scholarly journals Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study

10.2196/27175 ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. e27175
Author(s):  
Min Tian ◽  
Bo Wang ◽  
Zhao Xue ◽  
Dinghui Dong ◽  
Xuemin Liu ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cohort Study ◽  
Usual Care ◽  
Clinical Outcomes ◽  
Readmission Rate ◽  
High Efficiency ◽  
Warning Signs ◽  
Number Of Patients ◽  
Significant Difference

Background Technical capabilities for performing liver transplantation have developed rapidly; however, the lack of available livers has prompted the utilization of edge donor grafts, including those donated after circulatory death, older donors, and hepatic steatosis, thereby rendering it difficult to define optimal clinical outcomes. Objective We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation. Methods To determine the efficacy of telemedicine for follow-up after liver transplantation, we performed a clinical observation cohort study to evaluate the rate of recovery, readmission rate within 30 days after discharge, mortality, and morbidity. Patients (n=110) who underwent liver transplantation (with livers from organ donation after citizen's death) were randomly assigned to receive either telemedicine-based follow-up management for 2 weeks in addition to the usual care or usual care follow-up only. Patients in the telemedicine group were given a robot free-of-charge for 2 weeks of follow-up. Using the robot, patients interacted daily, for approximately 20 minutes, with transplant specialists who assessed respiratory rate, electrocardiogram, blood pressure, oxygen saturation, and blood glucose level; asked patients about immunosuppressant medication use, diet, sleep, gastrointestinal function, exercise, and T-tube drainage; and recommended rehabilitation exercises. Results No differences were detected between patients in the telemedicine group (n=52) and those in the usual care group (n=50) regarding age (P=.17), the model for end-stage liver disease score (MELD, P=.14), operation time (P=.51), blood loss (P=.07), and transfusion volume (P=.13). The length and expenses of the initial hospitalization (P=.03 and P=.049) were lower in the telemedicine group than they were in the usual care follow-up group. The number of patients with MELD score ≥30 before liver transplantation was greater in the usual care follow-up group than that in the telemedicine group. Furthermore, the readmission rate within 30 days after discharge was markedly lower in the telemedicine group than in the usual care follow-up group (P=.02). The postoperative survival rates at 12 months in the telemedicine group and the usual care follow-up group were 94.2% and 90.0% (P=.65), respectively. Warning signs of complications were detected early and treated in time in the telemedicine group. Furthermore, no significant difference was detected in the long-term visit cumulative survival rate between the two groups (P=.50). Conclusions Rapid recovery and markedly lower readmission rates within 30 days after discharge were evident for telemedicine follow-up management of patients post–liver transplantation, which might be due to high-efficiency in perioperative and follow-up management. Moreover, telemedicine follow-up management promotes the self-management and medication adherence, which improves patients’ health-related quality of life and facilitates achieving optimal clinical outcomes in post–liver transplantation.

scholarly journals Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study (Preprint)

2021 ◽  
Author(s):  
Min Tian ◽  
Bo Wang ◽  
Zhao Xue ◽  
Dinghui Dong ◽  
Xuemin Liu ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cohort Study ◽  
Usual Care ◽  
Clinical Outcomes ◽  
Readmission Rate ◽  
High Efficiency ◽  
Warning Signs ◽  
Number Of Patients ◽  
Significant Difference

