How Thinking About the Donor Influences Post-traumatic Growth in Liver Transplant Recipients.

OBJECTIVE: The aim of this work was to find out whether thinking frequently about the donor influences post-traumatic growth of liver transplant recipients. METHODS: The sample of 240 patients selected was made up of 185 men and 55 women with an overall mean age of 60.21 (SD 9.3) years. All of them had received liver transplants from cadaver donors. Transplant recipients were asked whether they thought frequently about the donor (yes or no) and filled out the Post-traumatic Growth Inventory. The t test for unpaired samples was applied to analyze how thinking frequently about the donor or not influenced post-traumatic growth. We also calculated the effect sizes by means of Cohen d or Cohen w depending on the nature of the variables analyzed (quantitative or qualitative). RESULTS: The liver transplant recipients who thought frequently about the donor, compared with those who did not, had higher total scores on post-traumatic growth (P = .000; d = 0.57; medium effect size). Furthermore, considering the effect sizes, the differences between the subgroups were more relevant on the following subscales: new possibilities (P = .000; d = 0.53; medium effect size), appreciation of life (P = .000; d = 0.60; medium effect size), and spiritual change (P = .000; d = 0.54; medium effect size). CONCLUSIONS: Patients who think frequently about the donor have more post-traumatic growth than those who do not.

Family Caregivers of Liver Transplant Recipients: Coping Strategies Associated With Different Levels of Post-traumatic Growth.

OBJECTIVE: Analyze the influence of 2 variables (post-traumatic growth and time since liver transplantation) on coping strategies used by the transplant recipient's family members. METHODS: In all, 218 family members who were their main caregivers of liver transplant recipients were selected. They were evaluated using the Posttraumatic Growth Inventory and the Brief COPE. A 3 × 3 factorial analysis of variance was used to analyze the influence that post-traumatic growth level (low, medium, and high) and time since transplantation (≤3.5 years, >3.5 to ≤9 years, and >9 years) exerted on caregiver coping strategies. RESULTS: No interactive effects between the two factors in the study were found. The only significant main effect was the influence of the post-traumatic growth factor on the following variables: instrumental support (P = .007), emotional support (P = .005), self-distraction (P = .006), positive reframing (P = .000), acceptance (P = .013), and religion (P = <.001). According to the most relevant effect sizes, low post-traumatic growth compared with medium growth was associated with less use of self-distraction (P = .006, d = -0.52, medium effect size), positive reframing (P = .001, d = -0.62, medium effect size), and religion (P = .000, d = -0.66, medium effect size), and in comparison with high growth, it was associated with less use of positive reframing (P = .002, d = -0.56, medium effect size) and religion (P = .000, d = 0.87, large effect size). CONCLUSION: Regardless of the time elapsed since the stressful life event (liver transplantation), family members with low post-traumatic growth usually use fewer coping strategies involving a positive, transcendent vision to deal with transplantation.

Cerebral Hemodynamics Patterns by Transcranial Doppler in Patients With Acute Liver Failure.

INTRODUCTION: About half of patients with acute liver failure (ALF) show clinical signs of cerebral edema and intracranial hypertension. Neuroimaging diagnostics and electroencephalography have poor correlation with intracranial pressure measurement. OBJECTIVE: The objective of this study was to characterize the cerebral hemodynamics patterns with transcranial Doppler (TCD) sonography in patients with ALF. METHOD: We studied 21 patients diagnosed with ALF, admitted to the intensive care unit (ICU) at the Centro de Investigaciones Médico Quirúrgicas of Cuba. All of these patients had a TCD performed on arrival at ICU, evaluating the following: systolic (SV), diastolic (DV), and medium (MV) flows velocities and pulsatility index (PI) in right middle cerebral artery (RMCA) via temporal windows. RESULTS: The sonographic patterns of cerebral hemodynamics were as follows: low-flow, 12 patients (57.1%); high resistance, 5 patients (23.8%); and hyperemic, 4 patients (19%). Patients who died while waiting had lower MV RMCA (56.1 vs 58.1 cm/s) and higher PI (1.71 vs 1.41) than patients who could undergo transplantation (P = .800 and P = .787, respectively). CONCLUSIONS: In patients diagnosed with ALF admitted to the ICU the predominating cerebral hemodynamic pattern was low-flow with resistance increase. The TCD was shown to be a useful tool in the initial evaluation for prognosis and treatment.

