Early complications in adult liver transplant recipients at the Wits Donald Gordon Medical Centre, South Africa

2020 ◽  
Vol 3 (1) ◽  
pp. 1-24
Author(s):  
Sheetal Chiba ◽  
Warren Lowman ◽  
Gunter Schleicher
Keyword(s):  
Demographic Data ◽  
Descriptive Analysis ◽  
Deceased Donor ◽  
Abdominal Sepsis ◽  
Infectious Complications ◽  
Meld Score ◽  
Medical Centre ◽  
Donor Liver Transplantation ◽  
Post Transplant ◽  
Tract Infections

Background Deceased donor liver transplantation (DDLT) is a transplant modality performed routinely in adults at Wits Donald Gordon Medical Centre (WDGMC). Infection, graft dysfunction, surgical and medical complications are common in the early post-transplant period, accounting for early morbidity and mortality. Objectives Provide a descriptive analysis of all complications in the first 30 days post DDLT. To investigate associations between recipient demographic data, comorbid diabetes, MELD score, and subsequent complications. Methods A retrospective review of adult DDLT recipients for the first 30 days post-transplant was performed at WDGMC for the period January 2015 - December 2016. Fischer’s exact test was used to assess relationships between demographic data and infectious complications, whilst an independent sample t-test was used for non-infectious complications. Results Seventy-eight DDLTs were performed, with 6 (8%) mortalities in the first 30 days. The median age was 54 years; 54% were male. In total, 24 recipients (31%) developed infectious complications. Sixteen patients (67% of the infectious cohort) had intra-abdominal sepsis, 6 (25%) developed lower respiratory tract infections, 6 (25%) skin and soft tissue infections, and 3 (13%) urinary tract infections. Of all infectious complications, 7 patients (29%) developed bacteremia. Non-infectious complications were developed in 55 patients (71%) of which renal complications were more common (67%). No significant association between age, gender, ascites, diabetes mellitus, MELD score, and any complications was found. Conclusion Non-infectious complications were more prominent than infectious complications in the first 30 days post-DDLT in adult recipients, with no significant association between recipient demographic data, comorbid diabetes, CMV status, and MELD score.

Early complications in adult liver transplant recipients at the Wits Donald Gordon Medical Centre, South Africa

2020 ◽  
pp. 1-24
Author(s):  
Sheetal Chiba ◽  
Warren Lowman ◽  
Gunter Schleicher
Keyword(s):  
Demographic Data ◽  
Deceased Donor ◽  
Infectious Complications ◽  
Meld Score ◽  
Medical Centre ◽  
Transplant Recipients ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Tract Infections ◽  
Liver Transplant Recipients

Background Deceased donor liver transplantation (DDLT) is the transplant modality performed routinely in adults at Wits Donald Gordon Medical Centre (WDGMC). Infection, graft dysfunction, surgical and medical complications are common in the early post-transplant period, accounting for early morbidity and mortality. Objectives To provide a descriptive analysis of all complications in the first 30 days post DDLT. To investigate associations between recipient demographic data, comorbid diabetes, MELD score, and subsequent complications. Methods A retrospective review of adult DDLT recipients for the first 30 days post-transplant performed at WDGMC for the period January 2015 - December 2016. Fischer’s exact test was used to assess relationships between demographic data and infectious complications, whilst an independent sample t-test was used for non-infectious complications. Results Seventy-eight DDLT were performed, with 6 (8%) mortalities in the first 30 days. The median age was 54 years; 54% were male. In total, 24 recipients (31%) developed infectious complications. Sixteen patients (67% of the infectious cohort) had intra-abdominal sepsis, 6 (25%) developed lower respiratory tract infections, 6 (25%) skin and soft tissue infections, and 3 (13%) urinary tract infections. Of all infectious complications, 7 patients (29%) developed bacteremia. Non-infectious complications developed in 55 patients (71%) of which renal complications were more common (67%). No significant association between age, gender, ascites, diabetes mellitus, MELD score, and any complications was found. Conclusion Non-infectious complications were more prominent than infectious complications in the first 30 days post-DDLT in adult recipients, with no significant association between recipient demographic data, comorbid diabetes, CMV status, and MELD score. Keywords: Early complications, liver transplant recipients, Deceased donor liver transplantation, Wits Donald Gordon Medical Centre, Model for End-Stage Liver Disease

scholarly journals HEPATOCELLULAR CARCINOMA PATIENTS ARE ADVANTAGED IN THE CURRENT BRAZILIAN LIVER TRANSPLANT ALLOCATION SYSTEM. A COMPETING RISK ANALYSIS

