Transarterial chemoembolization of hepatocellular carcinoma before liver transplantation and risk of post-transplant vascular complications: a multicentre observational cohort and propensity score-matched analysis

2021 ◽  
Author(s):  
D Sneiders ◽  
A P C S Boteon ◽  
J Lerut ◽  
S Iesari ◽  
N Gilbo ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Propensity Score ◽  
Hepatic Artery ◽  
Transarterial Chemoembolization ◽  
Vascular Complications ◽  
Hepatocellular Cancer ◽  
Matched Cohort ◽  
Increased Risk ◽  
Observational Cohort ◽  
Tace Treatment

Abstract Background Transarterial chemoembolization (TACE) in patients with hepatocellular cancer (HCC) on the waiting list for liver transplantation may be associated with an increased risk for hepatic artery complications. The present study aims to assess the risk for, primarily, intraoperative technical hepatic artery problems and, secondarily, postoperative hepatic artery complications encountered in patients who received TACE before liver transplantation. Methods Available data from HCC liver transplantation recipients across six European centres from January 2007 to December 2018 were analysed in a 1 : 1 propensity score-matched cohort (TACE versus no TACE). Incidences of intraoperative hepatic artery interventions and postoperative hepatic artery complications were compared. Results Data on postoperative hepatic artery complications were available in all 876 patients (425 patients with TACE and 451 patients without TACE). Fifty-eight (6.6 per cent) patients experienced postoperative hepatic artery complications. In total 253 patients who had undergone TACE could be matched to controls. In the matched cohort TACE was not associated with a composite of hepatic artery complications (OR 1.73, 95 per cent c.i. 0.82 to 3.63, P = 0.149). Data on intraoperative hepatic artery interventions were available in 825 patients (422 patients with TACE and 403 without TACE). Intraoperative hepatic artery interventions were necessary in 69 (8.4 per cent) patients. In the matched cohort TACE was not associated with an increased incidence of intraoperative hepatic artery interventions (OR 0.94, 95 per cent c.i. 0.49 to 1.83, P = 0.870) Conclusion In otherwise matched patients with HCC intended for liver transplantation, TACE treatment before transplantation was not associated with higher risk of technical vascular issues or hepatic artery complications.

Major depressive disorder increased risk of psoriasis: A propensity score matched cohort study

2021 ◽  
Vol 278 ◽  
pp. 407-412 ◽  
Author(s):  
Yi-Hsien Chen ◽  
Wei-Ming Wang ◽  
I-Hsun Li ◽  
Hui-Han Kao ◽  
Chin-Bin Yeh ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Cohort Study ◽  
Propensity Score ◽  
Depressive Disorder ◽  
Matched Cohort ◽  
Major Depressive ◽  
Matched Cohort Study ◽  
Increased Risk

Microscope-Assisted Arterial Anastomosis in Adult Living Donor Liver Transplantation: A Systematic Review and Meta-analysis of Outcomes

2021 ◽  
Author(s):  
Peggy J. Ebner ◽  
Katherine J. Bick ◽  
Juliet Emamaullee ◽  
Eloise W. Stanton ◽  
Daniel J. Gould ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Hepatic Artery ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Meta Analysis ◽  
Case Series ◽  
Vascular Complications ◽  
Donor Liver ◽  
Donor Liver Transplantation

Abstract Background Living donor liver transplantation (LDLT) has expanded the availability of liver transplant but has been associated with early technical complications including the devastating complication of hepatic artery thrombosis (HAT), which has been reported to occur in 14% to 25% of LDLT using standard anastomotic techniques. Microvascular hepatic artery reconstruction (MHAR) has been implemented in an attempt to decrease rates of HAT. The purpose of this study was to review the available literature in LDLT, specifically related to MHAR to determine its impact on rates of posttransplant complications including HAT. Methods A systematic review was conducted using PubMed/Medline and Web of Science. Case series and reviews describing reports of microscope-assisted hepatic artery anastomosis in adult patients were considered for meta-analysis of factors contributing to HAT. Results In all, 462 abstracts were screened, resulting in 20 studies that were included in the meta-analysis. This analysis included 2,457 patients from eight countries. The pooled rate of HAT was 2.20% with an overall effect size of 0.00906. Conclusion Systematic literature review suggests that MHAR during LDLT reduces vascular complications and improves outcomes posttransplant. Microvascular surgeons and transplant surgeons should collaborate when technical challenges such as small vessel size, short donor pedicle, or dissection of the recipient vessel wall are present.

