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malnutrition and liver transplant

R P Duarte, A C Sentanin, A M O da Silva, R M Tonella, G L Duarte, L S R Ratti, I F S F Boin
INTRODUCTION: Liver disease induces many organic and metabolic changes, leading to malnutrition and weight and muscular function loss. Surface electromyography is an easily applicable, noninvasive study, through which the magnitudes of the peaks on the charts depict voluntary muscle activity. AIM: To evaluate the diaphragmatic surface electromyography of postoperative liver transplantation subjects. METHODS: Subjects were patients who underwent liver transplantation and extubation in the Clinical Hospital of State University of Campinas...
May 2017: Transplantation Proceedings
Jennifer C Lai, Kenneth E Covinsky, Jennifer L Dodge, W John Boscardin, Dorry L Segev, John P Roberts, Sandy Feng
BACKGROUND: Cirrhosis is characterized by muscle wasting, malnutrition, and functional decline that confer excess mortality not well quantified by the MELDNa score. We aimed to develop a frailty index to capture these extrahepatic complications of cirrhosis and enhance mortality prediction in cirrhotics. METHODS: Consecutive outpatients listed for LT at a single transplant center without MELD exceptions were assessed with candidate frailty measures. Best subset selection analyses with Cox regression identified subsets of frailty measures that predicted waitlist mortality (=death or delisting due to sickness)...
April 19, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Kaleb J Marr, Abdel-Aziz Shaheen, Louisa Lam, Melanie Stapleton, Kelly Burak, Maitreyi Raman
BACKGROUND: Malnutrition is an important predictor of morbidity and mortality among cirrhotic patients. Our objectives were to assess protein-calorie malnutrition (PCM) in cirrhotic pre-liver transplant patients and to study the correlation between subjective global assessment (SGA) and other objective measures of malnutrition. METHODS: We recruited pre-liver transplant adult patients at our center between October 2012 and Oct 2015. Nutrition status was assessed via SGA...
February 2017: Clinical Nutrition ESPEN
S Acar, G Gencdal, M Tokac, E Eren, U Alkara, G Tellioglu, A Dinckan, M Akyildiz
Polycystic liver disease is characterized by multiple cystic lesions on the liver. It is an uncommon autosomal dominant disease. The cysts' diameters range from 20 to 30 cm to small microscopic nodules. Generally, more than half of the liver parenchyma is covered. The mass effect of the liver created by the large cysts can cause life-threatening symptoms such as weight loss, reduction of oral intake, and malnutrition. Liver transplantation is the best treatment option in symptomatic patients. We present a patient who had polycystic liver and kidney disease, and we performed liver transplantation because of his life-threatening symptoms...
April 2017: Transplantation Proceedings
Jia-Huei Tsai, Linda D Ferrell, Vivian Tan, Matthew M Yeh, Monika Sarkar, Ryan M Gill
While non-alcoholic steatohepatitis is a slowly progressive disease, patients may rarely present in acute liver failure. We describe six patients who developed severe hepatic dysfunction following rapid weight loss or malnutrition. Rapid weight loss (18 to 91 kg) occurred after Roux-en-Y gastric bypass in four patients and starvation-like dieting or hypoalbuminemia was noted in two patients. Four patients either died or received an urgent liver transplant. Pathologic findings were characterized by advanced alcoholic steatohepatitis-like features, including extensive/circumferential centrizonal pericellular fibrosis, central scar with perivenular sclerosis/veno-occlusion with superimposed hepatocellular dropout, abundant/prominent hepatocellular balloons, and numerous Mallory-Denk bodies, but there was no history of excess alcohol consumption...
March 3, 2017: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
K Atiemo, A Skaro, H Maddur, L Zhao, S Montag, L VanWagner, S Goel, A Kho, B Ho, R Kang, J L Holl, M M Abecassis, J Levitsy, D P Ladner
Although the Model for End-Stage Liver Disease sodium (MELD Na) score is now used for liver transplant allocation in the United States, mortality prediction may be underestimated by the score. Using aggregated electronic health record data from 7834 adult patients with cirrhosis, we determined whether the cause of cirrhosis or cirrhosis complications was associated with an increased risk of death among patients with a MELD Na score ≤15 and whether patients with the greatest risk of death could benefit from liver transplantation (LT)...
