the effect of postoperative long-term low-dose aspirin administration on the development of HCC and long-term survival of cirrhotic patients after splenectomy. METHODS: The clinical data of 264 adult patients with viral hepatitis-related cirrhosis who underwent splenectomy at the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2014 were analyzed retrospectively. Among these patients, 59 who started taking 100 mg/d aspirin within seven days were enrolled in the aspirin group. The incidence of HCC and overall survival were analyzed. RESULTS: During follow-up, 41 (15.53%) patients developed HCC and 37 (14.02%) died due to end-stage liver diseases or other serious complications. Postoperative long-term low-dose aspirin therapy reduced the incidence of HCC from 19.02% to 3.40% after splenectomy (log-rank test, P = 0.028). Univariate and multivariate analyses showed that not undertaking postoperative long-term low-dose aspirin therapy [odds ratio (OR) = 6.211, 95% confidence interval (CI): 1.142-27.324, P = 0.016] was the only independent risk factor for the development of HCC. Similarly, patients in the aspirin group survived longer than those in the control group (log-rank test, P = 0.041). Univariate and multivariate analyses showed that the only factor that independently associated with improved overall survival was postoperative long-term low-dose aspirin therapy [OR = 0.218, 95%CI: 0.049-0.960, P = 0.044]. CONCLUSION: In patients with viral hepatitis-related cirrhosis, long-term post-splenectomy administration of low-dose aspirin reduces the incidence of HCC and improves the long-term overall survival.


Assuntos
Aspirina/administração & dosagem , Carcinoma Hepatocelular/epidemiologia , Cirrose Hepática/complicações , Neoplasias Hepáticas/epidemiologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/prevenção & controle , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Hiperesplenismo/etiologia , Hiperesplenismo/cirurgia , Hipertensão Portal/etiologia , Hipertensão Portal/cirurgia , Incidência , Cirrose Hepática/mortalidade , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/prevenção & controle , Masculino , Pessoa de Meia-Idade , Veia Porta/patologia , Prognóstico , Estudos Retrospectivos , Esplenectomia/efeitos adversos , Fatores de Tempo , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle , Adulto Jovem
13.
Transplant Proc ; 51(6): 1972-1977, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399179

RESUMO

Bloodstream infections are a major factor contributing to morbidity and mortality following liver transplantation. The increasing occurrence of multidrug-resistant bloodstream infections represents a challenge for the prevention and treatment of those infections. The aim of this study was to evaluate the occurrence and microbiological profile of bloodstream infections during the early postoperative period (from day 0 to day 60) in patients undergoing liver transplantation from January 2005 to June 2016 at the State University of Campinas General Hospital. A total of 401 patients who underwent liver transplantation during this period were included in the study. The most common cause of liver disease was hepatitis C virus cirrhosis (34.01%), followed by alcoholic disease (16.24%). A total of 103 patients had 139 microbiologically proven bloodstream infections. Gram-negative bacteria were isolated in 63.31% of the cases, gram-positive bacteria in 28.78%, and fungi in 7.91%. Fifty-six infections (43.75%) were multidrug-resistant bacteria, and 72 (56.25%) were not. There was no linear trend concerning the occurrence of multidrug-resistant organisms throughout the study period. Patients with multidrug-resistant bloodstream infections had a significantly lower survival rate than those with no bloodstream infections and those with non-multidrug-resistant bloodstream infections. In conclusion, the occurrence of bloodstream infections during the early postoperative period was still high compared with other profile patients, as well as the rates of multidrug-resistant organisms. Even though the occurrence of multidrug resistance has been stable for the past decade, the lower survival rates associated with that condition and the challenge related to its treatment are of major concern.


