Optimizing patients’ condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = −0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.
In this article, we proposed a questionnaire for assessment of videofluorscopic examination in patients with swallowing disorders. It was developed during years 2015 - 2016 by the Department of Otolaryngology at the Medical University of Warsaw. The main body of the form consists of 3 parts assessing the oral phase, the pharyngeal phase and the esophageal phase. The main column contains a list of specific symptoms with yes/no answers. There is a four-point scale assessing the severity of the disorders from 0 to 3, where 0 corresponds to clinically insignificant findings, 1- mild impairment, 2 - moderate impairment, and 3 – severe impairment. Other elements of the form include: basic demographic and nutritional data, assessment of the consistency and texture of ingested food, food texture recommended based on the evaluation acc. to the recommendations of the International Dysphagia Diet Standardization Initiative (www.iddsi.org), and therapeutic assessment before implementation of speech therapy. The questionnaire was prepared on the basis of Trinity College survey, own experience and literature data.
for malignancies 2 or small -for -size syndrome in the recipients of living -donor grafts. 3 However, a smaller liver volume (LV) is observed in advanced liver cirrhosis with an increasing Child-Pugh class (CPC). 1,4-6 Additionally, according to Ozaki et al, 1 morphometric differences between etiologies would decrease with progression of cirrhosis. In individuals with cirrhosis and portal hypertension, only a 75% LV is expected compared with age -matched controls. 7 Changes in LV over time were suggested to be an indicator of therapeutic effectiveness or liver disease progression. 8 The advent of novel direct antiviral agents (DAAs), with a 90% efficacy of sustained viral IntroductIon Liver cirrhosis is characterized by several alterations affecting the hepatic tissue: fibrotic deposits involving the centrilobular vein, perisinusoidal space, and portal triad; active hepatocellular hyperplasia; and nodular formation with disruption of the normal microvascular architecture of the hepatic sinusoids, leading to progressive derangement of the liver morphology and function. However, Ozaki et al 1 noted numerous morphometric changes in liver modeling across various etiologies of cirrhosis.Liver volumetry is a method used to assess the risk of inducing liver failure in candidates for liver resection prior to hepatectomy
In liver transplantation, a side-to-side anastomosis is one of the commonly performed techniques of the inferior vena cava reconstruction. The authors report a case of an application of an endoscopic vascular linear stapler for a side-to-side caval anastomosis during deceased-donor liver transplantation. The back table procedure was performed in a standard fashion for a side-to-side anastomosis. The linear vascular stapler was introduced during the temporary clamping of the recipient’s inferior vena cava and the anastomosis was created without problems. Suturing of the resulting defect completed the anastomosis. The use of the stapler resulted in a shortening of the anastomosis time. The staple line after the reperfusion of the graft was completely sealed. The patient’s postoperative course was uncomplicated and post-operative ultrasound and computed tomography confirmed the patency of the anastomosis. This case demonstrates a novel approach to a side-to-side caval reconstruction during liver transplantation that enables a shortening of the implantation time and may improve the quality of anastomoses.
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