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liver, coagulation, transplantation

Elzbieta Kolaczkowska, Craig N Jenne
We read with interest the article by von Meijenfeldt et al.,(1) which reported on correlation between coagulation and the presence of cell-free DNA during/post liver transplantation. We agree with the authors that increased levels of cfDNA/nucleosomes most probably resulted from necrosis/damage during surgery. However, presence of complexes of DNA and myeloperoxidase (MPO) suggests formation of neutrophil extracellular traps (NETs). This article is protected by copyright. All rights reserved.
October 17, 2018: Liver Transplantation
Fien A von Meijenfeldt, Ton Lisman
We thank Kolaczkowska and Jenne for their interest in our paper on plasma levels of cell-free DNA and the association with activation of coagulation prior to and during liver transplantation. We observed elevated levels of MPO-DNA complexes in plasma of patients prior to liver transplantation, which indeed suggests formation of neutrophil extracellular traps (NETs) in patients with liver disease. However, we would like to stress that although the role of NETs in experimental animal models of liver disease has been well established, there is only scanty evidence of formation of NETs in human liver disease...
October 16, 2018: Liver Transplantation
M H Liu, F Zhou, X B Wang, L P Chen, G Z Li, Q Zhao
Objective: To investigate the incidence rate of transjugular intrahepatic portosystemic shunt (TIPS) complications in the treatment of cirrhotic portal hypertension, and analyze the cause of complication to management methods. Methods: Data of 116 patients obtained from Zhongnan Hospital of Wuhan University were retrospectively analyzed. Portal venous pressure, routine blood test, coagulation test, liver and kidney function test, ammonia blood test, imaging and endoscopy reports were collected before and after procedure...
August 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
Yanchi Wang, Junya Zhao, Nannan Duan, Wei Liu, Yuxuan Zhang, Miaojin Zhou, Zhiqing Hu, Mai Feng, Xionghao Liu, Lingqian Wu, Zhuo Li, Desheng Liang
Hemophilia B (HB) is an X-linked recessive bleeding disorder, caused by F9 gene deficiency. Gene therapy combined with the CRISPR/Cas9 technology offers a potential cure for hemophilia B. Now the Cas9 nickase (Cas9n) shows a great advantage in reducing off-target effect compared with wild-type Cas9. In this study, we found that in the multicopy ribosomal DNA (rDNA) locus, the homology directed recombination (HDR) efficiency induced by sgRNA-Cas9n was much higher than sgRNA-Cas9, meanwhile without off-target in six predicted sites...
October 5, 2018: International Journal of Molecular Sciences
Carsten Schumacher, Hendrik Eismann, Lion Sieg, Lars Friedrich, Dirk Scheinichen, Florian W R Vondran, Kai Johanning
OBJECTIVES: Increased transfusion requirements in liver transplantation have been reported to be associated with worsened outcomes, more frequent reinterventions, and higher expenses. Anesthesiologists might counteract this through improved coagulation management. We evaluated the effects of rotational thromboelastometry on transfusion and coagulation product requirements and on outcome measurements. MATERIALS AND METHODS: Patients who were 14 years or older and who were undergoing liver transplant at Hannover Medical School between January 2005 and December 2009 were included in this retrospective analysis...
October 5, 2018: Experimental and Clinical Transplantation
Michelle Lipton, Stephen Aniskevich
Acute compartment syndrome is the physiologic consequence of increasing pressures within an enclosed anatomic space; if left untreated, it can subsequently cause irreversible necrosis, nerve injury, and tissue damage. A number of iatrogenic causes have been reported in the literature; however, to the best of our knowledge, there are no prior reports of upper extremity compartment syndrome in orthotopic liver transplant following arterial line placement. Here, we report a 52-year-old male with a history of end-stage liver disease secondary to primary sclerosing cholangitis who presented for orthotopic liver transplant...
October 5, 2018: Experimental and Clinical Transplantation
King-Wah Chiu, Ting-Lung Lin, Chee-Chien Yong, Chih-Che Lin, Yu-Fan Cheng, Chao-Long Chen
RATIONALE: According to previously published studies, major complications arising from a percutaneous liver biopsy are rare and occur in less than 0.1% of cases. This report describes an approach to percutaneous liver biopsy that can help avoid damage to the liver in a living donor liver transplantation (LDLT) setting. PATIENT CONCERNS: Case 1: In the first case a donor percutaneous liver biopsy (PLB) of both lobes of the liver was performed for pre-LDLT evaluation...