Comparison of the affective symptomatology between liver transplant recipients and patients with multiple sclerosis considering their functional impairment.

OBJECTIVES: We aimed to compare the affective symptomatology in two medical conditions under immunotherapy (cadaveric liver transplantation [G1] and multiple sclerosis [G2]), considering their functional impairment, and to assess the clinical significance of the results regarding a representative age-adjusted sample of the general Spanish population (G3). METHODS: Using a cross-sectional design, 164 patients (82 per clinical group) were selected, matched for gender, and homogenized regarding age and functional impairment according to the Physical functioning subscale from the SF-36 Health Survey. The criterion variables were the Mental health and Role-emotional SF-36 subscales and the Hospital Anxiety and Depression Scale. An analysis of covariance was conducted, controlling for age and the Physical functioning score as covariates. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 7881). RESULTS: No statistically significant differences were found between conditions in any affective dimension (P > .05; ds1₋2 from 0.08 to 0.30) or in the percentage of clinical cases regarding the anxious (P = .628) or depressive spectrum (P = .716). The neurological patients showed clinically significant impairment in both SF-36 subscales (ds2₋3 = 0.55 and 0.52, respectively), but transplant recipients only differed from the general population in Role-emotional (d1₋3 = 0.81). CONCLUSIONS: Despite having controlled for functional impairment, important deterioration in daily functioning was still found in liver recipients due to emotional problems, and no relevant differences were observed even when compared with a neurodegenerative condition such as multiple sclerosis.

Influence of acute cellular rejection and depressive symptomatology on liver transplant recipients' quality of life.

BACKGROUND: The objective of this study was to analyze the influence of two variables (acute cellular rejection and depressive symptomatology) on liver transplant recipients' quality of life. METHODS: Using a 2 × 2 factorial design, two groups were selected: 44 patients who had acute cellular rejection and 44 patients without this medical complication. After an average of 6 years since the transplant, patients were assessed with the Hospital Anxiety and Depression Scale and the SF-36 Health Survey. Analysis of variance, t test for unpaired samples, and Cohen's d effect size index were applied. RESULTS: The presence of clinical depressive symptomatology negatively affected all dimensions of quality of life (P < .001; large effect sizes); and interactive effects between factors acute cellular rejection and depressive symptomatology were found in the dimensions role-physical (P = .049) and bodily pain (P = .017). Transplant recipients with clinical depressive symptomatology scored lower on both dimensions (role-physical, P = .110, d = 0.52, medium effect size; bodily pain, P = .001, d = 1.25, large effect size) if they had an acute cellular rejection. In contrast, if they did not exceed the clinical threshold for depressive symptomatology, there were no differences in these dimensions (role-physical, P = .239, d = -0.33, small effect size; bodily pain, P = .555, d = 0.16, null effect size) between transplant recipients with and without acute cellular rejection. CONCLUSIONS: Clinical depressive symptomatology is associated with poorer quality of life in liver transplant recipients; and the long-term differences in the dimensions role-physical and bodily pain between liver transplant recipients with and without acute cellular rejection depend on patients' mental health.

Evolution of quality of life in renal transplant recipients and patients with multiple sclerosis: a follow-up study.

