Decision making in liver transplantation-Limited application of the liver donor risk index

PURPOSE: To analyze mortality (7 days) or graft loss in liver transplantation (Tx) performed within the Awakening Protocol (AP) compared to sequential Tx. METHODS: Analysis of 243 liver tx (230 patients), divided into sequential tx or PD (early morning) to compare graft loss or death (7 days). Significant differences at p <0.05 RESULTS: The PD was adopted in 32.5% of tx. The cold ischemia time (p <0.01) and the interval until transplantation (p <0.01) were significantly different. Age of the donor and recipient, Donor Risk Index, MELD score, and donor base excess, sodium, creatinine and glucose were not different between groups. Previous abdominal surgery was a risk factor for early mortality, but was equally distributed between the groups. There was no difference in mortality or graft loss within 7 days (p = 0.521) CONCLUSION: The adoption of PD, to start tx the morning when harvesting occurs after 10p.m. did not result in worse patient and graft survival. Transplant patients with fulminant hepatic failure and high-risk grafts do not apply to this surgical tactics.

Download Full-text

Liver transplantation: a 10-year single center experience in Pernambuco- northeastern Brazil

Brazilian Journal of Transplantation ◽

10.53855/bjt.v13i2.227 ◽

2010 ◽

Vol 13 (2) ◽

pp. 1288-1292

Author(s):

Luiz Eduardo C. Miranda ◽

Paulo Sérgio Vieira de Melo ◽

Diego Laurentino Lima ◽

Bernardo Sabat ◽

Américo Gusmão Amorim ◽

...

Keyword(s):

Liver Transplantation ◽

Survival Curve ◽

Deceased Donor ◽

Conventional Technique ◽

University Hospital ◽

Northeastern Brazil ◽

Organ Shortage ◽

Single Center ◽

Liver Donor ◽

Single Center Experience

Purpose: The aim of this study is to analyze a ten-year single center experience in liver transplantation in Pernambuco - Northeastern region of Brazil. Methods: Data were retrospectively collected from medical records of 302 patients who underwent Orthotopic Liver Transplantation (OLT) between 1998 and 2008 at Oswaldo Cruz University Hospital, Pernambuco – Brazil. We analyzed just the outcomes and survival curve of 195 adult liver transplantation recipients from deceased donor. Results: Data concern liver donor, surgery technical aspects and liver transplantation recipients’ postoperative evolution are presented and discussed. This center has a significant experience in liver transplantation using conventional technique with no venovenous bypass. Efficient management of liver transplantation practice has made it feasible to keep the cold ischemia time within 6-7 hours. Because of the organ shortage, we have used a large amount of extended criteria liver donor. The survival 1-year rata was 76.4%. Conclusion: It is possible to provide a high-quality public medical assistance in an efficient and continuous manner in less developed areas of Brazil.

Download Full-text

Serological Risk Index Based on Alpha-Fetoprotein and C-Reactive Protein to Indicate Futile Liver Transplantation Among Patients with Advanced Hepatocellular Carcinoma

Digestive Diseases and Sciences ◽

10.1007/s10620-018-5296-9 ◽

2018 ◽

Vol 64 (1) ◽

pp. 269-280

Author(s):

Arno Kornberg ◽

Martina Schernhammer ◽

Jennifer Kornberg ◽

Helmut Friess ◽

Katharina Thrum

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Risk Index ◽

Alpha Fetoprotein ◽

Advanced Hepatocellular Carcinoma ◽

C Reactive Protein ◽

Reactive Protein

Download Full-text

Malaria Vulnerability Map Mobile System Development Using GIS-Based Decision-Making Technique

Mobile Information Systems ◽

10.1155/2018/8436210 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9

Author(s):

Jung-Yoon Kim ◽

Sung-Jong Eun ◽

Dong Kyun Park

Keyword(s):

Decision Making ◽

System Development ◽

Risk Index ◽

Malaria Risk ◽

Web Based ◽

Risk Calculation ◽

Database Construction ◽

Visual Expression ◽

Control And Prevention ◽

Vulnerability Map

This paper aimed at improving the lack of GIS information use and compatibility of multiplatform which represented limits that existing malaria risk analysis tools had. For this, the author developed mobile web-based malaria vulnerability map system using GIS information. This system consists of system database construction, malaria risk calculation function, visual expression function, and website and mobile application. This system was developed based on Incheon region only. Database includes information on air temperature and amount of precipitation as well. With regard to malaria risk calculation, guideline provided by Korea Centers for Disease Control and Prevention was followed first and then decision-making technique was used. Calculating criteria value for risk index made it possible to estimate more precise risk. With regard to visual expression function, database constructed earlier and risk information were linked to print out graphic map and graphs so that more intuitive and visible expression can be provided based on animation technique. This system allows a user to check information in real time and can be used anywhere anyplace. Mobile push function is to enhance user’s convenience. Such web map is useful to general users as well as experts.

Download Full-text

A Utilitarian Decision—Making Approach for Front End Design—A Systematic Literature Review

Buildings ◽

10.3390/buildings10020034 ◽

2020 ◽

Vol 10 (2) ◽

pp. 34

Author(s):

Joas Serugga ◽

Mike Kagioglou ◽

Patricia Tzortzopolous

Keyword(s):

Decision Making ◽

Literature Review ◽

Systematic Literature Review ◽

Quality Function Deployment ◽

Design Decision ◽

Visual Methods ◽

Front End ◽

Multi Attribute Utility Theory ◽

Limited Application ◽

Set Based Design

The complexity of construction processes often means interaction between various stakeholders, activities and tasks in order to deliver the expected outcomes. The intensity and dynamics of front-end design (FED) mean decision techniques and methods are important in supporting projects benefits delivery more importantly those based on utility of decision making. This paper explores a new utilitarian decision-making approach based on a systematic literature review of FED decision making. It presents the state of the art in design decision making concepts and analysis of tools over the last 10 years (2009–2019). From a total of 111 peer-reviewed journal papers, fifteen decision-making techniques are identified as dominant in design decision making, broadly grouped in four major categories as explanatory/rational, Multi Criteria Decision Making techniques (MCDM), Hybrid and Visual methods. The review finds that the most applied of the MCDM is Quality Function Deployment (QFD); while among the rational/explanatory techniques is set-based design (SBD). While there is limited application of Multi Attribute Utility Theory (MAUT) in decision making, the paper finds that the robust consistency and structured approach better captures the intricate dynamics of FED; including modelling of the subjectivity, interdependences and uncertainty in design discourse.

Download Full-text