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https://www.readbyqxmd.com/read/28437385/before-or-after-transplantation-a-review-of-the-cost-effectiveness-of-treating-waitlisted-patients-with-hepatitis-c
#1
Elliot B Tapper, Nezam H Afdhal, Michael P Curry
All patients with chronic hepatitis C virus (HCV) infections can and should be treated. Though highly effective direct-acting antiviral therapies are costly, the price of a cure is a 1-time investment that is outweighed by future benefits. For clinicians caring for patients requiring liver transplant, the key question relates to the timing of treatment: before or after liver transplantation? On 1 hand, treating HCV often improves our patients' model for end-stage liver disease (MELD) score, decreasing costs, and potentially improving longevity by reducing our patients' risk of death and transplantation...
May 2017: Transplantation
https://www.readbyqxmd.com/read/28433485/in-hospital-mortality-in-cirrhotic-patients-at-a-tertiary-care-center
#2
R Zubieta-Rodríguez, J Gómez-Correa, R Rodríguez-Amaya, K A Ariza-Mejia, N A Toloza-Cuta
INTRODUCTION: Cirrhosis of the liver is known for its high risk of mortality associated with episodes of acute decompensation. There is an even greater risk in patients that present with acute-on-chronic liver failure. The identification of patients at higher risk for adverse outcomes can aid in making the clinical decisions that will improve the prognosis for these patients. AIMS: To determine in-hospital mortality and evaluate the epidemiologic and clinical characteristics of patients with cirrhosis of the liver seen at a tertiary referral hospital...
April 19, 2017: Revista de Gastroenterología de México
https://www.readbyqxmd.com/read/28433216/implications-of-alternative-hepatorenal-prognostic-scoring-systems-in-acute-heart-failure-from-dose-ahf-and-rose-ahf
#3
Justin L Grodin, Dianne Gallup, Kevin J Anstrom, G Michael Felker, Horng H Chen, W H Wilson Tang
Because hepatic dysfunction is common in patients with heart failure (HF), the Model for End-Stage Liver Disease (MELD) may be attractive for risk stratification. Although alternative scores such as the MELD-XI or MELD-Na may be more appropriate in HF populations, the short-term clinical implications of these in patients with acute heart failure (AHF) are unknown. The MELD-XI and MELD-Na were calculated at baseline in 453 patients with AHF in the DOSE-AHF and ROSE-AHF trials. The correlations and associations for each score with cardiorenal biomarkers, short-term end points at 72 hours including worsening renal function and clinical events to 60 days were determined...
March 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28428719/safety-and-efficacy-of-tenofovir-in-chronic-hepatitis-b-related-decompensated-cirrhosis
#4
Soon Kyu Lee, Myeong Jun Song, Seok Hyun Kim, Byung Seok Lee, Tae Hee Lee, Young Woo Kang, Suk Bae Kim, Il Han Song, Hee Bok Chae, Soon Young Ko, Jae Dong Lee
AIM: To evaluate the safety and efficacy of tenofovir disoproxil fumarate (TDF) as a first-line therapy in decompensated liver disease. METHODS: We enrolled 174 chronic hepatitis B-related liver cirrhosis patients treated with 300 mg/d TDF at six Korean centers. Of the 174 cirrhosis patients, 57 were assigned to the decompensated cirrhosis group and 117 were assigned to the compensated cirrhosis group. We followed the patients for 12 mo and evaluated clinical outcomes, including biochemical, virological, and serological responses...
April 7, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28425415/drug-induced-liver-injury-at-a-tertiary-hospital-in-india-etiology-clinical-features-and-predictors-of-mortality
#5
Chetan Rathi, Nirav Pipaliya, Ruchir Patel, Meghraj Ingle, Aniruddha Phadke, Prabha Sawant
INTRODUCTION AND AIMS: Drug-induced liver injury (DILI) is rare; however, it is one of the important causes of acute liver failure which results in significant morbidity or mortality. MATERIAL AND METHODS: Patients with suspected DILI were enrolled based on predefined criteria and followed up for at least 6 months or until normalization of liver tests. Causality assessment was done by applying the Roussel Uclaf Causality Assessment Method model. RESULTS: We collected data from 82 individuals diagnosed with DILI at our hospital from 2014 through 2015 (41 men; median age, 38 years)...
