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1.
Zhonghua Wai Ke Za Zhi ; 58(10): 737-740, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-32993257

RESUMO

Liver transplantation(LT) is the "crown" of surgery and is also an important manifestation of national medical standards. In the past half century, China has made remarkable progress in LT. Currently, China is the second largest country of LT world widely and presents an international advanced level in the efficacy of LT. However, it is notable that there are still many bottlenecks to be solved in China. In the era of precision medicine and big data, the basic research of LT is largely lagging behind and unable to meet the rapid development of clinical needs. Strengthen the basic research of LT is a breakthrough strategy in rejuvenating the country through science and technology in the new era. A high-quality professional research team should be built through multi-disciplinary cooperation and superior resources gathering. Researcher's innovative thinking and strategic vision should be cultivated via the learning of new technologies (e.g., single-cell exploration and multi-omics analysis) and new courses (e.g., transplant oncology and transplant immunology). Government investment also needs to be increased to speed up the nurturing of high-level talents and get great achievements. Basic research is the driving force for China to become a leading country in LT.


Assuntos
Pesquisa Biomédica/normas , Transplante de Fígado , China , Humanos , Invenções , Transplante de Fígado/normas
2.
Intern Emerg Med ; 15(8): 1507-1515, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32979193

RESUMO

Transplant programs have been severely disrupted by the COVID-19 pandemic. Italy was one of the first countries with the highest number of deaths in the world due to SARS-CoV-2. Here we propose a management model for the reorganization of liver transplant (LT) activities and policies in a local intensive care unit (ICU) assigned to liver transplantation affected by restrictions on mobility and availability of donors and recipients as well as health personnel and beds. We describe the solutions implemented to continue transplantation activities throughout a given pandemic: management of donors and recipients' LT program, ICU rearrangement, healthcare personnel training and monitoring to minimize mortality rates of patients on the waiting list. Transplantation activities from February 22, 2020, the data of first known COVID-19 case in Italy's Emilia Romagna region to June 30, 2020, were compared with the corresponding period in 2019. During the 2020 study period, 38 LTs were performed, whereas 41 were performed in 2019. Patients transplanted during the COVID-19 pandemic had higher MELD and MELD-Na scores, cold ischaemia times, and hospitalization rates (p < 0.05); accordingly, they spent fewer days on the waitlist and had a lower prevalence of hepatocellular carcinoma (p < 0.05). No differences were found in the provenance area, additional MELD scores, age of donors and recipients, BMI, re-transplant rates, and post-transplant mortality. No transplanted patients contracted COVID-19, although five healthcare workers did. Ultimately, our policy allowed us to continue the ICU's operations by prioritizing patients hospitalized with higher MELD without any case of transplant infection due to COVID-19.


Assuntos
Cuidados Críticos/métodos , Transplante de Fígado/métodos , Pandemias/estatística & dados numéricos , Adulto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/tendências , Aglomeração , Doença Hepática Terminal/complicações , Doença Hepática Terminal/epidemiologia , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália/epidemiologia , Transplante de Fígado/normas , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia
3.
Turk J Gastroenterol ; 31(5): 348-355, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32519953

RESUMO

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a novel acute infectious disease that has rapidly reached staggering pandemic proportions. This review addresses gastroenterologists, hepatologists, liver transplant (LT) specialists, and health-care professionals working in the field of liver diseases and liver transplantation. It has been written based on a limited number of publications, recommendations of national and international liver and organ transplantation societies, and experiences of patients with COVID-19 around the world. The purpose of this review is to provide information addressing questions and concerns about COVID-19, to reveal the effects of the novel disease on patients with chronic liver disease and LT recipients, and to share information about ways in which this pandemic will affect clinical practices. We, the Turkish Association for the Study of the Liver (TASL), would like to remind you that this text is actually not a practical guide. It is imperative to act according to the standards set by health-care institutions and the Ministry of Health, Republic of Turkey.


