scholarly journals Effect of "the Awakening Protocol" in the outcome of liver transplantation

2013 ◽  
Vol 28 (suppl 1) ◽  
pp. 72-76
Author(s):  
Agnaldo Soares Lima ◽  
Leandro Ricardo de Navarro Amado ◽  
Malvina Maria de Freitas Duarte ◽  
Marcelo Dias Sanches ◽  
Alexandre Prado de Resende ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Base Excess ◽  
Risk Index ◽  
Graft Loss ◽  
Early Morning ◽  
Meld Score ◽  
The Awakening ◽  
Transplant Patients ◽  
Surgical Tactics ◽  
Patient And Graft Survival

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.

MELD score can predict post-orthotopic liver transplantation one-year patient and graft survival

2003 ◽  
Vol 124 (4) ◽  
pp. A694
Author(s):  
Sammy Saab ◽  
Victor S. Wang ◽  
Ayman B. Ibrahim ◽  
Francisco Durazo ◽  
Steven Han ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Graft Survival ◽  
Orthotopic Liver Transplantation ◽  
Meld Score ◽  
One Year ◽  
Patient And Graft Survival

Liver Transplantation – A Case Report

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.

Cytomegalovirus in Liver Transplant Patients

2021 ◽  
Vol 30 (3) ◽  
pp. 81-88
Author(s):  
Mahitab A. Youssef ◽  
Doaa T. Masallat ◽  
Ahmad M. Sultan ◽  
Sahar T. Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Bacterial Infections ◽  
Preventive Therapy ◽  
Meld Score ◽  
Cmv Infection ◽  
Post Transplantation ◽  
Transplant Patients ◽  
A Prospective Study

Background: Graft survival in liver transplant recipients is significantly lower in patients with a history of CMV infection compared to those without. In the absence of any preventive therapy 75% of recipients develop CMV infection post liver transplant. Objectives: This study detected the incidence of cytomegalovirus in liver transplant patients and evaluated post-transplant risk factors for HCMV and its complications. Methodology: A prospective study was conducted from the September 2018 till March 2020. Sixty subjects were involved; 30 patients were admitted for liver transplantation at the Gastroenterology Surgery Center (GISC), Mansoura university, and 30 donors. MELD score was calculated, blood samples were taken, CMV antibodies and CMV DNA were detected. Post transplantation follow up for 6 months and complications were reported. Results: HCMV viremia was detected in 46.6% recipients and in 10% donors by PCR. One recipient was positive for IgM and the rest were IgG positive and all donors were IgG positive. The most common reported complication after liver transplantation was bacterial infections (46.4%). Conclusions: Half of patients developed CMV infection after transplantation. The commonest risk factors for posttransplant CMV infection were seropositive donor or recipient >60 AU/mL, HCV patients, body mass index >25 and DM. Patients with positive HCMV infection had significantly higher MELD score than those reported negative HCMV

scholarly journals Impact of Recipient and Donor Obesity Match on the Outcomes of Liver Transplantation: All Matches Are Not Perfect

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Eliza W. Beal ◽  
Dmitry Tumin ◽  
Lanla F. Conteh ◽  
A. James Hanje ◽  
Anthony J. Michaels ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Graft Loss ◽  
Long Term Outcomes ◽  
Survival Curves ◽  
Liver Retransplantation ◽  
First Time ◽  
Transplantation Outcomes ◽  
Patient And Graft Survival ◽  
United Network

