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2.
J Viral Hepat ; 28(1): 4-11, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33190321

RESUMO

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus causing coronavirus disease 19 (COVID-19), with an estimated 22 million people infected worldwide so far although involving primarily the respiratory tract, has a remarkable tropism for the liver and the biliary tract. Patients with SARS-CoV-2 infection and no antecedent liver disease may display evidence of cytolytic liver damage, proportional to the severity of COVID-19 but rarely of clinical significance. The mechanism of hepatocellular injury is unclear and possibly multifactorial. The clinical impact of SARS-CoV-2 infection in patients with underlying chronic liver disease, a cohort whose global size is difficult to estimate, has been assessed appropriately only recently and data are still evolving. Patients with cirrhosis are at higher risk of developing severe COVID-19 and worse liver-related outcomes as compared to those with non-cirrhotic liver disease. OLT patients have an intermediate risk. Specific interventions in order to reduce the risk of transmission of infection among this high-risk population have been outlined by international societies, together with recommendations for modified treatment and follow-up regimens during the COVID-19 pandemic. When a vaccine against SARS-CoV-2 becomes available, patients with fibrotic liver disease and those with OLT should be considered as prime targets for prophylaxis of COVID-19, as all other highly susceptible subjects.


Assuntos
/complicações , Hepatopatias/complicações , Fígado/lesões , /patogenicidade , /epidemiologia , /terapia , Doença Crônica , Humanos , Fígado/virologia , Cirrose Hepática/complicações , Cirrose Hepática/epidemiologia , Cirrose Hepática/terapia , Hepatopatias/epidemiologia , Hepatopatias/terapia , Risco
3.
PLoS One ; 15(12): e0238568, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33264327

RESUMO

The risk of poor post-operative outcome and the benefits of surgical resection as a curative therapy require careful assessment by the clinical care team for patients with primary and secondary liver cancer. Advances in surgical techniques have improved patient outcomes but identifying which individual patients are at greatest risk of poor post-operative liver performance remains a challenge. Here we report results from a multicentre observational clinical trial (ClinicalTrials.gov NCT03213314) which aimed to inform personalised pre-operative risk assessment in liver cancer surgery by evaluating liver health using quantitative multiparametric magnetic resonance imaging (MRI). We combined estimation of future liver remnant (FLR) volume with corrected T1 (cT1) of the liver parenchyma as a representation of liver health in 143 patients prior to treatment. Patients with an elevated preoperative liver cT1, indicative of fibroinflammation, had a longer post-operative hospital stay compared to those with a cT1 within the normal range (6.5 vs 5 days; p = 0.0053). A composite score combining FLR and cT1 predicted poor liver performance in the 5 days immediately following surgery (AUROC = 0.78). Furthermore, this composite score correlated with the regenerative performance of the liver in the 3 months following resection. This study highlights the utility of quantitative MRI for identifying patients at increased risk of poor post-operative liver performance and a longer stay in hospital. This approach has the potential to inform the assessment of individualised patient risk as part of the clinical decision-making process for liver cancer surgery.


Assuntos
Hepatectomia , Neoplasias Hepáticas/cirurgia , Regeneração Hepática , Fígado/fisiopatologia , Imagem por Ressonância Magnética/métodos , Adenocarcinoma/fisiopatologia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Neoplasias dos Ductos Biliares/fisiopatologia , Neoplasias dos Ductos Biliares/cirurgia , Carcinoma Hepatocelular/fisiopatologia , Carcinoma Hepatocelular/cirurgia , Colangiocarcinoma/fisiopatologia , Colangiocarcinoma/cirurgia , Embolização Terapêutica , Feminino , Humanos , Hipertrofia , Fígado/patologia , Hepatopatias/complicações , Hepatopatias/fisiopatologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Veia Porta , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Método Simples-Cego , Resultado do Tratamento
4.
World J Gastroenterol ; 26(46): 7272-7286, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33362383

RESUMO

The global incidence of coronavirus disease 2019 (COVID-19) continues to increase despite health care efforts. The disease is caused by coronavirus 2 with high transmission and mortality rates. Little is known about the management of COVID-19 in advanced liver disease. The aim of work was to propose a plan for management of this drastic disease in case of this specific population with review of medications that could be suitable for advanced liver disease. All the guidelines and medications available for treatment of COVID-19 were reviewed with selection of the less toxic medications that could be used in advanced liver disease. Drugs suitable to manage COVID-19 in patients with liver disease might include remdesivir intravenously, nitazoxanide + sofosbuvir, ivermectin, tocilizumab, convalescent plasma, and low molecular weight heparin in certain situations. Advanced liver disease is associated with portal hypertension and splenomegaly with reduction of blood elements and immune dysfunction and impaired T cell function. Thus, when confronted by cytokine storm as an immune response to COVID-19, there may be an increase in the mortality rate of these patients. Through this review, a plan to treat COVID-19 in this special group of patients with advanced cirrhosis is proposed.