scholarly journals Cancer After Spinal Fusion

Neurosurgery ◽  
2013 ◽  
Vol 73 (3) ◽  
pp. 440-449 ◽  
Author(s):  
Shivanand P. Lad ◽  
Jacob H. Bagley ◽  
Isaac O. Karikari ◽  
Ranjith Babu ◽  
Beatrice Ugiliweneza ◽  
...  
Keyword(s):  
Propensity Score ◽  
Benign Tumor ◽  
Treated Group ◽  
Benign Tumors ◽  
High Dose ◽  
Matched Cohort ◽  
Covariate Balance ◽  
Increased Risk ◽  
Before And After ◽  
Risk Of Cancer

Abstract BACKGROUND: Bone morphogenetic protein (BMP) is used in tens of thousands of spinal fusions each year. A trial evaluating a high-dose BMP formulation demonstrated that its use may be associated with an increased risk of cancer. OBJECTIVE: To evaluate whether BMP, as commonly used today, is associated with an increased risk of cancer or benign tumors. METHODS: We performed a retrospective study using the Thomson Reuter MarketScan database. We retained all patients who had no previous diagnosis of cancer or benign tumor and had at least 2 years of uninterrupted enrollment in the database before and after their operations. A propensity score--matched cohort was created to ensure greater covariate balance between treatment groups. RESULTS: Within the propensity score--matched cohort (n = 4698), BMP-exposed patients had a nonsignificant increase in the rate of cancer diagnosis (9.37% vs 7.92%; P = .08). After adjustment for covariates, BMP exposure was associated with a 31% increased risk of benign tumor diagnosis (odds ratio, 1.31; 95% confidence interval, 1.02-1.68; P < .05). When the benign tumor diagnoses were stratified by organ type, BMP patients had significantly more diagnoses of benign nervous system tumors (0.81% vs 0.34%; P = .03), and within this group, benign tumors of the spinal meninges were much more common in the BMP-treated group (0.13% vs 0.02%; P = .002). CONCLUSION: The results of this large, independent, propensity-matched study suggest that the use of BMP in lumbar fusions is associated with a significantly higher rate of benign neoplasms but not malignancies.

scholarly journals Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Shetty ◽  
H Malik ◽  
A Abbas ◽  
Y Ying ◽  
W Aronow ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Kidney Injury ◽  
Matched Cohort ◽  
Hospital Outcomes ◽  
Increased Risk ◽  
The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

scholarly journals Prognostic Relevance of a Complete Pathologic Response in Liver Transplantation for Hepatocellular Carcinoma

2019 ◽  
Vol 26 (13) ◽  
pp. 4556-4565 ◽  
Author(s):  
Michał Grąt ◽  
Marek Krawczyk ◽  
Jan Stypułkowski ◽  
Marcin Morawski ◽  
Maciej Krasnodębski ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Propensity Score ◽  
Neoadjuvant Treatment ◽  
Pathologic Response ◽  
Secondary Outcome ◽  
Complete Pathologic Response ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Treatment Naïve

Abstract Background A complete pathologic response (CPR) after neoadjuvant treatment is reported to be associated with an exceptionally low risk of recurrence after liver transplantation for hepatocellular carcinoma (HCC). This study aimed to evaluate the prognostic role of CPR in liver transplantation for HCC. Methods This retrospective cohort study was based on 222 HCC transplant recipients. Incidence of recurrence and survival at 5 years were the primary and secondary outcome measures, respectively. Competing risk analyses were applied to evaluate recurrence incidence and its predictors. Propensity score matching was performed to compare the outcomes for patients after neoadjuvant treatment with and without CPR. Results Neoadjuvant treatment was performed for 127 patients, 32 of whom achieved CPR (25.2%). Comparison of baseline characteristics showed that the patients with CPR were at lowest baseline recurrence risk, followed by treatment-naïve patients and patients without CPR. Adjusted for potential confounders, CPR did not have any significant effects on tumor recurrence. No significant net reclassification improvement was noted after addition of CPR to existing criteria. Neoadjuvant treatment without CPR was associated with increased risk of recurrence in subgroups within the Milan criteria (p = 0.016), with alpha-fetoprotein concentration (AFP) model not exceeding 2 points (p = 0.021) and within the Warsaw criteria (p = 0.007) compared with treatment-naïve patients who were at risk similar to those with CPR. The 5-year incidences of recurrence in propensity score-matched patients with and without CPR were respectively 14.0% and 15.9% (p = 0.661), with corresponding survival rates of 73.2% and 67.4%, respectively (p = 0.329). Conclusions The findings showed that CPR is not independently associated with long-term outcomes after liver transplantation for HCC.

scholarly journals Association of Immediate Reinsertion of New Catheters With Subsequent Mortality Among Patients With Suspected Catheter Infection: a Cohort Study

2021 ◽  
Author(s):  
Yiyue Zhong ◽  
Liehua Deng ◽  
Limin Zhou ◽  
Shaoling Liao ◽  
Liqun Yue ◽  
...  
Keyword(s):  
Propensity Score ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
Cox Proportional Hazards ◽  
University Hospital ◽  
Matched Cohort ◽  
Central Venous ◽  
Kaplan Meier ◽  
Increased Risk

