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1.
Transplant Proc ; 52(5): 1585-1587, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32217008

RESUMO

INTRODUCTION: The aim of this retrospective study was to evaluate any relationship between cardiac power index (CPI) and preload indexes during liver transplantation (LT). METHODS: Thirty-three patients with normal preoperative cardiac evaluation undergoing LT were included. Anesthesia management was standardized. Monitoring included continuous cardiac output determination by pulmonary artery catheter. CPI was calculated throughout LT by using the following standard formula: Mean Arterial Pressure [mm Hg] × Cardiac Index [L/min/m2] × k, where k = 0.0022. A logistic regression to determine which preload indexes predicted an adequate CPI (≥ 0.4 watt/m2) was performed. Postregression analysis was carried out to calculate a cutoff of right ventricle end diastolic volume index (RVEDVI) able to guarantee an adequate CPI after establishing a sensitivity >0.9. The area under receiver operating characteristic curve (AUC) was also run separately for patients with a Model for End-Stage Liver Disease (MELD) score < or ≥ 25 to establish an accurate level of prediction in these subgroups (post-hoc analysis). RESULTS: Logistic regression showed that RVEDVI was the only predictor of CPI (AUC = 0.81). A cutoff value for RVEDVI of 105 mL/m2 was found (sensitivity = 90.5%; specificity = 50%). RVEDVI predicted CPI with moderate accuracy (AUC = 0.80) in patients with MELD < 25 (n = 25), whereas the prediction was highly accurate (AUC = 0.96) in patients with MELD ≥ 25 (n = 8). CONCLUSION: An RVEDVI = 105 mL/m2 can be considered a valid cutoff to perform a fluid challenge to optimize preload during LT. Sicker recipients (with MELD ≥ 25) could exhibit less tolerance to preload reduction, proven by a decrease of CPI below the minimum value considered safe (0.40 watt/m2).


Assuntos
Débito Cardíaco/fisiologia , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/cirurgia , Transplante de Fígado , Adulto , Idoso , Cateterismo de Swan-Ganz , Feminino , Hemodinâmica , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos
2.
Sci Rep ; 10(1): 822, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964979

RESUMO

Increased concentrations of the vasodilator histamine have been observed in patients undergoing abdominal surgery. The role of histamine during orthotopic liver transplantation (OLT) has only been studied in animals. The aim of this study was to measure plasma concentrations of histamine and its degrading enzyme diamine oxidase (DAO) in patients undergoing orthotopic liver transplantation, and assess whether histamine or DAO correlate with intraoperative noradrenaline requirements. Histamine and DAO concentrations were measured in 22 adults undergoing liver transplantation and 22 healthy adults. Furthermore, norepinephrine requirements during liver transplantation were recorded. Baseline concentrations of histamine and DAO were greater in patients, who underwent liver transplantation, than in healthy individuals (Histamine: 6.4 nM, IQR[2.9-11.7] versus 4.3 nM, IQR[3.7-7.1], p = 0.029; DAO: 2.0 ng/mL, IQR[1.5-4.1] versus <0,5 ng/mL, IQR[<0.5-1.1], p < 0.001). During liver transplantation, histamine concentrations decreased to 1.8 nM, IQR[0.5-4.9] in the anhepatic phase (p < 0.0001 versus baseline), and to 1.5 nM, IQR[0.5-2.9] after reperfusion (p < 0.0001 versus baseline). In contrast, DAO concentrations increased to 35.5 ng/ml, IQR[20-50] in the anhepatic phase (p = 0.001 versus baseline) and to 39.5 ng/ml, IQR[23-64] after reperfusion (p = 0.001 versus baseline), correlating inversely with histamine. Norepinephrine requirements during human liver transplantation correlated significantly with DAO concentrations in the anhepatic phase (r = 0.58, p = 0.011) and after reperfusion (r = 0.56; p = 0.022). In patients undergoing orthotopic liver transplantation, histamine concentrations decrease whereas DAO concentrations increase manifold. Diamine oxidase correlates with intraoperative norepinephrine requirements in patients undergoing OLT.


