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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
BMC Anesthesiol ; 19(1): 56, 2019 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-30987597

RESUMO

BACKGROUND: Mini-fluid challenge is a well tested and effective tool to predict fluid responsiveness under various clinical conditions. However, mini-fluid challenge has never been tested in patients with end-stage liver disease. This study investigated whether infusion of 150 ml albumin 5% can predict fluid responsiveness in cirrhotic patients following liver transplant. METHODS: Fifty patients receiving living donor liver transplant were included in the analysis. Mini-fluid challenge composed of 150 ml of albumin 5% administered over 1 min in three consecutive 50-ml fluid boluses. An additional 350 ml was then infused at a constant rate over 15 min (for a total of 500 ml). Stroke volume (SV) was measured as the product of the subaortic velocity time integral (VTI) and left ventricular outflow tract (LVOT) area. Fluid responsiveness was defined as an increase in SV by ≥15% after the infusion. RESULTS: Fifty patients were enrolled in the study. Fourteen patients were classified with Child A, 15 patients with Child B, and 21 patients with Child C cirrhosis. Thirty four patients were fluid responders and 16 patients were fluid non-responders. After 150 ml of albumin 5%, the SV increased significantly in our cohort. The area under receiver operating curve (AUROC) was 0.7 (95% confidence interval [CI] 0.5-0.8, P = 0.005). In subgroup analysis, the SV increased significantly after mini fluid challenge in the Child A group (P = 0.017) but not Child B or C groups (P = 0.3 and 0.29, respectively). The AUROC for mini-fluid challenge in the Child A group was 0.86 (95% confidence interval [CI] 0.6-0.9, P = 0.0004), while mini-fluid challenge failed to discriminate between responders and non-responders in Child B and C groups. CONCLUSION: A mini-fluid challenge of 150 ml albumin 5% can predict fluid responsiveness in liver transplant patients with fair sensitivity and specifiicty. Subgroup analyis revealed that minifluid challenge can predict fluid responsiveness in patients with Child A cirrhosis but not patients with Child B or C cirrhosis. TRIAL REGISTRATION: NCT03396159 . (Prospective registered). Initial registration date was 10/01/2018.


Assuntos
Doença Hepática Terminal/cirurgia , Hidratação/métodos , Hidratação/normas , Transplante de Fígado/normas , Albumina Sérica Humana/administração & dosagem , Adulto , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/fisiopatologia , Feminino , Hemodinâmica/efeitos dos fármacos , Hemodinâmica/fisiologia , Humanos , Transplante de Fígado/tendências , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
8.
Gastroenterology ; 156(8): 2230-2241.e11, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30742832

RESUMO

BACKGROUND & AIMS: We performed a nationwide, retrospective study to determine the incidence and causes of drug-induced liver injury (DILI) in mainland China. METHODS: We collected data on a total of 25,927 confirmed DILI cases, hospitalized from 2012 through 2014 at 308 medical centers in mainland China. We collected demographic, medical history, treatment, laboratory, disease severity, and mortality data from all patients. Investigators at each site were asked to complete causality assessments for each case whose diagnosis at discharge was DILI (n = 29,478) according to the Roussel Uclaf Causality Assessment Method. RESULTS: Most cases of DILI presented with hepatocellular injury (51.39%; 95% confidence interval [CI] 50.76-52.03), followed by mixed injury (28.30%; 95% CI 27.73-28.87) and cholestatic injury (20.31%; 95% CI 19.80-20.82). The leading single classes of implicated drugs were traditional Chinese medicines or herbal and dietary supplements (26.81%) and antituberculosis medications (21.99%). Chronic DILI occurred in 13.00% of the cases and, although 44.40% of the hepatocellular DILI cases fulfilled Hy's Law criteria, only 280 cases (1.08%) progressed to hepatic failure, 2 cases underwent liver transplantation (0.01%), and 102 patients died (0.39%). Among deaths, DILI was judged to have a primary role in 72 (70.59%), a contributory role in 21 (20.59%), and no role in 9 (8.82%). Assuming the proportion of DILI in the entire hospitalized population of China was represented by that observed in the 66 centers where DILI capture was complete, we estimated the annual incidence in the general population to be 23.80 per 100,000 persons (95% CI 20.86-26.74). Only hospitalized patients were included in this analysis, so the true incidence is likely to be higher. CONCLUSIONS: In a retrospective study to determine the incidence and causes of DILI in mainland China, the annual incidence in the general population was estimated to be 23.80 per 100,000 persons; higher than that reported from Western countries. Traditional Chinese medicines, herbal and dietary supplements, and antituberculosis drugs were the leading causes of DILI in mainland China.


