ABSTRACT
BACKGROUND: Studies have demonstrated that patients with end-stage liver disease (ESLD) often have a prolonged corrected QT interval (QTc) with variable changes in the QTc post-transplant. We sought to characterize the prevalence and degree of QTc prolongation in ESLD patients, identify risk factors for QTc prolongation, and assess changes in QTc following transplant. HYPOTHESIS: QTc interval is prolonged in ESLD patients pre-transplant due to a variety of risk factors and shortens following liver transplantation. METHODS: We conducted a retrospective, multicenter study utilizing 2 large liver-transplant databases. QTc intervals were calculated utilizing Bazett's formula. The cutoff used for prolonged QTc was 440 milliseconds for men and 460 milliseconds for women. RESULTS: There were 269 patients (169 men, 100 women) included in the final analysis. The mean pre-transplant QTc was prolonged (449.0 ms), whereas the mean post-transplant QTc shortened and was within normal limits (416.7 ms) (P < 0.0001). QTc shortened after transplant in 87% of patients. QTc normalized in 70% of patients. Age and Model for End-Stage Liver Disease (MELD) score were not predictive of prolonged QTc at baseline. CONCLUSIONS: ESLD patients often have a prolonged QTc, which frequently shortens or normalizes after transplant. Screening for prolonged QTc is warranted if medications known to prolong the QTc interval are used in ESLD patients pre-transplant. MELD score, age, and sex were not predictive of prolonged QTc at baseline.
Subject(s)
End Stage Liver Disease/surgery , Liver Transplantation , Long QT Syndrome/prevention & control , Electrocardiography , End Stage Liver Disease/complications , End Stage Liver Disease/diagnosis , Female , Humans , Linear Models , Logistic Models , Long QT Syndrome/diagnosis , Long QT Syndrome/etiology , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Treatment Outcome , United StatesABSTRACT
Over a decade of converging findings from clinical, observational and basic science research indicate that estrogen administration during the menopausal transition exerts beneficial effects on cognition and decreases a woman's risk of developing Alzheimer's disease (AD) later in life. This review article stresses the research focus of AD prevention, and introduces hormone therapy (HT) as a probable catalyst that may achieve this goal. Furthermore, this article outlines 3 mechanisms proposed to mediate estrogen's beneficial effects, discusses the controversy surrounding HT administration, and presents the most promising estrogen related research in AD prevention and treatment. Although controversial, cumulative evidence suggests that the potential of estrogen initiated during perimenopause to prevent AD needs to be systematically evaluated.
ABSTRACT
Bile duct stones and casts (BDS) after liver transplantation are associated with significant morbidity. Risk factors for BDS formation and the efficacy of treatment in liver transplant recipients have not been systematically studied. The aim of this study was to evaluate potential risk factors for the formation of BDS in patients post-liver transplant. A case-control study of consecutive liver transplant recipients at a university hospital from 1989 to 2007 was performed to identify risk factors for BDS formation. Cases included all liver transplant recipients with BDS, excluding those with concurrent t-tubes or biliary stents. Controls were chosen randomly from the total liver transplant population matched for year of transplantation. Pre- and post-OLT risk factors were analyzed with univariate and multivariate analyses. There were 49 cases and 101 controls over an 18-year-period (1289 liver transplants performed) with an incidence of 3.8% for BDS. In the cases, the median time to BDS diagnosis was 613 days from time of transplant. The controls had a median follow-up of 1530 days. Use of ursodeoxycholic acid was protective (P = 0.005), whereas bile duct pathology (P = 0.003), total cholesterol >/= 200 mg/dL (P = 0.008), and triglyceride >/= 150 mg/dL (P = 0.008) were significant risk factors for BDS formation. Endoscopic retrograde cholangiopancreatography (ERCP) was technically successful in all cases with resolution or improvement of liver chemistries in 59% (29) of patients. In conclusion, significant risk factors for forming BDS included bile duct pathology and elevated total cholesterol and triglyceride levels. Ursodeoxycholic acid had a significant effect in preventing the development of posttransplant BDS and should be used in those that are at increased risk. ERCP is a safe and effective diagnostic and therapeutic modality for these patients.