Assuntos
Amina Oxidase (contendo Cobre)/sangue , Doença Hepática Terminal/cirurgia , Histamina/sangue , Hipotensão/diagnóstico , Complicações Intraoperatórias/diagnóstico , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Idoso , Biomarcadores/sangue , Doença Hepática Terminal/sangue , Doença Hepática Terminal/fisiopatologia , Feminino , Hemodinâmica , Humanos , Hipotensão/diagnóstico por imagem , Hipotensão/etiologia , Cuidados Intraoperatórios , Complicações Intraoperatórias/tratamento farmacológico , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Norepinefrina/administração & dosagem
3.
Health Qual Life Outcomes ; 18(1): 10, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931822

RESUMO

BACKGROUND: Patients with liver cirrhosis often suffer from complications such as ascites, gastrointestinal bleeding, and infections, resulting in impaired quality of life. Frequently, the close relatives of patients also suffer from a lower quality of life in chronic diseases. In recent years, acute-to-chronic liver failure has been defined as a separate entity with high mortality. Often several organs are affected which makes intensive care therapy necessary. Little is known about the influence of acute-on-chronic-liver failure (ACLF) on the quality of life of patients and the psychosocial burden on close relatives. AIM: The purpose of this prospective study is to investigate the influence of decompensated liver cirrhosis and the onset of ACLF of the patient's' quality of life and the psychosocial burden of close relatives. METHOD: In this non - randomized prospective cohort study a total of 63 patients with acute decompensation of liver cirrhosis and hospital admission were enrolled in the study. To assess the quality of life of patients, the disease specific CLDQ questionnaire was assessed. In addition. Quality of life and psychosocial burden of first degree relatives was measured using the generic SF-36 questionnaire as well as the Zarit Burden Score. RESULTS: 21 of the 63 patients suffered from ACLF. Patients with ACLF showed a lower quality of life in terms of worries compared to patients with only decompensated liver cirrhosis (3,57 ± 1,17 vs. 4,48 ± 1,27; p value: 0,008) and increased systemic symptoms (3,29 ± 1,19 vs. 4,48 ± 1,58; p value: 0,004). The univariate analysis confirmed the link between the existence of an ACLF and the concerns of patients. (p value: 0,001). The organ failure score was significantly associated with overall CLDQ scores, especially with worries and systemic symptoms of patients. Interestingly the psychosocial burden and quality of life of close relative correlates with patient's quality of life and was influenced by the onset of an acute-on-chronic liver failure. CONCLUSION: Patients with decompensated liver cirrhosis suffer from impaired quality of life. In particular, patients with ACLF have a significantly reduced quality of life. The extent of the psychosocial burden on close relative correlates with poor quality of life in patients with decompensated liver disease and is influenced by the existence of ACLF.


Assuntos
Insuficiência Hepática Crônica Agudizada/psicologia , Doença Hepática Terminal/psicologia , Qualidade de Vida , Insuficiência Hepática Crônica Agudizada/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Doença Hepática Terminal/fisiopatologia , Família/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Prospectivos , Inquéritos e Questionários
4.
Transplantation ; 104(7): 1419-1428, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31644490

RESUMO

BACKGROUND: Liver transplant recipients suffer many postoperative complications. Few studies evaluated the effects of fluid management on these complications. We conducted an observational cohort study to evaluate the association between intraoperative fluid balance and postoperative acute kidney injury (AKI) and other postoperative complications. METHODS: We included consecutive adult liver transplant recipients who had their surgery between July 2008 and December 2017. Our exposure was intraoperative fluid balance, and our primary outcome was the grade of AKI at 48 hours after surgery. Our secondary outcomes were the grade of AKI at 7 days, the need for postoperative renal replacement therapy, postoperative red blood cell transfusions, time to first extubation, time to discharge from the intensive care unit (ICU), and 1-year survival. Every analysis was adjusted for potential confounders. RESULTS: We included 532 transplantations in 492 patients. We observed no effect of fluid balance on either 48-hour AKI, 7-day AKI, or on the need for postoperative renal replacement therapy after adjustments for confounders. A higher fluid balance increased the time to ICU discharge, and increased the risk of dying (hazard ratio = 1.21 [1.04,1.40]). CONCLUSIONS: We observed no association between intraoperative fluid balance and postoperative AKI. Fluid balance was associated with longer time to ICU discharge and lower survival. This study provides insight that might inform the design of a clinical trial on fluid management strategies in this population.