October 2018: Medicine (Baltimore)
Omar Alharthi, Vahid Etezadi
Introduction: Transjugular liver biopsy (TJLB) is a minimally invasive procedure performed to obtain hepatic tissue in patients whom standard percutaneous liver biopsy is contraindicated due to abnormal coagulation profile and/or severe ascites. Additionally, it has the advantage of simultaneously measuring the hepatic venous pressures. Case Presentation: 61-year-old male with history of pulmonary fibrosis, cholecystectomy and Hepatitis C underwent transjugular liver biopsy (TJLB) as part of his lung transplant workup...
December 2018: Radiology Case Reports
Elisabeth Kemter, Joachim Denner, Eckhard Wolf
PURPOSE OF REVIEW: Porcine islets represent a potentially attractive beta-cell source for xenotransplantation into patients with type 1 diabetes, who are not eligible to islet allo-transplantation due to a lack of suitable human donor organs. Recent progress in genetic engineering/gene editing of donor pigs provides new opportunities to overcome rejection of xeno-islets, to improve their engraftment and insulin secretion capacity, and to reduce the risk for transmission of porcine endogenous retroviruses...
September 18, 2018: Current Diabetes Reports
Yuanyuan Bai, Yang Li, Juan Liu, Peng Ju
OBJECTIVE: To evaluate the effect of iron metabolism of preoperation on the length of intensive care unit (ICU) stay in liver transplant recipients. METHODS: A retrospective study was conducted. 120 adult liver transplant recipients admitted to Tianjin First Central Hospital from September 2015 to September 2017 were enrolled. The basic data, model of end-stage liver disease (MELD) evaluation system score at admission; iron metabolism index, routine blood test, blood biochemistry, coagulation time and C-reactive protein (CRP) level within 24 hours after admission; intraoperative clinical indicators such as operation time, operation bleeding volume, red blood cells and fresh frozen plasma input volume, hot ischemia time, cold ischemia time, urine volume; and the length of ICU stay were collected...
August 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Kryssia I Rodriguez-Castro, Alessandro Vitale, Mariangela Fadin, Sarah Shalaby, Patrizia Zerbinati, Maria Teresa Sartori, Stefano Landi, Irene Pettinari, Fabio Piscaglia, Guohong Han, Patrizia Burra, Paolo Simioni, Marco Senzolo
BACKGROUND AND OBJECTIVE: Portal vein thrombosis (PVT) is a common complication in cirrhosis, and when complete, it increases morbidity and mortality in liver transplant candidates. The aim of the study was to assess the hemostatic status, as well as clinical characteristics of thrombus and patients, as predictors of therapeutic efficacy of anticoagulation for the treatment of PVT in cirrhotics. PATIENTS AND METHODS: Patients with cirrhosis consecutively treated for PVT with enoxaparin were enrolled...
September 4, 2018: European Journal of Gastroenterology & Hepatology
Fien A von Meijenfeldt, Laura C Burlage, Sarah Bos, Jelle Adelmeijer, Robert J Porte, Ton Lisman
BACKGROUND & AIMS: Patients undergoing liver transplantation have complex changes in their hemostatic system, and the net effect of these changes appears a 'rebalanced' hemostatic profile. Recently, a process called NETosis, in which a neutrophil expels DNA and proteins that form a web-like structure, has been described as a mechanism of pathogen entrapment. Increasing evidence suggests a pivotal role for neutrophil extracellular traps (NETs), and their main component cell-free DNA in activation of coagulation...
August 31, 2018: Liver Transplantation
Patrick Northup, Bethany Reutemann
Hemostasis is a complex balance of clot formation and dissolution that is largely modulated by protein synthesis and degradation in the liver. In the state of end-stage liver disease, there is a disruption of the hemostatic system due to hepatic protein synthetic dysfunction. Because historical clinical laboratory testing often only analyzes a portion of the hemostasis system, the clinician may be misled into believing that cirrhosis patients are imbalanced with a tendency toward bleeding. The modern understanding of hemostasis in cirrhosis involves a rebalance of hemostasis with a tenuous equilibrium between clotting and bleeding, but an equilibrium nonetheless...