May 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/28425409/the-utilization-of-palliative-care-services-in-patients-with-cirrhosis-who-have-been-denied-liver-transplantation-a-single-center-retrospective-review
#6
Sean G Kelly, Toby C Campbell, Luke Hillman, Adnan Said, Michael R Lucey, Parul D Agarwal
INTRODUCTION AND AIM: Utilization of palliative care services in patients dying of end-stage liver disease (ESLD) is understudied. We performed a retrospective review of palliative care services among patients with ESLD unsuitable for liver transplantation (LT) at a tertiary care center. MATERIAL AND METHODS: Deceased ESLD patients considered unsuitable for LT from 2007-2012 were identified. Patients were excluded if they received a transplant, had an incomplete workup, were lost to follow up or whose condition improved so LT was not needed...
May 2017: Annals of Hepatology
https://www.readbyqxmd.com/read/28425018/hepatocellular-carcinoma-and-liver-transplantation-changing-patterns-and-practices
#7
REVIEW
Nicole E Rich, Neehar D Parikh, Amit G Singal
Benefits of liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) are well established. However, there is debate regarding optimal and equitable selection of patients best served by LT, particularly in the face of limited organ availability. Herein, we discuss topics regarding LT selection criteria for patients with HCC. Recent change in UNOS policy currently mandates a 6-month observation period prior to priority listing and institutes a cap of 34 MELD exception points for patients with HCC...
April 19, 2017: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/28422425/negativization-of-viremia-prior-to-liver-transplant-reduces-early-allograft-dysfunction-in-hepatitis-c-recipients
#8
Silvia Martini, Francesco Tandoi, Lodovico Terzi di Bergamo, Silvia Strona, Bruna Lavezzo, Marco Sacco, Francesca Maione, Federica Gonella, Paolo Strignano, Dominic Dell Olio, Mauro Salizzoni, Giorgio Maria Saracco, Renato Romagnoli
Although early allograft dysfunction (EAD) negatively impacts on survival from the first months following liver transplantation (LT), direct-acting antivirals (DAAs) have revolutionized HCV therapy. We investigated the EAD definition best predicting 90-day graft loss and identified EAD risk factors in HCV positive recipients. From 11-2002 to 06-2016, 603 HCV-positive patients (hepatocellular carcinoma 53.4%) underwent a first LT with HCV-negative donors. Median recipient MELD score 15, median donor age 63 years...
April 19, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28422306/development-of-a-novel-frailty-index-to-predict-mortality-in-patients-with-end-stage-liver-disease
#9
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
https://www.readbyqxmd.com/read/28420029/interlobar-artery-resistive-index-predicts-acute-on-chronic-liver-failure-syndrome-in-cirrhotic-patients-with%C3%A2-acute-decompensation
#10
Pablo A Solís-Muñoz, Christopher Willars, Julia Wendon, George Auzinger, Michael A Heneghan, Maria De la Flor-Robledo, José A Solís-Herruzo
Introduction Patients with acutely decompensated (AD) cirrhosis are at risk for developing acute-on-chronic liver failure (ACLF) syndrome. This syndrome is associated with a high short-term mortality rate. The aim of our study was to identify reliable early predictors of developing ACLF in cirrhotic patients with AD. Patients and Methods We assessed 84 cirrhotic patients admitted for AD without ACLF on admission. We performed routine blood testing and detailed ultrasound Doppler studies of systemic arteries and mayor abdominal veins and arteries...