February 22, 2017: American Journal of Transplantation
Krishna Aj Mutgi, Grant Ghahramani, Karolyn Wanat, Heather Ciliberto
This patient was a liver transplant recipient and had a history of malnutrition. One tell-tale sign on the physical exam, however, left no doubt as to the diagnosis.
December 2016: Journal of Family Practice
S Malenicka, B-G Ericzon, M H Jørgensen, H Isoniemi, T H Karlsen, M Krantz, V Naeser, M Olausson, A Rasmussen, K Rönnholm, T Sanengen, T Scholz, B Fischler, A Nemeth
Biliary atresia (BA) is the most common indication for LT in children. We investigated whether this diagnosis per se, compared to other chronic liver diseases (OCLD), had an influence on patient survival. Data from 421 Scandinavian children, 194 with BA and 227 with OCLD, listed for LT between 1990 and 2010 were analyzed. The intention-to-treat survival and influencing risk factors were studied. Patients with BA had higher risk of death after listing than patients with OCLD. The youngest (<1 year) and smallest (<10 kg) children with the highest bilirubin (>510 μmol/L), highest INR (>1...
March 2017: Pediatric Transplantation
C Lindqvist, A Majeed, S Wahlin
BACKGROUND: It is challenging to identify malnutrition, which is a risk factor for poor outcome in patients with liver cirrhosis. In the present study, we aimed to investigate the prevalence of malnutrition among patients listed for liver transplantation, as assessed by different methods, and also to relate dual-energy X-ray absorptiometry (DXA) to short-term post-transplant outcomes. METHODS: In this retrospective cohort study, we reviewed the medical records of 106 patients who underwent liver transplantation in 2009-2012...
October 6, 2016: Journal of Human Nutrition and Dietetics: the Official Journal of the British Dietetic Association
Shikha S Sundaram, Cara L Mack, Amy G Feldman, Ronald J Sokol
Biliary atresia (BA) is a progressive, fibro-obliterative disorder of the intrahepatic and extrahepatic bile ducts in infancy. The majority of affected children will eventually develop end-stage liver disease and require liver transplantation (LT). Indications for LT in BA include failed Kasai portoenterostomy, significant and recalcitrant malnutrition, recurrent cholangitis, and the progressive manifestations of portal hypertension. Extrahepatic complications of this disease, such as hepatopulmonary syndrome and portopulmonary hypertension, are also indications for LT...
January 2017: Liver Transplantation
Srinivasan Dasarathy, Manuela Merli
Sarcopenia or loss of skeletal muscle mass is the major component of malnutrition and is a frequent complication in cirrhosis that adversely affects clinical outcomes. These include survival, quality of life, development of other complications and post liver transplantation survival. Radiological image analysis is currently utilized to diagnose sarcopenia in cirrhosis. Nutrient supplementation and physical activity are used to counter sarcopenia but have not been consistently effective because the underlying molecular and metabolic abnormalities persist or are not influenced by these treatments...
December 2016: Journal of Hepatology
Neha Bakshi, Kalyani Singh
BACKGROUND: Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. METHODS: We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body...
August 2016: Hepatobiliary Surgery and Nutrition
Thays Santana Guerra, Nelci Fenalt Hoehr, Ilka de Fátima Santana Ferreira Boin, Raquel Silveira Bello Stucchi
BACKGROUND: - In chronic liver disease, trace element levels in plasma are usually low. However, the specific cause and functional implications of this abnormality are yet not well understood. These element levels may decrease as a result of abnormal liver function in patients with cirrhosis and/or malnutrition. OBJECTIVE: - To evaluate the nutritional status and the profile of trace elements in plasma of patients with cirrhosis on a liver transplant list and to correlate them with disease severity...
April 2016: Arquivos de Gastroenterologia
Maria Kalafateli, Konstantinos Mantzoukis, Yan Choi Yau, Ali O Mohammad, Simran Arora, Susana Rodrigues, Marie de Vos, Kassiani Papadimitriou, Douglas Thorburn, James O'Beirne, David Patch, Massimo Pinzani, Marsha Y Morgan, Banwari Agarwal, Dominic Yu, Andrew K Burroughs, Emmanuel A Tsochatzis
BACKGROUND: Although malnutrition and sarcopenia are prevalent in cirrhosis, their impact on outcomes following liver transplantation is not well documented. METHODS: The associations of nutritional status and sarcopenia with post-transplant infections, requirement for mechanical ventilation, intensive care (ICU) and hospital stay, and 1 year mortality were assessed in 232 consecutive transplant recipients. Nutritional status and sarcopenia were assessed using the Royal Free Hospital-Global Assessment (RFH-GA) tool and the L3-psoas muscle index (L3-PMI) on CT, respectively...