BACKGROUND Technical capabilities for performing liver transplantation have developed rapidly; however, the lack of available livers has prompted the utilization of edge donor grafts, including those donated after circulatory death, older donors, and hepatic steatosis, thereby rendering it difficult to define optimal clinical outcomes. OBJECTIVE We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation. METHODS To determine the efficacy of telemedicine for follow-up after liver transplantation, we performed a clinical observation cohort study to evaluate the rate of recovery, readmission rate within 30 days after discharge, mortality, and morbidity. Patients (n=110) who underwent liver transplantation (with livers from organ donation after citizen's death) were randomly assigned to receive either telemedicine-based follow-up management for 2 weeks in addition to the usual care or usual care follow-up only. Patients in the telemedicine group were given a robot free-of-charge for 2 weeks of follow-up. Using the robot, patients interacted daily, for approximately 20 minutes, with transplant specialists who assessed respiratory rate, electrocardiogram, blood pressure, oxygen saturation, and blood glucose level; asked patients about immunosuppressant medication use, diet, sleep, gastrointestinal function, exercise, and T-tube drainage; and recommended rehabilitation exercises. RESULTS No differences were detected between patients in the telemedicine group (n=52) and those in the usual care group (n=50) regarding age (<i>P</i>=.17), the model for end-stage liver disease score (MELD, <i>P</i>=.14), operation time (<i>P</i>=.51), blood loss (<i>P</i>=.07), and transfusion volume (<i>P</i>=.13). The length and expenses of the initial hospitalization (<i>P</i>=.03 and <i>P</i>=.049) were lower in the telemedicine group than they were in the usual care follow-up group. The number of patients with MELD score ≥30 before liver transplantation was greater in the usual care follow-up group than that in the telemedicine group. Furthermore, the readmission rate within 30 days after discharge was markedly lower in the telemedicine group than in the usual care follow-up group (<i>P</i>=.02). The postoperative survival rates at 12 months in the telemedicine group and the usual care follow-up group were 94.2% and 90.0% (<i>P</i>=.65), respectively. Warning signs of complications were detected early and treated in time in the telemedicine group. Furthermore, no significant difference was detected in the long-term visit cumulative survival rate between the two groups (<i>P</i>=.50). CONCLUSIONS Rapid recovery and markedly lower readmission rates within 30 days after discharge were evident for telemedicine follow-up management of patients post–liver transplantation, which might be due to high-efficiency in perioperative and follow-up management. Moreover, telemedicine follow-up management promotes the self-management and medication adherence, which improves patients’ health-related quality of life and facilitates achieving optimal clinical outcomes in post–liver transplantation.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals Comparison of outcomes of ORIF versus bidirectional tractor and arthroscopically assisted CRIF in the treatment of lateral tibial plateau fractures: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiangtian Deng ◽  
Hongzhi Hu ◽  
Yiran Zhang ◽  
Weijian Liu ◽  
Qingcheng Song ◽  
...  
Keyword(s):  
Cohort Study ◽  
Internal Fixation ◽  
Clinical Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Tibial Plateau ◽  
Clinical Score ◽  
Lateral Tibial Plateau ◽  
Significant Difference

Abstract Background Lateral tibial plateau fractures (TPFs) are often treated with conventional open reduction and internal fixation (ORIF) through standard anterolateral sub-meniscal arthrotomy. There has been increasing support for “bidirectional rapid redactor” device-assisted closed reduction and internal fixation (CRIF) for treating TPFs. The aim of the present study is to compare the clinical and radiological outcomes between CRIF and ORIF procedures. Methods We performed a retrospective cohort study of 55 lateral TPF patients (Schatzker types I–III) who accepted surgical treatment at our trauma level 1 center between January 2016 and January 2018. They were divided into the CRIF group (32 patients) and the ORIF group (23 patients) based upon the different surgical protocols. The patients’ clinical outcome analysis was evaluated by using the Knee Society Score (KSS) and Rasmussen’s clinical score. For radiological assessment, changes in tibial plateau width (TPW), articular depression depth (ADD), medial proximal tibial angle (MPTA), and posterior tibial slope angle (PTSA) were evaluated using radiographs and computed tomography (CT) scan. Results The CRIF group had a mean follow-up of 28.9 months, and the ORIF group had a mean follow-up of 30.7 months (p>0.05). Furthermore, there was no statistically significant difference in terms of age, gender, injury mechanism, follow-up time, time interval from injury to surgery, and Schatzker classification in the two groups. With respect to the clinical outcomes including the KSS score and Rasmussen’s clinical score, there was also no significant difference (p>0.05). Nevertheless, the CRIF group had lower intra-operative blood loss, shorter hospitalization days, and better range of movement of the knee joint than the ORIF group (p<0.05). Furthermore, CRIF had better radiological results when compared to the ORIF group using Rasmussen’s radiological score (p<0.05), although no significant difference was observed in TPW, ADD, MPTA, and PTSA between the two groups (p>0.05). Conclusion The present study showed that CRIF could achieve comparable clinical outcomes and better radiological results for treating lateral TPFs as compared with conventional ORIF.