Assuntos
Causas de Morte , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Doença Hepática Terminal/induzido quimicamente , Falência Hepática Aguda/induzido quimicamente , Sistema de Registros , Doença Aguda , Adulto , Distribuição por Idade , Idoso , Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , China/epidemiologia , Doença Crônica , Estudos de Coortes , Intervalos de Confiança , Doença Hepática Terminal/epidemiologia , Doença Hepática Terminal/fisiopatologia , Feminino , Humanos , Incidência , Falência Hepática Aguda/epidemiologia , Falência Hepática Aguda/fisiopatologia , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Taxa de Sobrevida , Adulto Jovem
9.
Mol Biol Rep ; 46(1): 1127-1138, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30603953

RESUMO

Hepatitis is the principal cause of hepatocellular carcinoma (HCC) and decompensated cirrhosis. HCC is amongst the leading causes of deaths worldwide. Current therapeutic options have proven to be unsuccessful in treating this disease due to multifactorial nature of the disease. The present study was designed to investigate the role of IL-22 mediated survival of hepatocytes during cirrhosis and HCC. Resected/explanted liver tissue samples of patients with End Stage Liver Disease were obtained from Hepato-Pancreato-Biliary Liver Transplant Unit of Sheikh Zayed Hospital, Lahore, Pakistan. Qualitative expression of IL-22, SOCS3, and IL-22 induced anti-apoptotic protein, B-cell lymphoma extra-large (Bcl-xL), were evaluated by Immunohistochemical analysis (IHC). The IHC analysis revealed significantly high expression of IL-22, SOCS3, and Bcl-xL within explanted livers of HCC patients. Overall, the expression of SOCS3 was higher than any other protein, and the expression of all proteins showed significant variation in different group of patients based on clincopathological features. The results of the current study indicated that IL-22 mediated JAK-STAT pathway i.e. liver regeneration and healing is dependent on the disease progression and type of agent responsible for causing the infection in the first place. However, quantitative analysis of these factors in future can provide further evidence of the role of this pathway in HCC for development of anti-HCC therapies.


Assuntos
Doença Hepática Terminal/imunologia , Interleucinas/fisiologia , Regeneração Hepática/imunologia , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Doença Hepática Terminal/fisiopatologia , Feminino , Hepatócitos/imunologia , Hepatócitos/fisiologia , Humanos , Interleucinas/metabolismo , Fígado/metabolismo , Cirrose Hepática/patologia , Neoplasias Hepáticas/patologia , Regeneração Hepática/fisiologia , Masculino , Pessoa de Meia-Idade , Paquistão , Proteína 3 Supressora da Sinalização de Citocinas/análise , Proteína bcl-X/análise
10.
Dig Surg ; 36(1): 59-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29649828

RESUMO

BACKGROUND: Invasive fungal infection (IFI) is associated with high mortality after living donor liver transplant (LDLT). The aim of this study was to identify the risk factors for post-LDLT IFI for early diagnosis and improvement of antifungal treatment outcome. METHODS: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. RESULTS: During the follow-up period (1,553 ± 73 days, range 20-2,946 days), 15 patients (9.8%) developed IFI classified as "proven" (n = 8) and "probable" (n = 7) with fungal pathogens including Candida spp. (n = 10), Aspergillus spp. (n = 4), and Trichosporon (n = 2). Of these patients, 7 patients with IFI died despite treatment. The 1-, 3-, and 5-year survival rates were lower in patients with IFI than those without IFI (66.7/59.3/44.4 vs. 90.4/85.7/81.8%, respectively; p = 0.0026). Multivariate analysis identified model for end-stage liver disease score of ≥26 (OR 16.0, p = 0.0012) and post-transplant acute kidney injury (RIFLE criteria I- or F-class; OR 4.87, p = 0.047) as independent risk factors for IFI. CONCLUSION: Preoperative recipients' status and postoperative kidney dysfunction can affect an occurrence of post-transplant IFI. These risk factors would be taken into consideration for designation of proper antifungal therapy.