Assuntos
Infecções por Coronavirus/complicações , Gastroenterologia/normas , Gastroenteropatias/virologia , Transplante de Fígado/normas , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Hepatopatias/virologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Turquia/epidemiologia
5.
Arq Gastroenterol ; 57(1): 19-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294731

RESUMO

BACKGROUND: In Brazil, the Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for deceased donor liver transplantation (DDLT). Patients with hepatocellular carcinoma (HCC) receive standardized MELD exception points to account for their cancer risk of mortality, which is not reflected by their MELD score. OBJECTIVE: To compare DDLT rates between patients with and without HCC in Rio Grande do Sul, the Southernmost state of Brazil. METHODS: - We retrospectively studied 825 patients on the liver-transplant waiting list from January 1, 2007, to December 31, 2016, in a transplant center located in Porto Alegre, the capital of Rio Grande do Sul, to compare DDLT rates between those with and without HCC. The time-varying hazard of waiting list/DDLT was estimated, reporting the subhazard ratio (SHR) of waiting list/DDLT/dropout with 95% confidence intervals (CI). The final competing risk model was adjusted for age, MELD score, exception points, and ABO group. RESULTS: Patients with HCC underwent a transplant almost three times faster than patients with a calculated MELD score (SHR 2.64; 95% CI 2.10-3.31; P<0.001). The DDLT rate per 100 person-months was 11.86 for HCC patients vs 3.38 for non-HCC patients. The median time on the waiting list was 5.6 months for patients with HCC and 25 months for patients without HCC. CONCLUSION: Our results demonstrated that, in our center, patients on the waiting list with HCC have a clear advantage over candidates listed with a calculated MELD score.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/estatística & dados numéricos , Listas de Espera , Idoso , Brasil , Carcinoma Hepatocelular/mortalidade , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/normas , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
6.
Transplantation ; 104(6): e164-e173, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32150036

RESUMO

BACKGROUND: Patients with nonalcoholic steatohepatitis (NASH) are waitlisted at older ages than individuals with other liver diseases, but the effect of age on liver transplantation (LT) outcomes in this population and whether it differs from other etiologies is not known. We aimed to evaluate the impact of age on LT outcomes in NASH. METHODS: The United Network for Organ Sharing database was used to identify adults with NASH, hepatitis C virus (HCV) infection, and alcohol-related liver disease (ALD) listed for LT during 2004-2017. Patients were split into age groups (18-49, 50-54, 55-59, 60-64, 65-69, ≥70), and their outcomes were compared. RESULTS: From 2004 to 2017, 14 197 adults with NASH were waitlisted, and the proportion ≥65 increased from 15.8% to 28.9%. NASH patients ages 65-69 had an increased risk of waitlist and posttransplant mortality compared to younger groups, whereas the outcomes in ages 60-64 and 55-59 were similar. The outcomes of individuals with NASH were similar to patients of the same age group with ALD or HCV. Functional status and dialysis were predictors of posttransplant mortality in individuals ≥65 with NASH, and cardiovascular disease was the leading cause of death. CONCLUSIONS: Older NASH patients (≥65) have an increased risk of waitlist and posttransplant mortality compared to younger individuals, although outcomes were similar to patients with ALD or HCV of corresponding age. These individuals should be carefully evaluated prior to LT, considering their functional status, renal function, and cardiovascular risk. Further studies are needed to optimize outcomes in this growing population of transplant candidates.


Assuntos
Doença Hepática Terminal/cirurgia , Fígado Gorduroso Alcoólico/cirurgia , Hepatite C/cirurgia , Transplante de Fígado/estatística & dados numéricos , Hepatopatia Gordurosa não Alcoólica/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Causas de Morte , Progressão da Doença , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/patologia , Fígado Gorduroso Alcoólico/mortalidade , Fígado Gorduroso Alcoólico/patologia , Feminino , Hepatite C/mortalidade , Hepatite C/patologia , Humanos , Transplante de Fígado/normas , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/mortalidade , Hepatopatia Gordurosa não Alcoólica/patologia , Seleção de Pacientes , Período Pós-Operatório , Estados Unidos/epidemiologia , Listas de Espera/mortalidade , Adulto Jovem
7.
Transplantation ; 104(6): 1125-1130, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217937

RESUMO

Liver transplantation for cholangiocarcinoma has been an absolute contraindication worldwide due to poor results. However, in recent years and thanks to improvements of patient management and treatments of this cancer, this indication has been revisited. This consensus paper, approved by the International Liver Transplant Society, aims to provide a collection of expert opinions, consensus, and best practices surrounding liver transplantation for cholangiocarcinoma.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Colangiocarcinoma/terapia , Consenso , Transplante de Fígado/normas , Oncologia/normas , Neoplasias dos Ductos Biliares/mortalidade , Quimiorradioterapia Adjuvante/métodos , Quimiorradioterapia Adjuvante/normas , Colangiocarcinoma/mortalidade , Humanos , Terapia Neoadjuvante/métodos , Terapia Neoadjuvante/normas , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Taxa de Sobrevida , Resultado do Tratamento
8.
Transplantation ; 104(6): 1136-1142, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217938

