Analysis of Liver Transplantation Outcome in Patients With MELD Score ≥30

Ferraz-Neto, Ben Hur; Zurstrassen, M.P.V.C.; Hidalgo, R.; Meira-Filho, S.P.; Rezende, Marcelo Bruno de; Paes, Ângela Tavares; Afonso, R.C.

doi:10.1016/j.transproceed.2008.03.016

Cited by 39 publications

(38 citation statements)

References 14 publications

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“…The major primary lung structural disturbance causing hypoxemia in HPS is dilatation of pulmonary pre-capillary and post-capillary vessels [1][2][3][4][5]. Although the etiology of this intrapulmonary vasodilation has not been fully established, liver injury and/or portal hypertension trigger the release of endothelin-l, TNFalpha, cytokines, and mediate vascular shear stress and release of nitric oxide and carbon monoxide, all contributing to vasodilation [1][2][3][4][5]19]. Such vasodilation causes AVC that bypass gas exchange units; whereas, pulmonary arterial blood (mixed venous blood) passes either quickly or directly into the pulmonary veins, resulting in right-to-left shunt [1][2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Hepatopulmonary syndrome (HPS) is defined as the clinical triad of advanced liver disease, arterial deoxygenation (hypoxemia) and intrapulmonary vascular dilatation [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

“…Although the pathogenesis of this syndrome is not completely understood, hypoxemia may be mostly attributed to intrapulmonary right-to-left shunt due to abnormal arteriovenous communications (AVC) [1][2][3][4][5]. Tc-99m-macroaggregated albumin (MAA) perfusion scan has been widely used to confirm the existence of right-to-left shunt caused by AVC and to quantify its magnitude [1,4,6].…”

Section: Introductionmentioning

confidence: 99%

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Findings of hepatopulmonary syndrome on breath-hold perfusion SPECT-CT fusion images

Suga¹,

Kawakami²,

Iwanaga

et al. 2009

Ann Nucl Med

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Pulmonary perfusion SPECT-CT fusion images were used to characterize CT manifestations of intrapulmonary arteriovenous communications (AVC) causing right-to-left shunt and hepatopulmonary syndrome (HPS). After scanning the whole body and obtaining multiple view images of the lung, deep-inspiratory breath-hold (DIBrH) SPECT was obtained in 2 patients with HPS, which was automatically and three-dimensionally co-registered with DIBrH CT. In both patients, the whole body scan depicted systemic organs and confirmed the existence of right-to-left shunt. DIBrH SPECT-CT fusion images showed that perfusion defects were predominantly located at subpleural reticulo-nodular opacities and/or dilated vessels in the lung base. Subpleural reticulo-nodular opacities and/or dilated vessels in the lung base appear to be characteristic CT manifestation of intrapulmonary AVC in HPS.

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Section: Discussionmentioning

confidence: 99%

“…Hepatopulmonary syndrome (HPS) is defined as the clinical triad of advanced liver disease, arterial deoxygenation (hypoxemia) and intrapulmonary vascular dilatation [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Findings of hepatopulmonary syndrome on breath-hold perfusion SPECT-CT fusion images

Suga¹,

Kawakami²,

Iwanaga

et al. 2009

Ann Nucl Med

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“…MELD skorunun karaci¤er transplant al›c›lar›n›n sa¤-kal›m› üzerindeki etkisi konusunda çeliflkili çal›flmalar mevcuttur (9,(12)(13)(14)(15). Tsui TY ve ark.…”

Section: Tart›flmaunclassified

Erişkin Ortotopik Karaciğer Transplantasyonu Sonrası Uzamış Yoğun Bakım Gereksiniminin Ön Belirleyicileri