Assuntos
/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas , Hepatopatias/complicações , /complicações , Gastroenterologia , Humanos
5.
Cochrane Database Syst Rev ; 11: CD011803, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33164205

RESUMO

BACKGROUND: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including haemorrhage from oesophageal and gastrointestinal varices. Variceal haemorrhage commonly occurs in children with chronic liver disease or portal vein obstruction. Prevention is therefore important. In adults, numerous randomised clinical trials have demonstrated benefits of non-selective beta-blockers and endoscopic variceal ligation as primary prevention in decreasing the risk of variceal haemorrhage. In children, band ligation, beta-blockers, and sclerotherapy have been proposed as alternatives for primary prophylaxis of oesophageal variceal bleeding. However, primary prophylaxis is not the current standard of care in children because it is unknown whether those treatments are of benefit or cause harm when used for primary prophylaxis of oesophageal variceal bleeding in children and adolescents. OBJECTIVES: To determine the benefits and harms of band ligation versus sclerotherapy for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis. SEARCH METHODS: We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, PubMed, Embase, LILACS, and Science Citation Index Expanded (27 April 2020). We scrutinised the reference lists of retrieved publications, and performed a manual search from the main paediatric gastroenterology and hepatology conferences (NASPGHAN and ESPGHAN) abstract books from 2008 to 2019. We searched ClinicalTrials.gov, FDA, EMA, and WHO for ongoing clinical trials. There were no language or document type restrictions. SELECTION CRITERIA: We planned to include randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. If the search for randomised clinical trials retrieved quasi-randomised and observational studies, then we read them through to extract information on harms. DATA COLLECTION AND ANALYSIS: We planned to summarise data from randomised clinical trials by standard Cochrane methodologies. We planned to assess risk of bias and use GRADE to assess the certainty of evidence per outcome. Our primary outcomes were all-cause mortality, serious adverse events and liver-related morbidity, and quality of life. Our secondary outcomes were oesophageal variceal bleeding and adverse events not considered serious. We planned to analyse data with intention-to-treat. We planned to use Review Manager 5 to analyse the data. MAIN RESULTS: We found no randomised clinical trials assessing band ligation versus sclerotherapy for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. AUTHORS' CONCLUSIONS: Randomised clinical trials assessing the benefits or harms of band ligation versus sclerotherapy for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis are lacking. Therefore, trials with adequate power and proper design, assessing the benefits and harms of band ligation versus sclerotherapy on patient-relevant clinical outcomes such as mortality, quality of life, failure to control variceal bleeding, and adverse events are needed. Unless such trials are conducted and the results become published, we cannot make any conclusions regarding the benefits or harms of these two interventions.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Hipertensão Portal/complicações , Ligadura/métodos , Hepatopatias/complicações , Veia Porta , Escleroterapia , Trombose Venosa/terapia , Adolescente , Criança , Doença Crônica , Humanos , Prevenção Primária/métodos
6.
BMJ Case Rep ; 13(10)2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130588

RESUMO

An 82-year-old man with an extensive medical history presented to the emergency room with complaints of generalised weakness and cough. He tested positive for COVID-19 10 days prior to presenting to the emergency room. Although his symptoms started a week prior to diagnosis, his weakness increased, warranting emergency response. A comprehensive metabolic panel was drawn from the patient on admission, indicating markedly high liver function tests (LFTs) ≥20 times above the upper limit of normal. On day 1 of admission, the decision was still made to start remdesivir (5-day course) due to decompensated acute respiratory failure as well as dexamethasone. The patient's LFTs significantly improved throughout his hospital stay. The patient made a full recovery and was discharged on day 10 of hospitalisation.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Hepatopatias/diagnóstico , Pneumonia Viral/diagnóstico , Pneumonia Viral/tratamento farmacológico , Insuficiência Respiratória/diagnóstico , Monofosfato de Adenosina/administração & dosagem , Idoso de 80 Anos ou mais , Alanina/administração & dosagem , Dexametasona/administração & dosagem , Serviço Hospitalar de Emergência , Humanos , Tempo de Internação , Hepatopatias/complicações , Testes de Função Hepática , Masculino , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Alta do Paciente , Insuficiência Respiratória/terapia , Índice de Gravidade de Doença , Resultado do Tratamento
7.
Clin Mol Hepatol ; 26(4): 562-576, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33053932