February 2017: Journal of Cachexia, Sarcopenia and Muscle
Ragesh B Thandassery, Aldo J Montano-Loza
Most widely recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma; however, malnutrition and muscle wasting (sarcopenia) constitute common complications which negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Despite the important role that malnutrition and sarcopenia play in the prognosis of patients with cirrhosis, they are frequently overlooked, in part because nutritional assessment can be a difficult task in patients with cirrhosis due to fluid retention and/or overweight...
June 2016: Current Treatment Options in Gastroenterology
Roberto D'Angelo, Rita Rinaldi, Valerio Carelli, Elisa Boschetti, Leonardo Caporali, Mariantonietta Capristo, Carlo Casali, Giovanna Cenacchi, Laura Ludovica Gramegna, Raffaele Lodi, Antonio Daniele Pinna, Loris Pironi, Marta Stanzani, Caterina Tonon, Roberto D'Alessandro, Roberto De Giorgio
Mitochondrial neuro-gastro-intestinal encephalomyopathy (MNGIE) is a rare and unavoidably fatal disease due to mutations in thymidine phosphorylase (TP). Clinically it is characterized by gastrointestinal dysfunction, malnutrition/cachexia and neurological manifestations. MNGIE diagnosis remains a challenge mainly because of the complexity and rarity of the disease. Thus, our purposes were to promote a better knowledge of the disease in Emilia-Romagna region (ERR) by creating an accurate and dedicated network; to establish the minimal prevalence of MNGIE in Italy starting from ERR...
July 2016: Neurological Sciences
Augusto Lauro, Cal S Matsumoto, Ignazio R Marino, Vincenzo Berghella
The largest experience of pregnancy after solid organ transplantation is recorded in renal and liver recipients. Intestinal/multivisceral transplantation has shown steady improvements in graft and patient survival over the past 20 years and is rapidly becoming more established: the first pregnancy after this procedure was described 10 years ago, and so far eight cases of pregnancies with 100% successful live births have been reported worldwide. Specifically to this procedure, there are 2 factors to be considered in case of pregnancy: absorptive function of transplanted bowel and higher need of immune-suppressants...
January 2017: Journal of Maternal-fetal & Neonatal Medicine
Srinivasan Dasarathy
PURPOSE OF REVIEW: Sarcopenia or loss of skeletal muscle mass is the major component of malnutrition and occurs in the majority of patients with liver disease. Lower muscle contractile function also contributes to the adverse consequences of sarcopenia. There are no effective therapies to prevent or reverse sarcopenia in liver disease. This review will discuss the advances in diagnosis, pathogenesis, and treatment options for sarcopenia in liver disease. RECENT FINDINGS: Sarcopenia increases mortality and risk of development of other complications of cirrhosis, and worsens postliver transplant outcomes while quality of life is decreased...
May 2016: Current Opinion in Gastroenterology
M Sinclair, P J Gow, M Grossmann, P W Angus
BACKGROUND: Sarcopenia (loss of muscle mass) is common in cirrhosis and is associated with poor outcomes. Current teaching recommends the use of protein supplementation and exercise, however, this fails to address many other factors which contribute to muscle loss in this setting. AIMS: To summarise existing knowledge regarding the aetiology of sarcopenia in cirrhosis, diagnostic modalities and the clinical significance of this condition. In addition to discuss recent research findings that may allow the development of more effective treatments...
April 2016: Alimentary Pharmacology & Therapeutics
Gladys Ho, John Christodoulou
Phenylketonuria (PKU) is an inborn error of metabolism of the amino acid phenylalanine. It is an autosomal recessive disorder with a rate of incidence of 1 in 10,000 in Caucasian populations. Mutations in the phenylalanine hydroxylase (PAH) gene are the major cause of PKU, due to the loss of the catalytic activity of the enzyme product PAH. Newborn screening for PKU allows early intervention, avoiding irreparable neurological damage and intellectual disability that would arise from untreated PKU. The current primary treatment of PKU is the limitation of dietary protein intake, which in the long term may be associated with poor compliance in some cases and other health problems due to malnutrition...
April 2014: Translational pediatrics
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