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1.
Curr Cardiol Rep ; 23(8): 110, 2021 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-34216273

RESUMO

PURPOSE OF REVIEW: The aim of this study is to review current echocardiographic modalities utilized in the assessment of the preoperative liver transplant candidate with an emphasis on newer techniques. We sought to assess if newer methods imparted additional diagnostic or prognostic accuracy compared to prior methods based on existing studies. RECENT FINDINGS: Standard dobutamine stress echocardiography offers important information regarding operative risk and post-operative survival in liver transplant candidates; however, technologies such as speckle-tracking echocardiography (STE) and evaluation of diastolic function have emerged as useful tools as well. 2D-STE and diastolic echocardiography offer additional parameters such as global longitudinal strain and measures of diastolic dysfunction that can better predict peri-operative and post-operative complications in liver transplant candidates. If able, practitioners should utilize these methods routinely in their assessment of liver transplant candidates.


Assuntos
Cardiomiopatias , Transplante de Fígado , Diástole , Ecocardiografia , Ecocardiografia sob Estresse , Humanos , Reprodutibilidade dos Testes
2.
Acta Gastroenterol Belg ; 84(2): 347-359, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34217187

RESUMO

Liver transplantation (LT) remains the only curative option for patients suffering from end-stage liver disease, acute liver failure and selected hepatocellular carcinomas and access to the LT-waiting list is limited to certain strict indications. However, LT has shown survival advantages for patients in certain indications such as acute alcoholic hepatitis, hepatocellular carcinoma outside Milan criteria and colorectal cancer metastases. These newer indications increase the pressure in an already difficult context of organ shortage. Strategies to increase the transplantable organ pool are therefore needed. We will discuss here the use of HCV positive grafts as the use of normothermic isolated liver perfusion. Belgian Liver Intestine Advisory Committee (BeLIAC) from the Belgian Transplant Society (BTS) aims to guarantee the balance between the new indications and the available resources.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , Comitês Consultivos , Bélgica , Humanos , Intestinos
3.
Ann Palliat Med ; 10(6): 6168-6179, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237953

RESUMO

BACKGROUND: Acute kidney injury (AKI) is one of the postoperative complications following orthotopic liver transplantation (OLT), and is related to the high morbidity and mortality. Although there were numerous propensity factors for AKI, their cumulative influence remains unclear. Our aims were to develop a score model to predict postoperative AKI and to evaluate the impact of AKI on the recipients' long-term survival. METHODS: We retrospectively analyzed 99 adult patients underwent OLT in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between October 2014 and July 2020. The patients were dichotomized into the non-AKI and the AKI groups according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We defined stage-1 AKI as mild AKI, stage-2 AKI and stage-3 AKI as severe AKI. RESULTS: Overall, 29 (29.29%) patients developed AKI after OLT, of these, stage-1, stage-2, stage-3 account for 20.20% (20 of 99 patients), 2.02% (2 of 99 patients), 7.07% (7 of 99 patients), respectively; and 13.79% of postoperative AKI patients (4 of 29 patients) accepted renal replacement therapy (RRT). Operative time and MELD-Na score predicted the postoperative AKI, with odds ratio of 1.006, 1.061, respectively. The generated AKI prediction model is as follows: -5.594+0.007×operative time+0.060×MELD-Na. The area under the receiver operating characteristic curve (AUC) for the AKI prediction model was 0.762, and the sensitivity and specificity were 79.3%, 61.4%, respectively. There was no difference in long-term survival among the mild AKI group and the non-AKI group (P=0.751). However, the impact of severe AKI on long-term survival of patients was statistically significant when comparing the non-AKI group and the mild AKI group (P=0.001, P=0.011). CONCLUSIONS: AKI occurs frequently in adult patients after OLT, and it poses a threat to patients' long-term survival. The severe AKI has negative impact on long-term survival, while the mild AKI has limited impact on long-term survival, compared with non-AKI group. The novel AKI prediction model has prognostic value in identifying patients at high risk for postoperative AKI.