Assuntos
Lesão Renal Aguda/epidemiologia , Doença Hepática Terminal/cirurgia , Hidratação/efeitos adversos , Cuidados Intraoperatórios/efeitos adversos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Adulto , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/fisiopatologia , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Hidratação/métodos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Cuidados Intraoperatórios/métodos , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Equilíbrio Hidroeletrolítico/fisiologia
5.
Annu Rev Pathol ; 15: 23-50, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31399003

RESUMO

The liver is a complex organ performing numerous vital physiological functions. For that reason, it possesses immense regenerative potential. The capacity for repair is largely attributable to the ability of its differentiated epithelial cells, hepatocytes and biliary epithelial cells, to proliferate after injury. However, in cases of extreme acute injury or prolonged chronic insult, the liver may fail to regenerate or do so suboptimally. This often results in life-threatening end-stage liver disease for which liver transplantation is the only effective treatment. In many forms of liver injury, bipotent liver progenitor cells are theorized to be activated as an additional tier of liver repair. However, the existence, origin, fate, activation, and contribution to regeneration of liver progenitor cells is hotly debated, especially since hepatocytes and biliary epithelial cells themselves may serve as facultative stem cells for one another during severe liver injury. Here, we discuss the evidence both supporting and refuting the existence of liver progenitor cells in a variety of experimental models. We also debate the validity of developing therapies harnessing the capabilities of these cells as potential treatments for patients with severe and chronic liver diseases.


Assuntos
Células-Tronco Adultas/fisiologia , Plasticidade Celular/fisiologia , Fígado/lesões , Regeneração/fisiologia , Células-Tronco/fisiologia , Animais , Diferenciação Celular , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/fisiopatologia , Hepatócitos/fisiologia , Humanos , Fígado/fisiologia , Hepatopatias/fisiopatologia
6.
Ann Transplant ; 24: 639-646, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31844037

RESUMO

BACKGROUND Because of the supply shortage for homologous vein allografts, we previously used ringed Gore-Tex vascular grafts for middle hepatic vein (MHV) reconstruction in living donor liver transplantation. However, owing to the subsequent unavailability of ringed Gore-Tex grafts, we replaced them with Hemashield vascular grafts. This study aimed to compare the patency of Hemashield grafts with that of ringed Gore-Tex grafts. MATERIAL AND METHODS This was a retrospective double-arm study between the study group that used Hemashield grafts (n=63) and the historical control group that used ringed Gore-Tex grafts (n=126). RESULTS In the Gore-Tex and Hemashield groups, mean age was 53.1±6.2 and 54.3±10.4 years; model for end-stage liver disease score was 16.5±8.3 and 17.5±9.9; and graft-recipient weight ratio was 1.11±0.23 and 1.12±0.25, respectively. In the Gore-Tex graft group, V5 reconstruction was done in single (n=107, 84.9%), double (n=17, 13.5%), and none (n=2, 1.6%). V8 reconstruction was done in single (n=95, 75.4%), double (n=1, 0.8%), and none (n=30, 23.8%). In the Hemashield group, V5 reconstruction was done in single (n=43, 68.3%), double (n=19, 30.2%), and triple (n=1, 1.6%). V8 reconstruction was done in single (n=45, 71.4%), double (n=9, 14.3%), and none (n=9, 14.3%). One-year conduit patency rates in the Gore-Tex and Hemashield groups were 54.8% and 71.6%, respectively (p=0.048). CONCLUSIONS MHV reconstruction using Hemashield vascular grafts demonstrated higher short-term patency rates than those associated with ringed Gore-Tex vascular grafts. We suggest that the Hemashield vascular graft is one of the best prosthetic materials for MHV reconstruction.