Assuntos
Bacteriemia/mortalidade , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Idoso , Bacteriemia/microbiologia , Farmacorresistência Bacteriana Múltipla , Feminino , Fungos/isolamento & purificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Incidência , Cirrose Hepática/etiologia , Cirrose Hepática/microbiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos
14.
Transplant Proc ; 51(7): 2446-2450, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405739

RESUMO

AIM OF THE STUDY: Liver transplantation is widely applied as a standard and effective management of end-stage liver diseases, hepatocellular carcinoma, and acute liver failure. Investigation of morphologic and functional changes in the transplanted graft, gastrointestinal system, and spleen after transplantation is an important ground for assessment of post-transplantation results, early changes related to complications, and evaluation of response to treatment modalities. The aim of this study was to investigate the dynamics of changes in elastography of the liver graft and spleen after living-related liver transplantation. MATERIAL AND METHODS: The study included 14 cirrhotic patients after living-related liver graft transplantation. Stiffness of the spleen and liver was evaluated before transplantation and at 1, 3, and 6 months after transplantation with a Supersonic Aixplorer Multi Wave device. Each procedure consisted of measuring the density in 10 points (spots) of the organ. The final result was calculated as the mean value of successful measurements (must have been > 60% of all measurements) and expressed in kilopascals. RESULTS: The mean value of the liver and spleen stiffness before transplantation was 27 kPa (14-31 kPa) and 51 kPa (38-92 kPa), respectively. The stiffness of the spleen gradually reduced after transplantation to 40.3, 35.4, and 24.1 kPa (P = .001) at 1, 3, and 6 months. The stiffness of the liver graft in patients without complications was stable at 4-5 kPa, whereas the same value in patients with complications was increased (≥ 7.5 kPa). In 5 patients, endoscopic investigation confirmed the significant reduction of varicose veins after surgery. CONCLUSION: Elastography of the liver graft and spleen after liver transplantation can be recommended as a useful-for-patient 1-off method of investigation.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Transplante de Fígado/métodos , Fígado/diagnóstico por imagem , Baço/diagnóstico por imagem , Transplantes/diagnóstico por imagem , Adulto , Doença Hepática Terminal/complicações , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Fígado/patologia , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Baço/patologia , Transplantes/patologia , Resultado do Tratamento
15.
Transplant Proc ; 51(7): 2439-2441, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405746

RESUMO

PURPOSE: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown origin. Although the course of PSC is variable, it frequently is progressive, leading to cirrhosis and requiring a liver transplantation (LT) in more than half of the patients. PSC is the fifth most common indication for LT in the United States and one of the leading indications in Scandinavian countries, whereas PSC affects fewer than 5% of patients undergoing LT in Turkey. In this study, we analyzed our results in the patients with LT owing to PSC. MATERIALS AND METHODS: Between March 2013 and August 2017, all adult patients (>18 years) with LT owing to PSC were analyzed, and clinical data were obtained via retrospective review of patient charts. Demographic features, presence of any concomitant inflammatory bowel disease (IBD), time to LT, and outcome data were recorded. RESULTS: There were 15 patients (8 men and 7 women) with a mean age of 46 ± 13 (age at diagnosis = 36 y). Median time to transplantation was 3 years (range: .5-14 yrs.). All patients had a pretransplant history of IBD. Concomitant cholangiocarcinoma was diagnosed in 1 patient (6.5%). Postoperative complications were observed in 4 patients (26%), and in 2 patients (13%) PSC recurred at a mean of 52 months postorthotopic LT. Disease-free survival and overall survival were 37.3 and 38 ± 21 months, respectively. One of the patients with recurrence and 1 with graft failure owing to rejection died in the follow-up period. CONCLUSIONS: In one single-center study of adults with PSC, we found that all patients with PSC had IBD at diagnosis. The recurrence rate (13%) was comparable to the literature (20% [5.7-59%]). Despite the low frequency of PSC in our clinic, LT in these patients resulted in favorable outcomes regarding postoperative morbidity and mortality compared with other etiologies.


Assuntos
Colangite Esclerosante/cirurgia , Doenças Inflamatórias Intestinais/complicações , Cirrose Hepática/cirurgia , Transplante de Fígado/mortalidade , Adulto , Colangite Esclerosante/complicações , Feminino , Humanos , Cirrose Hepática/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Turquia
16.
Cardiovasc Intervent Radiol ; 42(12): 1760-1770, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31363898

