137 research outputs found
Acute kidney injury and post-reperfusion syndrome in liver transplantation
No full textIn the past decades liver transplantation (LT) has become the treatment of choice for patients with end stage liver disease (ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death (DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease (CKD). Acute kidney injury (AKI) post-LT has been recently recognized as an important risk factor for the occurrence of de novo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome (PRS) that can influence recipient’s morbidity and mortality. Post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since pre-LT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A PubMed search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on PubMed search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outcome for patients developing PRS-induced AKI in liver transplantation. In order to identify intra-operative risk factors/mechanisms specifically involved in PRS-induced AKI, avoiding confounding factors, we have limited our study to “acute kidney injury AND DCD AND liver transplantation”. Accordingly, three out of five studies were selected for our purpose
Predictive score for acute kidney injury in DCD vs. DBD liver transplantation. UK single centre study
No full textBackground: Acute kidney injury (AKI) is a major cause of mortality after liver transplantation (LT). Furthermore, liver transplant recipients with post- operative AKI are more likely to develop chronic kidney disease, compared to the transplant recipients without AKI. Liver transplantation from Donation after Circulatory Death (DCD) is a model with increased occurrence of AKI compared to Donation after Brain Death (DBD). This is likely to be related to a more severe ischaemic reperfusion injury sustained by the graft. Aim of the study is to identify a predictive score for AKI in DCD and DBD liver transplant. Methods: Retrospective single-centre study of 1150 patients undergone LT at Queen Elizabeth Hospital Birmingham from 2007 to 2014. Exclusion criteria: urgent transplantation (=66), combined with other organs (=16), living donor liver transplants (=7) and previous renal (=1) grafting. We considered: renal function pre-transplant and daily within one week post-transplant, characteristics of recipient and donor, graft variables and indicators of initial graft function. AKI was defined and classified on the basis of KDIGO Guidelines (2012).
Results: 1060 LT patients (247 DCD and 813 DBD) were included in the analysis. Predictive variables of AKI development in DCD patients were donor height, warm ischaemia time, plasma transfusions during transplant, recipient BMI and diabetes. We performed internal validation of the equation using bootstrapping methods: this model correctly classified the 67.4–81.7% of patients with sensitivity of 77.9–91.6% and specificity of 27.6–73.5%. Variables in the DBD equation included MELD, plasma transfusions during transplant, donor age and recipient BMI. This model correctly classified the 61.1%-69.4% of patients with sensitivity of 69.7–86.6% and specificity of 30.9–58.9%. Conclusion: We produced risk prediction equations that may be used to improve our understanding of the risk of AKI after DCD and DBD liver transplantation
Incidence and outcome of colorectal cancer in liver transplant recipients: A national, multicentre analysis on 8115 patients
No full textBACKGROUND AND AIMS: De novo malignancies after liver transplantation represent one of the leading causes of death in the long-term. It remains unclear if liver transplant recipients have an increased risk of colorectal cancer and if this negatively impacts on survival, particularly in those patients affected by primary sclerosing cholangitis and ulcerative colitis. METHODS: In this national multicentre cohort retrospective study, the incidence of colorectal cancer in 8115 evaluable adult patients undergoing a liver transplantation between January 1st 1990 and December 31st 2010 was compared to the incidence in the general population through standardised incidence ratios. RESULTS: 52 (0.6%) cases of colorectal cancer were identified at a median of 5.6 years post liver transplantation, predominantly grade 2 (76.9%) and stage T3 (50%) at diagnosis. The incidence rate of colorectal cancer in the whole liver transplant population was similar to the general UK population (SIR 0.92), but significantly higher (SIR 7.0) in the group of patients affected by primary sclerosing cholangitis/ulcerative colitis. One, five and ten-year survival rates from colorectal cancer diagnosis were 71%, 48% and 31% respectively and the majority of colorectal cancer patients died of cancer-specific causes. CONCLUSIONS: Liver transplantation alone is not associated with an increased risk of colorectal cancer development. The primary sclerosing cholangitis/ulcerative colitis liver transplant population showed a significantly higher risk of colorectal cancer development than the general population, with a high proportion of advanced stage at diagnosis and a reduced patient survival. This article is protected by copyright. All rights reserved
Retransplantation in Late Hepatic Artery Thrombosis: Graft Access and Transplant Outcome
No full textBackground Definitive treatment for late hepatic artery thrombosis (L-HAT) is retransplantation (re-LT); however, the L-HAT-associated disease burden is poorly represented in allocation models.Methods Graft access and transplant outcome of the re-LT experience between 2005 and 2016 was reviewed with specific focus on the L-HAT cohort in this single-center retrospective study.Results Ninety-nine (5.7%) of 1725 liver transplantations were re-LT with HAT as the main indication (n = 43; 43%) distributed into early (n = 25) and late (n = 18) episodes. Model for end-stage liver disease as well as United Kingdom model for end-stage liver disease did not accurately reflect high disease burden of graft failure associated infections such as hepatic abscesses and biliary sepsis in L-HAT. Hence, re-LT candidates with L-HAT received low prioritization and waited longest until the allocation of an acceptable graft (median, 103 days; interquartile range, 28-291 days), allowing for progression of biliary sepsis. Balance of risk score and 3-month mortality score prognosticated good transplant outcome in L-HAT but, contrary to the prediction, the factual 1-year patient survival after re-LT was significantly inferior in L-HAT compared to early HAT, early non-HAT and late non-HAT (65% vs 82%, 92% and 95%) which was mainly caused by sepsis and multiorgan failure driving 3-month mortality (28% vs 11%, 16% and 0%). Access to a second graft after a median waitlist time of 6 weeks achieved the best short- and long-term outcome in re-LT for L-HAT (3-month mortality, 13%; 1-year survival, 77%).Conclusions Inequity in graft access and peritransplant sepsis are fundamental obstacles for successful re-LT in L-HAT. Offering a graft for those in need at the best window of opportunity could facilitate earlier engrafting with improved outcomes
