Post-Reperfusion Liver Biopsy and Its Value in Predicting Mortality and Graft Dysfunction After Liver Transplantation

Zanchet, Marcos Vinícius; Silva, Larissa Luvison Gomes da; Matias, Jorge Eduardo Fouto; Coelho, Júlio Cézar Uili

doi:10.1590/0102-6720201600030014

Cited by 9 publications

(9 citation statements)

References 21 publications

(32 reference statements)

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“…In this scenario, the progression of fibrosis and the onset of cirrhosis are important prognostic factors for patients on the liver transplantation waiting list. The majority of complications and mortalities are related to the severity of cirrhosis, and portal hypertension and its associated complications 14 , 21 . The validation of the ability of elasticity quantification to reveal in real life, liver stiffness as an important factor for its widespread application.…”

Section: Introductionmentioning

confidence: 99%

Higher Values in Liver Elastography and Meld Score Are Mortality Predictors on Liver Transplant Waiting List

Nacif

Paranaguá‐Vezozzo

Matsuda

et al. 2018

ABCD, arq. bras. cir. dig.

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Background: Liver elastography have been reported in hepatocellular carcinoma (HCC) with higher values; however, it is unclear to identify morbimortality risk on liver transplantation waiting list. Aim:To assess liver stiffness, ultrasound and clinical findings in cirrhotic patients with and without HCC on screening for liver transplant and compare the morbimortality risk with elastography and MELD score. Method: Patients with cirrhosis and HCC on screening for liver transplant were enrolled with clinical, radiological and laboratory assessments, and transient elastography. Results: 103 patients were included (without HCC n=58 (66%); HCC n=45 (44%). The mean MELD score was 14.7±6.4, the portal hypertension present on 83.9% and the mean transient elastography value was 32.73±22.5 kPa. The median acoustic radiation force impulse value of liver parenchyma was 1.98 (0.65-3.2) m/s and 2.16 (0.59-2.8) m/s in HCC group. The HCC group was significantly associated with HCV infection (OR 26.84; p<0.0001), higher levels of serum alpha-fetoprotein (OR 5.51; p=0.015), clinical portal hypertension (OR 0.25; p=0.032) and similar MELD score (p=0.693). The area under the receiver operating characteristics (AUROC) showed sensitivity and specificity for serum alpha-fetoprotein (cutoff 9.1 ng/ml), transient elastography value (cutoff value 9 kPa), and acoustic radiation force impulse value (cutoff value 2.56 m/s) of 50% and 86%, 92% and 17% and 21% and 92%, respectively. The survival group had a mean transient elastography value of 31.65±22.2 kPa vs. 50.87±20.9 kPa (p=0.098) and higher MELD scores (p=0.035). Conclusion: Elastography, ultrasound and clinical findings are important non-invasive tools for cirrhosis and HCC on screening for liver transplant. Higher values in liver elastography and MELD scores predict mortality.

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Section: Introductionmentioning

confidence: 99%

Higher Values in Liver Elastography and Meld Score Are Mortality Predictors on Liver Transplant Waiting List

Nacif

Paranaguá‐Vezozzo

Matsuda

et al. 2018

ABCD, arq. bras. cir. dig.

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“…Published papers confirm that biliary complications after hepatic transplantation present a high incidence due to ischemia of the bile ducts [1-7]. After transplantation, its vascularization is exclusively supplied by vessels derived from the hepatic artery itself, due to the sectioning of the collateral vessels of the liver ligaments during liver withdrawal for transplantation [8,18,19].…”

Section: Discussionmentioning

confidence: 99%

Epidemiologic Study on the Incidence of Biliary Complications after Liver Transplantation

Silva¹,

Andrade²,

Lisboa³

et al. 2018

J Liver

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Introduction: Biliary complications after hepatic transplantation have a variable incidence of 10 to 25% among all complications after hepatic transplantation and mortality reported up to 10%, have an important impact on the patient's quality of life, since it implies the need for hospitalizations and multiple interventions for treatment. They are more frequent in the first year after transplantation, with progressive reduction of the frequency after 1 year. Objective: To evaluate the risk factors of greater impact in the development of bile duct stenosis in patients after liver transplantation. Methods: One hundred and eighty-eight charts of liver transplant patients were retrospectively evaluated. Inclusion criteria: liver transplanted patients from 2011 to December 2017. Exclusion criteria: deaths that occurred between the first month after transplantation, incomplete medical records and most cases of retransplants, except for patients who retransplanted as a consequence of their own complication. Results: Biliary complications were present in 14% (N=26) of the patients. Of these, 52% (N=21) presented stenosis of the biliary tract, followed by other complications such as cholangitis (20%), fistula calculation (10%), bilioma (3%). Among patients with bile duct stenosis, 19% (N=4) presented non-anastomotic stenosis and 81% (N=17) anastomotic stenosis. The cause of hepatopathy was in 42% of patients (N=9) ethanolic, followed by other causes such as: viral hepatitis, cryptogenic, autoimmune, fulminant hepatitis, NASH, CEP, glycogenosis and 1 case of secondary retransplantation to the bile complication itself. Conclusion: The incidence of biliary complications is comparable with the incidence reported in other institutions. The low incidence of bile duct stenosis reduces the power of the study to identify the most impacting risk factors.

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“…The MELD score was described to predict the three-month survival rate of patients submitted to transjugular intrahepatic portosystemic shunt and validated as a measure of probability of mortality in patients candidates for liver transplantation 11 , 24 , 31 . Since then, it has been adopted as a criterion in the allocation of liver for transplantation until the present day.…”

Section: Introductionmentioning

confidence: 99%

The Use of Meld Score (Model for End-Stage Liver Disease) and Derivatives in Cardiac Transplantation

Moraes

Fonseca-Neto

2018

ABCD, arq. bras. cir. dig.

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Introduction: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. Objective: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. Method: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors “heart transplantation”, “liver disease” and “prognosis”. From the total of 111 articles found, six were selected and composed the sample. Results: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. Conclusion: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.

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Post-Reperfusion Liver Biopsy and Its Value in Predicting Mortality and Graft Dysfunction After Liver Transplantation

Cited by 9 publications

References 21 publications

Higher Values in Liver Elastography and Meld Score Are Mortality Predictors on Liver Transplant Waiting List

Higher Values in Liver Elastography and Meld Score Are Mortality Predictors on Liver Transplant Waiting List

Epidemiologic Study on the Incidence of Biliary Complications after Liver Transplantation

The Use of Meld Score (Model for End-Stage Liver Disease) and Derivatives in Cardiac Transplantation

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