Assuntos
Antibioticoprofilaxia , Antifúngicos/uso terapêutico , Doença Hepática Terminal/cirurgia , Infecções Fúngicas Invasivas/prevenção & controle , Transplante de Fígado/efeitos adversos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Adolescente , Adulto , Idoso , Doença Hepática Terminal/fisiopatologia , Feminino , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/microbiologia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Adulto Jovem , beta-Glucanas/sangue
11.
Liver Int ; 39(2): 250-256, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30248234

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is rapidly becoming the leading cause of advanced liver disease in Western countries. NAFLD is defined in the presence of increased hepatic fat content, which is mainly stored under the form of neutral lipids within intracellular droplets and is not explained by at risk alcohol intake. In order to understand the pathogenesis, monitor the progression and find novel treatments for this condition, previous research efforts mainly addressed the role of inflammation. However, very recent data seem to suggest that hepatic lipid accumulation may be involved in NAFLD pathogenesis by driving secondary inflammation and fibrosis progression. Here, we will briefly review the novel results derived from natural history, genetics, imaging studies and therapeutic trials that support the notion that hepatic fat accumulation may represent a major clinical outcome and therapeutic target for NAFLD. Indeed, prospective and genetic data are consistent with hepatic fat being a driver of NAFLD progression. Furthermore, new technologies will render possible to monitor hepatic fat content without the need of invasive assessment, thereby allowing to identify patients at higher risk, and to monitor the response to drugs that act by decreasing hepatic lipid accumulation.


Assuntos
Doença Hepática Terminal/fisiopatologia , Metabolismo dos Lipídeos , Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/terapia , Dieta Hiperlipídica/efeitos adversos , Progressão da Doença , Doença Hepática Terminal/etiologia , Fibrose/etiologia , Humanos , Inflamação/etiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
Medicine (Baltimore) ; 97(42): e12774, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30334965

RESUMO

BACKGROUND: Various etiologies of chronic liver disease often result in cirrhosis. Beside obvious liver-related complications, cirrhosis also leads to loss of muscle mass and decreased exercise capacity. In this study, our aim was to conduct a systematic review of literature to investigate the efficacy of exercise interventions in patients with cirrhosis. METHOD: PubMed was used to perform the literature search. The mesh terms used were the following: (liver (and) cirrhosis (and) exercise or (exercise therapy)). The following terms were excluded: Non-alcoholic fatty liver disease (NAFLD). The search was limited to the English language and human research. The initial search was conducted on December 6, 2016 and re-reviewed May 2017. RESULTS: Seven studies met selection criteria. Training interventions ranged between 4 and 14 weeks in duration with an exercise frequency of 3 to 5 days per week. Most studies demonstrated an increase in maximal oxygen consumption using gas exchange techniques. Two of 3 studies demonstrated increased distance covered in the 6-minute walk test. One study showed a clinically significant decrease in hepatic venous pressure gradient, while another showed a transient increase only during exercise. There were no adverse effects of the exercise program reported. CONCLUSIONS: Exercise in selected patients with cirrhosis can have potential benefit in endurance and functional outcome measures without adverse effect from exercise.


Assuntos
Doença Hepática Terminal/terapia , Terapia por Exercício/métodos , Cirrose Hepática/terapia , Doença Hepática Terminal/fisiopatologia , Exercício/fisiologia , Tolerância ao Exercício , Humanos , Fígado/fisiopatologia , Cirrose Hepática/fisiopatologia , Consumo de Oxigênio , Resultado do Tratamento
13.
Pan Afr Med J ; 30: 123, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30374369