Assuntos
Veias Hepáticas/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Adulto , Prótese Vascular/efeitos adversos , Prótese Vascular/provisão & distribução , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Doença Hepática Terminal/diagnóstico por imagem , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Desenho de Prótese , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Enxerto Vascular/efeitos adversos , Enxerto Vascular/métodos , Grau de Desobstrução Vascular
7.
Indian Pediatr ; 56(11): 965-967, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31729328

RESUMO

We performed a review of case records of children diagnosed with hepatic venous outflow tract obstruction at our center in last 10 years. Out of 11 cases identified, 6 had variable blocks in the hepatic venous system and 4 had combined hepatic venous and inferior vena cava (IVC) block. One child with paroxysmal nocturnal hemoglobinuria (PNH) had isolated IVC involvement. Angioplasty was attempted in 3 patients; among them 2 had successful outcome. Seven children with advanced liver disease underwent transplantation, which was successful in six. With availability of modalities like interventional radiology and transplantation, the overall prognosis of hepatic venous outflow tract obstruction seems to be good when managed in a well-equipped center.


Assuntos
Angioplastia/métodos , Síndrome de Budd-Chiari , Doença Hepática Terminal , Veias Hepáticas , Transplante de Fígado , Síndrome de Budd-Chiari/etiologia , Síndrome de Budd-Chiari/fisiopatologia , Síndrome de Budd-Chiari/cirurgia , Criança , Doença Hepática Terminal/complicações , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/cirurgia , Feminino , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/fisiopatologia , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/cirurgia , Humanos , Índia/epidemiologia , Transplante de Fígado/métodos , Transplante de Fígado/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Radiografia Intervencionista/métodos
8.
Liver Transpl ; 25(12): 1756-1767, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31597218

RESUMO

Renal dysfunction is common in liver transplantation (LT) candidates, but differentiating between reversible and irreversible renal injury can be difficult. Kidney biopsy might be helpful in differentiating reversible from irreversible renal injury, but it is associated with significant complications. We aimed to identify pre-LT predictors of potentially reversible renal injury using histological information obtained on pre-LT renal biopsy. Data on 128 LT candidates who underwent pre-LT kidney biopsy were retrospectively collected and correlated with renal histological findings. Indications for kidney biopsy were iothalamate glomerular filtration rate (iGFR) ≤40 mL/minute, proteinuria >500 mg/day, and/or hematuria. According to the biopsy diagnosis, patients were grouped into the following categories: normal (n = 13); acute tubular necrosis (ATN; n = 25); membranoproliferative glomerulonephritis (n = 19); minimal histological changes (n = 24); and advanced interstitial fibrosis (IF) and glomerulosclerosis (GS) (n = 47). Compared with patients having advanced IF/GS, patients with normal biopsies and those with ATN had lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) and higher international normalized ratio and total bilirubin levels (<0.05 for all). Both SBP and DBP directly correlated with the degree of IF and GS (R = 0.3, P ≤ 0.02 for all). SBP ≤90 mm Hg was 100% sensitive and 98% specific in correlating with normal biopsies or ATN, whereas SBP ≥140 mm Hg was 22% sensitive and 90% specific in correlating with advanced IF/GS. Model for End-Stage Liver Disease score, serum creatinine, iGFR, urinary sodium excretion, and renal size did not correlate with biopsy diagnosis or degree of IF or GS. In conclusion, SBP at the time of LT evaluation correlates with renal histology, and it should be included along with other clinical and laboratory markers in the decision-making process to list patients with renal dysfunction for LT alone versus simultaneous liver-kidney transplantation.


Assuntos
Pressão Arterial/fisiologia , Doença Hepática Terminal/cirurgia , Nefropatias/diagnóstico , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Biópsia/estatística & dados numéricos , Determinação da Pressão Arterial/estatística & dados numéricos , Tomada de Decisão Clínica/métodos , Creatinina/sangue , Diagnóstico Diferencial , Doença Hepática Terminal/complicações , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/fisiopatologia , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Rim/patologia , Rim/fisiopatologia , Nefropatias/etiologia , Nefropatias/fisiopatologia , Nefropatias/terapia , Transplante de Fígado/normas , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/normas , Índice de Gravidade de Doença
9.
Arq Gastroenterol ; 56(3): 252-255, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633720