RESUMO

PURPOSE: Evaluate the efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) insertion on patients with schistosomiasis-induced liver fibrosis, and compare with that of patients with HBV-induced cirrhosis. MATERIALS AND METHODS: This was a retrospective study from November 2015 to December 2018 including 82 patients diagnosed with portal hypertension, one group of which is induced by schistosomiasis (n = 20), the other by hepatitis B virus (HBV) (n = 62). Both groups of subjects underwent TIPS placement for the management of portal hypertension complications. RESULTS: TIPS was inserted successfully in all patients (technical success 100%). After a median follow-up of 14 months following TIPS insertion, portal pressure gradient (PPG) value in both schistosomiasis-induced group and HBV-induced group underwent a significant decrease with no major difference between the two groups. There exists no significant difference demonstrated by Kaplan-Meier curves between two groups concerning cumulative rate of hepatic encephalopathy (HE) (log-rank p = 0.681), variceal rebleeding (log-rank p = 0.837) and survival (log-rank p = 0.429), and no statistically difference was found in terms of alleviation of portal vein thrombosis (PVT). In addition, splenectomy (HR 19, 95% CI 4-90, p < 0.001) was identified as independent predictor of PVT. CONCLUSIONS: TIPS placement is well-founded to be considered as a safe and effective treatment in patients with schistosomiasis-induced portal hypertension and relevant severe complications. We also found the risk of PVT is 19 times higher in patients who underwent splenectomy than in untreated patients. LEVEL OF EVIDENCE: Historically controlled studies, level 4.


Assuntos
Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Esquistossomose/complicações , Feminino , Seguimentos , Hepatite B/complicações , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/cirurgia , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
17.
Transplant Proc ; 51(7): 2408-2412, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31402246

RESUMO

BACKGROUND: In the present study, we aimed to put forward the relationship between multidetector computed tomography findings and scores for liver function evaluation. METHOD: Included in the study were 51 patients with liver cirrhosis. Preoperative creatinine levels, international normalized ratio and alpha-fetoprotein values, albumin and sodium levels, the presence of ascites and varices, Model for End-Stage Liver Disease (MELD) scores, MELD-Sodium (MELD-Na) scores, and Child-Turcotte-Pugh Classification, the presence of ascites and varices, the size of liver, the size and diameter of the spleen, portal vein diameter, splenic artery diameter, and proper hepatic and right hepatic artery diameter were all determined. RESULTS: Although the correlation between the spleen diameter and the MELD scores (P <.001) and MELD-Na scores (P = .02) was strong, there was no association with the Child-Turcotte-Pugh Classification (P = .08). Despite the correlations between portal vein diameter (P = .04) and splenic artery diameter (P = .04) and MELD scores, no association was detected with MELD-Na scores and the Child-Pugh scores. Even though a negative correlation between proper hepatic artery diameter (P = .18) and MELD-Na scores was noted, no statistically significant correlation could be identified with any scoring systems. In the multivariate linear regression analyses, the correlation between the portal vein diameter and MELD scores was significant as a radiologic finding. In the multiple linear regression analyses, the negative correlation between the right hepatic artery and MELD-Na scores diameter was statistically significant. In the multiple linear regression analyses, there was no statistically significant correlation between preoperative radiologic findings and Child-Turcotte-Pugh Classification. CONCLUSION: We believe that preoperative multislice computed tomography imaging in patients with chronic liver disease may contribute to the diagnosis of disease, the determination of vascular anomalies, and the grading of the severity of the disease.


Assuntos
Cirrose Hepática/diagnóstico , Testes de Função Hepática/estatística & dados numéricos , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Cirrose Hepática/cirurgia , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico
18.
J Laparoendosc Adv Surg Tech A ; 29(9): 1116-1121, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31329021