RESUMO

Introduction: The aim of the study was to determine the frequency of gallstones in patients with decompensated cirrhosis and to know about mean Body mass index (BMI) in patients of decompensated cirrhosis i.e End stage liver disease (ESLD) with and without gallstones. Methods: it is a cross sectional descriptive study, conducted at the department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi from 1st August 2014 to 28 February 2015. Two hundred patients were enrolled from outpatient clinics of Hepato-gastroenterology that fulfilled the defined selection criteria. Questionnaire was filled for data collection. SPSS version 20.0 was used to analyze data. Mean value of age and BMI was calculated by mean ± S.D. values. Mean ± SD was also calculated for BMI in patients with and without gallstones. Stratification of the age, gender, and liver disease severity were done and chi-Square test was applied. p-values less than 0.05 considered statistically significant. Results: Two hundred consecutive patients were enrolled among them 112(56%) were male. Mean age was 46.89 ± 11.9, BMI 23.59 ± 4.7 and CTP score was 9.7 ± 1.9. Most of the patient had Child class 'B' cirrhosis 102(51%), most common etiology was found to be Hepatitis C 133 (66.5%), cholelithiasis was found in 59(29.5%), sludge in 36 (18%) and both stone and sludge in 24(12%) of the cases. Advanced liver disease that is, more CTP score and child class 'C' was associated with increased frequency of gall stone formation (p-value = 0.012), and advancing age on age stratification (p-value = 0.024) however no relation was observed with increase BMI, gender, ethnicity, cause or duration of disease in this population. Conclusion: Gallstone formation is associated with advanced stage of cirrhosis and hepatitis C Virus related CLD, contrary to the established risk factors, no relation of gender or BMI was found in decompensated liver disease.


Assuntos
Doença Hepática Terminal/epidemiologia , Cálculos Biliares/epidemiologia , Hepatite C/complicações , Cirrose Hepática/epidemiologia , Adulto , Fatores Etários , Índice de Massa Corporal , Colelitíase/epidemiologia , Estudos Transversais , Doença Hepática Terminal/fisiopatologia , Feminino , Cálculos Biliares/etiologia , Hepatite C/epidemiologia , Humanos , Cirrose Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
14.
Hepatobiliary Pancreat Dis Int ; 17(4): 290-300, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30173786

RESUMO

BACKGROUND: Patients with end-stage liver disease (ESLD) have a compromised nutritional status because of the liver crucial role in regulating metabolic homeostasis and energy balance. DATA SOURCES: A systematic review of literature based on extensive relevant articles published from 2001 to 2017 in English in PubMed database was performed by searching keywords such as liver disease, non-alcoholic liver disease, alcoholic liver disease, malnutrition, epigenetics, gut microbiota, and probiotics. RESULTS: Liver transplantation would be one eligible therapy for ESLD patients, even if, the clinical outcome is negatively influenced by malnutrition and/or infections. The malnutrition is a condition of nutrient imbalance with a high incidence in ESLD patients. An accurate evaluation of nutritional status could be fundamental for reducing complications and prolonging the survival of ESLD patients including those undergoing liver transplantation. In addition, the interaction among nutrients, diet and genes via epigenetics has emerged as a potential target to reduce the morbidity and mortality in ESLD patients. The malnutrition induces changes in gut microbiota causing dysbiosis with a probable translocation of bacteria and/or pathogen-derived factors from the intestine to the liver. Gut microbiota contribute to the progression of chronic liver diseases as well as hepatocellular carcinoma. The administration of probiotics modulating gut microbiota could improve all chronic liver diseases. CONCLUSIONS: This review provides an update on malnutrition status linked to epigenetics and the potential benefit of some probiotics on the management of ESLD patients. In support of this view and to reveal the constant and growing interest in this field, some clinical trials are reported.


Assuntos
Bactérias/patogenicidade , Doença Hepática Terminal/microbiologia , Metabolismo Energético , Microbioma Gastrointestinal , Trato Gastrointestinal/microbiologia , Desnutrição/microbiologia , Estado Nutricional , Animais , Translocação Bacteriana , Disbiose , Doença Hepática Terminal/genética , Doença Hepática Terminal/fisiopatologia , Doença Hepática Terminal/terapia , Metabolismo Energético/genética , Epigênese Genética , Trato Gastrointestinal/metabolismo , Interação Gene-Ambiente , Interações Hospedeiro-Patógeno , Humanos , Desnutrição/genética , Desnutrição/fisiopatologia , Desnutrição/terapia , Estado Nutricional/genética , Probióticos/uso terapêutico , Prognóstico
15.
Scand J Gastroenterol ; 53(10-11): 1340-1346, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30257110

