Prognostic Value of Thyroid Hormone Levels in Patients Evaluated for Liver Transplantation

Thiel, David H. Van; Udani, Mahendra; Schade, Robert R.; Sanghvi, Ajitkumar T.; Starzl, Thomas E.

doi:10.1002/hep.1840050526

Cited by 29 publications

(11 citation statements)

References 22 publications

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“…Elevated preoperative bilirubin levels and the presence of peroperative ascites have been shown to differentiate between probable survivors and nonsurvivors in several studies examining the prognosis of nonshunt laparotomy in cirrhotic patients (9). Previous studies by our own group have shown that the plasma levels of several thyroid hormones, T 3 , T 4 and rT 3 , are important predictors of survival long enough to experience a transplant (10). The present study differs markedly from this earlier one, however, in that the population studied is quite different (those patients actually transplanted vs. those patients evaluated for transplantation), and the endpoints are very different (EMBI and survival after OLTx vs. survival long enough to have a transplant) (10).…”

Section: Discussionmentioning

confidence: 98%

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Cuervas-Mons¹,

Millán²,

Gavaler³

et al. 1986

Hepatology

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168

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Twenty-seven clinical and laboratory data and the subsequent clinical course of 93 consecutive adult patients who underwent orthotopic liver transplantation for various chronic advanced liver diseases were analyzed retrospectively to assess the risk factors of early major bacterial infection and death after the procedure. Forty-one patients (44%) had early major bacterial infection during hospitalization for orthotopic liver transplantation. The mortality rate was 70.7% in patients with early major bacterial infection and was 7.7% in patients without early major bacterial infection (p < 0.001). Total serum bilirubin, total white blood cell count and polymorphonuclear cell count, IgG (all p < 0.05) and plasma creatinine level (p < 0.001) were higher in patients that developed early major bacterial infection than in those who did not. By step-wise discriminant analysis, the strongest risk factor for early major bacterial infection was the serum creatinine level, which achieved an accuracy of 69% for a creatinine level greater than 1.58 mg per dl.Seven variables (ascites, hepatic encephalopathy, elevated white blood and polymorphonuclear cell count, decreased helper to suppressor T cell ratio and elevated plasma creatinine and bilirubin levels) were associated with a significant increased risk for death. A step-wise discriminant analysis of these seven factors resulted in the demonstration of serum creatinine as the greatest risk factor for mortality. A preoperative serum creatinine either less than or greater than 1.72 mg per dl accurately predicts survival or death, respectively, in 79% of cases. These data suggest that the baseline preoperative serum creatinine level provides the best indication of the short-term prognosis after liver transplantation than does any other preoperatively obtained index of the patient's status.Orthotopic liver transplantation (OLTx) has dramatically altered the otherwise fatal outcome for some patients with advanced chronic liver disease and has been reported to obtain a 70.8% survival in adult patients at 1 year after OLTx (1). Because both economic and human resources are limited within the health care system of most countries and institutions, liver transplantation ideally should be restricted to those patients with the greatest possibility of survival after the procedure, so the selection of appropriate candidates for OLTx has become an issue of considerable concern both for physicians and surgeons involved in the management of patients with advanced hepatic disease.In a recent series of adult patients with OLTx, 75% of the deaths occurred during the first 60 days post-transplantation (2). In this series, infectious complications were the most common cause of death. Ninety percent of the deaths due to infection following OLTx occurred during NIH Public Access Author ManuscriptHepatology. Author manuscript; available in PMC 2010 November 8. Published in final edited form as:Hepatology. 1986 ; 6(5): 922-927. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author M...

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Section: Discussionmentioning

confidence: 98%

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Cuervas-Mons¹,

Millán²,

Gavaler³

et al. 1986

Hepatology

Self Cite

168

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“…Many prognostic markers have been extensively analyzed to identify patients who will require OLT (4,(19)(20)(21)(22)(23)(24). Although not standardized, most centers have adapted the King's College (4) and the Clichy criteria (21).…”

Section: Discussionmentioning

confidence: 99%

Fulminant hepatic failure and serum phosphorus levels in children from the western part of Turkey

Öztürk¹,

Berktaş²,

Tunçel³

et al. 2010

Turk J Gastroenterol

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“…FT4 levels are normal and often elevated [48,50]. The low serum T3 and FT3 levels, the low T4, the high rT3 and rT3/T3 ratio correlate with the severity of the disease and have been considered to have prognostic value [50,52,53]. We found that the FT4/FT3 ratio (measured after separation on Sephadex LH 20) also increases with the severity of the disease (Fig.…”

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confidence: 62%

Hormones and Liver: Some Aspects of the Problem

Langer

Chiandussi

1987

Assessment and Management of Hepatobiliary Disease

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There are very tight interactions between the endocrine system and the liver. Hormones control many metabolic reactions and many processes of protein synthesis in the liver. The liver, on the other hand, is the major site for hormone metabolism. In the liver hormones may eitherbe transformed into more active compounds (e.g., thyroxine into the four times as active triidothyronine, vitamin 03 into its 25-0H form) or be inactivated, catabolized and disposed of. Liver also influences hormone blood levels, being the site of transport protein synthesis. It is also the major source of hormone-dependent growth factors and of their inhibitors. These complex interactions between hormones and liver occur via receptors. Accordingly, specific membrane, cytoplasmic, and nuclear receptors for many hormones have been identified in liver tissue [1]. The effectiveness of hormonal actions depends on the presence of specific receptors and is modulated by their concentration. The receptor binding capacity can be modified by the specific binding hormone and by other hormones as well. For example, estrogens may increase both estrogen and prolactin (PRL) receptors while testosterone decreases estrogen and PRL binding. Receptors for sexual hormones with properties similar to those in hormone-dependent sexual target tissues are present in the liver [2][3][4][5]. Very interesting studies carried out in the rat have shown sex-linked differences in some liver functions: there are differences in male and female steroid-metabolizing enzymes in the liver; male livers have more oxidizing enzymes and female livers have more reducing enzymes [6,7]; females have estrogen and PRL receptors; males, beside estrogen, have also androgen but not PRL receptors. Furthermore, male livers synthesize a malespecific protein -a male estrogen binder (MEBP) [3,7] which is not a receptor -and a protein excreted with the urine, the a-2u globulin [8]. These sex-linked differences are determined in the fetus at birth by androgen "imprinting" at the hypothalamic level, which represses a pituitary feminizing factor which has been identified as growth hormone [9]. Interestingly, growth hormone (GH) is secreted with a different pattern in male and female rats; this might be the signal which regulates the sexual dimorphism of these liver functions.Exogenous and endogenous estrogen excess (e.g., oral contraceptives and pregnancy) may effect several liver functions. It increases the synthesis of several proteins, such as hormone-transport proteins, ceruloplasmin, renin substrate, some drug-metabolizing enzymes, aminolevulinic acid synthetase, etc. Both estrogens and androgens seem to playa role in hepatic regeneration [10][11][12]. There is clinical evidence for an association between liver focal nodular hyperplasia and hepatocellular adenoma on one hand and oral contraceptive or anabolic steroid intake on the other [7,13]; elevated estrogenbinding capacity was found in liver adenoma tissue [14]. Hepatocellular carcinoma is Assessment and Management or Hepatobiliary Diseas...

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Prognostic Value of Thyroid Hormone Levels in Patients Evaluated for Liver Transplantation

Cited by 29 publications

References 22 publications

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Fulminant hepatic failure and serum phosphorus levels in children from the western part of Turkey

Hormones and Liver: Some Aspects of the Problem

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