Vasculobiliary complications following adult right lobe split liver transplantation from the perspective of reconstruction techniques
No full textSplit liver transplantation (SLT) compensates for the organ shortage and provides an alternative solution for recipients disadvantaged by a smaller body size. Variations in the hepatic arterial anatomy and reconstructive techniques may lead to more technical complications, and we sought to analyze the incidence and risk factors of vasculobiliary complications with respect to reconstructive techniques. We identified 171 adult right lobe SLT procedures and 1412 whole liver transplantation (WLT) procedures between January 2000 and June 2012 and compared the results of these 2 groups. In the SLT group, arterial reconstruction techniques were classified into 4 subgroups (I-IV), and biliary reconstruction was classified into 2 groups [duct-to-duct (DD) anastomosis and Roux-en-Y hepaticojejunostomy (RH)]. Specific surgical complications were analyzed against reconstruction techniques. The overall incidence of vascular and biliary complications in the SLT group was greater than that in the WLT group (P = 0.009 and P = 0.001, respectively). There was no difference in hepatic artery thrombosis (HAT), but we saw a tendency toward early HAT in the presence of multiple hepatic arteries supplying the right lobe graft (group IV; 20%) in comparison with the other arterial reconstruction groups (P = 0.052). No difference was noticed in the overall incidence of biliary complications in either DD or RH recipients across 4 arterial reconstruction groups. When the arterial reconstruction involved a right hepatic artery (groups II and III) combined with a DD biliary anastomosis, there was a significant preponderance of biliary complications (P = 0.04 and P = 0.01, respectively). There was no survival difference between SLT and WLT grafts. In conclusion, the complications of SLT are directly related to arterial and biliary reconstruction techniques, and this classification helps to identify high-risk reconstructive techniques.</p
Gamifying an M.Ed. Course: A Post-Mortem
No full textThis paper is about the collective experiences of a graduate level education course that had been partially gamified. A common model for graduate level Education courses uses a seminar approach where participants complete various readings and then respond to them in short editorials or blogs. This course gamified that component by requiring students to complete numerous small to medium sized activities that included these typical ones in order to accumulate points. These points contributed to their final grade. Students gave feedback on their experience with gamification throughout the course which included increased ownership and control of learning and grades, as well as unwanted competition, and onerous marking for the instructor. The paper concludes with suggestion
Outcomes following liver transplantation for seronegative acute liver failure: experience during a 12-year period with more than 100 patients.
No full textSeronegative hepatitis is a common cause of acute liver failure (ALF) requiring liver transplantation. The primary aim of this study was to examine outcomes following transplantation in this group and to identify factors associated with early (50 (P = .015; odds ratio, 4.2; 95% confidence interval, 1.3-14.1) and non-Caucasian recipient ethnicity (P = .015; odds ratio, 4.9; 95% confidence interval, 1.2-19.2) were other variables associated with early death on multivariate analysis. This study specifically examined factors that determine the early outcome of transplanted seronegative ALF patients. In conclusion, we found that donor and recipient factors identify patients who have a high chance of early death after transplantation
Optimal timing of liver transplantation for patients with primary biliary cirrhosis: use of prognostic modelling
No full textAssociation of fulminant non-A non-B hepatitis with homozygosity for HLA A1-B8-DR3
No full textBackground: For the majority of cases of acute liver failure in western Europe and North America an etiology cannot be defined. The condition is most often called fulminant non-A, non-B (NANB) hepatitis. Features such as female preponderance and presence of serum autoantibodies suggest a possible autoimmune basis. The aim of the present paper was to examine a possible human leukocyte antigen (HLA) association with fulminant NANB hepatitis. Methods: HLA A, B, and DR data of 55 adult Caucasian fulminant NANB patients were compared with those of 1449 local Caucasian controls. Results: In Caucasian patients, homozygosity (but not heterozygosity) for the alleles A1, B8, and DR3 were associated with fulminant NANB hepatitis (Pcorrected = 0.02, <0.00001 and 0.002, respectively). Greatest relative risk (RR) was associated with homozygosity for the A1-B8-DR3 haplotype (P <0.00001; RR: 12.8; 95% confidence interval [CI]: 5.7-22.3). HLA DR8 was also associated with development of the syndrome (RR: 4.2; 95%CI: 1.6-9.2). Conclusions: Homozygosity for the HLA haplotype A1-B8-DR3 confers susceptibility to the development of fulminant NANB hepatitis. This observation may imply a role for the immune response genes (which are flanked by HLA B and DR) in the pathogenesis of this syndrome. (C) 2005 Blackwell Publishing Asia Pty Ltd
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