August 2018: Liver Transplantation
Shiv Kumar Sarin, Ashok Choudhury
Acute-on-chronic liver failure (ACLF) is a distinct syndrome of liver failure in a patient with chronic liver disease presenting with jaundice, coagulopathy and ascites and/or hepatic encephalopathy, developing following an acute hepatic insult and associated with high 28-day mortality. The definition though lacks global consensus, excludes patients with known distinct entities such as acute liver failure and those with end-stage liver disease. The initial Systemic Inflammatory Response Syndrome (SIRS) because of cytokine storm in relation to acute insult and/or subsequent development of sepsis due to immunoparalysis leads to extrahepatic organ failure...
September 2018: Hepatology International
Mian Ahmad, Johann Mathew, Usama Iqbal, Rayhan Tariq
Massive blood loss has been a dreaded complication of liver transplantation, and the accompanying transfusion is associated with adverse outcomes in the form of decreased patient and graft survival. With advances in both surgical techniques and anesthetic management during transplantation, blood and blood products requirements reduced significantly. However, transfusion practices vary among different centers. The altered coagulation parameters in patients with liver cirrhosis results in a state of "rebalanced hemostasis" and patients are just as likely to clot as they are to bleed...
July 2018: Saudi Journal of Anaesthesia
Laura C Burlage, Sarah Bos, Jelle Adelmeijer, Takumi Sakai, Robert J Porte, Ton Lisman
BACKGROUND: Recombinant soluble human thrombomodulin (ART-123) is an anticoagulant and anti-inflammatory agent clinically used for treatment of disseminated intravascular coagulation. Preclinical studies have shown that ART-123 reduces hepatic ischemia/reperfusion. Although ART-123 may therefore have clinical benefit in orthotopic liver transplantation the substantial alterations in the hemostatic system may complicate its use in this setting. OBJECTIVE: Here we studied the in vitro effect of ART-123 on coagulation of patients with end-stage liver disease undergoing liver transplantation...
August 1, 2018: Liver Transplantation
Lesley De Pietri, Roberto Montalti, Daniele Nicolini, Roberto Ivan Troisi, Federico Moccheggiani, Marco Vivarelli
Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation (LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications (intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients...
July 21, 2018: World Journal of Gastroenterology: WJG
Marceli K Łukaszewski, Paweł Chudoba, Agnieszka Lepiesza, Marcin Rychter, Piotr Szyber
BACKGROUND: Coagulation system disorders in liver transplantation (ltx) patients are considered a serious issue. Liver cirrhosis leads to decreased synthesis of clotting factors and decreased elimination of waste products, including coagulation proteins. Platelet sequestration and dysfunction in an enlarged spleen additionally worsen these conditions. The resulting state, the most common pathology of the coagulation system, involves the reduction of clotting potential and hyperfibrinolysis...
July 18, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Mario Concha P, Verónica Mertz K, Gabriel Muñoz Castillo, Alejandro Delfino Y, Luis Cortínez F, Rodrigo Montaña R, Juan Cristóbal Pedemonte T, Ricardo Fuentes H
BACKGROUND: Compared to standard coagulation essays (SCE), such as international normalized ratio (INR), prothrombin activated partial thromboplastin time (aPTT), or platelet count, thromboelastograhy (TEG) offers precise and real-time information about hemostasis. TEG tests both platelet function and coagulation by assaying several parameters of clot formation dynamically in whole blood. AIM: To evaluate hemostasis in cirrhotic patients undergoing liver transplantation and determine the positive and negative predictive values of SCE for alterations of TEG...
March 2018: Revista Médica de Chile
I-Ting Peng, Ming-Ting Chung, Ching-Chung Lin
Postpartum hemorrhage remains a major threat to maternal health. Intervention after critical blood loss or development of disseminated intravascular coagulation may lead to disastrous organ failure and poor outcomes. A 30-year-old woman was transferred to our emergency department due to massive postpartum hemorrhage. Shock and disseminated intravascular coagulation ensued, and the patient's condition quickly deteriorated. We performed an emergency hysterectomy, but blood loss had been massive. Moreover, there was another episode of internal bleeding that led to further blood loss...
2018: Case Reports in Obstetrics and Gynecology
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