There is a paucity of literature examining recipient-donor obesity matching on liver transplantation outcomes. The United Network for Organ Sharing database was queried for first-time recipients of liver transplant whose age was ≥18 between January 2003 and September 2013. Outcomes including patient and graft survival at 30 days, 1 year, and 5 years and overall, liver retransplantation, and length of stay were compared between nonobese recipients receiving a graft from nonobese donors and obese recipient-obese donor, obese recipient-nonobese donor, and nonobese recipient-obese donor pairs. 51,556 LT recipients were identified, including 34,217 (66%) nonobese and 17,339 (34%) obese recipients. The proportions of patients receiving an allograft from an obese donor were 24% and 29%, respectively, among nonobese and obese recipients. Graft loss (HR: 1.27; 95% CI: 1.09–1.46;p=0.002) and mortality (HR: 1.38; 95% CI: 1.16–1.65;p<0.001) at 30 days were increased in the obese recipient-obese donor pair. However, 1-year graft (HR: 0.83; 95% CI: 0.74–0.93;p=0.002) and patient (HR: 0.84; 95% CI: 0.74–0.95;p=0.007) survival and overall patient (HR: 0.93; 95% CI: 0.86–1.00;p=0.042) survival were favorable. There is evidence of recipient and donor obesity disadvantage early, but survival curves demonstrate improved long-term outcomes. It is important to consider obesity in the donor-recipient match.

scholarly journals Predictive factors of early graft loss in living donor liver transplantation

2012 ◽  
Vol 49 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Rogério Camargo Pinheiro Alves ◽  
Eduardo Antunes da Fonseca ◽  
Carla Adriana Loureiro de Mattos ◽  
Sofia Abdalla ◽  
José Eduardo Gonçalves ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Serum Sodium Level ◽  
Graft Loss ◽  
Meld Score ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Group I ◽  
Early Graft

CONTEXT: Living donor liver transplantation has become an alternative to reduce the lack of organ donation. OBJECTIVE: To identify factors predictive of early graft loss in the first 3 months after living donor liver transplantation. METHODS: Seventy-eight adults submitted to living donor liver transplantation were divided into group I with 62 (79.5%) patients with graft survival longer than 3 months, and group II with 16 (20.5%) patients who died and/or showed graft failure within 3 months after liver transplantation. The variables analyzed were gender, age, etiology of liver disease, Child-Pugh classification, model of end-stage liver disease (MELD score), pretransplantation serum sodium level, and graft weight-to-recipient body weight (GRBW) ratio. The GRBW ratio was categorized into < 0.8 and MELD score into >18. The chi-square test, Student t-test and uni- and multivariate analysis were used for the evaluation of risk factors for early graft loss. RESULTS: MELD score <18 (P<0.001) and serum sodium level > 135 mEq/L (P = 0.03) were higher in group II than in group I. In the multivariate analysis MELD scores > 18 (P<0.001) and GRBW ratios < 0.8 (P<0.04) were significant. CONCLUSIONS: MELD scores >18 and GRBW < 0.8 ratios are associated with higher probability of graft failure after living donor liver transplantation.

scholarly journals Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Mihai Oltean ◽  
Christian Barrenäs ◽  
Paulo Ney Martins ◽  
Gustaf Herlenius ◽  
Bengt Gustafsson ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Risk Index ◽  
Graft Loss ◽  
Antioxidant Properties ◽  
First Year ◽  
Early Graft ◽  
High Bilirubin

Background.Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx).Methods.In 427 LTx patients, the AUROC curve based on bilirubin and AST at day 1 identified a cutoff of 2.04 mg/dL for the recipient pretransplant bilirubin. Recipients were grouped as having low (group L,n=152) or high (group H,n=275) bilirubin. Both groups had similar donor-related variables (age, preservation time, donor BMI > 28, and donor risk index (DRI)).Results.Alanine (ALT) and aspartate (AST) aminotransferase levels were higher in group L at day 1; ALT levels remained higher at day 2 in group L. LTx from high risk donors (DRI > 2) revealed a trend towards lower transaminases during the first two days after transplantation in group H. One month and 1-year patient survival were similar in groups L and H. High preoperative bilirubin did not affect the risk for early graft dysfunction (EGD), death, or graft loss during the first year after transplantation nor the incidence of acute rejection. LTx using donors with DRI > 2 resulted in similar rates of EGD in both groups.Conclusion.Increased bilirubin appears to reduce the early IRI after LTx yet this improvement was insufficient to improve the clinical outcome.

scholarly journals Recipient-Specific Risk Factors Impairing Patient and Graft Outcome after Pediatric Liver Transplantation—Analysis of 858 Transplantations in 38 Years