OBJECTIVE: We aimed to compare the evolution of quality of life in 2 medical conditions under immunotherapy (cadaveric renal transplantation [G1] and multiple sclerosis [G2]), and to assess the clinical significance of the results compared with a representative age-adjusted sample of the general Spanish population (G3). METHODS: Using a mixed design (2 × 2), the SF-36 Health Survey was administered to 60 patients with one of these clinical conditions (30 in each group; the patient group factor), matched for gender, and homogenized regarding age and working status. All renal patients had undergone transplantation 6 months before the first assessment, and all neurological patients presented a relapsing-remitting course and a mild-moderate disability level. Both patient groups were assessed a second time 6 months later (the phase factor). A mixed analysis of covariance was computed controlling for age as a covariate. Cohen's d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 5821). RESULTS: Statistically significant differences were found between patient groups in vitality, bodily pain, social functioning, and mental health (P < .01), in which worse levels were displayed by patients with multiple sclerosis in both phases (Cohen's ds1-2 from 0.61 to 1.40). Likewise, an interactive effect was observed in physical functioning [F(1,57) = 12.93; P = .001], such that the performance of daily physical activities improved in renal recipients after 6 months, but it decreased in neurological patients. Patients with multiple sclerosis showed higher, clinically significant impairment in all SF-36 dimensions in both phases compared with renal recipients (Cohen's ds2-3 from -0.50 to -1.61), who presented clinically significant impairment in general health, role-physical, and role-emotional (Cohen's ds1-3 from -0.73 to -1.28). CONCLUSIONS: Renal transplant recipients need specialized health care 1 year after transplantation because they still display relevant impairment in daily functioning compared with the general population.

Evolution of anxious-depressive symptomatology in liver and kidney transplant recipients: hospitalization and 12-month post-transplantation phases.

OBJECTIVE: The objective of this study was to compare the evolution (hospitalization in the transplantation unit and at 12 months post-transplantation) of anxious and depressive symptomatology in cadaveric transplant recipients as a function of type of organ implanted (liver or kidney). METHODS: Using a 2 × 2 mixed factorial design, 2 groups were selected: 34 liver transplant recipients and 41 kidney transplant recipients. Both groups were assessed in 2 phases: (1) in the transplantation unit after discharge from the intensive care unit; and (2) 12 months after discharge from the hospital following implantation surgery. The Hospital Anxiety and Depression Scale and the Scale for the Assessment of Social Support were administered. A mixed analysis of covariance was used to assess the influence on transplant recipients' anxious-depressive symptomatology of 2 independent factors: phase (hospitalization in the transplantation unit and at 12 months post-transplantation) and organ (liver and kidney). Perceived social support and age were included as covariates in the analyses. We also calculated d and w as effect size indexes. RESULTS: Interactive effects of the factors phase and organ were found in the variable anxiety (P = .005). Specifically, the following simple effects were significant: (1) kidney transplant recipients presented more anxious symptomatology while hospitalized in the transplantation unit than at 12 months post-transplantation (P = .001; d = 0.52; medium effect size); and (2) kidney transplant recipients presented more anxious symptomatology than liver transplant recipients while hospitalized in the transplantation unit (P = .013; d = -0.59; medium effect size). No statistically significant effect was obtained for the variable depression. CONCLUSION: Worse mental health (anxious symptoms) was associated with kidney transplant recipients but not with liver recipients while recovering from the implantation surgery in the transplantation unit.

Longitudinal study of liver transplant recipients' quality of life as a function of their perception of general health: at waiting list and at 3, 6, and 12 months post-transplantation.