Abstract 167: Impact of a Pharmacist-Led Outpatient Direct Oral Anticoagulation Service

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Geoffrey D Barnes ◽  
Emily Ashjian ◽  
Robert Yeshe ◽  
Brian Kurtz ◽  
Elizabeth Renner
Keyword(s):  
Usual Care ◽  
Patient Adherence ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Regression Modeling ◽  
Clinical Event ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Background: Direct oral anticoagulants (DOACs) represent novel alternatives to vitamin K antagonists but present new challenges for appropriate prescribing and ongoing patient adherence. We assessed the impact of a pharmacist-led DOAC service on prescription appropriateness and patient adherence as compared to usual care. Methods: We performed a retrospective, observational, matched cohort analysis of patients prescribed a DOAC at a large academic medical center between September 20, 2013 and December 31, 2014. We compared a group of patients (n=129) who participated in a pharmacist-led DOAC service to a matched group (n=129) who received usual care using coarsened exact matching based on prescriber specialty, DOAC prescribed, indication for anticoagulation and age. Co-primary endpoints included the percentage of patients who had appropriate DOAC therapy (FDA-approved medication and dose based on indication and renal function) prescribed at baseline and at 3-6 month follow up after initiating the medication. Secondary endpoints included mean medication possession ratios (MPR) for patients who received at least 3 months of DOAC therapy and had available pharmacy records (n=171). We performed multivariable logistic regression modeling for appropriate prescription and multivariable linear regression modeling for MPR. Results: Patients in the two groups were well balanced across multiple demographic and comorbid factors. Patients in the pharmacist-led DOAC service were significantly more likely to have an appropriate combination of DOAC and dose prescribed for their indication at baseline as compared to usual care (92.2% vs. 77.5%; adjusted odds ratio [aOR] 3.02, p=0.006). This finding persisted at follow up (93.7% vs. 81.1%; aOR=2.92, p=0.016). There was no significant difference between groups in the number of patients determined to have an appropriate DOAC prescribed for an FDA-approved indication (independent of dose) in the pharmacist-led service (95.3%) vs usual care (93.0%) at baseline (aOR 0.93, p=0.901). Patients in the pharmacist-led service had a mean adjusted MPR of 91.8% compared to 79.3% with usual care (p=0.001) over a median follow up of 248 days. Conclusions: A pharmacist-led DOAC service increases appropriate dosing of DOACs at baseline and follow up as well as patient adherence to therapy. Associated costs and clinical event rates associated with pharmacist-lead DOAC management remain to be investigated.

scholarly journals Arthroscopic Circumferential Labral Repair for Patients With Multidirectional Instability: A Comparative Outcome Study

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711989010
Author(s):  
Andrew Wall ◽  
Owen McGonigle ◽  
Thomas J. Gill
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Short Form ◽  
Labral Repair ◽  
Control Group ◽  
Recurrent Instability ◽  
Proper Patient Selection ◽  
Significant Difference ◽  
Repair Group

Background: Circumferential tears of the glenohumeral labrum are an uncommon injury, comprising 2.4% of all labral lesions. Currently, the clinical outcomes of arthroscopic circumferential labral repair for patients with instability and combined anterior, posterior, and superior labral tears are not well-known. Hypothesis: Patients treated with arthroscopic circumferential shoulder labral repairs will have inferior clinical outcomes and higher failure rates compared with patients who have isolated arthroscopic anterior labral repairs. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed to identify patients aged 18 years and older who underwent circumferential arthroscopic stabilization for recurrent instability as compared with an age-matched control group of arthroscopic primary anterior labral repairs. Age at surgery, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score, Simple Shoulder Test (SST) score, 12-Item Short Form Health Survey (SF-12) score (mental and physical), and overall patient satisfaction with surgery were assessed for each group. Results: A total of 35 consecutive patients (36 shoulders) who underwent an arthroscopic 360° circumferential labral repair were compared with a matched group of 31 patients who underwent an isolated arthroscopic anterior labral repair. The mean follow-up period was 34.3 and 56.8 months, respectively. No significant difference was found between the 2 groups for overall satisfaction with the surgery or recurrent instability. At the time of the follow-up survey, 22% of the patients experienced pain and 25% of the patients experienced instability in the circumferential repair group, whereas 15% of the patients experienced some level of pain and 30% of patients experienced a subjective sense of subtle instability in the isolated repair group. The ASES scores were 87.3 in the combined labral repair group and 93.3 in the isolated anterior group ( P = .35), SST scores were 10.7 and 11.3 ( P = .70), SF-12 mental scores were 54.6 and 56.8 ( P = .80), SF-12 physical scores were 53.2 and 54.2 ( P = .98), and age at time of the surgery was 26.7 and 24.6 years ( P = .33), respectively. There was no difference between the 2 groups in pre- and postoperative range of motion ( P > .05). Conclusion: There was no difference in shoulder stability and function in patients after 360° combined labral repairs versus anterior labral repair alone. With proper patient selection, patients can expect similar outcomes despite the more extensive surgical procedure and complex postoperative rehabilitation protocol for circumferential repairs.