RESUMO

OBJECTIVES: The clinical impact of portal vein thrombosis (PVT) in cirrhotic patients remains unclear. The aim of the study is whether recanalization of acute PVT in nonmalignant cirrhotic patients is associated with their prognosis. MATERIALS AND METHODS: We identified subject with PVT in cirrhotic patients from institutional database. Patients with ≥50% reduction in thrombus size were classified into the improved group and those with ≤49% reduction in thrombus size, or thrombus development in other branches were classified into the deteriorated group. We compared the cumulative survival rate, event-free survival rate (EFS), and liver function (albumin-to-bilirubin (ALBI) and model for end-stage liver disease XI (MELD-XI) between the two groups. RESULTS: Twenty-seven patients were enrolled in this retrospective study. Sixteen patients were classified into the improved group, and 11 were classified into the deteriorated group. In the improved group, the ALBI grade and MELD-XI measured before the onset of PVT and at one year after the onset of PVT were not significantly different. In contrast, MELD-XI was significantly aggravated in deteriorated group (MELD-XI [p = .02]). The cumulative survival of the two groups did not differ significantly; however, the EFS of the deteriorated group was significantly lower (p = .049). CONCLUSIONS: Residual thrombosis of PVT in cirrhotic patients increased the incidence of liver-related events and was associated with the deterioration of the liver function.


Assuntos
Doença Hepática Terminal/fisiopatologia , Cirrose Hepática/complicações , Fígado/fisiopatologia , Veia Porta/fisiopatologia , Trombose Venosa/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doença Hepática Terminal/mortalidade , Feminino , Humanos , Incidência , Japão/epidemiologia , Cirrose Hepática/diagnóstico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
16.
Ann Transplant ; 23: 622-630, 2018 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-30177675

RESUMO

BACKGROUND Prolonged QT interval is an integral part of the definition of cirrhotic cardiomyopathy. The aim of this study was to analyze the relationship between QT corrected (QTc) and the etiology and the severity of liver disease in relation to the complications of cirrhosis in candidates for orthotropic liver transplantation (OLTx). MATERIAL AND METHODS From 360 consecutive patients with end-stage liver disease (ESLD) consulted by a designated cardiologist, 160 patients underwent OLTx. The QTc was calculated according to 3 formulas in 151 ECG tracings with good quality. The severity of liver disease was assessed according to Child-Pugh classification and model for end-stage liver disease (MELD). This was a single-center study with register-based follow-up design. RESULTS Prolonged QTc over 440 ms was found in 51 subjects (33.8%), but none had prolonged QTc >500 ms. QTc corrected by Fridericia (F) formula was more suitable for patients with ESLD. We found no correlation between QTc interval and severity of liver disease. The QTc interval was higher in patients with alcoholic cirrhosis when compared to patients with viral hepatitis and ESLD of other etiologies. We observed a higher QTc interval in patients with gastroesophageal varices and encephalopathy. We did not notice any significant difference in the effect of the QTc interval on survival. CONCLUSIONS QTc interval might be associated with etiology and complication of ESLD. The prolonged QT interval is not associated with higher all-cause mortality after OLTx.


Assuntos
Doença Hepática Terminal/fisiopatologia , Síndrome do QT Longo/fisiopatologia , Adulto , Eletrocardiografia , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/etiologia , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Transplante de Fígado , Síndrome do QT Longo/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Can J Gastroenterol Hepatol ; 2018: 2586052, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30073154