Assuntos
Injúria Renal Aguda , Transplante de Fígado , Injúria Renal Aguda/etiologia , Adulto , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida
4.
World J Gastroenterol ; 27(24): 3682-3692, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34239278

RESUMO

BACKGROUND: With increasing rates of liver transplantation and a stagnant donor pool, the annual wait list removals have remained high. Living donor liver transplantation (LDLT) is an established modality in expanding the donor pool and is the primary method of liver donation in large parts of the world. Marginal living donors, including those with hepatic steatosis, have been used to expand the donor pool. However, due to negative effects of steatosis on graft and recipient outcomes, current practice excludes overweight or obese donors with more than 10% macro vesicular steatosis. This has limited a potentially important source to help expand the donor pool. Weight loss is known to improve or resolve steatosis and rapid weight loss with short-term interventions have been used to convert marginal donors to low-risk donors in a small series of studies. There is, however, a lack of a consensus driven standardized approach to such interventions. AIM: To assess the available data on using weight loss interventions in potential living liver donors with steatotic livers and investigated the feasibility, efficacy, and safety of using such donors on the donor, graft and recipient outcomes. The principal objective was to assess if using such treated donor livers, could help expand the donor pool. METHODS: We performed a comprehensive literature review and meta-analysis on studies examining the role of short-term weight loss interventions in potential living liver donors with hepatic steatosis with the aim of increasing liver donation rates and improving donor, graft, and recipient outcomes. RESULTS: A total of 6 studies with 102 potential donors were included. Most subjects were males (71). All studies showed a significant reduction in body mass index post-intervention with a mean difference of -2.08 (-3.06, 1.10, I 2 = 78%). A significant reduction or resolution of hepatic steatosis was seen in 93 of the 102 (91.2%). Comparison of pre- and post-intervention liver biopsies showed a significant reduction in steatosis with a mean difference of -21.22 (-27.02, -15.43, I 2 = 56%). The liver donation rates post-intervention was 88.5 (74.5, 95.3, I 2 = 42%). All donors who did not undergo LDLT had either recipient reasons or had fibrosis/steatohepatitis on post intervention biopsies. Post-operative biliary complications in the intervention group were not significantly different compared to controls with an odds ratio of 0.96 [(0.14, 6.69), I 2 = 0]. The overall post-operative donor, graft, and recipient outcomes in treated donors were not significantly different compared to donors with no steatosis. CONCLUSION: Use of appropriate short term weight loss interventions in living liver donors is an effective tool in turning marginal donors to low-risk donors and therefore in expanding the donor pool. It is feasible and safe, with comparable donor, graft, and recipient outcomes, to non-obese donors. Larger future prospective studies are needed.


Assuntos
Fígado Gorduroso , Transplante de Fígado , Humanos , Fígado , Transplante de Fígado/efeitos adversos , Doadores Vivos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Perda de Peso
5.
MMWR Morb Mortal Wkly Rep ; 70(27): 961-966, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34237046

RESUMO

Unexpected donor-derived hepatitis B virus (HBV) infection is defined as a new HBV infection in a recipient of a transplanted organ from a donor who tested negative for total antihepatitis B core antibody (total anti-HBc), hepatitis B surface antigen (HBsAg), and HBV DNA* before organ procurement. Such infections are rare and are associated with injection drug use among deceased donors (1). During 2014-2019, CDC received 20 reports of HBV infection among recipients of livers from donors who had no evidence of past or current HBV infection. Investigation included review of laboratory data and medical records. Fourteen of these new HBV infections were detected during 2019 alone; infections were detected a median of 38 (range = 5-116) weeks after transplantation. Of the 14 donors, 13 were hepatitis C virus (HCV)-seropositive† and had a history of injection drug use within the year preceding death, a positive toxicology result, or both. Because injection drug use is the most commonly reported risk factor for hepatitis C,§ providers caring for recipients of organs from donors who are HCV-seropositive or recently injected drugs should maintain awareness of infectious complications of injection drug use and monitor recipients accordingly (2). In addition to testing for HBV DNA at 4-6 weeks after transplantation, clinicians caring for liver transplant recipients should consider testing for HBV DNA 1 year after transplantation or at any time if signs and symptoms of viral hepatitis develop, even if previous tests were negative (2).