2020 ◽  
Vol 57 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Santiago RODRÍGUEZ ◽  
Alfeu de Medeiros FLECK JR ◽  
Marcos MUCENIC ◽  
Cláudio MARRONI ◽  
Ajacio BRANDÃO
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplant ◽  
Risk Model ◽  
Rio Grande ◽  
Deceased Donor ◽  
Meld Score ◽  
Waiting List ◽  
Competing Risk ◽  
Rio Grande Do Sul ◽  
Donor Liver Transplantation

ABSTRACT BACKGROUND: In Brazil, the Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for deceased donor liver transplantation (DDLT). Patients with hepatocellular carcinoma (HCC) receive standardized MELD exception points to account for their cancer risk of mortality, which is not reflected by their MELD score. OBJECTIVE: To compare DDLT rates between patients with and without HCC in Rio Grande do Sul, the Southernmost state of Brazil. METHODS - We retrospectively studied 825 patients on the liver-transplant waiting list from January 1, 2007, to December 31, 2016, in a transplant center located in Porto Alegre, the capital of Rio Grande do Sul, to compare DDLT rates between those with and without HCC. The time-varying hazard of waiting list/DDLT was estimated, reporting the subhazard ratio (SHR) of waiting list/DDLT/dropout with 95% confidence intervals (CI). The final competing risk model was adjusted for age, MELD score, exception points, and ABO group. RESULTS: Patients with HCC underwent a transplant almost three times faster than patients with a calculated MELD score (SHR 2.64; 95% CI 2.10-3.31; P<0.001). The DDLT rate per 100 person-months was 11.86 for HCC patients vs 3.38 for non-HCC patients. The median time on the waiting list was 5.6 months for patients with HCC and 25 months for patients without HCC. CONCLUSION: Our results demonstrated that, in our center, patients on the waiting list with HCC have a clear advantage over candidates listed with a calculated MELD score.

scholarly journals Long-Term Infectious Complications of Kidney Transplantation

2021 ◽  
pp. CJN.15971020
Author(s):  
Akansha Agrawal ◽  
Michael G. Ison ◽  
Lara Danziger-Isakov
Keyword(s):  
Opportunistic Infections ◽  
Fungal Infections ◽  
Solid Organ Transplantation ◽  
Infectious Complications ◽  
Solid Organ ◽  
Post Transplant ◽  
Barr Virus ◽  
Clostridioides Difficile ◽  
Epstein Barr ◽  
Tract Infections

Infections remain a common complication of solid-organ transplantation. Most infections in the first month after transplant are typically health care–associated infections, whereas late infections, beyond 6–12 months, are community-acquired infections. Opportunistic infections most frequently present in the first 12 months post-transplant and can be modulated on prior exposures and use of prophylaxis. In this review, we summarize the current epidemiology of postkidney transplant infections with a focus on key viral (BK polyomavirus, cytomegalovirus, Epstein-Barr virus, and norovirus), bacterial (urinary tract infections and Clostridioides difficile colitis), and fungal infections. Current guidelines for safe living post-transplant are also summarized. Literature supporting prophylaxis and vaccination is also provided.