OBJECTIVE: The objective of this study was to compare the evolution (at waiting list, and at 3, 6, and 12 months post-transplantation) of quality of life of cadaveric liver transplant recipients as a function of their perception of general health. METHODS: Two groups (15 patients with better and 15 with worse self-perception of health 1 year after transplantation) were assessed at the pretransplantation and post-transplantation phases using the EuroQol (EQ-5D) questionnaire. Mixed analysis of covariance was performed with 2 factors: phase (at waiting list and at 3, 6, and 12 months post-transplantation) and perception of general health (better and worse). Cohen's d was also calculated. RESULTS: Interactive effects were found in the variables pain/discomfort (P = .010) and anxiety/depression (P = .001). The following simple effects reached large effect sizes. Transplant recipients presented more pain/discomfort when on the waiting list than at 3 months (worse self-perception, P = .022, d = 1.35; better self-perception, P = .001, d = 0.95). At 6 months (P = .001, d = -1.45) and at 12 months (P = .001, d = -1.75), transplant recipients with worse self-perception displayed more pain/discomfort. Transplant recipients with better self-perceived health showed more anxiety/depression when on the waiting list than at 3 months (P = .004, d = 1.49), at 6 months (P = .005, d = 1.48), and at 12 months (P = .001, d = 1.97). Patients with worse self-perception presented more anxiety/depression when on the waiting list than at 6 months (P = .030, d = 1.21) and 12 months compared with at 3 months (P = .011, d = -0.97) and 6 months (P = .001, d = -1.39). At 12 months, transplant recipients with worse self-perception showed more anxiety/depression (P = .001, d = -2.18). CONCLUSION: Pain/discomfort and, especially, anxiety/depression contribute to liver transplant recipients' worse general health status 1 year after transplantation.

Biopsychosocial functioning in liver patients of alcoholic etiology as a function of self-perceived pain level.

OBJECTIVE: To compare the biopsychosocial functioning among liver transplantation and cirrhotic patients as a function of self-perceived pain level. METHODS: We selected two groups of liver patients of the same gender (men) and disease etiology (alcoholic): there were 39 liver transplant recipients and 34 severe cirrhotic patients. The Hospital Anxiety and Depression Scale and the SF-36 Health Questionnaire were used. We applied analysis of covariance, with age and model end-stage liver disease (MELD) scores as covariates to assess the influence of two independent factors: (1) group (liver transplant recipients and cirrhotic patients), and (2) self-perception of pain (mild and high). We also calculated Cohen's d as an effect size index. RESULTS: No interactive effects were found between factors group and self-perceived pain in any of the variables studied. With regard to the main effects, we found statistically significant differences in the following variables between: a) liver transplant recipients and cirrhotic patients: anxiety (P = .000), depression (P = .003), role-physical (P = .001), mental health (P = .016), general health (P = .000), vitality (P = .000), and physical functioning (P = .000); and b) liver patients with mild and high self-perceived pain: anxiety (P = .008), depression (P = .000), role-physical (P = .002), mental health (P = .000), vitality (P = .000), and physical functioning (P = .001). In all the indicated variables, with medium and large effect sizes (Cohen's ds from 0.58 to 1.64), the cirrhotic patients and patients with a high level of self-perceived pain had much poorer mental health and quality of life. CONCLUSION: Alcoholic cirrhotic male patients with a high level of self-perceived pain had the greatest biopsychosocial impairment, even exceeding the clinical threshold in the anxiety and depression scales; and the highest biopsychosocial well-being was associated with liver transplant recipients with a mild level of self-perceived pain.

Affective status in liver transplant recipients as a function of self-perception of general health.

OBJECTIVE: We aimed to determine whether there were differences with regard to anxiety and depressive symptomatology between liver transplant recipients with better (G(1)) versus worse (G(2)) self-perceptions of general health compared with pre-liver transplantation cirrhotic patients (G(3)). METHODS: The groups of patients included 168 recipients including 85 and 83 with better or worse self-perceptions of general health, respectively, and 75 cirrhotic pre-liver transplantation patients. For the psychological assessment we used the Hospital Anxiety and Depression Scale and the general health dimension of the SF-36 Health Questionnaire. The following analyses were used: Analysis of variance (ANOVA) with post hoc pairwise comparisons by means of Tukey's test and Cohen's d, an effect size index. RESULTS: Significant differences were observed among the three groups for the variables of anxiety (P = .000) and depression (P = .000). Specifically, liver transplant recipients with better self-perceptions of general health displayed lower scores (better mental health) compared with those showing worse self-perceptions or cirrhotic patients. There were no differences between the latter two groups. The differences in these variables were relevant (large effect sizes) for anxiety (Cohen's d(1-2) = -1.075, Cohen's d(1-3) = -1.155) and for depression (Cohen's d(1-2) = -1.145, Cohen's d(1-3) = -1.158). CONCLUSION: The anxious-depressive status was not necessarily better among liver transplant recipients. There was great variability among them as a function of self-perceived general health. Transplant recipients with worse self-perception of general health presented the same anxiety-depressive levels as patients with severe liver disease in the pretransplantation phase; the latter groups reach the clinical threshold on the depression scale.