Assuntos
Hepatite B/epidemiologia , Transplante de Fígado/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assunção de Riscos , Doadores de Tecidos/psicologia , Doadores de Tecidos/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
7.
BMJ Case Rep ; 14(5)2021 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059542

RESUMO

Hereditary haemochromatosis results in multiorgan dysfunction secondary to iron overload. Haemojuvelin (HJV)-associated haemochromatosis, is a rapidly progressing form of haemochromatosis caused by mutation in the HJV that frequently results in heart and liver failure. Herein, we describe the successful treatment of a 39-year-old woman with decompensated heart failure and liver cirrhosis requiring extracorporeal membrane oxygenation who was successfully treated with combined heart-liver transplantation. Following her life-saving multiorgan transplantation, she was also noted to have rapid correction of her serum ferritin to normal levels. She remains healthy with excellent allograft function and normal iron and ferratin levels 4 years after the procedure. To our knowledge, this case is the first demonstration that combined heart-liver transplantation is a feasible option for patients with heart and liver failure secondary to HJV-associated haemochromatosis and indeed offers a long-standing corrective solution to treat this condition and restore physiologically normal iron metabolism.


Assuntos
Transplante de Coração , Hemocromatose , Sobrecarga de Ferro , Transplante de Fígado , Adulto , Feminino , Hemocromatose/complicações , Humanos , Sobrecarga de Ferro/etiologia , Fígado
8.
BMC Gastroenterol ; 21(1): 262, 2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118888

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) can lead to liver failure which renders to liver transplant. miRNAs might be detected as biomarkers in subclinical stage of several hepatobiliary disorders like HCC. Therefore, in the present study, alterations in miRNAs as biomarkers were detected in LT patients with HCC. METHODS: Fourteen tissue samples composed of 5 rejected and 9 non-rejected ones were used for studying the miRNAs expression pattern using LNA-array probe assay and the result was evaluated by in house SYBR Green Real-time PCR protocols on 30 other tissue samples composed of 10 rejected and 20 non-rejected ones for the selected miRNAs. All samples were collected from liver transplanted patients with HCC. RESULTS: The study results revealed that in rejected patients compared to non-rejected ones, hsa-miR-3158-5p, -4449, -4511, and -4633-5p were up-regulated and hsa-miR-122-3p, -194-5p, 548as-3p, and -4284 were down-regulated. ROC curve analysis also confirmed that miR194-5p and -548as-3p in up-regulated and also, miR-3158-5p, -4449 in down-regulated microRNAs are significantly important molecules in rejection. CONCLUSION: Finally, the tissue levels of specific miRNAs (especially hsa-miR-3158-5p, -4449, -194-5p and -548as-3p) significantly correlated with the development of HCC, which can be present as biomarkers after further completing studies.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , MicroRNAs , Biomarcadores Tumorais/genética , Carcinoma Hepatocelular/genética , Carcinoma Hepatocelular/cirurgia , Perfilação da Expressão Gênica , Regulação Neoplásica da Expressão Gênica , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/cirurgia , MicroRNAs/genética , Transcriptoma
9.
Int J Surg ; 90: 105979, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34077810

