Pub Date : 2015-02-26DOI: 10.2174/1874418401508010001
F. Ihle, G. Zimmermann, T. Meis, R. Hatz, S. Czerner, L. Frey, P. Ueberfuhr, B. Meiser, J. Behr
Background: The purpose of this study was to examine clinical and non- clinical determinants of quality of life (QoL) in lung transplant recipients (LTR). Methods: QoL was measured cross-sectional in 152 LTR (4.5±3.2 years after lung transplantation (LTx); 95 (63%) double LTx; 80 (53%) female; age 50±11.9 years; 28 (18%) bronchiolitis obliterans syndrome (BOS) stage ≥ 1) using the SF-36, the "Quality of Life Profile for Chronic Diseases Questionnaire" as well as the "St. GeorgesRespiratory Questionnaire". Gender, age, body mass index (BMI), time after LTx, procedure type, underlying disease, marital- and professional status and exercise capacity (6-minute walk test, 6MWT) were tested for their predictive value by non-parametric significance tests and ANOVA and ANCOVA. Results: There was a significant correlation with higher physical QoL scores for age < 48 years (p<0.05), a BMI of 21.0 - 25.2 kg/m 2 (p<0.05), a 6MWT≥ 430m (p<0.001), for cystic fibrosis patients (p<0.05) without BOS (p<0.05) and who go to work (p=0.018). Females boasted a superior social health (p=0.04) and less respiratory symptoms (p=0.023). Double LTx was a significant predictor for both, mental and physical health (p<0.05). Subsequent analysis of covariance revealed only BMI (p=0.024), BOS stage (p<0.001), underlying disease (p=0.01) and exercise capacity according to 6MWT (p<0.001) as significant predictors for QoL independent of age. Conclusion: The study results suggest that returning to normal BMI and improving exercise capacity seem to be important therapeutic approaches to enhance QoL after LTx. Future investigations should focus on prophylaxis and therapy of BOS to further optimize QoL after LTx.
{"title":"Determinants of Quality of Life After Lung Transplantation","authors":"F. Ihle, G. Zimmermann, T. Meis, R. Hatz, S. Czerner, L. Frey, P. Ueberfuhr, B. Meiser, J. Behr","doi":"10.2174/1874418401508010001","DOIUrl":"https://doi.org/10.2174/1874418401508010001","url":null,"abstract":"Background: The purpose of this study was to examine clinical and non- clinical determinants of quality of life (QoL) in lung transplant recipients (LTR). Methods: QoL was measured cross-sectional in 152 LTR (4.5±3.2 years after lung transplantation (LTx); 95 (63%) double LTx; 80 (53%) female; age 50±11.9 years; 28 (18%) bronchiolitis obliterans syndrome (BOS) stage ≥ 1) using the SF-36, the \"Quality of Life Profile for Chronic Diseases Questionnaire\" as well as the \"St. GeorgesRespiratory Questionnaire\". Gender, age, body mass index (BMI), time after LTx, procedure type, underlying disease, marital- and professional status and exercise capacity (6-minute walk test, 6MWT) were tested for their predictive value by non-parametric significance tests and ANOVA and ANCOVA. Results: There was a significant correlation with higher physical QoL scores for age < 48 years (p<0.05), a BMI of 21.0 - 25.2 kg/m 2 (p<0.05), a 6MWT≥ 430m (p<0.001), for cystic fibrosis patients (p<0.05) without BOS (p<0.05) and who go to work (p=0.018). Females boasted a superior social health (p=0.04) and less respiratory symptoms (p=0.023). Double LTx was a significant predictor for both, mental and physical health (p<0.05). Subsequent analysis of covariance revealed only BMI (p=0.024), BOS stage (p<0.001), underlying disease (p=0.01) and exercise capacity according to 6MWT (p<0.001) as significant predictors for QoL independent of age. Conclusion: The study results suggest that returning to normal BMI and improving exercise capacity seem to be important therapeutic approaches to enhance QoL after LTx. Future investigations should focus on prophylaxis and therapy of BOS to further optimize QoL after LTx.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"8 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2015-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-10-18DOI: 10.2174/1874418401307010033
T. Gonçalves, V. Yamaki, João Vitor Baia Coelho, M. V. Brito, S. Percário
Ischemia and reperfusion is a very frequently phenomenon that is presented in many clinical situations like in liver transplantation as well as in traumatic situation of these organs.One way of minimizing this injury is the remote ischemic perconditioning, described in myocardial ischemia, in which brief nonlethal cycles of ischemia and reperfusion of the arm or leg are applied remotely during index ischemia. Therefore, this current study aims to compare the effects of perconditioning and postconditioning on injury of ischemia and reperfusion in the liver.
