RESUMO
Background: Liver transplantation is the accepted standard of care for patients with End Stage Liver Disease [ESLD]. Since the liver transplant programme restarted in King Faisal Specialist Hospital and Research centre in 2001 and results have been improving. We review the overall results of liver transplantation over the last 6 years
Patients and Methods: Characteristic of patient population: Data retrospectively reviewed between April 2001 to January 2007 years, our center performed 122 liver transplantations, 77 from deceased donors [DDL T], and 45 from living donors [LDLT], in 118 patients 4 cases were retransplanted. Perioperative Management: All patients were evaluated preoperatively according to the institute protocol. All patients received general anesthesia according to our protocol. Swan Ganzcatheterization and Rapid Infusion System [RIS] only used when clinically indicated most of the patients were assisted by mechanical ventilation in Medical Surgical Intensive Care Unit [MSICU] postoperatively. Fluid therapy and vasoactive agents were managed according to haemodynamic parameters
Results: The patients were 68 male and 54 female. Their median age was 43 years, ranging from 2 to 63 years. 111 patients were adult and 11 patients were pediatrics. In DDLT the median operating and anesthesia time were 8 hours [range 4-19], and 9 hours [range 5-20] respectively, median MSICU discharge time 15 hours [range 9-85] and hospital stay was 13 days [range, 6-183]. After a median fol/ow-up period of 760 days [range, 2-2085], the overall patient and graft survival rates was 86%. Deaths were due to primary non-function in 4 patients, central pontine myelinolysis in one patient, chronic rejection in one patient, recurrent malignancy in 2 patients, and recurrent HCV infection in 3 patients. In the LDLT group; median operating and Anesthesia time were 11 hours [range, 7-17] and 12 [range 818] respectively. Median MSICU discharge time was 16 hours [range 4-76] and median hospital stay was 15 days [range, 7-127]. After follow-up period of 685 days [range, 26-1540], the overall patient and graft survival rates were 90% and 80% respectively. Graft failure and deaths were due to hepatic anery thrombosis in 2 cases, biliaIy complication in one patient, uncontrollable bleeding in one patient, portal vein thrombosis in 2 cases, and smalI-for-size-syndrome in 3 patients. Four patients were successfully retransplanted using cadaveric organs. The median intraoperative packed red blood cells [PRBCs] transfused was 6 units [range 0-40] and 4 units [range 0-65] in DDLT and LDLT groups respectively
Conclusions: Both DDLT and LDLT are being successfully performed at KFSH and RC with good outcomes. Our early experience indicates higher rate of biliary and vascular complications in the LDLT group. Intraoperative Packed Red cells, blood products, fluid replacement and estimated blood loss in both groups were matching the international centers results
RESUMO
Osteoporosis is an important complication in chronic liver disease patients. This study assessed bone mineral density [BMD] in Saudi pre-transplant cirrhotic patients compared to healthy controls, evaluated its relation to gender, disease etiology and severity. We included 91 patients and 56 healthy controls [mean +/- SD age 46.1 +/- 14.8 and 55.6 +/- 12.9 years; with 45[49.5%] and 13[24.1%] were males respectively. BMD [g/cm2], Z-score [a SD from measure related to age and sex], and T-score [a SD related to peak bone mass for a young adult] of the lumbar vertebrae [L] and the femoral neck [F] were obtained using dual-photon absorptiometry. Osteoporosis was defined as a T-score of <-2.5 and osteopenia as a T- score between -1 and -2.5. Patients were significantly younger and included more males than controls p<0.001 and P<0.01 respectively. Despite that, the osteopenia calculated index was significantly higher in patients than controls [2.39 +/- 2.23 versus 1.04 +/- 1.53 respectively; p<0.01]. The mean lumbar BMD, Z-score and T-score in patients and controls were [0.91 +/- 1.6 g/cm2, -1.44 +/- 1.20 and -1.48 +/- 1.5] and [1.03 +/- 1.7, -0.24 +/- 1.1 and -0.72 +/- 1.2] respectively; p<0.001 for all. However, patients and controls had comparable femoral BMD and femoral T-score [0.84 +/- 0.1 6 g/cm2 and -1.18 +/- 1.2] and [0.85 +/- 0.13 g/cm2 and -0.88 +/- 1.1]; p= 0.51 and 0.14 respectively, but the femoral Z-score was significantly lower in patients' group [-0.73 +/- 1.1 and -0.25 +/- 1.0 for patients and controls respectively; p<0.01]. The mean MELD and Child-Pugh scores in patients were 15.1 +/- 6.4 and 9.4 +/- 2.2 respectively. Depending on the Z-score, lumbar and femoral osteopenia +/- osteoporosis in patients and controls were detected in 43[53.1%] and 24[29.3%] and 9 [16.7%] and 4[7.4%] [p<0.001 and p<0.01] respectively. Within patients, BMD was significantly less in females and in those with viral etiology compared to males and non-viral etiology [p<0.01 for both]. No correlation was detected between either the MELD score or the Child-Pugh score and lumbar or femoral BMD, T-score or Z-score. Low BMD is very common in cirrhotic patients awaiting liver transplantation irrespective of disease severity. Lower BMD is more severe in female patients and those with viral etiology. These findings necessitate early detection, proper treatment, avoidance of post-transplant steroid induction in these patients