April 18, 2017: Ultraschall in der Medizin
https://www.readbyqxmd.com/read/28416232/experience-in-real-clinical-practice-with-new-direct-acting-antivirals-in-chronic-hepatitis-c
#11
Fernando Manuel Jiménez-Macías, Manuel Cabanillas-Casafranca, Marta Maraver-Zamora, Gema Romero-Herrera, Federico García-García, Antonio Correia-Varela-Almeida, Ana Cabello-Fernández, Manuel Ramos-Lora
INTRODUCTION AND OBJECTIVE: Inclusion of direct-acting antivirals into clinical practice in patients with chronic HCV (CHC) has been a milestone in medicine. PATIENTS AND METHODS: Analytical, prospective study, involving 126 patients with chronic HCV treated with direct-acting antivirals. Efficacy and safety of treatment and factors associated with failure treatment were evaluated. RESULTS: Age 54±10. Male (70%). Cirrhosis (60%). Distribution according to genotypes: G1a (31%), G1b (42%); G3 (14%); G4 (13%)...
April 14, 2017: Medicina Clínica
https://www.readbyqxmd.com/read/28414786/the-model-for-end-stage-liver-disease-meld-as-a-predictor-of-short-term-mortality-in-staphylococcus-aureus-bloodstream-infection-a-single-centre-observational-study
#12
Jan A Roth, Andreas F Widmer, Sarah Tschudin-Sutter, Marc Dangel, Reno Frei, Manuel Battegay, Balthasar L Hug
BACKGROUND: Automated laboratory-based prediction models may support clinical decisions in Staphylococcus aureus bloodstream infections (BSIs), which carry a particularly high mortality. Small studies indicated that the laboratory-based Model for End-stage Liver Disease (MELD) score is a risk factor for mortality in critically ill patients with infections. For S. aureus BSIs, we therefore aimed to assess a potential association of the MELD score with mortality. METHODS: In this single-centre observational study, all consecutive patients with a first episode of methicillin-susceptible S...
2017: PloS One
https://www.readbyqxmd.com/read/28410915/early-hospital-readmission-in-decompensated-cirrhosis-incidence-impact-on-mortality-and-predictive-factors
#13
Betty P Morales, Ramon Planas, Ramon Bartoli, Rosa M Morillas, Margarita Sala, Eduard Cabré, Irma Casas, Helena Masnou
BACKGROUND & AIMS: The early hospital readmission of patients with decompensated cirrhosis is a current problem. A study is presented on the incidence, the impact on mortality, and the predictive factors of early hospital readmission. PATIENTS AND METHODS: On the study included 112 cirrhotic patients, discharged after some decompensation between January 2013 and May 2014. Multivariate analyses were performed to identify predictors of early readmission and mortality...
March 18, 2017: Digestive and Liver Disease
https://www.readbyqxmd.com/read/28410631/comparison-of-three-caval-reconstruction-techniques-in-orthotopic-liver-transplantation-a-retrospective-review
#14
Tiffany Chan, Kristin DeGirolamo, Stephanie Chartier-Plante, Andrzej K Buczkowski
BACKGROUND: Classic caval reconstruction during liver transplantation involves complete cross-clamping and resection of the recipient inferior vena cava (IVC) followed by donor IVC interposition. Other techniques preserve the IVC, with piggyback (PB) to the hepatic veins or side-to-side (SS) caval anastomosis. Avoidance of cross-clamping may be beneficial for minimizing hemodynamic instability and transfusion requirements. METHODS: Retrospective review of a provincial transplant database (2007-2011)...
April 6, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28407441/same-policy-different-impact-center-level-effects-of-share-35-liver-allocation
#15
Douglas R Murken, Allison W Peng, David D Aufhauser, Peter L Abt, David S Goldberg, Matthew H Levine
Early studies of national data suggest that the Share 35 allocation policy increased liver transplants without compromising post-transplant outcomes. Changes in center-specific volumes and practice patterns in response to the national policy change are not well characterized. Understanding center-level responses to Share 35 is crucial for optimizing the policy and constructing effective future policy revisions. Data from the United Network for Organ Sharing were analyzed to compare center-level volumes of allocation-MELD ≥35 transplants pre- and post-policy implementation...