RESUMO

Liver transplantation (LT) offers excellent long-term outcome for certain patients with hepatocellular carcinoma (HCC), with a push to not simply rely on tumor size and number. Selection criteria should also consider tumor biology (including alpha-fetoprotein), probability of waitlist and post-LT survival (ie, transplant benefit), organ availability, and waitlist composition. These criteria may be expanded for live donor LT (LDLT) compared to deceased donor LT though this should not adversely affect the double equipoise in LDLT, namely ensuring both acceptable recipient outcomes and donor safety. HCC patients with compensated liver disease and minimal tumor burden have low urgency for LT, especially after local-regional therapy with complete response, and do not appear to derive the same benefit from LT as other waitlist candidates. These guidelines were developed to assist in selecting appropriate HCC patients for both deceased donor LT and LDLT.


Assuntos
Carcinoma Hepatocelular/cirurgia , Seleção do Doador/normas , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/normas , Seleção de Pacientes , Carcinoma Hepatocelular/mortalidade , Consenso , Conferências de Consenso como Assunto , Europa (Continente) , Humanos , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/métodos , Doadores Vivos , Oncologia/métodos , Oncologia/normas , Segurança do Paciente , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Estados Unidos , Listas de Espera/mortalidade
9.
Transplantation ; 104(6): 1131-1135, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217939

RESUMO

Liver transplantation (LT) for unresectable colorectal liver metastases has long been abandoned because of dismal prognoses. After the dark ages, advances in chemotherapy and diagnostic imaging have enabled strict patient selection, and the pioneering study from the Oslo group has contributed to the substantial progress in this field. For unresectable neuroendocrine liver metastases, LT for patients who met the Milan criteria was able to achieve excellent long-term outcomes. The guidelines further adopted in the United States and Europe were based on these criteria. For hepatoblastoma, patients with unresectable and borderline-resectable disease are considered good candidates for LT; however, the indications are yet to be defined. In the budding era of transplant oncology, it is critically important to recognize the current status and unsolved questions for each disease entity. These guidelines were developed to serve as a beacon of light for optimal patient selection for LT and set the stage for future basic and clinical studies.


Assuntos
Neoplasias Colorretais/patologia , Hepatoblastoma/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/normas , Tumores Neuroendócrinos/cirurgia , Neoplasias Colorretais/cirurgia , Consenso , Conferências de Consenso como Assunto , Europa (Continente) , Humanos , Neoplasias Hepáticas/secundário , Oncologia/métodos , Oncologia/normas , Tumores Neuroendócrinos/secundário , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas , Estados Unidos
10.
Transplantation ; 104(6): 1143-1149, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217940

RESUMO

Although liver transplantation (LT) is the best treatment for patients with localized hepatocellular carcinoma (HCC), recurrence occurs in 6%-18% of patients. Several factors, particularly morphological criteria combined with dynamic parameters, known before LT modify this risk and combined in prediction models may be used to stratify patients at need of variable surveillance strategies. Additional variables though likely explain differences in recurrence rates in patients with the same pre-LT HCC status. One of these variables is possibly immunosuppression (IS). Once recurrence takes place, management is highly heterogenous. Within the International Liver Transplantation Society Consensus Conference on Liver Transplant Oncology, working group 4 aim was to analyze the data regarding posttransplant management of recipients undergoing LT for HCC. Three areas of research were considered: (1) cancer prediction models and surveillance strategies; (2) tailored IS for cancer recipients; and (3) new adjuvant therapies for HCC recurrence. Following formulation of several questions, a literature search was undertaken with abstract review followed by article retrieval and full-data extraction. The grading of recommendations assessment, development and evaluation (GRADE) system was used for evidence rating incorporating strength of recommendation and quality of evidence.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/normas , Recidiva Local de Neoplasia/diagnóstico , Cuidados Pós-Operatórios/normas , Técnicas de Ablação/métodos , Técnicas de Ablação/normas , Carcinoma Hepatocelular/mortalidade , Quimiorradioterapia Adjuvante/métodos , Quimiorradioterapia Adjuvante/normas , Consenso , Conferências de Consenso como Assunto , Europa (Continente) , Humanos , Neoplasias Hepáticas/mortalidade , Transplante de Fígado/métodos , Oncologia/métodos , Oncologia/normas , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/terapia , Cuidados Pós-Operatórios/métodos , Guias de Prática Clínica como Assunto , Prognóstico , Medição de Risco , Fatores de Risco , Sociedades Médicas/normas , Resultado do Tratamento , Estados Unidos
12.
Gastroenterol. hepatol. (Ed. impr.) ; 43(3): 169-177, mar. 2020.
Artigo em Espanhol | IBECS | ID: ibc-190793