RESUMO

BACKGROUND: Fatigue is highly prevalent in end stage liver disease, the studies about its association with exercise capacity in cirrhotic patients before liver are scarse. OBJECTIVE: In this study, we evaluated fatigue in 95 in end stage liver disease patients awaiting transplantation, compared to healthy volunteers, and tested the association between exercise capacity and fatigue. METHODS: Cross-sectional study of patients with chronic liver disease treated at a referral center in Fortaleza, Brazil. Fatigue was quantified with the Fatigue Severity Scale. The patients were submitted to the 6-min walk test, the 6-min step test, the Hospital Anxiety and Depression Scale, C-reative protein measurement and hematocrit count, measurement of dyspnea among other tests. Fatigue data were obtained from healthy individuals for comparison with patients. RESULTS: The mean age of patients was 45.9±12.3 years, and 53.7% were male. Fatigue, anxiety and depression levels were higher among end stage liver disease patients than among controls. A negative correlation was observed between 6 min step test and Fatigue Severity Scale score (r= -0.2; P=0.02) and between hematocrit count and Fatigue Severity Scale score (r= -0.24; P=0.002). Dyspnea on the Borg scale and fatigue were positively correlated (r=31; P=0.002). In the multivariate analysis, low 6-min step test values and high levels of dyspnea were associated with fatigue. CONCLUSION: Fatigue was more prevalent and severe in end stage liver disease patients than in healthy controls. Low 6MST values and high levels of dyspnea were associated with fatigue in this scenario.


Assuntos
Doença Hepática Terminal/psicologia , Tolerância ao Exercício/fisiologia , Fadiga/psicologia , Transplante de Fígado/psicologia , Adulto , Transtornos de Ansiedade/psicologia , Estudos Transversais , Transtorno Depressivo/psicologia , Doença Hepática Terminal/fisiopatologia , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Listas de Espera
10.
Postepy Biochem ; 65(3): 193-201, 2019 10 01.
Artigo em Polonês | MEDLINE | ID: mdl-31643166

RESUMO

Liver diseases that lead to its failure are one of the most frequent causes of death worldwide. Taking into account liver's complexity, there are no drug for acute or acute on chronic liver failure treatment. So far the only effective therapy is the liver transplantation. Unfortunately donor shortage is a main problem of this therapy. Due to this fact scientists have been looking for a new alternatives. The most promising are cell transplantation and bioartificial support systems. Without doubt hepatocytes are the best source of cells to use. But isolated human hepatocytes dedifferentiate very quickly and lose their functions ex vivo. Therefore, the new sources of cells, which could replace hepatocytes, are highly sought after. It is believed that, in order to help patients suffering from liver disease, the approach to solve this problem should be considered on different levels.


Assuntos
Doença Hepática Terminal/terapia , Hepatócitos/citologia , Hepatócitos/transplante , Fígado Artificial , Doença Hepática Terminal/patologia , Doença Hepática Terminal/fisiopatologia , Hepatócitos/patologia , Humanos
11.
Gastroenterol Nurs ; 42(5): 428-434, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31574071

RESUMO

Nonalcoholic fatty liver disease is a growing condition among adolescent and adult populations, present in around 20%-30% of people in the United Kingdom. Nonalcoholic fatty liver disease is known as a silent disease and over many years may go on to cause nonalcoholic steatohepatitis. In the future it may become a leading contributor to cirrhosis, liver transplantation, and mortality. In recent years, programs have been set up to raise awareness of this condition with the first International NASH (nonalcoholic steatohepatitis) Day taking place in 2018; nevertheless, nonalcoholic fatty liver disease and nonalcoholic steatohepatitis is still not clearly understood by many. An extensive review has shown a lack of nursing literature on this topic, and effective specialist nurse input for this patient group should be a key component in tackling this growing epidemic in the years to come.


Assuntos
Progressão da Doença , Doença Hepática Terminal/epidemiologia , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/epidemiologia , Cirrose Hepática/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adolescente , Adulto , Doenças Assintomáticas , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/fisiopatologia , Fígado Gorduroso/terapia , Feminino , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/fisiopatologia , Masculino , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/terapia , Prevalência , Medição de Risco , Análise de Sobrevida , Reino Unido/epidemiologia , Adulto Jovem
12.
Clin Liver Dis ; 23(4): 755-780, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31563221

RESUMO

Patients with portal hypertension will increasingly present for nontransplant surgery because of the increasing incidence of, and improving long-term survival for, chronic liver disease. Such patients have increased perioperative morbidity and mortality caused by the systemic pathophysiology of liver disease. Preoperative assessment should identify modifiable causes of liver injury and distinguish between compensated and decompensated cirrhosis. Risk stratification, which is crucial to preparing patients and their families for surgery, relies on scores such as Child-Turcotte-Pugh and Model for End-stage Liver Disease to translate disease severity into quantified outcomes predictions. Risk factors for postoperative complications should also be recognized.


