J G O'Grady

University of Leeds, Leeds, England, United Kingdom

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Publications (6)10.47 Total impact

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    ABSTRACT: Although there is a fall in lumbar spine bone mineral density (BMD) after liver transplantation, little is known about femoral neck or total body BMD. Therefore we determined: (a) the proportion of patients with preexisting hepatic osteopenia before transplantation and (b) the effects of transplantation on global and regional BMD. Retrospective analysis of BMD measurements of patients before and up to 2 years after liver transplantation. BMD was assessed by dual energy X-ray absorptiometry in 56 patients, before and at regular intervals after liver transplantation, for up to 24 months, to measure total body, lumbar spine (L2-L4) and femoral neck BMDs. Pre-transplant, 23% of patients had osteoporosis (a negative Z score > 2). Paired data before and after transplantation revealed no change in total body BMD. However, there was a fall in lumbar spine BMD (1.04+/-0.03 to 1.02+/-0.03 g/cm2; P < 0.04) at 1 month after transplantation. The reduction in lumbar spine BMD was seen up to 12 months, BMD at 18-24 months being similar to pre-transplant values. Femoral neck BMD also fell (0.96+/-0.06 to 0.83+/-0.04 g/cm2; P < 0.03), but only after 6-9 months, thereafter remaining below pre-transplant values until the end of the follow-up period. Although osteopenia is common in patients with liver disease, total bone density does not fall after transplantation. Nonetheless regional lumbar spine and femoral neck bone density does fall after transplantation with a risk period for femoral neck fracture which may extend for up to 2 years.
    European Journal of Gastroenterology & Hepatology 03/1999; 11(2):157-63. · 1.92 Impact Factor
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    ABSTRACT: The effects of orthotopic liver transplantation on body composition are unclear. We aimed to assess changes in body composition after transplantation using dual energy x-ray absorptiometry and total body potassium. Dual energy x-ray absorptiometry and total body potassium counting to assess muscle mass were performed in 55 patients before and up to 24 months after liver transplantation and the results expressed as paired data before and at time intervals after transplantation. The results showed that total body weight fell by 3.6 +/- 1.3 kg (p < 0.02) at 1 month, with a maximal fall in lean tissue mass at 2-5 months of 4.8 +/- 1.2 kg (p < 0.003). Thereafter, no change in lean tissue mass was recorded, although there were increases at 12 and 24 months of total body weight (11.5 +/- 2.4 kg, 7.8 +/- 3.1 kg; p < 0.03, respectively) and fat mass (12.9 +/- 2.2 and 10.5 +/- 2.7 kg; p < 0.003). A fall in total body potassium was seen at 1 month (118 +/- 12 mmol; p < 0.003) and 2-5 months (176 +/- 9.9 mmol; p < 0.03), which mirrored the fall in lean mass. After liver transplantation there is an initial fall in body weight due to a loss of lean mass. Lean mass does not recover after transplantation, although there is an increase in fat mass that leads to the observed increase in total body weight.
    Liver International 06/1998; 18(3):173-9.
  • Applied Radiation and Isotopes 05/1998; 49(5-6):661-2. · 1.18 Impact Factor
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    ABSTRACT: After liver transplantation there is a fall in lean body mass. To determine the risk factors for this fall in lean body mass using univariate and subgroup analyses. Dual energy X-ray absorptiometry was performed in 36 patients (12 with Child-Pugh Class A, 20 with Class B and 4 with Class C disease) before and up to 24 months after liver transplantation. Univariate and sub-group comparative analyses were performed to assess possible risk factors for the fall in lean body mass post-transplantation. The pre-transplantation serum albumin inversely correlated with the fall lean body mass at 1 month (r = 0.55; p < 0.009) and at 6-9 months (r = 0.51; p < 0.05) post-transplantation. A positive correlation between the fall in lean body mass and: (i) cumulative dose of steroids administered at 2-5 months (r = 0.57; p < 0.05) and (ii) length of hospital stay after transplantation (r = 0.52; p < 0.05) were also observed. Neither the severity or presence of cholestatic liver disease pre-transplant, nor acute cellular rejection post-transplant were risk factors for a fall in lean mass. A hypercatabolic state post-transplant (represented by low albumin pre-transplantation), immobility, lack of exercise and steroid induced catabolism of muscle may cause the observed fall in lean mass after liver transplantation. Earlier transplantation of patients with better nutritional status and the use of low dose steroid immunosuppressive regimens may prevent the observed fall in lean body mass after transplantation.
    Applied Radiation and Isotopes 01/1998; 49(5-6):663-4. · 1.18 Impact Factor
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    ABSTRACT: Quinine, an alkaloid that occurs in the bark of trees of the genus Cinchona, has been used for the treatment of malaria in humans for over 150 years. In 1888 it was reported that quinine was more toxic to plant tissues and frog eggs in the light than in the dark; thus it is probably one of the first pure compounds shown to be a photosensitizer for biological systems. During this century, because of the toxic side effects of quinine and the appearance of quinine-resistant malarial strains, a search was begun to identify synthetic antimalarial compounds with improved properties. A number have been identified and are now in widespread use; but like quinine, most of these are also photosensitizers. Because of the very large numbers of patients receiving antimalarials, many studies have been made of the photophysical, photochemical and photosensitizing properties of quinine and several of the most commonly used synthetic antimalarials (chloroquine, primaquine, quinacrine and mefloquine). The results of these studies are summarized in this review. Most antimalarials photosensitize in part by the generation of singlet oxygen, although free radical pathways may also be involved. The carcinogenic and photocarcinogenic properties of antimalarials and related compounds are briefly surveyed.
    Journal of Photochemistry and Photobiology B Biology 01/1998; 42(1). · 3.11 Impact Factor
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    ABSTRACT: In areas with endemic hepatitis E virus (HEV), acute liver failure secondary to hepatitis E infection is common in pregnancy and associated with a mortality rate of up to 20%. However, there is little information on the clinical course of severe hepatitis E infection during pregnancy in non-endemic areas such as the UK. Here we describe two cases of severe hepatitis E in pregnancy in patients returning from the Indian subcontinent. These cases were diagnosed by the detection of IgM anti-HEV antibody using an enzyme immunoassay with recombinant hepatitis E viral antigens. The first case describes acute hepatic failure, with coagulopathy and encephalopathy, warranting intensive therapy and elective ventilation. In the other case, the patient had severe hepatitis with coagulopathy. Both cases spontaneously resolved with no foetal loss. These cases highlight the need for suspicion of HEV infection in patients returning from endemic areas and presenting with acute non-A non-B hepatitis, especially when pregnant. Furthermore, the intensive treatment of acute liver failure caused by HEV may reduce the high mortality reported in Asia.
    Journal of Viral Hepatitis 02/1997; 4(1):51-4. · 3.08 Impact Factor