Abstract BackgroundCentral venous catheter (CVC) insertion complications are a prevalent and significant problem in the intensive care unit (ICU), but optimal strategy for management in patients with suspected catheter-related bloodstream infection (CRBSI) remains unclear. We sought to determine the effect of immediate reinsertion of new catheter (IRINC) on 30-day mortality among patients after central venous catheter (CVC) removal for suspected CRBSI.MethodsWe conducted a propensity-score-matched cohort of suspected CRBSI who underwent IRINC or not in a 32-bed ICU of university hospital in China during the period from January 2009 through April 2021. We used the results of catheter tip culture to identify patients with suspected CRBSI by index for institutional electronic laboratory databases. The inclusion criteria were age ≥ 18 years, CVC and suspected CRBSI. The exclusion criteria were dialysis catheters, peripheral catheterization, length of stay less than 48 hours, and patients with no access to medical records. Kaplan-Meier method was used to analyze 30-day mortality before and after propensity-score-matching, and adjusted hazard ratio (HR) and 95% confidence interval (CI) for mortality in matched cohort were estimated with Cox proportional hazards models.ResultsIn total, 1238 patients with CVC removal due to suspected CRBSI were identified. Among these patients, 877 (70.8%) underwent IRINC, and 361 (29.2%) did not. In 682 propensity score-matched patients, IRINC was associated with an increased risk of 30-day mortality (HR, 1.481; 95% CI, 1.028 to 2.134) after multivariable, multilevel adjustment. Kaplan-Meier analysis found that IRINC showed a similar risk of mortality before matching (P=0.00096) and after matching (P=0.018). The competing risks analysis confirmed the results of the propensity score-matched analysis. The attributable risk for bloodstream infection was not significantly different (HR, 1.081; 95% CI 0.964 to 1.213) but that for pneumonia was significantly different (HR, 1.128; 95% CI 1.031 to 1.233) in patients with suspected CRBSI in terms of 30-day mortality.ConclusionsIRINC during suspected CRBSI was associated with an increased 30-day mortality risk. These data suggest that it is necessary to focus more on other insertion-related complications along with preventing CRBSI in critically ill patients.Trial RegistrationThis study was registered with the China Clinical Trials Registry (ChiCTR1900022175), URL: http://www.chictr.org.cn/index.aspx.

Impact of Hepatopulmonary Syndrome in Liver Transplantation Candidates and the Role of Angiogenesis

2021 ◽  
pp. 2102304
Author(s):  
Steven M. Kawut ◽  
Michael J. Krowka ◽  
Kimberly A. Forde ◽  
Nadine Al-Naamani ◽  
Karen L. Krok ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Vascular Complications ◽  
Hepatopulmonary Syndrome ◽  
Functional Class ◽  
Hazard Ratio ◽  
Arterial Oxygen ◽  
Risk Of Death ◽  
Increased Risk

Hepatopulmonary syndrome affects 10–30% of patients with cirrhosis and portal hypertension. We evaluated the serum angiogenic profile of hepatopulmonary syndrome and assessed the clinical impact of hepatopulmonary syndrome in patients evaluated for liver transplantation.The Pulmonary Vascular Complications of Liver Disease 2 study was a multicentre, prospective cohort study of adults undergoing their first liver transplantation evaluation. Hepatopulmonary syndrome was defined as an alveolar-arterial oxygen gradient ≥15 mmHg (≥20 mmHg if age >64 years), positive contrast-enhanced transthoracic echocardiography, and absence of lung disease.We included 85 patients with hepatopulmonary syndrome and 146 patients without hepatopulmonary syndrome. Patients with hepatopulmonary syndrome had more complications of portal hypertension and slightly higher Model for End-stage Liver Disease-Na score compared to those without hepatopulmonary syndrome (median [interquartile range] 15 [12, 19] versus 14 [10, 17], p=0.006). Hepatopulmonary syndrome patients had significantly lower six minute walk distance and worse functional class. Hepatopulmonary syndrome patients had higher circulating angiopoietin-2, Tie2, tenascin-C, c-kit, VCAM-1, and von Willebrand factor levels, and lower E-selectin levels. Patients with hepatopulmonary syndrome had an increased risk of death (hazard ratio 1.80 [1.03–3.16], p=0.04) which persisted despite adjustment for covariates (hazard ratio 1.79 [1.02–3.15], p=0.04). This association did not vary based on levels of oxygenation reflecting the severity of hepatopulmonary syndrome.Hepatopulmonary syndrome was associated with a profile of abnormal systemic angiogenesis, worse exercise and functional capacity, and an overall increased risk of death.

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