scholarly journals Use of Preoperative Magnetic Resonance Imaging to Predict Clinical Outcomes After Core Muscle Injury Repair

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199580
Author(s):  
Matthew J. Kraeutler ◽  
Jennifer Kurowicki ◽  
Iciar M. Dávila Castrodad ◽  
Edward Milman ◽  
Toghrul Talishinskiy ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cohort Study ◽  
Magnetic Resonance ◽  
Physical Examination ◽  
Clinical Outcomes ◽  
Muscle Injury ◽  
Resonance Imaging ◽  
Ucla Activity Score ◽  
Significant Difference

Background: Core muscle injury (CMI), often referred to as a sports hernia or athletic pubalgia, is a common cause of groin pain in athletes. Imaging modalities used to assist in the diagnosis of CMI include ultrasound (US) and magnetic resonance imaging (MRI). Purpose: To determine if preoperative MRI findings predict clinical outcomes after surgery for CMI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed on a consecutive series of patients who were operatively treated for CMI by a single surgeon. CMI was diagnosed based on history, physical examination, and a positive US. In addition, all patients underwent a preoperative MRI. Patients were divided into 2 groups based on whether the MRI was interpreted as positive or negative for CMI. All patients underwent mini-open CMI repair. Patient-reported outcomes (PROs) were collected both pre- and postoperatively and included a visual analog scale (VAS) for pain, the University of California, Los Angeles (UCLA) activity score, and the modified Harris Hip Score. Results: A total of 39 hips were included in this study, of which 17 had a positive MRI interpretation for CMI (44%) and 22 had a negative MRI interpretation (56%). Mean age at the time of surgery was 35 years (range, 17-56 years), and mean follow-up was 21 months (range, 12-35 months). No significant difference was found between groups in mean age or time to follow-up. Patients in both groups demonstrated significant improvement from preoperative to most recent follow-up in terms of the UCLA activity score ( P < .05). VAS scores significantly improved for patients with a positive MRI interpretation ( P = .001) but not for those with a negative MRI interpretation ( P = .094). No significant difference on any PROs was found between groups at the most recent follow-up. Conclusion: Successful clinical outcomes can be expected in patients undergoing surgery for CMI diagnosed based on history, physical examination, and US. Patients with a preoperative MRI consistent with CMI may experience greater improvement in pain postoperatively, although MRI does not predict postoperative activity level in these patients.

scholarly journals Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Gamal Khafagy ◽  
Mohamed El-Begermy ◽  
Marwa Mohamed El-Begermy ◽  
Pretty O. Afifi
Keyword(s):  
Tympanic Membrane ◽  
Chronic Otitis Media ◽  
Fat Graft ◽  
Cartilage Graft ◽  
Tympanic Membrane Perforations ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hearing Outcomes ◽  
Age Range

Abstract Background This study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults. In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes. Results The success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing. Conclusions Inlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

scholarly journals A meta-analysis indicating extra-short implants (≤ 6 mm) as an alternative to longer implants (≥ 8 mm) with bone augmentation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoran Yu ◽  
Ruogu Xu ◽  
Zhengchuan Zhang ◽  
Yang Yang ◽  
Feilong Deng
Keyword(s):  
Survival Rate ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Bone Augmentation ◽  
Moderate Quality ◽  
Short Implants ◽  
Significant Difference ◽  
Complications Rate