April 13, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28405326/von-willebrand-factor-and-alkaline-phosphatase-predict-re-transplantation-free-survival-after-the-first-liver-transplantation
#16
Andreas Wannhoff, Conrad Rauber, Kilian Friedrich, Christian Rupp, Wolfgang Stremmel, Karl Heinz Weiss, Peter Schemmer, Daniel N Gotthardt
BACKGROUND: After liver transplantation (LT), there are liver-related, infectious and cardiovascular complications that contribute to reduced graft survival. These conditions are associated with an increase in the Von Willebrand factor antigen (VWF-Ag), which was previously correlated with survival in cirrhotic patients. OBJECTIVE: Evaluate VWF-Ag as a predictive marker of re-transplantation-free survival in patients after LT. METHODS: We measured VWF-Ag in patients after first LT and then followed them prospectively with regard to the primary endpoint, namely re-transplantation-free survival...
February 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28403575/comparison-of-two-equivalent-meld-scores-for-hepatocellular-carcinoma-patients-using-data-from-the-united-network-for-organ-sharing-liver-transplant-waiting-list-registry
#17
Sarah K Alver, Douglas J Lorenz, Kenneth Washburn, Michael R Marvin, Guy N Brock
Hepatocellular carcinoma (HCC) patients have been advantaged on the liver transplant waiting list within the United States, and a 6-month delay and exception point cap have recently been implemented to address this disparity. An alternative approach to prioritization is an HCC-specific scoring model such as the MELD Equivalent (MELDEQ ) and the mixed new deMELD. Using data on adult patients added to the UNOS waitlist between 9/30/2009 and 6/30/14, we compared projected dropout and transplant probabilities for HCC patients under these two models...
April 12, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28403563/the-impact-of-infections-on-delisting-patients-from-the-liver-transplantation-waiting-list
#18
Louise J M Alferink, Rosalie C Oey, Bettina E Hansen, Wojciech G Polak, Henk R van Buuren, Robert A de Man, Carolina A M Schurink, Herold J Metselaar
BACKGROUND: Approximately 20% of the patients listed for liver transplantation die before transplantation can be accomplished. Understanding risk factors for waiting list mortality may help to improve survival and organ allocation. Infections are very common in patients with cirrhosis and are associated with significant morbidity and mortality. This study analysed the frequency and characteristics of infections in patients awaiting liver transplantation, identified risk factors for withdrawal from the waiting list and evaluated the impact of infections on the clinical outcome...
April 12, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/28403210/molecular-adsorbent-recirculating-system-mars-in-acute-liver-injury-and-graft-dysfunction-results-from-a-case-control-study
#19
Hans U Gerth, Michele Pohlen, Gerold Thölking, Hermann Pavenstädt, Marcus Brand, Christian Wilms, Anna Hüsing-Kabar, Dennis Görlich, Iyad Kabar, Hartmut H J Schmidt
BACKGROUND: The primary therapeutic goals in the treatment of liver injury are to support liver regeneration or bridge the gap to liver transplantation (LT). Molecular adsorbent recirculating system (MARS) therapy has shown beneficial effects for specific symptoms of liver failure; however, general survival advantages have not yet been demonstrated. AIM: We studied the effects of MARS therapy compared to standard medical treatment (SMT) in two patient cohorts: in patients with an acute liver injury and in those with graft dysfunction (GD)...
2017: PloS One
https://www.readbyqxmd.com/read/28399656/teaching-old-dyes-new-tricks-biological-probes-built-from-fluoresceins-and-rhodamines
#20
Luke D Lavis
Small-molecule fluorophores, such as fluorescein and rhodamine derivatives, are critical tools in modern biochemical and biological research. The field of chemical dyes is old; colored molecules were first discovered in the 1800s, and the fluorescein and rhodamine scaffolds have been known for over a century. Nevertheless, there has been a renaissance in using these dyes to create tools for biochemistry and biology. The application of modern chemistry, biochemistry, molecular genetics, and optical physics to these old structures enables and drives the development of novel, sophisticated fluorescent dyes...
April 7, 2017: Annual Review of Biochemistry
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