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Maria Kalafateli, Fred Wickham, Maria Burniston, Evangelos Cholongitas, Eleni Theocharidou, Matteo Garcovich, James O'Beirne, Rachel Westbrook, Gioacchino Leandro, Andrew K Burroughs, Emmanuel A Tsochatzis
: Current expressions based on serum creatinine concentration overestimate kidney function in cirrhosis leading to significant differences between "true" and calculated glomerular filtration rate (GFR). We compared the performance of MDRD-4, MDRD-6 and CKD-EPI with "true" GFR and the impact of this difference on MELD calculation. We subsequently developed and validated a GFR equation specifically for cirrhosis and compared the performance of the new derived formula with existing GFR formulas...
October 25, 2016: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Barbara J Turner, Yuanyuan Liang, Amit Singal
OBJECTIVES: Noninvasive measures are widely used to assess fibrosis and may be used to prioritize hepatitis C virus (HCV) treatment. We examined risks for likely fibrosis in patients with chronic HCV infection using fibrosis-4 (FIB-4) and imaging. PATIENTS AND METHODS: A HCV screening program diagnosed chronic HCV in patients born from 1945 to 1965 admitted in a safety net hospital. Likely fibrosis was based on FIB-4 (≥1.45) alone or combined with imaging interpreted as fibrosis or cirrhosis...
October 17, 2016: European Journal of Gastroenterology & Hepatology
Kristopher P Croome, David D Lee, Justin M Burns, Dana K Perry, Justin H Nguyen, Andrew P Keaveny, Hani M Wadei, C Burcin Taner
:  Introduction and aim. Many transplant programs have expanded eligibility to include patients previously ineligible because of advanced age. Outcomes of simultaneous liver-kidney transplantation (SLK) in recipients with advanced age are not known. MATERIAL AND METHODS: Data from patients undergoing transplantation between 2002 and 2015 were obtained from the UNOS Standard Analysis and Research file. RESULTS: SLK recipients aged ≥ 65 years (N = 677), SLK recipients aged < 65 years (N = 4517), and recipients of liver transplant alone(LTA) aged ≥ 65 years(N = 8495) were compared...
November 2016: Annals of Hepatology
Jan Biegus, Robert Zymliński, Mateusz Sokolski, Paweł Siwołowski, Piotr Gajewski, Sylwia Nawrocka-Millward, Elżbieta Poniewierka, Ewa A Jankowska, Waldemar Banasiak, Piotr Ponikowski
AIM: Multi-organ dysfunction often complicates the natural course of acute heart failure (AHF) and identifies patients with poor prognosis. The MELD score (Model of End-Stage Liver Dysfunction) combines data reflecting liver and kidney function, which makes it a potentially useful tool for the assessment of patients with AHF. To assess the prognostic utility of the MELD score in patients with AHF. METHODS AND RESULTS: The MELD score was calculated on admission and during hospital stay (days 2-3) using a formula that does not take into account the international normalized ratio (MELD XI)...
October 6, 2016: European Journal of Heart Failure
Po-Hong Liu, Chia-Yang Hsu, Cheng-Yuan Hsia, Yun-Hsuan Lee, Yi-You Chiou, Yi-Hsiang Huang, Fa-Yauh Lee, Han-Chieh Lin, Ming-Chih Hou, Teh-Ia Huo
BACKGROUND: The severity of liver dysfunction in hepatocellular carcinoma (HCC) is often estimated with Child-Turcotte-Pugh (CTP) classification or model for end-stage liver disease (MELD) score. We aim to investigate the performance of albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grade, which are recently reported to be simple and objective measurements for liver reserve in HCC. METHODS: Between 2002 and 2014, consecutive 3,182 HCC patients were enrolled to follow up their survival...
October 3, 2016: Journal of Gastroenterology and Hepatology
Fanny Lebossé, Olivier Guillaud, Julien Forestier, Marie Ecochard, Olivier Boillot, Sabine Roman, François Mion, Jérôme Dumortier
BACKGROUND AND AIMS: The prognosis of cirrhotic patients is usually assessed by Child-Pugh and MELD scores. Metabolic liver function tests such as aminopyrine breath test (ABT) and indocyanine green clearance (IGC) have been shown to reveal hepatocellular dysfunction. The aim of this retrospective study was to compare the prognostic value of the MELD score, Child-Pugh score, ABT and IGC in a large cohort of cirrhotic patients. METHODS: Between January 1996 and June 2008, 711 cirrhotic patients were included and the primary endpoint was survival without LT...
