Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis

Takeda, Kazuhisa; Tanaka, Kuniya; Kumamoto, Takafumi; Nojiri, Kazunori; Mori, Rintaro; Taniguchi, Koichi; Matsuyama, Ryusei; Endo, Itaru

doi:10.1007/s00595-011-0040-5

Cited by 14 publications

(6 citation statements)

References 28 publications

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“…Although data have shown that invasive Aspergillus may occur in liver transplantation [ 1 , 3 , 11 ], it has rarely been reported in other liver diseases. Much uncertainty remains in liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical findings in 19 cases of invasive pulmonary aspergillosis with liver cirrhosis

Chen

Yang

Huang

et al. 2014

Multidiscip Respir Med

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BackgroundAspergillus infection was mostly reported with high mortality rates and a bad prognosis in immunocompromised patients, but data were lacking on the clinical characteristics of aspergillus infection in liver cirrhosis. The aim of this study was to retrospectively assess the morbidity and mortality rate, clinical manifestation, risk factors, and medication of invasive pulmonary aspergillosis (IPA) in liver cirrhosis in The First Affiliated Hospital, College of Medicine, Zhejiang University.MethodsPatients with liver cirrhosis who had been diagnosed with proven or probable IPA by clinical and laboratory parameters from 1st December 2008 to 1st May2012 were retrospectively evaluated for predisposing factors for IPA and clinical outcome. The follow up ended on 30th July2012. IPA was defined according to European Organization for Research and Treatment of Cancer/Mysoses Study group criteria.ResultsIn total, 6,600 patients with liver cirrhosis were enrolled, and 19 out of these developed IPA. Seventeen out of 19 patients died. Imaging findings such as the halo sign and lower respiratory tract infection symptoms contributed to the early diagnosis of IPA. Possible risk factors for IPA included a high Child-Turcotte-Pugh (CTP) score, broad antibiotic usage and steroid exposure. The use of antifungal compounds may prolong a patient’s life.ConclusionsThe mortality of liver cirrhosis with IPA is high. Liver cirrhosis should be considered a risk factor of IPA. Once patients with high CTP scores and steroid and broad spectrum antibiotics exposure present cough and fever, IPA should be taken into consideration and antifungal agents should be used as soon as possible.

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Section: Discussionmentioning

confidence: 99%

Clinical findings in 19 cases of invasive pulmonary aspergillosis with liver cirrhosis

Chen

Yang

Huang

et al. 2014

Multidiscip Respir Med

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“…Pre-operative intubation also was an independent predictor of one-month mortality, a finding that has not been reported in prior studies of complications after OLT. One study has demonstrated that among patients who underwent emergency or elective living-donor liver transplantation (LDLT), those who underwent emergency LDLT had higher rates of pre-operative intubation, suggesting greater pre-transplant acuity and possibly poorer post-transplant outcome ( 27 ). Further, intraoperative arrhythmias were also independently associated with one-month mortality, corroborating studies that have suggested patients with atrial fibrillation may be at increased risk of mortality after liver transplantation ( 28 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Neurological Complications and One-Month Mortality after Liver Transplantation

DiNorcia

Sher

et al. 2014

Front. Neurol.

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Background: Neurological complications are common after orthotopic liver transplantation (OLT). We aimed to characterize the risk factors associated with neurological complications and mortality among patients who underwent OLT in the post-model for end-stage liver disease (MELD) era.Methods: In a retrospective review, we evaluated 227 consecutive patients at the Keck Hospital of the University of Southern California before and after OLT to define the type and frequency of and risk factors for neurological complications and mortality.Results: Neurological complications were common (n = 98), with encephalopathy being most frequent (56.8%), followed by tremor (26.5%), hallucinations (11.2%), and seizure (8.2%). Factors associated with neurological complications after OLT included preoperative dialysis, hepatorenal syndrome, renal insufficiency, intra-operative dialysis, preoperative encephalopathy, preoperative mechanical ventilation, and infection. Preoperative infection was an independent predictor of neurological complications (OR 2.83, 1.47–5.44). One-month mortality was 8.8% and was independently associated with urgent re-transplant, preoperative intubation, and intra-operative arrhythmia.Conclusion: Neurological complications are common in patients undergoing OLT in the post-MELD era, with encephalopathy being most frequent. An improved understanding of the risk factors related to both neurological complications and one-month mortality post-transplantation can better guide perioperative care and help improve outcomes among OLT patients.

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“…Although IPA has been reported in patients after liver transplantation3,7,12, IPA has rarely been observed in patients with other liver diseases. Early diagnosis of IPA is difficult; therefore, research has focused on the identification of patients at a high risk for IPA so that antifungal prophylaxis and empirical treatment improves their survival.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Invasive Pulmonary Aspergillosis and Hospital Mortality in Acute-On-Chronic Liver Failure Patients: A Retrospective-Cohort Study

Chen¹,

Yang²,

Huang³

et al. 2013

Int. J. Med. Sci.

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Background: Invasive pulmonary aspergillosis (IPA) in acute-on-chronic liver failure (ACLF) patients is associated with a high mortality. But the clinical characteristics of and the risk factors for IPA among patients with ACLF remains unclear. This study was aimed at assessing clinical manifestation, the risk factors and antifungal medications for as well as the mortality due to IPA in ACLF patients at the First Affiliated Hospital, College of Medicine, Zhejiang University.Patients and Methods: Patients with ACLF who were diagnosed with proven or probable IPA by clinical and laboratory parameters from 1 December 2008 to 1 May 2012 were retrospectively evaluated to determine the risk factors for IPA and the clinical outcomes. The follow-up ended on 30 July 2012. Multivariate analysis was performed to identify the risk factors for mortality and the development of IPA.Results: In total, 787 patients with ACLF were enrolled, and 39 of these patients developed IPA. Thirty seven of these 39 patients died in spite of treatment with antifungal drugs. Controls included 48 patients who did not have a pulmonary infection. The survival rate of patients with IPA was significantly lower than that of those without IPA. IPA was found to be independently associated with age (p = 0.021), encephalopathy (p = 0.002), and steroid use (p = 0.000). There was significant difference in the prognosis between the patients treated with either voriconazole or itraconazole and those without antifungal treatment.Conclusions: Patients with ACLF and IPA have a high mortality rate. Patients with ACLF who present with encephalopathy should avoid steroids, as they increase the mortality rate. Azoles may prolong the survival time.

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Emergency versus elective living-donor liver transplantation: a comparison of a single center analysis

Abstract: Careful perioperative management, including preoperative investigation of aspergillosis and empiric antibiotic therapy, should be considered for emergency LDLT patients who fulfill IPA risk factors.

Cited by 14 publications

References 28 publications

Clinical findings in 19 cases of invasive pulmonary aspergillosis with liver cirrhosis

Clinical findings in 19 cases of invasive pulmonary aspergillosis with liver cirrhosis

Predictive Factors of Neurological Complications and One-Month Mortality after Liver Transplantation

Risk Factors for Invasive Pulmonary Aspergillosis and Hospital Mortality in Acute-On-Chronic Liver Failure Patients: A Retrospective-Cohort Study

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