Kundakcı¹,

Pirat²,

Kömürcü³

et al. 2011

tybdd

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B Bu u ç ça al l› ›fl flm ma a O Oc ca ak k 2 20 01 11 1' 'd de e S So oc ci ie et ty y o of f C Cr ri it ti ic ca al l C Ca ar re e M Me ed di ic ci in ne e 4 40 0 t th h A An nn nu ua al l M Me ee et ti in ng g k ka ap ps sa am m› ›n nd da a p po os st te er r b bi il ld di ir ri is si i o ol la ar ra ak k S Sa an n D Di ie eg go o' 'd da a s su un nu ul lm mu ufl flt tu ur r. . Amaç:Ortotopik karaci¤er transplantasyonundan sonra hastalar›n erken postoperatif izlemleri yo¤un bak›mda gerçeklefltirilmektedir. Ancak bu hastalar›n yo¤un bak›mda kal›fl süreleri ve bu süreyi belirleyen etkenler tam olarak bilinmemektedir. Uzam›fl yo¤un bak›m yat›fl gereksinimi, yo¤un bak›mlar›n fiziksel ve finansal kaynaklar›n›n tü-ketimini artt›r›rken, hasta sonuçlar›n› olumsuz etkileyebilir. Bu çal›fl-man›n amac›, eriflkin ortotopik karaci¤er transplantasyonlar›ndan sonra uzam›fl yo¤un bak›m gereksiniminin s›kl›¤›n› ve buna sebep olabilecek operasyon öncesi sebepleri saptamakt›r. Gereç ve Yöntem: Ocak 2000 -fiubat 2009 tarihleri aras›nda gerçeklefltirilen 112 eriflkin ortotopik karaci¤er transplantasyonunun verileri retrospektif olarak tarand›. Hastalar›n demografik ve klinik özellikleri, preoperatif laboratuar testleri, intraoperatif hemodinamik parametreler ve yap›lan transfüzyonlar, yo¤un bak›m ve hastane kal›fl süreleri ve mortalite h›zlar› gibi parametreler kaydedildi. Uzam›fl yo¤un bak›mda kal›fl süresi, transplantasyon sonras› 3 günden uzun yo¤un bak›m gereksinimi olarak kabul edildi. Bulgular: Elli dokuz hastada (%53) uzam›fl yo¤un bak›m gereksinimi saptand›. Uzam›fl yo¤un bak›m gereksinimi olan hastalar, olmayanlar ile karfl›laflt›r›ld›¤›nda, model for end-stage liver disease (MELD) ve Child-Pugh skorlar› daha yüksek (her ikisi için p<0,001), preoperatif hemoglobin düzeyleri daha düflük (p=0,04), preoperatif kan üre azotu düzeyleri daha yüksek (p=0,013), koroner arter hastal›¤› s›kl›¤› daha az (p=0,046), anestezi süreleri daha uzun (p=0,010), intraoperatif hipotansif atak s›kl›¤› daha yüksek (p=0,013) ve intraoperatif kan ürü-nü transfüzyonu miktar› daha yüksek (p=0,004) bulundu. ‹statistiksel olarak anlaml› bulunan bu parametreler ile oluflturulan lojistik regresyon modelinde yüksek MELD skoru (OR: 1,4, CI%95:1,1-1,7, p=0,010) uzam›fl yo¤un bak›m gereksinimi için risk faktörü olarak belirlendi. Uzam›fl yo¤un bak›m gereksinimi olan hastalar, di¤er hastalar ile karfl›laflt›r›ld›¤›nda daha yüksek mortalite oranlar›na sahiptiler (%41'e karfl›n %9, p<0,001

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“…Der MELDScore basiert ausschließlich auf objektiven Laborbefunden [Kreatinin, "international normalized ratio" (INR), Serumbilirubin]. Daraus ergibt sich, verglichen mit der vorherigen Vergabepraxis nach dem Child-TurcottePugh-System, eine Bevorzugung von kränkeren Patienten mit einem höheren perioperativen Risiko [17]. Ein MELD-Wert >30 ist mit einer höheren postoperativen Letalität assoziiert.…”

Section: "Model Of End Stage Liver Disease Score"unclassified

Intensive therapy after solid organ transplantation

et al. 2010

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Transplantation medicine is an interdisciplinary task and the priority objective is a fast recovery to patient independence. After kidney transplantation the crucial aims are monitoring of transplant perfusion, maintainance of an adequate volume status and avoidance of nephrotoxic medications. Transplantation for patients with advanced chronic liver failure has become more common since the implementation of the model of end stage liver disease (MELD) allocation system which is associated with more complicated proceedings. The essentials of critical care after liver transplantation are monitoring of transplant function, diagnosis of perfusion or biliary tract problems, specific substitution of coagulation factors and hemodynamic optimation due to avoidance of hepatic congestion. Many patients listed for heart transplantation need preoperative intensive care due to impaired heart function. Postoperatively a specific cardiac support with pulmonary arterial dilatators and inotropics is usually necessary. Lung transplantation aims at an improvement of patient quality of life. Postoperative critical care should provide a limitation of the pulmonary arterial pressure, avoidance of volume overload and rapid weaning from the respirator.

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Analysis of Liver Transplantation Outcome in Patients With MELD Score ≥30

Cited by 39 publications

References 14 publications

Findings of hepatopulmonary syndrome on breath-hold perfusion SPECT-CT fusion images

Findings of hepatopulmonary syndrome on breath-hold perfusion SPECT-CT fusion images

Erişkin Ortotopik Karaciğer Transplantasyonu Sonrası Uzamış Yoğun Bakım Gereksiniminin Ön Belirleyicileri

Intensive therapy after solid organ transplantation

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