{"title":"First Demonstration of the Effects of Remote Per- and Postconditioning onIschemia and Reperfusion Induced Hepatic Injury","authors":"T. Gonçalves, V. Yamaki, João Vitor Baia Coelho, M. V. Brito, S. Percário","doi":"10.2174/1874418401307010033","DOIUrl":"https://doi.org/10.2174/1874418401307010033","url":null,"abstract":"Ischemia and reperfusion is a very frequently phenomenon that is presented in many clinical situations like in liver transplantation as well as in traumatic situation of these organs.One way of minimizing this injury is the remote ischemic perconditioning, described in myocardial ischemia, in which brief nonlethal cycles of ischemia and reperfusion of the arm or leg are applied remotely during index ischemia. Therefore, this current study aims to compare the effects of perconditioning and postconditioning on injury of ischemia and reperfusion in the liver.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"7 1","pages":"33-34"},"PeriodicalIF":0.0,"publicationDate":"2013-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-20DOI: 10.2174/1874418420130513001
M. Chu, A. Dare, A. Bartlett, A. Phillips, A. Hickey
Background: The impact of hepatic steatosis on bioenergetics following hepatic ischemia-reperfusion injury (IRI) remains controversial and is associated with variable reports on its outcome. Large numbers of studies have been published examining the relationship between hepatic steatosis and cellular bioenergetics following hepatic IRI. This sys- tematic review evaluates these studies. Methods: An electronic search of the Medline and Embase databases (January 1946 to June 2012) was performed to select studies that reported relevant outcomes in animal models or patients with hepatic steatosis subjected to IRI. Results: A total of 489 articles were identified, of which 63 animal studies met the predefined criteria and were included in the study. There was large variation in the type of animal model, duration and type of IRI utilized and histological de- scription of hepatic steatosis. Bioenergetic impairments appear to increase the susceptibility of steatotic livers to IRI. The most common impairment was decreased adenosine triphosphate recovery with increased oxidative stress following IRI. Impaired mitochondrial function play a key role in the susceptibility of steatotic livers to IRI. Conclusions: Animals with >30% hepatic steatosis have been shown to have poor outcome following IRI. Despite limita- tions of different experimental models and inconsistency in histological description, impaired mitochondrial function and bioenergetics appear to be important mediators in the decreased tolerance of steatotic livers to IRI. Future studies need to be consistent and clinically relevant to further improve our understanding of this issue.
{"title":"Effect of Hepatic Steatosis on Bioenergetic Function During HepaticIschemia-reperfusion: A Systematic Review","authors":"M. Chu, A. Dare, A. Bartlett, A. Phillips, A. Hickey","doi":"10.2174/1874418420130513001","DOIUrl":"https://doi.org/10.2174/1874418420130513001","url":null,"abstract":"Background: The impact of hepatic steatosis on bioenergetics following hepatic ischemia-reperfusion injury (IRI) remains controversial and is associated with variable reports on its outcome. Large numbers of studies have been published examining the relationship between hepatic steatosis and cellular bioenergetics following hepatic IRI. This sys- tematic review evaluates these studies. Methods: An electronic search of the Medline and Embase databases (January 1946 to June 2012) was performed to select studies that reported relevant outcomes in animal models or patients with hepatic steatosis subjected to IRI. Results: A total of 489 articles were identified, of which 63 animal studies met the predefined criteria and were included in the study. There was large variation in the type of animal model, duration and type of IRI utilized and histological de- scription of hepatic steatosis. Bioenergetic impairments appear to increase the susceptibility of steatotic livers to IRI. The most common impairment was decreased adenosine triphosphate recovery with increased oxidative stress following IRI. Impaired mitochondrial function play a key role in the susceptibility of steatotic livers to IRI. Conclusions: Animals with >30% hepatic steatosis have been shown to have poor outcome following IRI. Despite limita- tions of different experimental models and inconsistency in histological description, impaired mitochondrial function and bioenergetics appear to be important mediators in the decreased tolerance of steatotic livers to IRI. Future studies need to be consistent and clinically relevant to further improve our understanding of this issue.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"7 1","pages":"10-32"},"PeriodicalIF":0.0,"publicationDate":"2013-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-06DOI: 10.2174/1874418420130605002
U. Johnson, H. Hinic, Anders Billstrom, H. Gabel