RESUMO

BACKGROUND/AIMS: Although coronavirus disease 2019 (COVID-19) has spread rapidly worldwide, the implication of pre-existing liver disease on the outcome of COVID-19 remains unresolved.
. METHODS: A total of 1,005 patients who were admitted to five tertiary hospitals in South Korea with laboratory-confirmed COVID-19 were included in this study. Clinical outcomes in COVID-19 patients with coexisting liver disease as well as the predictors of disease severity and mortality of COVID-19 were assessed.
. RESULTS: Of the 47 patients (4.7%) who had liver-related comorbidities, 14 patients (1.4%) had liver cirrhosis. Liver cirrhosis was more common in COVID-19 patients with severe pneumonia than in those with non-severe pneumonia (4.5% vs. 0.9%, P=0.006). Compared to patients without liver cirrhosis, a higher proportion of patients with liver cirrhosis required oxygen therapy; were admitted to the intensive care unit; had septic shock, acute respiratory distress syndrome, or acute kidney injury; and died (P<0.05). The overall survival rate was significantly lower in patients with liver cirrhosis than in those without liver cirrhosis (log-rank test, P=0.003). Along with old age and diabetes, the presence of liver cirrhosis was found to be an independent predictor of severe disease (odds ratio, 4.52; 95% confidence interval [CI], 1.20-17.02;P=0.026) and death (hazard ratio, 2.86; 95% CI, 1.04-9.30; P=0.042) in COVID-19 patients.
. CONCLUSION: This study suggests liver cirrhosis is a significant risk factor for COVID-19. Stronger personal protection and more intensive treatment for COVID-19 are recommended in these patients.


Assuntos
Infecções por Coronavirus/patologia , Hepatopatias/patologia , Pneumonia Viral/patologia , Fatores Etários , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Humanos , Oxigenação Hiperbárica , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Cirrose Hepática/complicações , Cirrose Hepática/mortalidade , Cirrose Hepática/patologia , Hepatopatias/complicações , Hepatopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Prognóstico , República da Coreia , Fatores de Risco , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
8.
Ann Transplant ; 25: e926196, 2020 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-33106469

RESUMO

Liver transplantation during the COVID-19 pandemic is challenging. Both donor and recipient issues can be influenced by the risks attributed to the pandemic. Allocation policy may need to be modified and criteria may be influenced by local infection rates and availability of medical facilities. Modifying immunosuppression (IS) protocols is controversial and is not evidence-based. In this study, we review the published literature on liver transplant recipients who were infected with COVID-19. A literature review was performed using PubMed, ScienceDirect, and WHO databases to identify relevant English-language articles published up to May 20, 2020. Fifteen articles reported 120 liver transplant recipients who were infected with COVID-19. Only 10 papers with 22 patients reported full encounter characteristics. Four papers reported 23, 17, 13, and 6 patients, respectively, but with minimal data. One paper reported the authors' own 39 patients' characteristics and demographics. The mean age was 58.2 years with 66% males. The most commonly reported presentations in descending order were fever (91%), cough (36.7%), shortness of breath (SOB) (31.8%), and diarrhea (31.8%). Liver transplant patients infected with COVID-19 were maintained on Tac (79%), mycophenolate (MMF) (48.4%), and Prednisone (29.6%) and were managed by reducing MMF in 14.3% of patients and reducing Tac in 14.3% of patients; 28.6% of patients needed ICU admission, 13.6% of patients had died, and the reported general population COVID-19 mortality rate was 3.4%. The clinical presentation of COVID-19 in liver transplant recipients may be different from the general population, with higher rates of severe disease, complications, and mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Controle de Infecções , Hepatopatias/cirurgia , Transplante de Fígado , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Humanos , Hepatopatias/complicações , Hepatopatias/mortalidade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Prognóstico
9.
Arch Iran Med ; 23(10): 713-717, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33107315

