Cárdenas A, Ginès P. Management of patients with cirrhosis awaiting liver transplantation

GI Unit, Institut Clinic de Malalties Digestives i Metaboliques, Hospital Clinic,and University of Barcelona, Institut d’Investigacions Biomédiques August Pi-Sunyer (IDIBAPS), Ciber de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
Gut (Impact Factor: 14.66). 03/2011; 60(3):412-21. DOI: 10.1136/gut.2009.179937
Source: PubMed


The demand for OLT continues to be on the rise with patients spending a long time on the waiting list; this not only increases the risk of developing further decompensation but also mortality. The complications discussed above may not only lead to removal from the waiting list in some cases but also a poorer outcome following transplantation. Therefore the appropriate prevention, recognition and treatment of the above-mentioned complications of cirrhosis will have a positive impact on the outcome before and after liver transplantation.

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Available from: Andres Cardenas, Jan 08, 2014
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    • "The probability of mortality as 50% or more has been reported for patients with serum sodium concentrations below 120 mmol/L independently of underlying disease [2] [3] [4]. Second, adverse outcomes, including mortality, are higher in hyponatremic patients with a wide range of underlying diseases [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]. "
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    ABSTRACT: Background Hyponatraemia increases morbidity and mortality, but the extent to which this condition influences mortality independently of other contributing factors is unclear. Materials and methods All hyponatremic patients admitted to the internal medicine department during a six month period were included. Medical records were reviewed and patients' demographics, underlying disease, cause of hyponatremia and in-hospital deaths were noted. Control group consisted of patients with normonatremia admitted to the same department during the same period matched 1:1 by sex, age and underlying disease. Difference in in-hospital mortality rate between the study and control groups was tested by chi-square test. Baseline demographics, underlying diseases, cause of hyponatremia and state of hyponatremia correction as possible risk factors for mortality were tested in a multivariate analysis. Results The baseline cohort of all admitted patients consisted of 2171 patients. Hyponatraemia was found in 278 (13%) patients (160 females and 118 males). The three most common causes of hyponatremia included gastrointestinal loss (52 patients), decreased oral intake (47 patients), and dilution hyponatremia (45 patients). The in-hospital mortality rate in the hyponatremic group was significantly higher compared with the control group (22% vs 7%, respectively; OR 3.75, 95% CI 2.17–6.48, p < 0.0001). In a multivariate analysis age above 65 years, dilution hyponatremia, decreased oral intake as etiologic factors of hyponatremia, and unsuccessful hyponatremia correction were independent factors associated with increased mortality. Conclusion Hyponatraemia represents independent factor associated with in-hospital mortality. Age above 65 years, failure to correct hyponatremia and some specific etiologic factors of hyponatremia are related to increased mortality.
    Full-text · Article · Apr 2014 · European Journal of Internal Medicine
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    • "When hepatic decompensation has occurred, the morbidity increases rapidly. After the first manifestation of ascites the one year mortality increases up to 40% [1], [2]. The patients' prognosis further deteriorates upon occurrence of spontaneous bacterial peritonitis or hepatorenal syndrome. "
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    ABSTRACT: Liver cirrhosis is associated with high morbidity and mortality. MicroRNAs (miRs) circulating in the blood are an emerging new class of biomarkers. In particular, the serum level of the liver-specific miR-122 might be a clinically useful new parameter in patients with acute or chronic liver disease. Here we investigated if the serum level of miR-122 might be a prognostic parameter in patients with liver cirrhosis. 107 patients with liver cirrhosis in the test cohort and 143 patients in the validation cohort were prospectively enrolled into the present study. RNA was extracted from the sera obtained at the time of study enrollment and the level of miR-122 was assessed. Serum miR-122 levels were assessed by quantitative reverse-transcription PCR (RT-PCR) and were compared to overall survival time and to different complications of liver cirrhosis. Serum miR-122 levels were reduced in patients with hepatic decompensation in comparison to patients with compensated liver disease. Patients with ascites, spontaneous bacterial peritonitis and hepatorenal syndrome had significantly lower miR-122 levels than patients without these complications. Multivariate Cox regression analysis revealed that the miR-122 serum levels were associated with survival independently from the MELD score, sex and age. Serum miR-122 is a new independent marker for prediction of survival of patients with liver cirrhosis.
    Full-text · Article · Sep 2012 · PLoS ONE
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    • "There is currently no justification for automatically and systematically increasing priority for candidates with symptoms of HE. At this time, because of the lack of a quantifiable, verifiable and reproducible method of documenting HE, intractable or complicated HE should be addressed by the " Review Boards " and additional priority be assigned case-by-case[113]. Reasons for prioritization other than reduced quality of life due to HE are both a negative effect on patient nutritional status in the pre-transplant period through decreased oral intake and the increased risk for post-transplant neurological complications associated with the severity of HE before transplantation[114,115]. "
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    ABSTRACT: Liver transplantation is indicated in patients with acute liver failure, decompensated cirrhosis, hepatocellular carcinoma and rare liver-based genetic defects that trigger damage of other organs. Early referral to a transplant center is crucial in acute liver failure due to the high mortality with medical therapy and its unpredictable evolution. Referral to a transplant center should be considered when at least one complication of cirrhosis occurs during its natural history. However, because of the shortage of organ donors and the short-term mortality after liver transplantation on one hand and the possibility of managing the complications of cirrhosis with other treatments on the other, patients are carefully selected by the transplant center to ensure that transplantation is indicated and that there are no medical, surgical and psychological contraindications. Patients approved for transplantation are placed on the transplant waiting list and prioritized according to disease severity. Thus, the appropriate timing of transplantation depends on recipient disease severity and, although this is still a matter of debate, also on donor quality. These two variables are known to determine the "transplant benefit" (i.e., when the expected patient survival is better with, than without, transplantation) and should guide donor allocation.
    Full-text · Article · Aug 2012
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