The World Transplant Games (WTG) is a biennial worldwide sporting event. Most published research relating to WTG has focused on medical issues. However, few studies have examined factors such as psychological wellbeing in sport for this group. The purpose of this study is to provide a description of the English-speaking participants at the WTG and analyze five research questions linked to how (1) health, (2), satisfaction with sports participation (3), perceived com- petence, (4) health as a benefit of sport participation (5), and impaired health as a cost of sports participation, are related to psychological factors in sports. There were a total of 253 participants with a mean age of 43.6 years, originating from seven English-speaking nations. Four validated psychological questionnaires were used, as well as a screening of back- ground data of the group. The main characteristics of the English-speaking population were university educated middle age men with kidney transplants, who had participated in athletics at a rather high competitive level before the transplant. The main statistical findings particularly showed that satisfaction with sport participation, perceived health and health as a benefit were the dependent variables that explained most of the variance in the analysis. In conclusion, perceived compe- tence, enjoyment and health seem to be critical psychological factors that essentially act as prime motivating factors be- hind participation in games such as WTG, and ultimately lead to a sense of psychological well-being among the partici- pants. Finally, there is a discussion of future research, as well as the practical value of the results.
{"title":"Transplant Recipients’ Experience of Participation at the World TransplantGames in Gothenburg 2011: A Study of Psychological Well-being","authors":"U. Johnson, H. Hinic, Anders Billstrom, H. Gabel","doi":"10.2174/1874418420130605002","DOIUrl":"https://doi.org/10.2174/1874418420130605002","url":null,"abstract":"The World Transplant Games (WTG) is a biennial worldwide sporting event. Most published research relating to WTG has focused on medical issues. However, few studies have examined factors such as psychological wellbeing in sport for this group. The purpose of this study is to provide a description of the English-speaking participants at the WTG and analyze five research questions linked to how (1) health, (2), satisfaction with sports participation (3), perceived com- petence, (4) health as a benefit of sport participation (5), and impaired health as a cost of sports participation, are related to psychological factors in sports. There were a total of 253 participants with a mean age of 43.6 years, originating from seven English-speaking nations. Four validated psychological questionnaires were used, as well as a screening of back- ground data of the group. The main characteristics of the English-speaking population were university educated middle age men with kidney transplants, who had participated in athletics at a rather high competitive level before the transplant. The main statistical findings particularly showed that satisfaction with sport participation, perceived health and health as a benefit were the dependent variables that explained most of the variance in the analysis. In conclusion, perceived compe- tence, enjoyment and health seem to be critical psychological factors that essentially act as prime motivating factors be- hind participation in games such as WTG, and ultimately lead to a sense of psychological well-being among the partici- pants. Finally, there is a discussion of future research, as well as the practical value of the results.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"7 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2013-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-03-22DOI: 10.2174/1874418401206010001
K. S. Korkmaz, W. Rogier, H. Verspaget, J. Dubbeld, R. Wolterbeek, A. R. V. Erkel, B. D. Rooij, Minneke C. Coenraad, J. Ringers, B. Hoek
Background: After orthotopic liver transplantation (OLT) early detection of biliary strictures is important. Our aim was to evaluate the predictive value of routine serum liver chemistry profiling and abdominal ultrasound as non- invasive diagnostic tools in detecting biliary strictures after OLT. Methods: We performed a retrospective study in which 141 primary OLTs, performed between 1992 and 2007 with more than 1 year follow-up, were included. Routinely assessed serum levels of alkaline phosphatase, alanine-aminotransferase, aspartate-aminotransferase, gamma-glutamyl transpeptidase and bilirubin at 3, 6, 9 and 12 months, and abdominal ultrasounds performed at 3, 6 and 12 months after OLT were evaluated. All biliary strictures requiring intervention occurring after 3 months were included. Time-dependent Cox regression analysis was performed to identify predictive factors for the development of biliary strictures. Results: Eighteen grafts developed non-anastomotic strictures (12.8%) and 18 grafts (12.8%) developed anastomotic strictures requiring intervention. An elevated gamma-glutamyl transpeptidase (HR 1.24 per 100 IU/L; p = 0.05) and dilated bile ducts on ultrasound (HR 3.45; p < 0.01) were found to have an independent predictive value for the development of biliary strictures requiring intervention. Bilirubin and the other studied liver enzymes were not independently predictive. Conclusion: Dilated bile ducts on ultrasound and elevated gamma-glutamyltranspeptidase after OLT are independent predictive factors for the development of biliary strictures requiring intervention. Routine assessment by serum gGT and US at 3-month intervals during the first year post-OLT is useful to screen for biliary strictures post-OLT.