Relatives' mental health during the liver transplantation process.

OBJECTIVE: To compare the mental health of relatives of liver transplant patients during the three phases: pretransplantation, waiting list, and posttransplantation. MATERIALS AND METHODS: This follow-up study used the Hospital Anxiety and Depression Scale (HADS) to assess the relatives of 35 liver transplant patients (one relative for each patient). The anxiety-depression status was compared across the three liver transplant phases: pretransplant study (G(1)), from the first to the third month after admission to the waiting list (G(2)), and the 3 months after liver transplantation (G(3)). Student t test for paired samples was used for statistical analysis, and Cohen d calculated as an effect size index. RESULTS: Significant differences were observed (P = .000) among the three phases in anxiety and depression variables. In both, the greatest affective symptomatology corresponded to the phases prior to the liver transplantation (G(1) and G(2)) and the lowest in the post-liver transplant stage (G(3)). Relevant differences (large effect size) were noted between pre- and posttransplant phases in both HADS subscales: anxiety (Cohen d(1-3) = 1.197; Cohen d(2-3) = 0.817) and depression (Cohen d(1-3) = 1.228; Cohen' d(2-3) = 1.239). CONCLUSION: Relatives show poorer mental health during the phases prior to liver transplantation compared with the posttransplantation.

Trace-metal distribution of cigarette ashes as marker of tobacco brands.

The trace-metal distribution of cigarette ashes offers a potential interest from the point of view of forensics and criminology dealing with the determination and classification of tobacco brands. There is a vast bibliography related to the determination of different metals in tobacco leaves. Nevertheless, none of them are directly linked to this matter. Therefore, in this work we present a methodology to assess the viability of discriminating between different tobacco brands by analysing the ashes after smoking. This methodology encompasses the data analysis by atomic techniques (inductively coupled plasma) and further data analysis by principal component analysis and partial least squares-discriminant analysis. The metal distribution (Zn, B, Mn, Fe, Mg, Cu, Ti, Al, Sr, Ca, Ba, Na, Li, and K) of cigarette ashes of different tobacco brands was determined in 149 samples obtained from local stores, representing the most common brands of cigarettes readily available to consumers in Spain. Further analysis of the data with PCA denoted significant differences between different brands of tobacco in their metallic content. In that sense, blond tobaccos were found to contain different patterns in metallic content than black tobaccos. Intrinsic differences were found between different brands, being possible to study the relationship between each brand and its metallic concentration and compare this relationship with other brands. Moreover the possibility of developing classification models to be able to discriminate between different brands was also introduced.

Quality of life in spanish patients with liver transplant.

BACKGROUND: Liver transplantation is the optimal method of treatment in patients with end-stage liver failure. Transplantation medicine has significantly progressed in the last time, but some psychology and psychosomatic problems still remain unsolved. Health-Related Quality of Life (HRQL) in liver transplant is considered a useful measure of evolutionary process of the illness. OBJECTIVE: The authors analyzed the evolution of HRQL in pre-transplant (waiting-list patients) and post-transplant (first year after liver transplant) periods of liver transplant Spanish patients. METHODS: A prospective and longitudinal study was carried out among patients who received a liver transplant from a deceased donor. They were assessed in four phases: at the time of inclusion on the transplant waiting-list, and 3, 6, and 12 months after receiving the graft. We used a structured interview and SF-36 and Euroqol-5D (EQ-5D) Health Questionnaires. RESULTS: The greater differences were found between pre-transplant and post-transplant stages with less well-being in the stage before the transplant. No significantly differences were observed when comparing the 3, 6 and 12 months from post-transplant stage. CONCLUSION: The HQRL of liver patients improved after the transplant, being appreciated a tendency to the stabilization from three months onwards. We suggest that the psychological intervention, in liver patients, should be conducted in waiting-list patients and in the first 3 months post-transplant, periods with a poor mental health (anxiety, depression, and stress by fear to the unknown thing) and a low adhesion to the treatment that can generate a smaller graft and/or patient survival.