RESUMO

BACKGROUND: liver lateral section graft is the most common graft type used for transplantation in children worldwide. Compared to whole liver grafts, a higher rate of biliary complications has been described. Historically, 2 techniques have been described for transection of liver - trans-hilar or trans-umbilical parenchymal transection. Though these techniques allow dividing the biliary system at two distinct positions, the usual surgical strategies do not take advantage of this advantage. MATERIAL AND METHODS: A retrospective study was conducted on 40 candidates who volunteered for donation of their left lateral liver section for transplantation, between October 2017 and April 2019. Preoperative imaging was analyzed to depict the arterial and biliary anatomy of the liver and their variations, with a dedicated attention to the left liver (segments 2, 3 and 4). Anatomy of the biliary system was taken into account for defining the optimal surgical strategy - either through a trans-hilar or a trans-umbilical parenchymal transection. RESULTS: In 26/40 patients, arterial or biliary variations were much relevant for decision-making on the optimal plane of liver division (trans-umbilical (N = 14) and trans-hilar (N = 26)). This resulted in 23 grafts with a single artery and bile duct, 6 grafts with double arteries and a single bile duct, and 9 grafts with double bile ducts and a single artery; only two grafts had complex anatomy. There was no arterial complication and the overall incidence of biliary problems was 14.7%. All grafts are functioning well at a mean follow-up of 19.6 ± 8.5 months. CONCLUSIONS: Anatomical variations are frequent and their knowledge is relevant for procurement of lateral section liver graft. Knowledge of these variation, or -better- preoperative biliary imaging is helpful in guiding parenchymal transection at procurement and preparing optimal liver grafts.


Assuntos
Variação Anatômica , Ductos Biliares/anatomia & histologia , Transplante de Fígado/métodos , Fígado/anatomia & histologia , Obtenção de Tecidos e Órgãos/métodos , Adolescente , Adulto , Artérias/anatomia & histologia , Ductos Biliares/irrigação sanguínea , Criança , Humanos , Fígado/irrigação sanguínea , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Umbigo
10.
Medicine (Baltimore) ; 100(25): e26463, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160449

RESUMO

RATIONALE: Veno-occlusive disease (VOD) is characterized by painful hepatomegaly, ascites, weight gain, and jaundice with nonthrombotic, fibrous obliteration of the centrilobular hepatic veins. VOD after liver transplantation is a rare complication, with an incidence of approximately 2%; however, it can be life-threatening in severe cases. The precise etiology and mechanism of VOD after liver transplantation remains unclear. Acute cellular rejection, antibody-mediated rejection, and treatment with tacrolimus or azathioprine may be associated with the development of VOD after liver transplantation. Additionally, the optimal treatment of VOD after liver transplantation has not yet been established and focuses on supportive care. Defibrotide is an anti-ischemic and antithrombotic drug with no systemic anticoagulant effects. Moreover, only a few reports have investigated the use of defibrotide for VOD after liver transplantation, which has shown promising results. PATIENT CONCERNS: A 39-year-old woman with primary biliary cholangitis underwent living-donor liver transplantation at our center. She experienced right upper quadrant pain with increased ascites, pleural effusion, and weight gain on postoperative day 14. DIAGNOSES: Imaging and pathological tests showed no evidence of rejection or vessel complications. VOD was diagnosed clinically based on the findings of weight gain, ascites, jaundice, and pathological biopsy. INTERVENTIONS: Defibrotid, 25 mg/kg/day, was administered intravenously for 21 days. OUTCOMES: She showed complete clinical resolution of the VOD. LESSONS: Herein, we report a case of successful defibrotide treatment of VOD after living-donor liver transplantation.


Assuntos
Rejeição de Enxerto/tratamento farmacológico , Hepatopatia Veno-Oclusiva/tratamento farmacológico , Cirrose Hepática Biliar/cirurgia , Transplante de Fígado/efeitos adversos , Polidesoxirribonucleotídeos/uso terapêutico , Adulto , Aloenxertos/patologia , Biópsia , Feminino , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/etiologia , Hepatopatia Veno-Oclusiva/diagnóstico , Hepatopatia Veno-Oclusiva/etiologia , Humanos , Fígado/patologia , Doadores Vivos , Resultado do Tratamento
11.
Medicine (Baltimore) ; 100(26): e26487, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190174