{"title":"Sequential Liver Chemistry Profiling and Abdominal Ultrasound Assessments to Predict Biliary Strictures after Liver Transplantation","authors":"K. S. Korkmaz, W. Rogier, H. Verspaget, J. Dubbeld, R. Wolterbeek, A. R. V. Erkel, B. D. Rooij, Minneke C. Coenraad, J. Ringers, B. Hoek","doi":"10.2174/1874418401206010001","DOIUrl":"https://doi.org/10.2174/1874418401206010001","url":null,"abstract":"Background: After orthotopic liver transplantation (OLT) early detection of biliary strictures is important. Our aim was to evaluate the predictive value of routine serum liver chemistry profiling and abdominal ultrasound as non- invasive diagnostic tools in detecting biliary strictures after OLT. Methods: We performed a retrospective study in which 141 primary OLTs, performed between 1992 and 2007 with more than 1 year follow-up, were included. Routinely assessed serum levels of alkaline phosphatase, alanine-aminotransferase, aspartate-aminotransferase, gamma-glutamyl transpeptidase and bilirubin at 3, 6, 9 and 12 months, and abdominal ultrasounds performed at 3, 6 and 12 months after OLT were evaluated. All biliary strictures requiring intervention occurring after 3 months were included. Time-dependent Cox regression analysis was performed to identify predictive factors for the development of biliary strictures. Results: Eighteen grafts developed non-anastomotic strictures (12.8%) and 18 grafts (12.8%) developed anastomotic strictures requiring intervention. An elevated gamma-glutamyl transpeptidase (HR 1.24 per 100 IU/L; p = 0.05) and dilated bile ducts on ultrasound (HR 3.45; p < 0.01) were found to have an independent predictive value for the development of biliary strictures requiring intervention. Bilirubin and the other studied liver enzymes were not independently predictive. Conclusion: Dilated bile ducts on ultrasound and elevated gamma-glutamyltranspeptidase after OLT are independent predictive factors for the development of biliary strictures requiring intervention. Routine assessment by serum gGT and US at 3-month intervals during the first year post-OLT is useful to screen for biliary strictures post-OLT.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"6 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2012-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-30DOI: 10.2174/1874418401105010030
A. Gasbarrini, F. Ponziani
All around the world, several transplant centres are involved in a complex medical and surgical management of the candidates for liver transplantation. In Italy too, this is a consolidated practice, even if affected by the shortage of donors and available organs to be transplanted. The education about the importance of the donation and a better clinicians’ awareness of the procedures, the risks and the benefits of liver transplantation, will improve the administration of this precious health resource.