September 2016: Journal of Gastrointestinal and Liver Diseases: JGLD
Andrea Schlegel, Michael Linecker, Philipp Kron, Georg Györi, Michelle L De Oliveira, Beat Müllhaupt, Pierre-Alain Clavien, Philipp Dutkowski
Allocation of liver grafts triggers emotional debates, as those patients, not receiving an organ, are prone to death. We analyzed a high MELD cohort (lab MELD≥30, n=100, median lab MELD of 35 (IQR: 31-37) of liver transplant recipients at our center over the last ten years, and compared results with a low MELD group, matched by propensity scoring for donor age, recipient age and cold ischemia. Endpoints of our study were cumulative post-transplant morbidity, cost, and survival. Six different prediction models, including D-MELD, Delta MELD, DRI, SOFT, BAR, and UCLA-FRS, were applied in both cohorts to identify risk for poor outcome and high cost...
September 27, 2016: American Journal of Transplantation
Christophe Bureau, Dominique Thabut, Frédéric Oberti, Sébastien Dharancy, Nicolas Carbonell, Antoine Bouvier, Philippe Mathurin, Philippe Otal, Pauline Cabarrou, Jean Marie Péron, Jean Pierre Vinel
BACKGROUND & AIMS: There is controversy over the ability of transjugular intrahepatic portosystemic shunts (TIPS) to increase survival times of patients with cirrhosis and refractory ascites. The high rate of shunt dysfunction with the use of uncovered stents counteracts the benefits of TIPS. We performed a randomized controlled trial to determine the effects of TIPS with stents covered with polytetrafluoroethylene in these patients. METHODS: We performed a prospective study of 62 patients with cirrhosis and at least 2 large volume paracenteses within a period of at least 3 weeks; the study was performed at 4 tertiary care centers in France from August 2005 through December 2012...
September 20, 2016: Gastroenterology
Remi Neviere, Pierre Trinh-Duc, Sébastien Hulo, Jean Louis Edme, Aurélie Dehon, Emmanuel Boleslawski, Sébastien Dharancy, Gilles Lebuffe
Our objective was to investigate the predictive value of fractional nitric oxide (NO) concentration in exhaled breath (FeNO) and aerobic capacity (peak VO2 ) for postoperative sepsis in liver transplantation candidates. Patients were identified and charts of all consecutive patients were prospectively reviewed. Bacterial sepsis represented the commonest postoperative complications (30%), which was attributed to peritonitis, pneumonia, and catheter-related infections. Preoperative FeNO and peak VO2 values were lower in patients with postoperative sepsis...
September 20, 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Hatem Elalfy, Walid Elsherbiny, Ashraf Abdel Rahman, Dina Elhammady, Shaker Wagih Shaltout, Ayman Z Elsamanoudy, Bassem El Deek
AIM: To build a diagnostic non-invasive model for screening of large varices in cirrhotic hepatitis C virus (HCV) patients. METHODS: This study was conducted on 124 post-HCV cirrhotic patients presenting to the clinics of the Endemic Medicine Department at Mansoura University Hospital for evaluation before HCV antiviral therapy: 78 were Child A and 46 were Child B (score ≤ 8). Inclusion criteria for patients enrolled in this study was presence of cirrhotic HCV (diagnosed by either biopsy or fulfillment of clinical basis)...
August 28, 2016: World Journal of Hepatology
Ewa Wunsch, Marcin Krawczyk, Malgorzata Milkiewicz, Jocelyn Trottier, Olivier Barbier, Markus F Neurath, Frank Lammert, Andreas E Kremer, Piotr Milkiewicz
Autotaxin (ATX) is involved in the synthesis of lysophosphatidic acid. Both have recently been linked to cholestatic pruritus and liver injury. We aimed to investigate whether ATX is an indicator of cholestatic liver injury, health-related quality of life (HRQoL) and prognosis based on a group of 233 patients, 118 with primary biliary cholangitis (PBC) and 115 with primary sclerosing cholangitis (PSC). Patients were followed for 1-60 months, cumulative survival rates were calculated. ATX activity was significantly higher in both groups than in the 103 controls, particularly in patients with cirrhosis and in patients with longer disease duration...
2016: Scientific Reports
B Szyguła-Jurkiewicz, M Zakliczyński, W Szczurek, P Nadziakiewicz, M Gąsior, M Zembala
BACKGROUND: The Model for End-Stage Liver Disease (MELD) scoring system incorporating a combination of hepatic and renal laboratory parameters does not adequately reflect the degree of multi-organ dysfunction in patients with heart failure, who need oral anticoagulation. In order to exclude the impact of oral anticoagulation on the international normalized ratio (INR), we used the MELD excluding INR (MELD-XI) score. The aims of the study were to calculate the individual preoperative MELD-XI score and its ability to predict 1-year mortality after heart transplantation and to identify other preoperative laboratory prognostic parameters...
June 2016: Transplantation Proceedings
Allyson Hart, David P Schladt, Jessica Zeglin, Joshua Pyke, W Ray Kim, John R Lake, John P Roberts, Ryutaro Hirose, David C Mulligan, Bertram L Kasiske, Jon J Snyder, Ajay K Israni
BACKGROUND: The probability of liver transplant and death on the waiting list in the United States varies greatly by donation service area (DSA) due to geographic differences in availability of organs and allocation of priority points, making it difficult for providers to predict likely outcomes after listing. We aimed to develop an online calculator to report outcomes by region and patient characteristics. METHODS: Using the Scientific Registry of Transplant Recipients database, we included all prevalent US adults aged 18 years or older waitlisted for liver transplant, examined on 24 days at least 30 days apart over a 2-year period...