RESUMO

ABSTRACT: To evaluate the effect of preoperative serum alpha-fetoprotein(AFP) level to total tumor volume (TTV) ratio as a prognostic marker on predicting the tumor recurrence and overall survival time of patients with hepatocellular carcinoma (HCC) after liver transplantation.One-hundred eight patients with HCC who underwent liver transplantation in Beijing Chaoyang Hospital from April 2013 to October 2017 were studied. Divided into AFP/TTV≤2 group and AFP/TTV>2 group by the best cut-off score calculated by receiver operation characteristic curve, the clinical and pathological data of the patients in two groups were compared to explore the relationship between AFP/TTV and tumor recurrence together with the prognosis of HCC patients after liver transplantation. Risk factors of early tumor recurrence and poor prognosis of HCC in patients after liver transplantation were studied by multivariate regression analysis. Kaplan-Meier survival analysis was used to compare the tumor-free survival and overall survival between the two groups of patients.In 108 patients, 47 patients have AFP/TTV≤2 while 61 patients have AFP/TTV>2. Patients in AFP/TTV≤2 group have longer tumor-free survival time and overall survival time compared with patients in AFP/TTV>2 group. The age, total bilirubin level, serum AFP level, TTV, portal vein tumor thrombus and AFP/TTV (all P < .05) of patient with HCC are closely related to poor prognosis after liver transplantation. Multivariate regression analysis showed that have portal vein tumor thrombus (hazard ratio [HR] = 2.345, P < .05), TTV≥65.5 cm3 (HR = 2.701, P < .05) and AFP/TTV > 2 (HR = 4.624, P < .05) are independent risk factors for poor prognosis of patients with HCC after liver transplantation while TTV≥65.5 cm3 (HR = 2.451, P < .05) and AFP/TTV > 2 (HR = 4.257, P < 0.05) were independent risk factors for tumor recurrence at the same time.The tumor recurrence and the prognosis of patients with HCC after liver transplantation is affected by many factors. AFP/TTV ratio has important predictive value for the tumor recurrence and the prognosis of patients with HCC after liver transplantation. AFP/TTV>2 is an independent risk factor for both early tumor recurrence and poor prognosis of patients with HCC after liver transplantation.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , Recidiva Local de Neoplasia , Veia Porta , alfa-Fetoproteínas/análise , Biomarcadores Tumorais/sangue , Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Testes de Função Hepática/métodos , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Valor Preditivo dos Testes , Prognóstico , Medição de Risco/métodos , Fatores de Risco , Carga Tumoral
12.
Medicine (Baltimore) ; 100(23): e26187, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115002

RESUMO

ABSTRACT: Cosmetic appearance is a major concern for living donors. However, little is known about the impact of a surgical scar on body image changes in living liver donors. The aim of this study was to identify potential factors that cause displeasing upper midline incision scar, and to evaluate the overall satisfaction regarding body image and scarring after living donor hepatectomy.Donors who underwent right lobe hepatectomy were recruited. Exclusion criteria included reoperation, refusal to participate, and lost follow-up. All donors were invited to complete the Vancouver Scar Scale (VSS) and the body image questionnaire. According to the VSS results of upper midline incision scar, donors were divided into 2 groups: good scarring group (VSS ≤4) and bad scarring group (VSS >4). we compared the clinical outcomes, including the demographics, preoperation, intraoperation, and postoperation variables. The study also analyzed the results of the body image questionnaire.The proportion of male donors was 48.9%. The bad scarring group consisted of 63% of the donors. On multivariate analysis, being a male donor was found to be an independent predictor of a cosmetically displeasing upper midline incision scar with statistical significance. The results of body image questionnaires, there were significant differences in cosmetic score and confidence score among the 2 groups.The upper midline incision and male donors have higher rates of scarring in comparison with the transverse incision and female donors. Donors who reported having a higher satisfaction with their scar appearance usually had more self-confidence. However, the body image won't be affected. Medical staff should encourage donors to take active participation in wound care and continuously observe the impact of surgical scars on psychological changes in living liver donors.