{"title":"Editorial: Before and after Liver Transplantation","authors":"A. Gasbarrini, F. Ponziani","doi":"10.2174/1874418401105010030","DOIUrl":"https://doi.org/10.2174/1874418401105010030","url":null,"abstract":"All around the world, several transplant centres are involved in a complex medical and surgical management of the candidates for liver transplantation. In Italy too, this is a consolidated practice, even if affected by the shortage of donors and available organs to be transplanted. The education about the importance of the donation and a better clinicians’ awareness of the procedures, the risks and the benefits of liver transplantation, will improve the administration of this precious health resource.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 1","pages":"30-31"},"PeriodicalIF":0.0,"publicationDate":"2011-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-30DOI: 10.2174/1874418401105010035
F. Ponziani, M. Novi, E. Rinninella, A. Gasbarrini
Hepatocellular carcinoma (HCC) is a major problem worldwide, representing the fifth most common tumor among the general population (1). Several molecular pathways seem to be involved in HCC growth and progression, realizing an intricate mechanism of proliferative and angiogenetic stimulation and inhibiting apoptosis. The recent identification of these molecular pathways has improved our knowledge of HCC tumorigenesis and has setted up a more specific approach to HCC treatment. However, since non advanced HCC is one of the most common indications for liver transplantation, the recent novelties in pharmacologic inhibition of HCC growth mechanisms have opened new interesting opportunities in recipients' immunosuppressive treatment. M-TOR inhibitors belong to the group of rapamycine analogues, are used as second line immunosuppressive drugs and capable to inhibit one of the most active molecular pathways in HCC cells: the m-TOR pathway. In this review, we explain the mechanism and the molecular elements involved, up- and downstream, in m-TOR activation, providing an overview of the other features of HCC tumorigenesis too. Moreover, we describe the effects of m-TOR inhibition on HCC cells in vitro and in animal models, as well as on liver transplant recipients at risk of or with a manifest tumor recurrence and on de novo post-transplant malignancies. Finally, we discuss the possible efficacy of a proper combined therapy, well tolerated by patients and active against multiple molecular targets, to obtain a synergistic effect on the tumor mass with the greatest benefit for patients' survival and quality of life.
{"title":"Walking on the Molecular Pathway: m-TOR Inhibition in the Liver Transplant Setting","authors":"F. Ponziani, M. Novi, E. Rinninella, A. Gasbarrini","doi":"10.2174/1874418401105010035","DOIUrl":"https://doi.org/10.2174/1874418401105010035","url":null,"abstract":"Hepatocellular carcinoma (HCC) is a major problem worldwide, representing the fifth most common tumor among the general population (1). Several molecular pathways seem to be involved in HCC growth and progression, realizing an intricate mechanism of proliferative and angiogenetic stimulation and inhibiting apoptosis. The recent identification of these molecular pathways has improved our knowledge of HCC tumorigenesis and has setted up a more specific approach to HCC treatment. However, since non advanced HCC is one of the most common indications for liver transplantation, the recent novelties in pharmacologic inhibition of HCC growth mechanisms have opened new interesting opportunities in recipients' immunosuppressive treatment. M-TOR inhibitors belong to the group of rapamycine analogues, are used as second line immunosuppressive drugs and capable to inhibit one of the most active molecular pathways in HCC cells: the m-TOR pathway. In this review, we explain the mechanism and the molecular elements involved, up- and downstream, in m-TOR activation, providing an overview of the other features of HCC tumorigenesis too. Moreover, we describe the effects of m-TOR inhibition on HCC cells in vitro and in animal models, as well as on liver transplant recipients at risk of or with a manifest tumor recurrence and on de novo post-transplant malignancies. Finally, we discuss the possible efficacy of a proper combined therapy, well tolerated by patients and active against multiple molecular targets, to obtain a synergistic effect on the tumor mass with the greatest benefit for patients' survival and quality of life.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 1","pages":"35-43"},"PeriodicalIF":0.0,"publicationDate":"2011-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-30DOI: 10.2174/1874418401105010050
Avolio A.W., S. Agnes, M. Siciliano, F. Ponziani, A. Grieco, N. Nicolotti, E. Annicchiarico, G. Boscarino, M. Barone
Donor Risk Index (DRI) has been introduced to predict post-transplant graft survival (GS) using donor data. The MELD score, which is the gold-standard in scoring liver disease in liver transplant candidates, has a low prognostic significance. The present analysis is aimed to assess the role of DRI and of MELD score in predicting the outcome after liver transplantation, in short (180 days) and medium term (1460 days). The Organ Procurement Transplantation Network (OPTN) database relevant to 23.392 consecutive cases in the MELD era was used. Cases were stratified in classes according to DRI (4 classes), MELD (6 classes), and DRI-MELD match (24 classes). GS was assessed by Kaplan Meier method at 0-1460 days. Differences were tested by Log-rank test. All three parameters allow an effective stratification. Using the DRI, the gaps between the highest and lowest GS were 7.8% and 14.9%, at 180 and 1460 days, respectively. Using the MELD score, the gaps were 10.2% and 9.5%, respectively. Using DRI-MELD, the gaps were 25.5% and 35.4%, respectively. Both the DRI and the MELD can predict the outcome, although the predictive power of the DRI is the highest of the two, and the predictive power of the donor- recipient match, is even higher.
