High-priority liver transplantation and simultaneous sleeve gastrectomy in MELD 32 end-stage liver disease: a case report with long-term follow-up

We report on 43 groin herniorrhaphy operations, 18 in 18 patients with documented cirrhosis and 25 in 24 patients after liver transplantation (LT), over a 10-year period at UCLA. Average follow up was 33 months. Most patients were males (84%) with reducible inguinal hernias (70%). Child's class of cirrhotic patients was B in 66 per cent and A and C in 17 per cent each; 7 patients (39%) went on to LT. Compared with post-LT patients, patients with cirrhosis had significantly lower platelets and significantly higher bilirubin, international normalized ratio, and Model for End-stage Liver Disease scores. Mesh was used in 33 per cent of the cirrhotic group and 48 per cent of the LT group. There were four minor wound complications but no deaths, major complications, infections, or ascitic leaks in either group. Two hernias recurred in the cirrhosis group (11%) and none after LT. We conclude that with proper patient selection, groin herniorrhaphy with or without mesh is a safe and durable procedure in patients with cirrhosis and after LT. This is the first large series of groin herniorrhaphy after LT.

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The Model for End-Stage Liver Disease Score and the Follow-Up Period Can Cause the Shift of Circulating Lymphocyte Subsets in Liver Transplant Recipients

Frontiers in Medicine ◽

10.3389/fmed.2021.779443 ◽

2022 ◽

Vol 8 ◽

Author(s):

Fei Pan ◽

Shuang Cao ◽

Xian-Liang Li ◽

Ya-nan Jia ◽

Ruo-lin Wang ◽

...

Keyword(s):

Liver Disease ◽

T Cell ◽

Lymphocyte Subsets ◽

T Cell Subsets ◽

Disease Score ◽

End Stage Liver Disease ◽

Long Term Follow Up ◽

The Absolute ◽

End Stage

Little is known about the shift of lymphocytes under the condition of the model for end-stage liver disease score and the follow-up period. Then, we detected the peripheral blood from liver transplant recipients by flow cytometry and compared the results. The model for end-stage liver disease score affected the percentages of T-cell subsets and B cells during the short-term follow-up period, but failed to influence the lymphocyte subsets during the long-term follow-up period. In contrast, the follow-up period not only affected the absolute counts of T-cell subsets and natural killer (NK) cells in patients with the low model for end-stage liver disease scores, but also influenced the percentages and absolute counts of T-cell subsets in patients with the high model for end-stage liver disease scores. In the two-way ANOVA, we further revealed that the model for end-stage liver disease score was associated with the percentages of T cells and CD4+ T cells and the absolute numbers of T-cell subsets and B cells, while the follow-up period was associated with the percentages of T-cell subsets and the absolute numbers of lymphocyte subsets. Therefore, patients with either the low model for end-stage liver disease scores or the long-term follow-up period are in a relatively activated immune condition.

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Assessing the Prognostic Performance of the Child-Pugh, Model for End-Stage Liver Disease, and Albumin-Bilirubin Scores in Patients with Decompensated Cirrhosis: A Large Asian Cohort from Gastroenterology Department

Disease Markers ◽

10.1155/2020/5193028 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Si-Zhe Wan ◽

Yuan Nie ◽

Yue Zhang ◽

Cong Liu ◽

Xuan Zhu

Keyword(s):

Liver Disease ◽

Roc Curve ◽

Meld Score ◽

The Other ◽

Decompensated Cirrhosis ◽

Short Term ◽

End Stage Liver Disease ◽

End Stage

Background and Aim. Various methods, including the Child-Pugh score, the model for end-stage liver disease (MELD) score, the MELD combined with serum sodium concentration (MELD-Na) score, the integrated MELD (iMELD) score, and the albumin-bilirubin (ALBI) score, have been widely used for predicting the survival of decompensated cirrhosis (DeCi) patients. In this study, we defined and compared the prognostic value of these scores to predict mortality in DeCi patients. Methods. We performed a single-center, observational retrospective study and analyzed 456 DeCi patients who were hospitalized in the gastroenterology department. The biochemical examination results and demographic characteristics of the patients were obtained, and five scores were calculated upon admission after 24 hours. All patients were observed until death, loss to follow-up, or specific follow-up times (28 days, 90 days, and 6 months). A receiver operating characteristic (ROC) curve was used to evaluate the ability of these methods to predict mortality in DeCi patients. Results. At 28 days, 90 days, and 6 months, the cumulative number of deaths was 50 (11.0%), 76 (16.6%), and 91 (19.9%), respectively. The scores were significantly higher in nonsurviving patients than in surviving patients. All scores yielded viable values in predicting 28-day, 90-day, and 6-month prognoses for DeCi patients. The areas under the ROC curve (AUROCs) of the ALBI score were higher than those of the other scores, which were only over 0.700 at 28 days. The AUROC of the MELD score was higher than that of the other scores, including the MELD-Na and iMELD scores, at 90 days and 6 months. Conclusion. All five methods (Child-Pugh score, MELD score, MELD-Na score, iMELD score, and ALBI score) provided a reliable prediction of mortality for both the short-term and long-term prognosis of patients with DeCi. The ALBI score may be particularly useful for assessing short-term outcomes, whereas the MELD score may be particularly useful for assessing long-term outcomes.

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Medical Problems Occurring During the Long-term Follow-up after Liver Transplantation

Swiss Surgery ◽

10.1024/1023-9332.9.5.237 ◽

2003 ◽

Vol 9 (5) ◽

pp. 237-241 ◽

Cited By ~ 2

Author(s):

Demirag ◽

Bühler ◽

Majno ◽

Berney ◽

Chilcott ◽

...

Keyword(s):

Liver Transplantation ◽

Metabolic Bone Disease ◽

Long Term Results ◽

Medical Problems ◽

Metabolic Bone ◽

Long Term Follow Up ◽

End Stage ◽

Patient Survival Rate

Liver transplantation is a standardized therapy for end-stage liver disease. With current immunosuppressive protocols and patient care, ten-year patient survival rate has reached 60%. Several medical complications may develop during this period, including renal dysfunction, hypertension, diabetes mellitus, hyperlipidemia, and metabolic bone disease. The aim of this article is to analyze long-term results of several clinical trials reporting common medical dysfunctions after liver transplantation and to discuss their management.

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Liver Transplantation – A Case Report

Asian Journal of Nursing Education and Research ◽

10.52711/2349-2996.2021.00112 ◽

2021 ◽

pp. 466-472

Author(s):

Arockiaseeli Mabel Annarani. I ◽

Amalorpavamari Lucas ◽

Gnanadeepam Gnanadeepam ◽

Shirley Ann. C ◽

Christy Gunaseeli. S

Keyword(s):

Liver Transplantation ◽

Case Report ◽

Liver Disease ◽

Meld Score ◽

Blood Type ◽

End Stage Liver Disease ◽

Transplant Patients ◽

End Stage ◽

Active Alcohol ◽

Morbid Conditions

Liver transplantation is a treatment option for patients with End-stage Liver disease for whom all possible modes of surgical and medical treatment have been exhausted. The indications for Liver transplantation can be either acute or chronic liver disease. The absolute contra indications are active alcohol or substance abuse, severe cardiopulmonary or other co morbid conditions that would preclude meaningful recovery after transplant. Patients are listed on the waiting list according to their blood type and Model of End- Stage Liver Disease (MELD) score. The surgical procedure entails the excision of both donor and recipient livers and transplantation of the donor liver into the recipient (Orthotopic Liver Transplantation). This article gives an overview about liver transplantation and its management. A case report is presented and the nursing care has been discussed in detail.

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