Assuntos
Cicatriz/etiologia , Transplante de Fígado/efeitos adversos , Satisfação do Paciente , Ferida Cirúrgica/complicações , Doadores de Tecidos/psicologia , Adulto , Imagem Corporal/psicologia , Distribuição de Qui-Quadrado , Cicatriz/psicologia , Estudos Transversais , Feminino , Humanos , Transplante de Fígado/psicologia , Transplante de Fígado/normas , Doadores Vivos/psicologia , Doadores Vivos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Psicometria/instrumentação , Psicometria/métodos , Ferida Cirúrgica/psicologia , Inquéritos e Questionários , Doadores de Tecidos/estatística & dados numéricos
13.
Medicine (Baltimore) ; 100(22): e26218, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087899

RESUMO

ABSTRACT: This study evaluated the severe hepatic outcome (SHO) in patients with schizophrenia and viral hepatitis who received antipsychotics.Using the nationwide Taiwan National Health Insurance Research Database, patients first diagnosed with schizophrenia between 2002 and 2013 were identified. Patients diagnosed with schizophrenia who had viral hepatitis, including hepatitis B virus (HBV) or hepatitis C virus (HCV), were designated as the viral hepatitis group. A control group without viral hepatitis was matched for age, sex, and index year in a 2:1 ratio. Patients with severe hepatic outcomes before enrollment were excluded. The 2 cohorts were observed until December 31, 2013. The primary endpoint was occurrence of a SHO, including liver cancer, liver failure, liver decompensation, or transplantation.Among the 16,365 patients newly diagnosed with schizophrenia between January 2002 and December 2013, we identified 614 patients with viral hepatitis and 1228 matched patients without viral hepatitis. Of these 1842 patients, 41 (2.22%) developed SHOs, including 26 (4.23%) in the viral hepatitis group and 15 (1.22%) in the control group, during the mean follow-up period of 3.71 ±â€Š2.49 years. Cox proportional hazard analysis indicated that the SHO risk increased by 3.58 (95% confidence interval [CI]: 1.859-6.754; P < .001) in patients with schizophrenia and viral hepatitis. Moreover, patients with schizophrenia having HCV had a higher SHO risk than those without viral hepatitis (hazard ratio: 5.07, 95% CI: 1.612-15.956; P < .0001). Patients having both schizophrenia and viral hepatitis, especially HCV, had a higher risk of SHOs.


Assuntos
Antipsicóticos/efeitos adversos , Hepatite B/psicologia , Hepatite C/psicologia , Palmitato de Paliperidona/uso terapêutico , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Estudos de Casos e Controles , Feminino , Seguimentos , Hepacivirus/isolamento & purificação , Hepatite B/complicações , Hepatite B/epidemiologia , Vírus da Hepatite B/isolamento & purificação , Hepatite C/complicações , Hepatite C/epidemiologia , Humanos , Falência Hepática/induzido quimicamente , Falência Hepática/metabolismo , Neoplasias Hepáticas/induzido quimicamente , Neoplasias Hepáticas/metabolismo , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Palmitato de Paliperidona/efeitos adversos , Prevalência , Modelos de Riscos Proporcionais , Fatores de Risco , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Taiwan/epidemiologia
14.
Front Immunol ; 12: 535012, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34093514

RESUMO

Rejection after organ transplantation is a cause of graft failure. Effectively reducing rejection and inducing tolerance is a challenge in the field of transplantation immunology. The liver, as an immunologically privileged organ, has high rates of spontaneous and operational tolerance after transplantation, allowing it to maintain its normal function for long periods. Although modern immunosuppression regimens have serious toxicity and side effects, it is very risky to discontinue immunosuppression regimens blindly. A more effective treatment to induce immune tolerance is the most sought-after goal in transplant medicine. Tregs have been shown to play a pivotal role in the regulation of immune balance, and infusion of Tregs can also effectively prevent rejection and cure autoimmune diseases without significant side effects. Given the immune characteristics of the liver, the correct use of Tregs can more effectively induce the occurrence of operational tolerance for liver transplants than for other organ transplants. This review mainly summarizes the latest research advances regarding the characteristics of the hepatic immune microenvironment, operational tolerance, Treg generation in vitro, and the application of Tregs in liver transplantation. It is hoped that this review will provide a deeper understanding of Tregs as the most effective treatment to induce and maintain operational tolerance after liver transplantation.