RESUMO

Objective: To analyze the small molecular metabolic compounds of nonbioartificial liver for treatment of hepatic failure and make further efforts to study the clinical efficacy, mechanism of action, and pathogenesis of hepatic failure. Methods: 52 patients who met the standard of artificial liver treatment for liver failure were enrolled; these patients included 6 cases of acute liver failure (11.54%), 3 cases of subacute liver failure (5.77%), acute-on-chronic liver failure in 10 cases (19.23%), and 33 cases of chronic liver failure (63.46%). Treatment modes included plasma exchange in 34 patients (65.38%), bilirubin adsorption in 9 patients (17.31%), and hemofiltration in 9 patients (17.31%). The clinical efficacy of artificial liver was assessed by monitoring the effects in the near future. Significant changes in metabolic compounds of liver failure in the treatment before and after artificial liver were screened by using Ultra-Performance Liquid Chromatography-Mass Spectrometry (UPLC-MS). Related metabolic pathways were analyzed by MetaboAnalyst. Results: After artificial liver treatment, the liver function and coagulation function of liver failure patients were significantly improved (P < 0.01), the Meld score was lower than that before treatment, and the difference was statistically significant (P < 0.05). Serum metabolomics identified 29 small metabolic compounds and 12 metabolic pathways with variable projection importance (VIP) greater than 1 before and after artificial liver treatment. There were 11 metabolic compounds of VIP over 1 and 7 metabolic pathways in the different modes of artificial liver treatment for chronic liver failure. Among them, bile acid metabolism, fatty acid metabolism, and amino acid metabolism are the main sources. Conclusion: Artificial liver treatment can effectively improve liver function and blood coagulation function and Meld score, clinical symptoms and signs in patients with liver failure; the curative effect of artificial liver was verified, which reflected the clinical value of artificial liver in the treatment of liver failure. Artificial liver treatment of liver failure on fatty acids and primary bile acid synthesis pathway was the most significant. The difference of fatty acid, primary bile acid synthesis pathway, and phenylalanine metabolic pathway in different artificial liver patterns of chronic liver failure was the most significant. This provides a new basis for understanding the mechanism of hepatic failure and the mechanism of liver failure by artificial liver treatment.


Assuntos
Insuficiência Hepática Crônica Agudizada/sangue , Insuficiência Hepática Crônica Agudizada/terapia , Bilirrubina/sangue , Doença Hepática Terminal/sangue , Doença Hepática Terminal/terapia , Metaboloma , Insuficiência Hepática Crônica Agudizada/fisiopatologia , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aminoácidos/sangue , Aspartato Aminotransferases/sangue , Ácidos e Sais Biliares/sangue , Doença Hepática Terminal/fisiopatologia , Ácidos Graxos/sangue , Hemofiltração , Humanos , Fígado Artificial , Redes e Vias Metabólicas , Troca Plasmática , Tempo de Protrombina , Albumina Sérica/metabolismo , gama-Glutamiltransferase/sangue
18.
Ann Intern Med ; 169(5): 273-281, 2018 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-30083748

RESUMO

Background: Organs from hepatitis C virus (HCV)-infected deceased donors are often discarded. Preliminary data from 2 small trials, including THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy Recipients), suggested that HCV-infected kidneys could be safely transplanted into HCV-negative patients. However, intermediate-term data on quality of life and renal function are needed to counsel patients about risk. Objective: To describe 12-month HCV treatment outcomes, estimated glomerular filtration rate (eGFR), and quality of life for the 10 kidney recipients in THINKER-1 and 6-month data on 10 additional recipients. Design: Open-label, nonrandomized trial. (ClinicalTrials.gov: NCT02743897). Setting: Single center. Participants: 20 HCV-negative transplant candidates. Intervention: Participants underwent transplant with kidneys infected with genotype 1 HCV and received elbasvir-grazoprevir on posttransplant day 3. Measurements: The primary outcome was HCV cure. Exploratory outcomes included 1) RAND-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) quality-of-life scores at enrollment and after transplant, and 2) posttransplant renal function, which was compared in a 1:5 matched sample with recipients of HCV-negative kidneys. Results: The mean age of THINKER participants was 56.3 years (SD, 6.7), 70% were male, and 40% were black. All 20 participants achieved HCV cure. Hepatic and renal complications were transient or were successfully managed. Mean PCS and MCS quality-of-life scores decreased at 4 weeks; PCS scores then increased above pretransplant values, whereas MCS scores returned to baseline values. Estimated GFRs were similar between THINKER participants and matched recipients of HCV-negative kidneys at 6 months (median, 67.5 vs. 66.2 mL/min/1.73 m2; 95% CI for between-group difference, -4.2 to 7.5 mL/min/1.73 m2) and 12 months (median, 72.8 vs. 67.2 mL/min/1.73 m2; CI for between-group difference, -7.2 to 9.8 mL/min/1.73 m2). Limitation: Small trial. Conclusion: Twenty HCV-negative recipients of HCV-infected kidneys experienced HCV cure, good quality of life, and excellent renal function. Kidneys from HCV-infected donors may be a valuable transplant resource. Primary Funding Source: Merck.