RESUMO

A pesar del consenso universal sobre la necesidad de administrar profilaxis para evitar la recurrencia de la hepatitis B después del trasplante hepático (TH), no existen hasta el momento unas recomendaciones nacionales sobre las pautas concretas para la profilaxis y el tratamiento de la infección por el virus de la hepatitis B (VHB) en el TH. El objetivo de la VII Reunión de consenso organizada por la Sociedad Española de Trasplante Hepático (SETH) fue unificar criterios y protocolos clínicos entre todas unidades de TH en España, sobre cómo prevenir y tratar la reinfección por el VHB después del TH. La evidencia y las recomendaciones de este documento se han llevado a cabo acuerdo con el sistema Grading of Recommendations Assessment Development and Evaluation (GRADE). En el presente documento se describen las recomendaciones y su grado de evidencia para: la definición de la recurrencia del VHB post-TH y sus factores de riesgo, la monitorización y la profilaxis de la recurrencia del VHB tras el TH en sus diversas etapas, el tratamiento de la hepatitis B antes y después del TH, y la profilaxis de la infección por VHB los receptores de TH con donantes anti-HBc positivo


Whilst prophylaxis of hepatitis B is universally accepted after liver transplantation (LT), national recommendations for the prophylaxis and treatment of hepatitis B virus (HBV) infection after LT are lacking in Spain. The aim of the VII consensus meeting organised by the Spanish Society of Liver Transplantation (SETH) was to set recommendations on the prophylaxis and treatment of hepatitis B after LT. The scientific evidence and strength of recommendations was evaluated by using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system. This document describes the recommendations and their level of evidence for: the definition and risk factors for hepatitis B recurrence after LT, monitoring and prophylaxis of hepatitis B recurrence at different periods after LT, treatment of hepatitis B before and after LT, and the prophylaxis of HBV infection by the recipients of LT with hepatitis B core antigen positive donors


Assuntos
Humanos , Conferências de Consenso como Assunto , Hepatite B/terapia , Transplante de Fígado/normas , Hepatite B/prevenção & controle , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Transplante de Fígado/métodos , Espanha , Fatores de Risco , Prevenção Secundária
15.
Transplantation ; 104(3): 476-481, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31634329

RESUMO

The development of multiple highly effective and safe direct-acting antivirals to treat hepatitis C virus (HCV) has resulted in greater ease and confidence in managing HCV infection in transplant recipients that in turn has impacted the solid organ transplant community as well. In the United States, the opioid epidemic has increased the number of overdose deaths with a concomitant increase in younger HCV viremic donors after brain death being identified. At the same time, a decrease in HCV viremic transplant candidates has led to a growing interest in exploring the use of HCV viremic liver and kidney donor allografts in HCV-negative recipients. To date, experience with the use of HCV viremic liver and kidney allografts in HCV-negative recipients is limited to a few small prospective research trials, case series, and case reports. There are also limited data on recipient and donor selection for HCV viremic liver and kidney allografts. In response to this rapidly changing landscape in the United States, experts in the field of viral hepatitis and liver and kidney transplantation convened a meeting to review current data on liver and kidney recipient selection and developed consensus opinions related specifically to recipient and donor selection of HCV viremic liver and kidney allografts.


Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/transmissão , Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Seleção de Pacientes , Complicações Pós-Operatórias/prevenção & controle , Aloenxertos/patologia , Aloenxertos/virologia , Antibioticoprofilaxia/normas , Biópsia , Consenso , Conferências de Consenso como Assunto , Seleção do Doador/normas , Hepacivirus/isolamento & purificação , Hepatite C Crônica/virologia , Humanos , Rim/virologia , Transplante de Rim/normas , Fígado/patologia , Fígado/virologia , Transplante de Fígado/normas , Complicações Pós-Operatórias/virologia , Transplantados , Estados Unidos , Viremia/transmissão , Viremia/virologia
16.
Transplantation ; 104(1): 113-121, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31233480