RESUMO

The coronavirus associated disease 2019 (COVID-19) caused by the SARS-CoV-2 virus has rapidly spread all around the world and became pandemic in March 2020. Data on liver transplantation and chronic liver disease during the pandemic has remained scarce, and there is little information on whether immunosuppressed patients are at higher risk of developing severe COVID-19 infection. This review provides information for health care providers who care for patients with liver transplantation and chronic liver diseases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Controle de Infecções , Hepatopatias/cirurgia , Transplante de Fígado , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Hepatopatias/complicações , Hepatopatias/mortalidade , Pandemias , Pneumonia Viral/terapia
10.
Acta Biomed ; 91(3): e2020005, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921703

RESUMO

ackground: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures.


Assuntos
Doenças Biliares/cirurgia , Infecções por Coronavirus/complicações , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Serviço Hospitalar de Emergência/normas , Hepatopatias/cirurgia , Pancreatopatias/cirurgia , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/complicações , Betacoronavirus , Doenças Biliares/complicações , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Humanos , Hepatopatias/complicações , Masculino , Pessoa de Meia-Idade , Pancreatopatias/complicações , Pandemias , Pneumonia Viral/epidemiologia
11.
Drug Des Devel Ther ; 14: 3001-3013, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32801640

RESUMO

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now a global outbreak of disease. The antiviral treatment acts as one of the most important means of SARS-CoV-2 infection. Alteration of physiological characteristics in special populations may lead to the change in drug pharmacokinetics, which may result in treatment failure or increased adverse drug reactions. Some potential drugs have shown antiviral effects on SARS-CoV-2 infections, such as chloroquine, hydroxychloroquine, favipiravir, lopinavir/ritonavir, arbidol, interferon alpha, and remedsivir. Here, we reviewed the literature on clinical effects in COVID-19 patients of these antiviral agents and provided the potential antiviral agent options for pregnant women, elderly patients, liver or renal dysfunction patients, and severe or critically ill patients receiving renal replacement therapy or ECMO after SARS-CoV-2 infection.


Assuntos
Antivirais/farmacologia , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Idoso , Antivirais/efeitos adversos , Antivirais/farmacocinética , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Humanos , Nefropatias/complicações , Hepatopatias/complicações , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez
12.
Zhonghua Gan Zang Bing Za Zhi ; 28(7): 548-552, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32791787

RESUMO

Fungal infection complicated in patients with severe liver disease is not only an important predisposing factor bringing liver failure in patients, but also one of the important causes for the aggravation of the disease and even death. However, its clinical manifestations are not specific, and thereby easily leading to be undiagnosed. Therefore, early screening, and standardized treatment are very important to improve the prognosis.


Assuntos
Hepatopatias , Micoses , Humanos , Hepatopatias/complicações , Micoses/complicações , Micoses/diagnóstico , Prognóstico
13.
Zhonghua Gan Zang Bing Za Zhi ; 28(7): 553-556, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32791788

RESUMO

Patients with severe liver disease are prone to bacterial and fungal infections, and then develop toxic shock. The onset of the disease may be insidious, but the disease progresses rapidly with a high fatality rate. Current research results show that special conditions such as translocation of intestinal flora and immune paralysis in patients with severe liver disease are susceptible factors for infection and toxic shock. Furthermore, it is currently recognized that the treatment of severe liver disease complicated with toxic shock must be treated with antibiotics and maintenance of hemodynamic stability. Other treatments, such as hydrocortisone and strict glycemic control, are quite controversial and may not necessarily reduce mortality. Herein, we summarize the epidemiology, susceptibility factors; diagnosis and management strategies of severe liver disease complicated with toxic shock, highlighting the characteristics of toxic shock under the background of severe liver disease, so as to detect, prevent and treat septic shock in patients with severe liver disease as early as possible to reduce the fatality rate.