Assuntos
Hipertensão Portal/fisiopatologia , Cirrose Hepática/fisiopatologia , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/fisiopatologia , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Hipertensão Portal/etiologia , Laparoscopia , Cirrose Hepática/complicações , Desnutrição/diagnóstico , Desnutrição/etiologia , Desnutrição/terapia , Mortalidade , Apoio Nutricional , Derivação Portossistêmica Transjugular Intra-Hepática , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
14.
Cells ; 8(10)2019 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-31546729

RESUMO

Chronic liver diseases constitute a significant economic, social, and biomedical burden. Among commonly adopted approaches, only organ transplantation can radically help patients with end-stage liver pathologies. Cell therapy with hepatocytes as a treatment for chronic liver disease has demonstrated promising results. However, quality human hepatocytes are in short supply. Stem/progenitor cells capable of differentiating into functionally active hepatocytes provide an attractive alternative approach to cell therapy for liver diseases, as well as to liver-tissue engineering, drug screening, and basic research. The application of methods generally used to isolate mesenchymal stem cells (MSCs) and maintain them in culture to human liver tissue provides cells, designated here as liver MSCs. They have much in common with MSCs from other tissues, but differ in two aspects-expression of a range of hepatocyte-specific genes and, possibly, inherent commitment to hepatogenic differentiation. The aim of this review is to analyze data regarding liver MSCs, probably another type of liver stem/progenitor cells different from hepatic stellate cells or so-called hepatic progenitor cells. The review presents an analysis of the phenotypic characteristics of liver MSCs, their differentiation and therapeutic potential, methods for isolating these cells from human liver, and discusses issues of their origin and heterogeneity. Human liver MSCs are a fascinating object of fundamental research with a potential for important practical applications.


Assuntos
Fígado/citologia , Fígado/fisiologia , Células-Tronco Mesenquimais/fisiologia , Tecido Adiposo/citologia , Adulto , Diferenciação Celular/fisiologia , Doença Hepática Terminal/patologia , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/terapia , Hepatócitos/fisiologia , Humanos , Imunomodulação/fisiologia , Transplante de Células-Tronco Mesenquimais
15.
PLoS One ; 14(8): e0221079, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31412075

RESUMO

Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. We aimed to clarify whether perioperative exercise capacity was related to long-term survival in hepatocellular carcinoma patients with chronic liver injury undergoing hepatectomy. One hundred-six patients with hepatocellular carcinoma underwent pre- and postoperative cardiopulmonary exercise testing to determine their anaerobic threshold, defined as the point between carbon dioxide production and oxygen consumption per unit of time. Testing involved 35 items including blood biochemistry analysis, in-vivo component analysis, dual-energy X-ray absorptiometry, and cardiopulmonary exercise testing preoperatively and 6 months postoperatively. We classified patients with anaerobic threshold ≥ 90% 6 months postoperatively compared with the preoperative level as the maintenance group (n = 78) and patients with anaerobic threshold < 90% as the decrease group (n = 28). Five-year recurrence-free survival rates were 39.9% vs. 9.9% (maintenance vs. decrease group) (hazard ratio: 1.87 [95% confidence interval: 1.12-3.13]; P = 0.018). Five-year overall survival rates were maintenance: 81.9%, and decrease: 61.7% (hazard ratio: 2.95 [95% confidence interval: 1.37-6.33]; P = 0.006). Multivariable Cox proportional hazards models showed that perioperative maintenance of anaerobic threshold was an independent prognostic indicator for both recurrence-free- and overall survival. Although the mean anaerobic threshold from preoperative to postoperative month 6 decreased in the exercise-not-implemented group, the exercise-implemented group experienced increased anaerobic threshold, on average, at postoperative month 6. The significant prognostic factor affecting postoperative survival for chronic liver injury patients with HCC undergoing hepatectomy was maintenance of anaerobic threshold up to 6 months postoperatively.