{"title":"Donor Risk Index and MELD Score Interactions in Graft Survival Prediction after Liver Transplantation. An Analysis of the OPTN-UNOS Database","authors":"Avolio A.W., S. Agnes, M. Siciliano, F. Ponziani, A. Grieco, N. Nicolotti, E. Annicchiarico, G. Boscarino, M. Barone","doi":"10.2174/1874418401105010050","DOIUrl":"https://doi.org/10.2174/1874418401105010050","url":null,"abstract":"Donor Risk Index (DRI) has been introduced to predict post-transplant graft survival (GS) using donor data. The MELD score, which is the gold-standard in scoring liver disease in liver transplant candidates, has a low prognostic significance. The present analysis is aimed to assess the role of DRI and of MELD score in predicting the outcome after liver transplantation, in short (180 days) and medium term (1460 days). The Organ Procurement Transplantation Network (OPTN) database relevant to 23.392 consecutive cases in the MELD era was used. Cases were stratified in classes according to DRI (4 classes), MELD (6 classes), and DRI-MELD match (24 classes). GS was assessed by Kaplan Meier method at 0-1460 days. Differences were tested by Log-rank test. All three parameters allow an effective stratification. Using the DRI, the gaps between the highest and lowest GS were 7.8% and 14.9%, at 180 and 1460 days, respectively. Using the MELD score, the gaps were 10.2% and 9.5%, respectively. Using DRI-MELD, the gaps were 25.5% and 35.4%, respectively. Both the DRI and the MELD can predict the outcome, although the predictive power of the DRI is the highest of the two, and the predictive power of the donor- recipient match, is even higher.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"24 1","pages":"50-55"},"PeriodicalIF":0.0,"publicationDate":"2011-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68073318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-30DOI: 10.2174/1874418401105010032
B. Annicchiarico, M. Siciliano, A. Avolio, S. Agnes, A. Gasbarrini
Sustained virologic response (SVR) to the antiviral therapy for chronic hepatitis C virus infection before liver transplantation (LT) can prevent graft infection. Pegylated (PEG)- interferon (IFN) may ameliorate the SVR, improving the risk-to-benefit ratio of antiviral therapy in cirrhotics awaiting LT. From January 2001 to March 2009, 21 HCV- infected cirrhotics eligible for LT were treated with PEG-IFN alpha-2b (1.5 µg/kg weight/week) and ribavirin (800-1200 mg/day). Mean age was 53.7±7.9 years. There were 11 men. Eleven had genotype 1b. Child-Pugh score was 9.5±1.2, Model for End-Stage Liver Disease score 16.6±1.8. Besides virologic failure, full dosage and planned length of therapy were tolerated in 5 patients (23.8%). Adverse events occurred in all patients, life-threatening in 9 (42.9%). No patient died during treatment. Adverse events caused treatment withdrawal in 11 patients (52.4%), ribavirin and/or PEG-IFN reduction in 7 (33.3%). On an intention-to-treat basis, SVR was obtained in 4 patients (19.0%). None of the genotype 1 or 3 patients obtained SVR; 50.0% of genotype 2 patients obtained SVR. All patients with SVR experienced rapid virological response (RVR). Six patients (three nonresponders, two relapsers, one sustained responder) were transplanted; six died; four are awaiting LT; two are under evaluation for listening; three refused LT. The risk-to-benefit ratio is against treatment with PEG-IFN and ribavirin of severely decompensated genotype 1 cirrhotics. In contrast, antiviral therapy is probably beneficial in genotype 2 subjects, due to an expected SVR rate of 50%. However, one must carefully consider the high risk for severe adverse events.