Assuntos
Hepatopatias , Choque Séptico , Antibacterianos/uso terapêutico , Humanos , Hepatopatias/complicações , Hepatopatias/tratamento farmacológico , Choque Séptico/complicações , Choque Séptico/tratamento farmacológico
14.
Zhonghua Gan Zang Bing Za Zhi ; 28(7): 608-612, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32791798

RESUMO

Objective: To understand the clinical features and outcomes of chronic liver diseases overlapping with CMV infection. Methods: Clinical characteristics, treatment and outcome of patients of chronic liver diseases overlapping with CMV infection were analyzed retrospectively. T-test was used for measurement data and χ (2) test was used for count data. All measurement data were expressed by (x ± s). P > 0.05 was not determined as significant. P < 0.05 was regarded as statistically significant. Results: Chronic liver diseases overlapping with CMV infections had similar clinical features. Etiopathogenic treatment + symptomatic supportive treatment + CMV overlapping infection treatment (including antiviral therapy, corticosteroids consideration, clearing heat and traditional Chinese choleretic medicine, etc) were the primary principles of therapy. The incidence of cytomegalovirus infection accounted for 4.125% during the corresponding hospitalization period. Cytomegalovirus infection had relatively caused liver function damage in patients with milder clinical symptoms and signs. Biochemical indicators before and after treatment showed that there was no significant difference in total bilirubin (TBil) before (262.93 ± 178.944) µmol/L and after one week of treatment (245.08 ± 179.332) µmol/L (P > 0.05). However, when TBIL was compared with three (156.58 ± 147.461) µmol/L and four weeks (103.39 ± 102.218) µmol/L) of treatment, the decrease was significant (P < 0.05, P < 0.01). Alanine aminotransferase (ALT) after one week (293.57 ± 467.438) U/L (P < 0.01) of treatment was significantly lower than before treatment (782.34 ± 828.801) U/L. Gamma-glutamyl transferase (GGT) after treatment (202.52 ± 155.174)U/L was significantly lower than before treatment(280.69 ± 205.619)U/L). Total bile acid (TBA) was increased after treatment (198.04 ± 155.174)µmol/L, when compared with that of before treatment (62.93 ± 178.944)µmol/L. Biochemical indicators of liver diseases had shown typical features of cholestasis, and the slow and reduced flow of bile acid was tracked and observed. Compared with the advanced group (182.45 ± 214.169) umol/L, the total bilirubin in inflammation group (50.36 ± 26.282) umol/L was decreased (P < 0.05). Moreover, advanced group (122.18 ± 106.780) umol/L (P < 0.05) had elevated total bile acid normalization rate than that of bile acid group (54.82 ± 56.123) umol/L, and the inflammatory phase had significantly better outcome than those with advanced-stage. Conclusion: Chronic liver diseases overlapping with cytomegalovirus infection has a good therapeutic outcome in the inflammatory phase, but in the advanced-stage; the therapeutic efficacy and outcome is poor and perilous.


Assuntos
Infecções por Citomegalovirus/complicações , Hepatopatias/complicações , Alanina Transaminase , Colestase , Humanos , Hepatopatias/virologia , Prognóstico , Estudos Retrospectivos
16.
Rev Gastroenterol Mex ; 85(3): 312-320, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32620315

RESUMO

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) virus. COVID-19 affected more than 6million persons worldwide in fewer than 4 months, after the report of the first cases in China in December 2019. The relation of the disease caused by SARS-Cov-2 to immunosuppressive treatment used in different gastrointestinal disorders is uncertain, resulting in debate with regard to suspending immunosuppressive therapy to improve infection outcome. Said suspension implies the inherent risk for graft rejection or autoimmune disease exacerbation that can potentially worsen the course of the infection. Based on the presently available evidence, a treatment stance has been established for patients with gastrointestinal diseases that require immunosuppressive therapy.


Assuntos
Infecções por Coronavirus/complicações , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Hepatopatias/tratamento farmacológico , Pancreatopatias/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Humanos , Hepatopatias/complicações , Transplante de Fígado , Transplante de Pâncreas , Pancreatopatias/complicações
18.
Am J Cardiol ; 129: 42-45, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32540168