Influence of relatives' anxious symptomatology on the quality of life of pretransplant hepatic patients.

OBJECTIVES: We sought to analyze the influence of anxiety symptoms of relatives of patients undergoing a pretransplant study on the quality of life of the hepatic patients body pain, physical role, mental health, general health, vitality, social functioning, emotional role, and physical functioning. MATERIALS AND METHODS: We assessed 2 groups: 51 patients with hepatic cirrhosis and 51 of their closest relatives who were studied while the patients were hospitalized to undergo the pretransplant study. We used a "Psychosocial Survey" (in both groups), the "Hospital Anxiety and Depression Scale" (HADS) in the relatives, and the "SF-36 Health Survey" (in the patients). RESULTS: The results showed that the patients whose relatives presented clinical levels of anxiety showed the worst quality of life, specifically for the dimensions "mental health" (P=.016) and "emotional role" (P=.041).

Comparison of anxious and depressive symptomatology among pretransplant hepatic patients and their relatives.

OBJECTIVE: We sought to compare the anxiety and depressive symptoms of patients undergoing pretransplant evaluation with those of their closest relatives. MATERIALS AND METHODS: We assessed 51 patients with hepatic cirrhosis and 51 relatives who were the main care giver for each patient. All subjects were assessed during the interval when the patients were hospitalized to undergo the medical assessment to determine their inclusion on the waiting list for liver transplantation. In both groups, we used a "Psychosocial Survey" and the "Hospital Anxiety and Depression Scale." RESULTS: Significant differences were observed in anxiety (P=.001), but not in depression (P=.820). Specifically, relatives presented higher levels of anxiety compared with the hepatic patients. CONCLUSION: The relatives were worse off psychologically than the patients.

Application of enzymatic probe sonication extraction for the determination of selected veterinary antibiotics and their main metabolites in fish and mussel samples.

A new method based on enzymatic probe sonication extraction prior to high-performance liquid chromatography (HPLC) has been developed for the determination of 11 antibiotics (drugs) and the main metabolites of five of them in fish tissue and mussel samples. The analytes belong to four different classes of antibiotics (sulfonamides, tetracyclines, penicillins and amphenicols). The analysed compounds were sulfadiazine (SDI) and N(4)-acetylsulfadiazine (NDI) metabolite, sulfamethazine (SMZ) and N(4)-acetylsulfamethazine (NMZ), sulfamerazine (SMR) and N(4)-acetylsulfamerazine (NMR), sulfamethoxazole (SMX), trimetroprim (TMP), amoxicillin (AMX) and its main metabolite amoxicilloic acid (AMA), ampicillin (AMP) and its main metabolite ampicilloic acid (APA), chloramphenicol (CLF), thiamphenicol (TIF), oxytetracycline (OXT) and chlortetracycline (CLT). The main factors affecting the extraction efficiency (type of enzyme, type and volume of extractant, ultrasounds power and extraction time) were optimised in tissue of hake (Merluccius merluccius), anchovy (Engraulis encrasicolus), mussel (Mytilus sp.) and wedge sole (Solea solea). The extraction was carried out using an extraction time of 5 min with 5 mL of water and subsequent clean-up with dichloromethane. High-performance liquid chromatography (HPLC) with diode array (DAD) and fluorescence (FLD) detectors was used for the determination of the antibiotics. The separation of the analysed compounds was conducted by means of a Phenomenex Gemini C(18) (150 mm x 4.6 mm I.D., particle size 5 microm) analytical column with LiChroCART LiChrospher C(18) (4 mm x 4 mm, particle size 5 microm) guard-column. Analysed drugs were determined using formic acid 0.1% (v/v) in water and acetonitrile in gradient elution mode as mobile phase. The proposed method was also evaluated by a laboratory assay consisting of the determination of the targeted analytes in samples of Cyprinus carpio which had previously administered the antibiotics.