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 641
Author(s):  
Christoph Leiskau ◽  
Norman Junge ◽  
Eva-Doreen Pfister ◽  
Imeke Goldschmidt ◽  
Frauke Mutschler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Graft Survival ◽  
Graft Loss ◽  
Single Center ◽  
Vein Thrombosis ◽  
Pediatric Liver ◽  
High Urgency ◽  
Patient And Graft Survival

(1) Background and Aim: Despite excellent long-term results in pediatric liver transplantation (pLTx), mortality and graft loss still are to be diminished. We aim to describe time-dependent changes and long-term outcome of a large single-center pLTx cohort and to identify independent recipient-related risk factors impairing patient and graft survival. (2) Methods: This is a retrospective single-center study analyzing all pediatric liver transplants from 1983–2020. Risk factors for mortality and graft loss were identified by univariable and multi-linear regression analysis. (3) Results: We analyzed 858 liver transplantations in 705 pediatric patients. Five-year patient/graft survival increased from 60.9%/48.0% (1983–1992) to 97.5%/86.5% (OR = 12.5; p < 0.0001/OR = 6.5; p < 0.0001) (2014–2020). Indications changed significantly over time, with a higher proportion of patients being transplanted for malignancies and metabolic disease and indications of PFIC and α1AT-deficiency declining. The era of transplantation (log7.378/9.657; p < 0.0001) and indication of acute liver failure (log = 1.944/2.667; HR = 2.015/1.772; p = 0.0114/0.002) impairs patient/graft survival significantly in the multivariate analysis. Furthermore, patient survival is worsened by re-transplantation (log = 1.755; HR = 1.744; p = 0.0176) and prolonged waiting times in high-urgency status (log = 2.588; HR = 1.073; p = 0.0026), whereas the indication of biliary atresia improved outcome (log = 1.502; HR = 0.575; p = 0.0315). Graft survival was additionally impaired by pre-existing portal vein thrombosis (log = 1.482; HR = 2.016; p = 0.0330). (4) Conclusions: Despite more complex indications, patient and graft survival after pLTx continue to improve.. Acute liver failure remains the indication with poorest outcome, and listing for high urgency liver transplantation should be considered carefully and early to keep waiting time on HU list short. Furthermore, pre-transplant portal vein thrombosis should be prevented whenever possible to improve graft survival.

scholarly journals LATE ACUTE REJECTION IN LIVER TRANSPLANT: A SYSTEMATIC REVIEW

2015 ◽  
Vol 28 (3) ◽  
pp. 212-215 ◽  
Author(s):  
Lucas Souto NACIF ◽  
Rafael Soares PINHEIRO ◽  
Rafael Antônio de Arruda PÉCORA ◽  
Liliana DUCATTI ◽  
Vinicius ROCHA-SANTOS ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Rejection ◽  
Liver Transplant ◽  
Graft Survival ◽  
Graft Loss ◽  
Survival Rates ◽  
Clinical Manifestations ◽  
Adequate Treatment ◽  
Pubmed Database ◽  
Patient And Graft Survival

Introduction: Late acute rejection leads to worse patient and graft survival after liver transplantation. Aim: To analyze the reported results published in recent years by leading transplant centers in evaluating late acute rejection and update the clinical manifestations, diagnosis and treatment of liver transplantation. Method: Systematic literature review through Medline-PubMed database with headings related to late acute rejection in articles published until November 2013 was done. Were analyzed demographics, immunosuppression, rejection, infection and graft and patient survival rates. Results: Late acute rejection in liver transplantation showed poor results mainly regarding patient and graft survival. Almost all of these cohort studies were retrospective and descriptive. The incidence of late acute rejection varied from 7-40% in these studies. Late acute rejection was one cause for graft loss and resulted in different outcomes with worse patient and graft survival after liver transplant. Late acute rejection has been variably defined and may be a cause of chronic rejection with worse prognosis. Late acute rejection occurs during a period in which the goal is to maintain lower immunosuppression after liver transplantation. Conclusion: The current articles show the importance of late acute rejection. The real benefit is based on early diagnosis and adequate treatment at the onset until late follow up after liver transplantation.

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