October 2016: Transplantation
Xingshun Qi, Guohong Han, Chun Ye, Yongguo Zhang, Junna Dai, Ying Peng, Han Deng, Jing Li, Feifei Hou, Zheng Ning, Jiancheng Zhao, Xintong Zhang, Ran Wang, Xiaozhong Guo
BACKGROUND Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. MATERIAL AND METHODS All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Bahar Aydınlı, Ümit Karadeniz, Aslı Demir, Çiğdem Yıldırım Güçlü, Dilek Kazancı, Rabia Koçulu, Candan Haytural, Ayşegül Özgök, Erdal Birol Bostancı, Ali Zorlu
OBJECTIVE: To evaluate the factors that affects the postperfusion syndrome in cadaveric liver transplantations and the effect of the postperfusion syndrome on discharge from the hospital. METHODS: Patients who underwent cadaveric liver transplantations between 2007 and 2013 were scanned retrospectively. Intraoperative anaesthesia records, intensive care unit follow-up forms and discharge reports were examined from patient files. Overall, 43 patients having complete data were included in the study...
June 2016: Turkish Journal of Anaesthesiology and Reanimation
M W Fromer, T A Aloia, J P Gaughan, U M Atabek, F R Spitz
BACKGROUND: The MELD score has been demonstrated to be predictive of hepatectomy outcomes in mixed patient samples of primary and secondary liver cancers. Because MELD is a measure of hepatic dysfunction, prior conclusions may rely on the high prevalence of cirrhosis observed with primary lesions. This study aims to evaluate MELD score as a predictor of mortality and develop a risk prediction model for patients specifically undergoing hepatic metastasectomy. METHODS: ACS-NSQIP 2005-2013 was analyzed to select patients who had undergone liver resections for metastases...
October 2016: European Journal of Surgical Oncology
Brianna M Krafcik, Alik Farber, Mohammad H Eslami, Jeffrey A Kalish, Denis Rybin, Gheorghe Doros, Elizabeth G King, Jeffrey J Siracuse
OBJECTIVES: The Model of End-Stage Liver Disease (MELD) score has been traditionally utilized to prioritize for liver transplantation; however, recent literature has shown its value in predicting surgical outcomes for patients with hepatic dysfunction. The benefit of carotid endarterectomy in asymptomatic patients is dependent on low perioperative morbidity. Our objective was to use MELD score to predict outcomes in asymptomatic patients undergoing carotid endarterectomy. METHODS: Patients undergoing carotid endarterectomy were identified in the National Surgical Quality Improvement Program data sets from 2005 to 2012...
August 2016: Vascular and Endovascular Surgery
Prashanth Ashok Kumar, Kavitha Subramanian
INTRODUCTION: Chronic Liver Disease (CLD) is characterised by gradual destruction of liver tissue over time. Ischemia Modified Albumin (IMA) is an upcoming biomarker shown to be elevated in conditions associated with ischemia and oxidative stress. Albumin levels are greatly reduced in patients with CLD and studying its alterations will provide essential information regarding the molecular changes occurring to it. AIM: The study aims to estimate IMA and IMA/Albumin ratio in patients with CLD and to correlate it with parameters assessing liver function and the Model for End Stage Liver Disease (MELD) score...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
Kyota Fukazawa, Seigo Nishida, Ernesto A Pretto, Youri Vater, Jorge D Reyes
BACKGROUND: In orthotopic liver transplantation (OLT) size-mismatch may cause adverse outcomes. We previously reported on a method to predict donor-recipient size-mismatch using the body surface area index (BSAi). In this study, we hypothesized that graft survival of size-mismatch transplantation deteriorates with higher model for end-stage liver disease (MELD) score at transplantation. METHODS: We evaluated non-parametrically the association of BSAi and MELD with 1-year graft survival with a generalized additive model...
July 2016: Journal of Hepato-biliary-pancreatic Sciences
Mona Ascha, Sami Abuqayyas, Ibrahim Hanouneh, Laith Alkukhun, Mark Sands, Raed A Dweik, Adriano R Tonelli
AIM: To investigate if echocardiographic and hemodynamic determinations obtained at the time of transjugular intrahepatic portosystemic shunt (TIPS) can provide prognostic information that will enhance risk stratification of patients. METHODS: We reviewed medical records of 467 patients who underwent TIPS between July 2003 and December 2011 at our institution. We recorded information regarding patient demographics, underlying liver disease, indication for TIPS, baseline laboratory values, hemodynamic determinations at the time of TIPS, and echocardiographic measurements both before and after TIPS...
April 18, 2016: World Journal of Hepatology
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