Assuntos
Doença Hepática Terminal/cirurgia , Hepatite C , Transplante de Rim/efeitos adversos , Doadores de Tecidos , Antivirais/uso terapêutico , Benzofuranos/uso terapêutico , Creatinina/sangue , Combinação de Medicamentos , Doença Hepática Terminal/complicações , Doença Hepática Terminal/fisiopatologia , Feminino , Genótipo , Taxa de Filtração Glomerular , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Humanos , Imidazóis/uso terapêutico , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Qualidade de Vida , Quinoxalinas/uso terapêutico , RNA Viral/sangue , Resultado do Tratamento , Carga Viral
19.
Gastroenterology ; 155(3): 629-647, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30012333

RESUMO

Mitochondria regulate hepatic lipid metabolism and oxidative stress. Ultrastructural mitochondrial lesions, altered mitochondrial dynamics, decreased activity of respiratory chain complexes, and impaired ability to synthesize adenosine triphosphate are observed in liver tissues from patients with alcohol-associated and non-associated liver diseases. Increased lipogenesis with decreased fatty acid ß-oxidation leads to the accumulation of triglycerides in hepatocytes, which, combined with increased levels of reactive oxygen species, contributes to insulin resistance in patients with steatohepatitis. Moreover, mitochondrial reactive oxygen species mediate metabolic pathway signaling; alterations in these pathways affect development and progression of chronic liver diseases. Mitochondrial stress and lesions promote cell death, liver fibrogenesis, inflammation, and the innate immune responses to viral infections. We review the involvement of mitochondrial processes in development of chronic liver diseases, such as nonalcoholic fatty, alcohol-associated, and drug-associated liver diseases, as well as hepatitis B and C, and discuss how they might be targeted therapeutically.


Assuntos
Doença Hepática Terminal/etiologia , Mitocôndrias Hepáticas/fisiologia , Doenças Mitocondriais/complicações , Transdução de Sinais/fisiologia , Doença Hepática Terminal/fisiopatologia , Humanos , Metabolismo dos Lipídeos/fisiologia , Fígado/fisiopatologia , Doenças Mitocondriais/fisiopatologia , Estresse Oxidativo/fisiologia , Espécies Reativas de Oxigênio/metabolismo
20.
World J Emerg Surg ; 13: 32, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30034510

RESUMO

The increasing prevalence of advanced cirrhosis among operative candidates poses a major challenge for the acute care surgeon. The severity of hepatic dysfunction, degree of portal hypertension, emergency of surgery, and severity of patients' comorbidities constitute predictors of postoperative mortality. Comprehensive history taking, physical examination, and thorough review of laboratory and imaging examinations typically elucidate clinical evidence of hepatic dysfunction, portal hypertension, and/or their complications. Utilization of specific scoring systems (Child-Pugh and MELD) adds objectivity to stratifying the severity of hepatic dysfunction. Hypovolemia and coagulopathy often represent major preoperative concerns. Resuscitation mandates judicious use of intravenous fluids and blood products. As a general rule, the most expeditious and least invasive operative procedure should be planned. Laparoscopic approaches, advanced energy devices, mechanical staplers, and topical hemostatics should be considered whenever applicable to improve safety. Precise operative technique must acknowledge common distortions in hepatic anatomy, as well as the risk of massive hemorrhage from porto-systemic collaterals. Preventive measures, as well as both clinical and laboratory vigilance, for postoperative hepatic and renal decompensation are essential.


Assuntos
Serviços Médicos de Emergência/normas , Doença Hepática Terminal/cirurgia , Cirurgia Geral/normas , Serviços Médicos de Emergência/métodos , Doença Hepática Terminal/fisiopatologia , Cirurgia Geral/métodos , Humanos , Hipertensão Portal/fisiopatologia , Hipertensão Portal/cirurgia , Assistência Perioperatória/métodos , Qualidade da Assistência à Saúde/tendências , Índice de Gravidade de Doença , Ultrassonografia/métodos
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