Risk-Benefit Point of MELD Score in Patients Waiting for Deceased Donor Liver Transplantation

2018 ◽  
Vol 227 (4) ◽  
pp. e226
Author(s):  
Sena Iwamura ◽  
Toshimi Kaido ◽  
Yosuke Miyachi ◽  
Siyuan Yao ◽  
Hisaya Shirai ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Deceased Donor ◽  
Meld Score ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Deceased Donor Liver Transplantation

scholarly journals Changes in the allocation policy for deceased donor livers in Korea: perspectives from anesthesiologists

2021 ◽  
Vol 16 (1) ◽  
pp. 68-74
Author(s):  
Seung Yeon Yoo ◽  
Gaab Soo Kim
Keyword(s):  
Scoring System ◽  
Deceased Donor ◽  
Meld Score ◽  
Red Blood Cell Transfusion ◽  
Objective Condition ◽  
Intraoperative Bleeding ◽  
Allocation Policy ◽  
Donor Liver Transplantation ◽  
Before And After ◽  
End Stage

Background: The allocation policy for deceased donor livers in Korea was changed in June 2016 from Child-Turcotte-Pugh (CTP) scoring system-based to Model for End-stage Liver Disease (MELD) scoring system-based. Thus, it is necessary to review the effect of allocation policy changes on anesthetic management.Methods: Medical records of deceased donor liver transplantation (DDLT) from December 2014 to May 2017 were reviewed. We compared the perioperative parameters before and after the change in allocation policy.Results: Thirty-seven patients underwent DDLT from December 2014 to May 2016 (CTP group), and 42 patients underwent DDLT from June 2016 to May 2017 (MELD group). The MELD score was significantly higher in the MELD group than in the CTP group (36.5 ± 4.6 vs. 26.5 ± 9.4, P < 0.001). The incidence of hepatorenal syndrome (HRS) was higher in the MELD group than in the CTP group (26 vs. 7, P < 0.001). Packed red blood cell transfusion occurred more frequently in the MELD group than in the CTP group (5.0 ± 3.6 units vs. 3.4 ± 2.2 units, P = 0.025). However, intraoperative bleeding, vasopressor support, and postoperative outcomes were not different between the two groups.Conclusions: Even though the patient’s objective condition deteriorated, perioperative parameters did not change significantly.

scholarly journals Enterococcus faecalis exploits the human fibrinolytic system to drive excess collagenolysis: implications in gut healing and identification of druggable targets

2020 ◽  
Vol 318 (1) ◽  
pp. G1-G9 ◽  
Author(s):  
Richard A. Jacobson ◽  
Kiedo Wienholts ◽  
Ashley J. Williamson ◽  
Sara Gaines ◽  
Sanjiv Hyoju ◽  
...  
Keyword(s):  
Enterococcus Faecalis ◽  
Healing Process ◽  
Abdominal Sepsis ◽  
Infectious Complications ◽  
Fibrinolytic System ◽  
Clinical Safety ◽  
High Concentrations ◽  
Clinically Significant

Perforations, anastomotic leak, and subsequent intra-abdominal sepsis are among the most common and feared complications of invasive interventions in the colon and remaining intestinal tract. During physiological healing, tissue protease activity is finely orchestrated to maintain the strength and integrity of the submucosa collagen layer in the wound. We (Shogan, BD et al. Sci Trans Med 7: 286ra68, 2015.) have previously demonstrated in both mice and humans that the commensal microbe Enterococcus faecalis selectively colonizes wounded colonic tissues and disrupts the healing process by amplifying collagenolytic matrix-metalloprotease activity toward excessive degradation. Here, we demonstrate for the first time, to our knowledge, a novel collagenolytic virulence mechanism by which E. faecalis is able to bind and locally activate the human fibrinolytic protease plasminogen (PLG), a protein present in high concentrations in healing colonic tissue. E. faecalis-mediated PLG activation leads to supraphysiological collagen degradation; in this study, we demonstrate this concept both in vitro and in vivo. This pathoadaptive response can be mitigated with the PLG inhibitor tranexamic acid (TXA) in a fashion that prevents clinically significant complications in validated murine models of both E. faecalis- and Pseudomonas aeruginosa-mediated colonic perforation. TXA has a proven clinical safety record and is Food and Drug Administration approved for topical application in invasive procedures, albeit for the prevention of bleeding rather than infection. As such, the novel pharmacological effect described in this study may be translatable to clinical trials for the prevention of infectious complications in colonic healing. NEW & NOTEWORTHY This paper presents a novel mechanism for virulence in a commensal gut microbe that exploits the human fibrinolytic system and its principle protease, plasminogen. This mechanism is targetable by safe and effective nonantibiotic small molecules for the prevention of infectious complications in the healing gut.

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