RESUMO

Studies have shown that highly selected patients who underwent combined heart-kidney (HK) and heart-liver transplants (HLv) have short- and long-term outcomes comparable to those observed in primary heart transplantation (HT). Adults patients with stage D heart failure that underwent combined HK, HLv, and heart-lung (HL) were identified in the United Network for Organ Sharing registry from 1991 to 2016, with follow-up through March 2018. We conducted inverse probability of treatment weighting survival analysis of long-term survival stratified by type of combined organ transplant, accounting for donor, recipient, and operative characteristics. We identified 2,300 patients who underwent combined organ transplant (HK 1,257, HLv 212, HL 831). HL recipients were more likely white (77%), women (58%), with congenital heart disease (44.5%), and longer waiting list time (median 195 days). HK transplant increased significantly during the study period where as HL decreased significantly. Median survival was 12.2 years for HK (95% confidence intervals [CI] 10.8 to 12.8), 12 for HLv (95% CI 8.6 to 17.6) but significantly lower at 4.5 years for HL (95% CI 3.6 to 5.8). Combined HK and HLv transplantation rates are increasing and long-term survival is comparable to primary HT, unlike HL which is associated with decreasing trends and significantly lower survival.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Transplante de Rim , Transplante de Fígado , Mortalidade , Adulto , Afro-Americanos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Restritiva/complicações , Grupo com Ancestrais do Continente Europeu , Feminino , Rejeição de Enxerto , Cardiopatias Congênitas/complicações , Insuficiência Cardíaca/complicações , Transplante de Coração-Pulmão , Hispano-Americanos , Humanos , Nefropatias/complicações , Nefropatias/cirurgia , Hepatopatias/complicações , Hepatopatias/cirurgia , Pneumopatias/complicações , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Reoperação , Taxa de Sobrevida
19.
Dtsch Med Wochenschr ; 145(11): 722-726, 2020 06.
Artigo em Alemão | MEDLINE | ID: mdl-32492740

RESUMO

The recommended indications for short-term use of human albumin in patients with decompensated cirrhosis are the following: prevention of paracenteses induced circulatory dysfunction, treatment of hypovolemia, prevention of hepatorenal syndrome in high-risk patients with spontaneous bacterial peritonitis, as well as treatment of hepatorenal syndrome. Liver cirrhosis is associated with systemic inflammation, which is further increased in decompensated cirrhosis and acute-on-chronic liver failure. Besides its function as plasma expander, albumin is known to have pleiotropic non-oncotic properties. It serves as antioxidant, scavenging and provides immune-modulating and endothelium protective functions. Albumin treatment may be beneficial to prevent further decompensation and acute-on-chronic liver failure. Recent studies suggest, that long-term albumin administration in patients with cirrhosis and ascites improves survival, prevents complications, facilitates the management of ascites and reduces hospitalizations. Moreover, during infections albumin may prevent development of acute-on-chronic liver failure. Still, further studies are needed to confirm these disease-modifying effects of albumin, define its optimal dosage and administration schedule and detect patients who benefit most from albumin administration in different scenarios.


Assuntos
Albuminas/uso terapêutico , Cirrose Hepática , Hepatopatias , Humanos , Inflamação , Cirrose Hepática/complicações , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/fisiopatologia , Hepatopatias/complicações , Hepatopatias/tratamento farmacológico , Hepatopatias/fisiopatologia
20.
Transplant Proc ; 52(7): 2128-2132, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32553508

RESUMO

BACKGROUND: Model for End-Stage Liver Disease (MELD) score is used to assess the severity of chronic liver disease. It is implemented in transplantology in the process of qualification for urgent liver transplant. The aim of our study was to assess the liver function of patients qualified for lung transplant using MELD score, taking under consideration mean pulmonary artery pressure as an important risk factor of death. METHODS: The study group consisted of 123 patients qualified for lung transplant in Silesian Center for Heart Diseases between 2004 and 2017. Data relevant for MELD score calculations and medial pulmonary artery pressure were acquired from medical records. RESULTS: The average MELD score among patients qualified for lung transplant was 8.24 points, and mean pulmonary pressure (mPAP) was 35.02 mm Hg. Patients with idiopathic pulmonary artery hypertension acquired the highest MELD and highest mPAP results (13.1 points and 57.7 mm Hg, respectively). Patients with idiopathic pulmonary fibrosis presented higher mean MELD-Na score among those with pulmonary arterial hypertension than those without pulmonary arterial hypertension (36.59 mm Hg; 7.74 points vs 18 mm Hg; 6.5 points). There is strong positive correlation between MELD-Na and mPAP among patients who underwent lung transplant because of idiopathic pulmonary fibrosis. CONCLUSIONS: This is the first study in the worldwide literature assessing MELD-Na as a predictor of survival among patients qualified for lung transplant and those who already are recipients. Further studies regarding this issue are required as authors will explore this issue in the future.


Assuntos
Hepatopatias/complicações , Testes de Função Hepática , Transplante de Pulmão , Índice de Gravidade de Doença , Adulto , Feminino , Humanos , Pneumopatias/complicações , Pneumopatias/cirurgia , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Fatores de Risco
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