Assuntos
Absorciometria de Fóton , Carcinoma Hepatocelular , Doença Hepática Terminal , Teste de Esforço , Hepatectomia , Neoplasias Hepáticas , Modelos Biológicos , Idoso , Limiar Anaeróbio , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/fisiopatologia , Carcinoma Hepatocelular/cirurgia , Intervalo Livre de Doença , Doença Hepática Terminal/diagnóstico por imagem , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/cirurgia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida
16.
Transplantation ; 103(11): 2287-2303, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31283679

RESUMO

BACKGROUND: Weight gain and obesity are well-known clinical issues in liver transplantation (LTx). However, their impacts on patient outcomes remain unclear, as only the impact of pre-LTx body mass index (BMI) on survival has been meta-analyzed. We summarized and synthesized the evidence on pre- and post-LTx body weight parameters' relations with post-LTx outcomes such as survival, metabolic and cardiovascular comorbidities, and healthcare utilization. METHODS: We followed the Cochrane Handbook for Systematic Reviews of Interventions' recommendations. Quality was assessed via a 19-item instrument. Odds ratios and 95% confidence intervals were calculated for outcomes investigated in ≥5 studies. RESULTS: Our meta-analysis included 37 studies. Patients with pre-LTx BMI ≥ 30 kg/m and BMI ≥ 35 kg/m had lower overall survival rates than those with pre-LTx normal weight (72.6% and 69.8% versus 84.2%; P = 0.02 and P = 0.03, respectively). Those with pre-LTx BMI ≥ 30 kg/m had worse overall graft survival than normal weight patients (75.8% and 85.4%; P = 0.003). Pre-LTx BMI and pre-LTx overweight were associated with new-onset diabetes (P < 0.001 and P = 0.015, respectively), but post-LTx BMI showed no relationship. No associations were evident with healthcare utilization. CONCLUSIONS: Patients with BMI values ≥30 kg/m had worse patient and graft survival than those with normal weight. Few of the reviewed studies examined post-LTx body weight parameters or other relevant outcomes such as cardiovascular comorbidities. High heterogeneity as well as diverse definitions and operationalizations of measurement and outcomes severely impeded comparability.


Assuntos
Peso Corporal , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/cirurgia , Transplante de Fígado/métodos , Índice de Massa Corporal , Comorbidade , Complicações do Diabetes , Diabetes Mellitus/diagnóstico , Doença Hepática Terminal/fisiopatologia , Sobrevivência de Enxerto , Humanos , Tempo de Internação , Obesidade/fisiopatologia , Razão de Chances , Sobrepeso/fisiopatologia , Fatores de Risco , Resultado do Tratamento , Ganho de Peso
18.
Zhonghua Gan Zang Bing Za Zhi ; 27(5): 330-342, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31177656

RESUMO

Malnutrition is common in patients with end-stage liver disease (ESLD) and is an independent risk factor for survival, therefore it should be treated as the same important guideline as ascites and hepatic encephalopathy. However, up to now, there is no clinical nutrition guideline for patients with ESLD in China. In order to standardize the nutrition treatment, Chinese Society of Hepatology (CSH) and Chinese Society of Gastroenterology (CSGE), Chinese Medical Association(CMA) co-organized and co-developed this guideline. Recommendations on nutritional screening and assessment as well as principles of intervention and management in patients with ESLD were provided to help clinicians make rational decisions on clinical malnutrition.


Assuntos
Doença Hepática Terminal/complicações , Gastroenterologia/normas , Encefalopatia Hepática , Cirrose Hepática/complicações , Desnutrição/dietoterapia , Guias de Prática Clínica como Assunto , Ascite , China , Doença Hepática Terminal/fisiopatologia , Nutrição Enteral/normas , Humanos , Desnutrição/fisiopatologia , Avaliação Nutricional , Estado Nutricional
19.
Semin Cardiothorac Vasc Anesth ; 23(3): 300-308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31068104