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor. Currently, liver transplantation may be the optimal treatment for HCC in cirrhotic patients. Patient selection is currently based on tumor size. We developed a program to offer liver transplantation to selected patients with HCC outside of traditional criteria. METHODS: Retrospective review for patients transplanted with HCC between April 2008 and June 2017. Patients were grouped by tumor size according to Milan, University of California San Francisco (UCSF), and outside UCSF criteria. Patient demographics, laboratory values, and outcomes were compared. Patients radiographically outside Milan criteria were selected based on tumor control with locoregional therapy (LRT) and 9 months of stability from LRT. α-fetoprotein values were not exclusionary. RESULTS: Two hundred twenty HCC patients were transplanted, 138 inside Milan, 23 inside UCSF, and 59 beyond UCSF criteria. Patient survival was equivalent at 1, 3, or 5 years despite pathologic tumor size. Waiting time to transplantation was not significantly different at an average of 344 days. In patients outside UCSF, tumor recurrence was equivalent to Milan and UCSF criteria recipients who waited >9 months from LRT. Although tumor recurrence was more likely in outside of UCSF patients (3% versus 9% versus 15%; P = 0.02), recurrence-free survival only trended toward significance among the groups (P = 0.053). CONCLUSIONS: Selective patients outside of traditional size criteria can be effectively transplanted with equivalent survival to patients with smaller tumors, even when pathologic tumor burden is considered. Tumor stability over time can be used to help select patients for transplantation.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Transplante de Fígado/normas , Recidiva Local de Neoplasia/epidemiologia , Seleção de Pacientes , Técnicas de Ablação/métodos , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Quimioterapia Adjuvante/métodos , Progressão da Doença , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco , Sorafenibe/uso terapêutico , Fatores de Tempo , Carga Tumoral
17.
Transplantation ; 104(7): 1413-1418, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31644488

RESUMO

BACKGROUND: The vast majority of patients with cirrhosis have low Model for End-Stage Liver Disease-Sodium (MELD-Na) scores; however, the ability for the MELD-Na score to predict patient outcomes at low scores is unclear. METHODS: Adult patients in a multicenter, Chicago-wide database of medical records with International Classification of Disease, Ninth Edition codes of cirrhosis and without a history of hepatocellular carcinoma were included. Records were linked with the state death registry, and death certificates were manually reviewed. Deaths were classified as "liver-related," "non-liver-related," and "non-descript" as adjudicated by a panel comprised of a transplant surgeon, a hepatologist, and an internist. A sensitivity analysis was performed where patients with hepatocellular carcinoma were included. RESULTS: Among 7922 identified patients, 3999 patients had MELD-Na scores that were never higher than 15. In total, 2137 (27%) patients died during the study period with higher mortality rates for the patients in the high MELD-Na group (19.4 (41.6%) versus 4.1 (12.6%) per 100 person-y, P < 0.001). The high MELD-Na group died of a liver-related cause in 1142 out of 1632 (70%) as compared to 240 out of 505 (47.5%) deaths in the low MELD-Na group. There was no difference in the distribution of subcategory of liver-related death between low and high MELD-Na groups. Among subclassification of liver-related deaths, the most common cause of death was "Infectious" in both groups. CONCLUSIONS: Despite persistently low MELD-Na scores, patients with cirrhosis still experience high rates of liver-related mortality.


Assuntos
Doença Hepática Terminal/mortalidade , Cirrose Hepática/mortalidade , Índice de Gravidade de Doença , Sódio/sangue , Listas de Espera/mortalidade , Adulto , Idoso , Causas de Morte , Chicago/epidemiologia , Atestado de Óbito , Progressão da Doença , Doença Hepática Terminal/sangue , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/patologia , Feminino , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Transplante de Fígado/normas , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prognóstico , Medição de Risco/estatística & dados numéricos , Fatores de Tempo
18.
Transplantation ; 104(7): 1396-1402, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31651793

