Effect of ursodeoxycholic acid on liver regeneration capacity after living donor hepatectomy: a prospective, randomized, double-blind clinical trial.

OBJECTIVE: Ursodeoxycholic acid (UDCA) has multiple hepatoprotective activities: it modifies the bile acid pool, decreases levels of endogenous, hydrophobic bile acids while increasing the proportion of nontoxic hydrophilic bile acids. It also has cytoprotective, antiapoptotic, and immunomodulatory properties. The aim of this study was to analyze the effect of postoperative administration of UDCA on liver regeneration capacity. PATIENTS AND METHODS: This is a single-center, prospective, randomized, double-blind study that was carried out in our Liver transplant Institute. Sixty living liver donors (LLDs) who underwent right lobe living donor hepatectomy were divided into two groups using computer-generated random numbers: one group received oral UDCA 500 mg 12 hourly for 7 days (UDCA group; n=30) from the first postoperative day (POD) and the other did not receive UDCA (non-UDCA group; n=30). Both groups were compared in terms of the following parameters: clinical and demographic parameters, liver enzymes (ALT, AST, ALP, GGT, total bilirubin, direct Bilirubin), and INR. RESULTS: The median ages in the UDCA and non-UDCA were 31 years (95% CI for median: 26-38) and 24 years (95% CI for median: 23-29), respectively. Liver function tests showed significant differences at various times within the first seven PODs. The INR was lower in UDCA group patients on POD3 and POD4. However, GGT was significantly lower on POD6 and POD7 for the UDCA group. Total bilirubin was also significantly lower on POD3 for the UDCA group patients, but ALP was lower all from POD1 to POD7. A significant difference was also observed in AST on POD3, POD5 and POD6. CONCLUSIONS: Postoperative administration of oral UDCA significantly improves liver function tests and INR among LLDs.

Preoperative Therapeutic Plasma Exchange and Surgical Treatment in Thyrotoxicosis Patients: A Single-Centre Retrospective Cohort Study.

Context: Therapeutic plasma exchange (TPE) provides time for thyroidectomy in thyrotoxic patients. Objective: TPE is indicated in cases where antithyroid medications cannot be used due to the side effects or attain no adequate hormonal suppression response at the highest dosage and in cases of rapid onset of clinical symptoms. This study presents the treatment results of patients who underwent TPE and were subsequently operated for thyrotoxicosis. Design: The patients who underwent thyroidectomy and TPE between January 1999 and February 2019 were retrospectively analyzed. Subjects and Methods: The files of 27 patients with thyrotoxicosis who performed TPE prior to surgery were analyzed in relation to the demographic and clinical features. Results: We included 15 (55.6%) females, 12 (44.4%) males with a mean age of 44 (23-82) years. The pre-TPE mean free thyroxine (fT4) level was 12 (5-46) pmol/L while free tri-iodothyronine (fT3) level was 34 (17-141) pmol/L. The post-TPE fT4 level was 6 (3-10) pmol/L while the fT3 level was 21 (12-41). There was one case of an allergic reaction during the procedure. In the postoperative follow-up, there was transient hypocalcemia in 8 (29%) patients, permanent hypocalcemia in 1 (3.7%) patient, and surgical site infection in 1 (3.7%) patient. Conclusion: Preoperative TPE is an alternative treatment option for thyrotoxic patients. This is an especially effective treatment for patients with inadequate response or adverse reaction to antithyroid drugs or patients who need urgent surgery for thyroid storm.