Profile of organ donors not authorized for judicial reasons.

Loss of donors as a consequence of a coroner's refusal to authorize is an unusual problem that prevents organs becoming available for transplantation. Of 1123 effective donors, 433 (38.5%) died of accidental death. In these latter, it was therefore necessary to request judicial authorization for donation during the coroner's examination. Organ extraction was not performed because of judicial refusal in 15 of these donors (3.46% of the total number of judicial extractions requested and 1.33% of the total number of donors). Despite the lack of differences in the cause of death profile in the four provinces, large differences were noted between the provinces, with most judicial refusals in Malaga (10 refusals; 6.6% of the total judicial refusals), followed by Granada with five refusals (2.9%), Seville with two refusals (1.7%), and zero in Almería. To minimize these judicial refusals, we propose joint action protocols between transplant coordinators, judges, and coroners for these donors to be examined in the hospital prior to extraction and in the operating room during extraction. Any external lesion of judicial interest can then be examined, photographed, and evaluated.

Factors that predict survival in patients with cirrhosis considered for liver transplantation.

OBJECTIVE: To identify prognostic factors for survival at 6 and 12 months in patients evaluated for liver transplantation using Child-Pugh (CP) classification and the Model for End-Stage Liver Disease (MELD) score. METHODS: We evaluated 144 patients with cirrhosis who were candidates for liver transplantation. We excluded patients with hepatocellular carcinoma, recent liver recipients, and patients who died because of factors unrelated to liver disease. The studied variables were age and sex; prothrombin time; platelet count; albumin, cholesterol, bilirubin, creatinine, and serum sodium concentrations; CP classification and MELD score; and the presence of ascites, encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, and previous variceal bleeding. Data were processed using statistical software (SPSS version 13.0). RESULTS: Of the 144 patients, 27 (18.7%) did not survive because of complications of liver disease. Univariate analysis showed the most significant factors to be sex, prothrombin time, bilirubin and albumin levels; ascites, encephalopathy, CP classification, and MELD score. At Cox regression analysis, only CP classification proved to be a valid predictor of survival in our cohort. The lowest survival according to CP classification at 6 and 12 months corresponded to stage C and to MELD scores higher than 15. CONCLUSIONS: Child-Pugh classification is an independent prognostic factor for recipient survival. Stage C in the CP classification and a MELD score higher than 15 were strongly related to worse survival. Both scores must be taken into consideration for adequate evaluation of liver transplantation for candidates.

Application of the McCluskey Index to predict blood product requirements during liver transplantation.

BACKGROUND: A recent study proposed a risk index (McCluskey index) based on 7 parameters to identify the transfusion needs of patients during surgery and in the first 24 hours postoperation. The initial objective of our study was to validate this predictor for blood product transfusions. PATIENTS AND METHODS: We undertook a retrospective, observational study of all liver transplant patients between January 1, 2005 and December 31, 2006. The following variables were recorded for each patient: age, gender, patient comorbidity, biochemical values prior to liver transplantation, and transfusion needs. RESULTS: Comparing the transfusion needs of those patients with scores <5 with those of scores >/=5, we observed significant differences in terms of the use of red blood cell concentrates, plasma, and platelets, both during the first 24 hours and in the total number. The index sensitivity was 80% (95% confidence interval [CI]: 71.23-88.76), with a specificity of 84.21% (95% CI: 67.81-100), where the positive predictive value was 95.52% (95% CI: 90.57-100.4) and the negative predictive value was 50% (95% CI: 32.67-67.32). CONCLUSION: The McCluskey index showed sufficient sensitivity and specificity to predict which patients will require a massive transfusion.