RESUMO

BACKGROUND: Model for End-Stage Liver Disease (MELD) score-based liver transplant allocation was implemented as a fair and objective measure to prioritize patients based upon disease severity. Accuracy and reproducibility of MELD is an essential assumption to ensure fairness in organ access. We hypothesized that variability in laboratory methodology between centers could impact allocation scores for individuals on the transplant waiting list. METHODS: Aliquots of 30 patient serum samples were analyzed for creatinine, bilirubin, and sodium in all transplant centers within United Network for Organ Sharing (UNOS) region 9. Descriptive statistics, intraclass correlation coefficients (ICCs), and linear mixed-effects regression were used to determine the relationship between center, bilirubin, and calculated MELD-sodium (MELD-Na) score. RESULTS: The mean MELD-Na score per sample ranged from 14 to 38. The mean range in MELD-Na per sample was 3 points, but 30% of samples had a range of 4-6 points. Correlation plots and intraclass correlation coefficient analysis confirmed bilirubin interfered with creatinine, with worsening agreement in creatinine at high bilirubin levels. Center and bilirubin were independently associated with creatinine reported in mixed-effects models. Unbiased hierarchical clustering suggested that samples from specific centers have consistently higher creatinine and MELD-Na values. CONCLUSIONS: Despite implementation of creatinine standardization, centers within a single UNOS region report clinically significant differences in MELD-Na on an identical sample, with differences of up to 6 points in high MELD-Na patients. The bias in MELD-Na scores based upon center choice within a region should be addressed in the current efforts to eliminate disparities in liver transplant access.


Assuntos
Doença Hepática Terminal/diagnóstico , Transplante de Fígado/normas , Alocação de Recursos/normas , Índice de Gravidade de Doença , Centros de Atenção Terciária/normas , Aloenxertos/provisão & distribução , Bilirrubina/sangue , Serviços de Laboratório Clínico/normas , Creatinina/sangue , Definição da Elegibilidade/normas , Doença Hepática Terminal/sangue , Humanos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Padrões de Referência , Reprodutibilidade dos Testes , Sódio/sangue , Estados Unidos , Listas de Espera
19.
Biomed Res Int ; 2019: 6467134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31828112

RESUMO

For several years, research has been carried out on the effectiveness of solutions for perfusion and preservation of organs, including the liver. There is a search for an optimal pharmacological composition of these solutions, allowing to preserve or improve vital functions of the organ for as long as possible until it is transplanted into a recipient. Hormones due to their properties, often resulting from their pleiotropic effects, may be a valuable component for optimizing the composition of liver perfusion and preservation solutions. The paper presents the current state of knowledge on liver perfusion and preservation solutions modified with hormones. It also shows the characteristics of the hormones evaluated, taking into account their physiological functions in the body.


Assuntos
Hormônios/farmacologia , Fígado/efeitos dos fármacos , Soluções para Preservação de Órgãos/farmacologia , Traumatismo por Reperfusão/prevenção & controle , Animais , Dopamina/farmacologia , Glucagon/farmacologia , Hormônios/química , Humanos , Transplante de Fígado/normas , Melatonina/farmacologia , Soluções para Preservação de Órgãos/química , Prolactina/farmacologia , Sobrevivência de Tecidos/efeitos dos fármacos
20.
World J Gastroenterol ; 25(47): 6799-6812, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31885421

RESUMO

Liver transplantation (LT) remains the best option for patients with end-stage liver disease but the demand for organs from deceased donors continues to outweigh the available supply. The advent of highly effective anti-viral treatments has reduced the number of patients undergoing LT for hepatitis C (HCV) and hepatitis B (HBV) related liver disease and yet the number of patients waiting for LT continues to increase, driven by an increase in the patients listed with a diagnosis of cirrhosis due to non-alcoholic steatohepatitis and alcohol-related liver disease. In addition, human immunodeficiency virus (HIV) infection, which was previously a contra-indication for LT, is no longer a fatal disease due to the effectiveness of HIV therapy and patients with HIV and liver disease are now developing indications for LT. The rising demand for LT is projected to increase further in the future, thus driving the need to investigate potential means of expanding the pool of potential donors. One mechanism for doing so is utilizing organs from donors that previously would have been discarded or used only in exceptional circumstances such as HCV-positive, HBV-positive, and HIV-positive donors. The advent of highly effective anti-viral therapy has meant that these organs can now be used with excellent outcomes in HCV, HBV or HIV infected recipients and in some cases uninfected recipients.


Assuntos
Seleção do Doador/normas , Doença Hepática Terminal/cirurgia , Transplante de Fígado/normas , Aloenxertos/efeitos dos fármacos , Aloenxertos/provisão & distribução , Aloenxertos/virologia , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/transmissão , Soropositividade para HIV/virologia , Hepatite B/tratamento farmacológico , Hepatite B/transmissão , Hepatite B/virologia , Hepatite C/tratamento farmacológico , Hepatite C/transmissão , Hepatite C/virologia , Humanos
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