{"title":"Pegylated-Interferon and Ribavirin for Chronic Hepatitis C Virus Infection in Decompensated Cirrhotics Awaiting Liver Transplantation","authors":"B. Annicchiarico, M. Siciliano, A. Avolio, S. Agnes, A. Gasbarrini","doi":"10.2174/1874418401105010032","DOIUrl":"https://doi.org/10.2174/1874418401105010032","url":null,"abstract":"Sustained virologic response (SVR) to the antiviral therapy for chronic hepatitis C virus infection before liver transplantation (LT) can prevent graft infection. Pegylated (PEG)- interferon (IFN) may ameliorate the SVR, improving the risk-to-benefit ratio of antiviral therapy in cirrhotics awaiting LT. From January 2001 to March 2009, 21 HCV- infected cirrhotics eligible for LT were treated with PEG-IFN alpha-2b (1.5 µg/kg weight/week) and ribavirin (800-1200 mg/day). Mean age was 53.7±7.9 years. There were 11 men. Eleven had genotype 1b. Child-Pugh score was 9.5±1.2, Model for End-Stage Liver Disease score 16.6±1.8. Besides virologic failure, full dosage and planned length of therapy were tolerated in 5 patients (23.8%). Adverse events occurred in all patients, life-threatening in 9 (42.9%). No patient died during treatment. Adverse events caused treatment withdrawal in 11 patients (52.4%), ribavirin and/or PEG-IFN reduction in 7 (33.3%). On an intention-to-treat basis, SVR was obtained in 4 patients (19.0%). None of the genotype 1 or 3 patients obtained SVR; 50.0% of genotype 2 patients obtained SVR. All patients with SVR experienced rapid virological response (RVR). Six patients (three nonresponders, two relapsers, one sustained responder) were transplanted; six died; four are awaiting LT; two are under evaluation for listening; three refused LT. The risk-to-benefit ratio is against treatment with PEG-IFN and ribavirin of severely decompensated genotype 1 cirrhotics. In contrast, antiviral therapy is probably beneficial in genotype 2 subjects, due to an expected SVR rate of 50%. However, one must carefully consider the high risk for severe adverse events.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 1","pages":"32-34"},"PeriodicalIF":0.0,"publicationDate":"2011-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2011-05-30DOI: 10.2174/1874418401105010056
M. Garcovich, A. Burroughs, C. Campanale, A. Gasbarrini, A. Grieco
When end stage liver disease occurs, liver transplantation is the only effective treatment available. In the past, liver transplantation was frequently accompanied by considerable bleeding complications and massive transfusion requirements, while only in recent years advances in operative management and a better understanding of the pathophysiology of coagulation have determined a better outcome for this major surgery. In addition, accumulating evidence shows that the overall haemostatic function in patients with cirrhosis facing liver transplantation may not be shifted towards a bleeding diathesis as traditionally believed, but that both bleeding episodes and thrombotic events may take place as major peri- and post-operative complications in patients undergoing liver surgery. The aim of this review paper is to offer an overview of recent developments that have gradually improved our understanding about the changes that may occur in the haemostatic system of patients undergoing liver transplantation, taking into account the best way to monitor them.
{"title":"Monitoring of Haemostasis during Liver Transplantation","authors":"M. Garcovich, A. Burroughs, C. Campanale, A. Gasbarrini, A. Grieco","doi":"10.2174/1874418401105010056","DOIUrl":"https://doi.org/10.2174/1874418401105010056","url":null,"abstract":"When end stage liver disease occurs, liver transplantation is the only effective treatment available. In the past, liver transplantation was frequently accompanied by considerable bleeding complications and massive transfusion requirements, while only in recent years advances in operative management and a better understanding of the pathophysiology of coagulation have determined a better outcome for this major surgery. In addition, accumulating evidence shows that the overall haemostatic function in patients with cirrhosis facing liver transplantation may not be shifted towards a bleeding diathesis as traditionally believed, but that both bleeding episodes and thrombotic events may take place as major peri- and post-operative complications in patients undergoing liver surgery. The aim of this review paper is to offer an overview of recent developments that have gradually improved our understanding about the changes that may occur in the haemostatic system of patients undergoing liver transplantation, taking into account the best way to monitor them.","PeriodicalId":90368,"journal":{"name":"The open transplantation journal","volume":"5 1","pages":"56-62"},"PeriodicalIF":0.0,"publicationDate":"2011-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68072801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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