Assuntos
Pesquisa Biomédica/métodos , Tolerância Imunológica/imunologia , Transplante de Fígado/métodos , Linfócitos T Reguladores/imunologia , Imunologia de Transplantes/imunologia , Tolerância ao Transplante/imunologia , Pesquisa Biomédica/tendências , Previsões , Rejeição de Enxerto/imunologia , Humanos , Fígado/imunologia
15.
World J Gastroenterol ; 27(20): 2576-2585, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: covidwho-1256683

RESUMO

Starting from December 2019 the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has extended in the entire world giving origin to a pandemic. Although the respiratory system is the main apparatus involved by the infection, several other organs may suffer coronavirus disease 2019 (COVID-19)-related injuries. The human tissues expressing angiotensin-converting enzyme 2 (ACE2) are all possible targets of viral damage. In fact myocarditis, meningo-encephalitis, acute kidney injury and other complications have been described with regard to SARS-CoV-2 infection. The liver has a central role in the body homeostasis contributing to detoxification, catabolism and also synthesis of important factor such as plasma proteins. ACE2 is significantly expressed just by cholangiocytes within the liver, however transaminases are increased in more than one third of COVID-19 patients, at hospital admission. The reasons for liver impairment in the course of this infection are not completely clear at present and multiple factors such as: Direct viral effect, release of cytokines, ischemic damage, use of hepatotoxic drugs, sepsis, and others, may contribute to damage. While COVID-19 seems to elicit just a transient alteration of liver function tests in subjects with normal hepatic function, of concern, more severe sequelae are frequently observed in patients with a reduced hepatic reserve. In this review we report data regarding SARS-CoV-2 infection in subjects with normal or diseased liver. In addition the risks of COVID-19 in immunosuppressed patients (either transplanted or suffering for autoimmune liver diseases) are also described.


Assuntos
COVID-19 , Transplante de Fígado , Humanos , Fígado , Peptidil Dipeptidase A , SARS-CoV-2
16.
Transplant Proc ; 53(5): 1541-1547, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34074467

RESUMO

BACKGROUND: Acute kidney injury (AKI) is common after liver transplantation (LT). Induction with interleukin-2 receptor antagonists is often used as a "renal-sparing" strategy. The aim of this study was to assess this approach in a real-world setting in an LT center. METHODS: A retrospective cohort analysis of LTs between 2011 and 2018 was performed to assess the impact of a renal-sparing strategy using basiliximab in conjunction with mycophenolate mofetil and corticosteroids from day 0 post-LT along with delayed introduction of tacrolimus. This was compared with a group receiving tacrolimus, mycophenolate mofetil, and corticosteroids from the outset. RESULTS: The renal-sparing regimen was associated with significantly lower incidence of all-stage AKI at day 7 post-LT (36% vs 55%, P = .006) and less decline in renal function at 3 months (39% vs 57%, P = .01). No further significant differences in renal outcomes were observed at other time points on follow-up to 1 year post-LT. There was no significant difference in the incidence of acute cellular rejection, inpatient length of stay or graft survival. The decision to adopt a renal-sparing regimen was predominantly made on a clinically reactive basis within the first 24 hours post-LT in 77%, and was preordained in 23%. Cost-effectiveness analysis did not find evidence of a significant cost saving when using a renal-sparing strategy. CONCLUSION: This study provides real-world analysis of the use of a renal-sparing immunosuppression regimen in LT. Although improvements in incidence of AKI in the short term were demonstrated, this did not translate to cost savings or improved renal outcomes after 3 months.


Assuntos
Injúria Renal Aguda/prevenção & controle , Basiliximab/administração & dosagem , Imunossupressores/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Tacrolimo/administração & dosagem , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Corticosteroides/administração & dosagem , Adulto , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Imunossupressão/métodos , Incidência , Rim/efeitos dos fármacos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
17.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(2): 239-244, 2021 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-34137229

RESUMO

To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (=-2.31, <0.05). Glucocorticoid therapy (=4.054, <0.01), FK506 drug concentration in the first week after operation (=3.482, <0.05) and sTG (=3.156, <0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72. TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.