AbstractExtra-short implants, of which clinical outcomes remain controversial, are becoming a potential option rather than long implants with bone augmentation in atrophic partially or totally edentulous jaws. The aim of this study was to compare the clinical outcomes and complications between extra-short implants (≤ 6 mm) and longer implants (≥ 8 mm), with and without bone augmentation procedures. Electronic (via PubMed, Web of Science, EMBASE, Cochrane Library) and manual searches were performed for articles published prior to November 2020. Only randomized controlled trials (RCTs) comparing extra-short implants and longer implants in the same study reporting survival rate with an observation period at least 1 year were selected. Data extraction and methodological quality (AMSTAR-2) was assessed by 2 authors independently. A quantitative meta-analysis was performed to compare the survival rate, marginal bone loss (MBL), biological and prosthesis complication rate. Risk of bias was assessed with the Cochrane risk of bias tool 2 and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. 21 RCTs were included, among which two were prior registered and 14 adhered to the CONSORT statement. No significant difference was found in the survival rate between extra-short and longer implant at 1- and 3-years follow-up (RR: 1.002, CI 0.981 to 1.024, P = 0.856 at 1 year; RR: 0.996, CI 0.968 to 1.025, P  = 0.772 at 3 years, moderate quality), while longer implants had significantly higher survival rate than extra-short implants (RR: 0.970, CI 0.944 to 0.997, P < 0.05) at 5 years. Interestingly, no significant difference was observed when bone augmentations were performed at 5 years (RR: 0.977, CI 0.945 to 1.010, P = 0.171 for reconstructed bone; RR: 0.955, CI 0.912 to 0.999, P < 0.05 for native bone). Both the MBL (from implant placement) (WMD: − 0.22, CI − 0.277 to − 0.164, P < 0.01, low quality) and biological complications rate (RR: 0.321, CI 0.243 to 0.422, P < 0.01, moderate quality) preferred extra-short implants. However, there was no significant difference in terms of MBL (from prosthesis restoration) (WMD: 0.016, CI − 0.036 to 0.068, P = 0.555, moderate quality) or prosthesis complications rate (RR: 1.308, CI 0.893 to 1.915, P = 0.168, moderate quality). The placement of extra-short implants could be an acceptable alternative to longer implants in atrophic posterior arch. Further high-quality RCTs with a long follow-up period are required to corroborate the present outcomes.Registration number The review protocol was registered with PROSPERO (CRD42020155342).

scholarly journals Incidence, Characteristics, and Prognosis of Incidentally Discovered Hepatocellular Carcinoma after Liver Transplantation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Walid El Moghazy ◽  
Samy Kashkoush ◽  
Glenda Meeberg ◽  
Norman Kneteman
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Tumor Recurrence ◽  
Patient Survival ◽  
Steady Increase ◽  
Liver Transplants ◽  
Significant Difference ◽  
One Year ◽  
Over Time

Background. We aimed to assess incidentally discovered hepatocellular carcinoma (iHCC) over time and to compare outcome to preoperatively diagnosed hepatocellular carcinoma (pdHCC) and nontumor liver transplants.Methods.We studied adults transplanted with a follow-up of at least one year. Patients were divided into 3 groups according to diagnosis of hepatocellular carcinoma.Results.Between 1990 and 2010, 887 adults were transplanted. Among them, 121 patients (13.6%) had pdHCC and 32 patients (3.6%) had iHCC; frequency of iHCC decreased markedly over years, in parallel with significant increase in pdHCC. Between 1990 and 1995, 120 patients had liver transplants, 4 (3.3%) of them had iHCC, and only 3 (2.5%) had pdHCC, while in the last 5 years, 263 patients were transplanted, 7 (0.03%) of them had iHCC, and 66 (25.1%) had pdHCC (P<0.001). There was no significant difference between groups regarding patient survival; 5-year survival was 74%, 75.5%, and 77.3% in iHCC, pdHCC, and non-HCC groups, respectively (P=0.702). Patients with iHCC had no recurrences after transplant, while pdHCC patients experienced 17 recurrences (15.3%) (P=0.016).Conclusions.iHCC has significantly decreased despite steady increase in number of transplants for hepatocellular carcinoma. Patients with iHCC had excellent outcomes with no tumor recurrence and survival comparable to pdHCC.

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