RESUMO

Objective: This study was aimed to evaluate the correlation between clinically significant portal hypertension (CSPH) and postoperative complications and risk predictors of postoperative complications. Methods: The retrospective study was conducted to identify the effect. The cirrhotic patients were divided into two groups, those with or without CSPH. The intraoperative and postoperative conditions were evaluated. Multivariate logistic regression analysis was performed to identify potential risk predictors for postoperative complications in cirrhotic patients with CSPH. Results: The cirrhotic patients with CSPH who underwent laparoscopic cholecystectomy (LC) had postoperative hospitalization than the patients without CSPH. However, the incidence of postoperative complications between two groups showed no significant difference. The results of multivariate analysis showed that male, gallbladder wall >3 mm, size of stones ≥1 cm, scores of Model for end-stage liver disease (MELD) ≥10, and operation time >60 minutes were the potential risk predictors for postoperative complications. Conclusions: CSPH did not increase the incidence of postoperative complications in cirrhotic patients who underwent LC, but increased conversion rate and prolonged postoperative hospitalization. Furthermore, our study showed that gender, sizes of gallbladder wall and stones, scores of MELD, and operation time were the important postoperative risk predictors for cirrhotic patients with CSPH.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistolitíase/cirurgia , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , China/epidemiologia , Colecistolitíase/etiologia , Feminino , Humanos , Incidência , Cirrose Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
19.
Ann Transplant ; 24: 418-425, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31308357

RESUMO

BACKGROUND Serum sodium (Na) is considered to reflect the severity of liver cirrhosis. In the last few years, much effort has been made to integrate this association into prognostic models after liver transplantation. The aim of this study was to investigate the associations between peritransplant Na and neurological complications, as well as short-term survival, after liver transplantation. MATERIAL AND METHODS A total of 306 liver transplantations between 2012 and 2015 were evaluated. Pre- and posttransplant sodium concentrations were investigated with regard to 3-month survival and incidence of posttransplant neurological complications, along with other factors present in the operative side of the recipient and donor. RESULTS The 3-month survival rate was 94%. Neither hyponatremia (<130 mEq/L) nor hypernatremia (>145 mEq/L) at pretransplantion predicted 3-month survival. A large amount of intraoperative blood transfusion and a large delta Na showed a significant association with poor outcomes at 3 months. On multivariate analysis, the requirement of blood transfusion and warm ischemia time remained independent prognostic factors for 3-month mortality. Hyponatremia and a large delta Na tended to lead to the frequent development of neurological complications. These complications, secondary to rapid Na correction, were concerning and potentially led to a prolonged hospital stay and early mortality. CONCLUSIONS Rapid change in the sodium level might be caused by large amounts of blood transfusion products. This leads to a diminished short-term survival, as well as a higher rate of neurological complications.


Assuntos
Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/etiologia , Sódio/sangue , Feminino , Humanos , Hipernatremia/sangue , Hipernatremia/complicações , Hiponatremia/sangue , Hiponatremia/complicações , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
20.
Medicine (Baltimore) ; 98(30): e16529, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348269

RESUMO

Although endoscopic papillary balloon dilation (EPBD) seems to cause fewer instances of bleeding, there are insufficient data to determine the optimal methods for decreasing the risk of bleeding in cirrhotic patients.In this study, we compared the bleeding risks following endoscopic biliary sphincterotomy (EST) vs EPBD in cirrhotic patients and identified clinical factors associated with bleeding and 30-day mortality.Taiwan's National Health Insurance Database was used to identify 3201 cirrhotic patients who underwent EST or EPBD between January 1, 2010, and December 31, 2013.We enrolled 2620 patients receiving EST and 581 patients receiving EPBD. The mean age was 63.1 ±â€Š13.9 years, and 70.4% (2252/3201) were men. The incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding was higher among patients treated with EST than those treated with EPBD (EST vs EPBD: 3.5% vs 1.9%). Independent predisposing factors for bleeding included EST, renal function impairment, and antiplatelet or anticoagulant therapy. The overall 30-day mortality was 4.0% (127/3201). Older age, renal function impairment, hepatic encephalopathy, bleeding esophageal varices, ascites, hepatocellular carcinoma, biliary malignancy, and pancreatic malignancy were associated with higher risks for 30-day mortality.To decrease post-ERCP hemorrhage, EPBD is the preferred method in patients with cirrhosis, especially for those who have renal function impairment or are receiving antiplatelet or anticoagulant therapy.


Assuntos
Cateterismo/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Dilatação/efeitos adversos , Cirrose Hepática/cirurgia , Hemorragia Pós-Operatória/etiologia , Esfinterotomia Endoscópica/efeitos adversos , Idoso , Cateterismo/instrumentação , Cateterismo/métodos , Bases de Dados Factuais , Dilatação/métodos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Esfinterotomia Endoscópica/métodos , Taiwan/epidemiologia , Resultado do Tratamento
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