Assuntos
Diabetes Mellitus , Transplante de Fígado , China/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Humanos , Transplante de Fígado/efeitos adversos , Fatores de Risco , Tacrolimo/efeitos adversos , Triglicerídeos
18.
Ethiop J Health Sci ; 31(2): 429-438, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34158795

RESUMO

Background: This systematic review is conducted to explore available information on clinical presentations, laboratory finding and outcomes of SARS-COV-2 in liver transplant patients. Methods: We searched four databases for relevant terms related to COVID-19 and liver transplantation and collected both case reports and case series on liver transplantation published up to the end of September 2020. Results: After initial screening of irrelevant articles, 25 studies were included and analyzed in this review. Among the 59 patients included, 78.3% were over 50 years old, and 71.6% were males. The majority of patients (93.3%) were hospitalized. The most common presenting symptoms were fever (72.9%) followed by dyspnea and cough (54.2%). The majority of patients revealed a high level of CRP (64.3%). Moreover, high level ALT, AST and ALP were reported in 64.3, 37.5, 30.5 and 22.2% of patients. A total, 9(15.3%), of cases died as a result of complications of COVID-19. Chest radiographs were reported in 72.9%(43/59) of cases that 94% demonstrated radiologic evidence of abnormality. Conclusion: The results demonstrated that the most prevalent symptoms and signs were fever, dyspnea and cough. Moreover, most patients were males and hospitalized. The rate of mortality and high level of CRP, ALT/AST and ALP is similar within the non-immune suppressed and general population. However, early detection of high level of serum CRP, ALT/AST and ALP combined with a clinical COVID-19 symptom and finding of CT scan may be used as an index for the presence and severity of the disease.


Assuntos
COVID-19/diagnóstico , Transplante de Fígado , SARS-CoV-2/isolamento & purificação , COVID-19/complicações , Teste de Ácido Nucleico para COVID-19 , Feminino , Febre , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Via Transcriptase Reversa
19.
Chirurgia (Bucur) ; 116(3): 339-346, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1289368

RESUMO

Introduction: There are still debatable facts about estimating the risk and severity of coronavirus disease (COVID-19) in liver transplant recipients, as well as assessing the impact of the immunosuppressive therapy on the clinical course and incidence of liver failure. Material and Methods: We present a prospective study of liver transplant recipients with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection admitted for treatment to the department of First Clinic of Abdominal Surgery, Military Medical Academy, Sofia during 25.11.2020 04.01.2021. The diagnosis is confirmed by a positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection from a naso-pharyngeal swab. COVID-19 severity is estimated as mild (oxygen saturation (SpO2) 94% on room air and no imaging findings of pneumonia), moderate (SpO2 94%, imaging suggestive of pneumonia), and severe (need for high flow oxygen supplementation). Results: Three liver transplant recipients with COVID-19 were admitted and treated in our department during 25.11.2020 04.01.2021. All of them were male, mean age of 51.33 years (47 - 59) and their liver transplantations were performed 13, 5, and 1.5 years before. In each of the three patients a different clinical form of the disease was registered mild (n=1), moderate (n=1), and severe (n=1). Only the patient with severe disease had comorbidities - hypertension, diabetes, and obesity. The patients with mild and moderate disease received dual immunosuppressive therapy with tacrolimus and mycophenolate mofetil while the one with severe disease - tacrolimus only. A dose reduction of tacrolimus was undertaken following serum level evaluation without changing the dose of the mycophenolate mofetil for those on dual therapy. The patient with severe disease died from respiratory failure leading to a case fatality rate of 33.3%. Conclusion: Early diagnosis and hospitalization where possible are essential for the prompt initiation of treatment, prevention of complications and development of severe forms of COVID-19 in liver transplant recipients, especially in patients with comorbidities such as hypertension, diabetes, and obesity. During the course of treatment there may be a dose reduction of the immunosuppressive therapy but not discontinuation, especially of the calcineurin inhibitor in mono- or dual-therapy regimens.


Assuntos
COVID-19 , Transplante de Fígado , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , SARS-CoV-2 , Resultado do Tratamento
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