RESUMO

Background and Objective. End-stage liver disease is characterized by a precarious imbalance of hemostasis. Detrimental consequences of hypofibrinolysis, also known as fibrinolytic shutdown, have been recently demonstrated, and its significance in visceral (ie, an allograft that contains the intestine) transplant remains unknown. Design and Setting. To fill this gap, following institutional review board approval, this retrospective study included 49 adult recipients of visceral allografts (14 "visceral allograft without the liver" and 35 "multivisceral" with the liver) transplanted between 2010 and 2018 in a single university hospital, and for whom pre-incisional thromboelastography was available. Based on percent clot lysis 30 minutes after maximal amplitude, patients were stratified into 3 fibrinolysis phenotypes: fibrinolytic shutdown, physiologic fibrinolysis, and hyperfibrinolysis. Results. Fibrinolytic shutdown occurred in 57% of patients, with higher incidence in recipients of multivisceral transplant (69%) compared with visceral allograft without liver (29%) allografts (P = .04). Fibrinolytic shutdown was associated with an increase in both intraoperative thrombosis and hemorrhage. Intraoperative thrombosis (18%) occurred only with multivisceral transplant, and accounted for 36% of in-hospital mortality. A clinically meaningful reduction in incidence of intraoperative thrombosis was noted in recipients who received intravenous heparin thromboprophylaxis. Logistic regression identified pretransplant platelet count as a risk factor for fibrinolytic shutdown (odds ratio = 0.992, 95% confidence interval = [0.984-0.998]; χ2 = 7.8, P = .005). Conclusions. This study highlights fibrinolytic shutdown as a dominant and clinically important feature of the hemostatic imbalance in recipients undergoing visceral transplantation.


Assuntos
Doença Hepática Terminal/cirurgia , Fibrinólise/fisiologia , Hemorragia/epidemiologia , Transplante de Fígado/métodos , Trombose/epidemiologia , Adulto , Anticoagulantes/administração & dosagem , Doença Hepática Terminal/fisiopatologia , Feminino , Hemorragia/etiologia , Hemostasia/fisiologia , Heparina/administração & dosagem , Humanos , Incidência , Intestinos/transplante , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose/etiologia , Trombose/prevenção & controle , Adulto Jovem
20.
Ann Surg ; 269(6): 1025-1033, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31082898

RESUMO

OBJECTIVE: To investigate the safety and efficacy of somatostatin as liver inflow modulator in patients with end-stage liver disease (ESLD) and clinically significant portal hypertension (CSPH) undergoing liver transplantation (LT) (ClinicalTrials.gov number,01290172). BACKGROUND: In LT, portal hyperperfusion can severely impair graft function and survival, mainly in cases of partial LT. METHODS: Thirty-three patients undergoing LT for ESLD and CSPH were randomized double-blindly to receive somatostatin or placebo (2:1). The study drug was administered intraoperatively as 5-mL bolus (somatostatin: 500 µg), followed by a 2.5 mL/h infusion (somatostatin: 250 µg/h) for 5 days. Hepatic and systemic hemodynamics were measured, along with liver function tests and clinical outcomes. The ischemia-reperfusion injury (IRI) was analyzed through histological and protein expression analysis. RESULTS: Twenty-nine patients (18 receiving somatostatin, 11 placebo) were included in the final analysis. Ten patients responded to somatostatin bolus, with a significant decrease in hepatic venous portal gradient (HVPG) and portal flow of -28.3% and -29.1%, respectively. At graft reperfusion, HVPG was lower in patients receiving somatostatin (-81.7% vs -58.8%; P = 0.0084), whereas no difference was observed in the portal flow (P = 0.4185). Somatostatin infusion counteracted the decrease in arterial flow (-10% vs -45%; P = 0.0431). There was no difference between the groups in the severity of IRI, incidence of adverse events, long-term complications, graft, and patient survival. CONCLUSIONS: Somatostatin infusion during LT in patients with CSPH is safe, reduces the HVPG, and preserves the arterial inflow to the graft. This study establishes the efficacy of somatostatin as a liver inflow modulator.


Assuntos
Doença Hepática Terminal/complicações , Doença Hepática Terminal/cirurgia , Hormônios/uso terapêutico , Hipertensão Portal/tratamento farmacológico , Transplante de Fígado , Somatostatina/uso terapêutico , Idoso , Método Duplo-Cego , Doença Hepática Terminal/fisiopatologia , Feminino , Humanos , Hipertensão Portal/complicações , Masculino , Pessoa de Meia-Idade , Pressão na Veia Porta , Resultado do Tratamento
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