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1.
Clin Exp Dermatol ; 47(3): 602-604, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34762321

RESUMO

Patients with Muir-Torre syndrome (MTS) commonly have germline mismatch repair mutations in MLH1, MSH2 or MSH6, with a strong predominance in MSH2. A subset of approximately one-third of patients will instead have an autosomal recessive base excision repair mutation in MUTYH called MUTYH polyposis. To the best of our knowledge, this is the first report of coexisting germline MSH2 and MUTYH mutations in a patient with MTS.


Assuntos
DNA Glicosilases/genética , Mutação em Linhagem Germinativa , Síndrome de Muir-Torre/genética , Proteína 2 Homóloga a MutS/genética , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Síndrome de Muir-Torre/diagnóstico , Síndrome de Muir-Torre/cirurgia
3.
BJS Open ; 3(2): 146-152, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30957060

RESUMO

Background: Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely. Methods: Studies that incorporated an economic analysis comparing early with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis were identified by means of a systematic review. A meta-analysis was performed on those cost evaluations. The quality of economic valuations contained therein was evaluated using the Quality of Health Economic Studies (QHES) analysis score. Results: Six studies containing cost analyses were included in the meta-analysis with 1128 patients. The median healthcare cost of ELC versus DLC was €4400 and €6004 respectively. Five studies had adequate data for pooled analysis. The standardized mean difference between ELC and DLC was -2·18 (95 per cent c.i. -3·86 to -0·51; P = 0·011; I 2 = 98·7 per cent) in favour of ELC. The median QHES score for the included studies was 52·17 (range 41-72), indicating overall poor-to-fair quality. Conclusion: Economic evaluations within clinical trials favour ELC for ACC. The limited number and poor quality of economic evaluations are noteworthy.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Análise Custo-Benefício , Tempo para o Tratamento/normas , Colecistectomia Laparoscópica/economia , Colecistectomia Laparoscópica/normas , Colecistite Aguda/economia , Ensaios Clínicos como Assunto , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Fatores de Tempo , Resultado do Tratamento
4.
Int J Surg ; 33 Pt A: 151-6, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27512909

RESUMO

PURPOSE: Iatrogenic bile duct injury (BDI) is the most significant associated complication to laparoscopic cholecystectomy (LC). Little is known about the evolution of the pattern of BDI in the era of laparoscopy. The aim of the study is to assess the pattern of post-LC BDIs managed in a tertiary referral centre. METHODS: Post-LC BDI referred over two decades were studied. Demographic data, type of BDI (classified using the Strasberg System), clinical symptoms, diagnostic investigations, timing of referral, post-referral management and morbidity were analysed. The pattern of injury, associated vascular injuries rate and their management were compared over two time periods (1992-2004,2005-2014). RESULTS: 78 BDIs were referred. During the second time period Strasberg A injuries decreased from 14% to 0 and Strasberg E1increased from 4% to 23%, the rate of associated vascular injury was six time higher (3.6% versus 22.7%), more patients had an attempted repair at the index hospital (16% versus 35%) sand fewer patients could be managed without surgical intervention at the referral hospital (28% versus 4%). CONCLUSION: Complexity of referred BDIs and rate of associated vascular injuries have increased over time. These findings led to more patients managed requiring surgical intervention at the referral hospital.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Doenças do Ducto Colédoco/etiologia , Ducto Colédoco/lesões , Doenças da Vesícula Biliar/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Resultado do Tratamento
5.
J Gastrointest Surg ; 19(4): 736-42, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25595309

RESUMO

INTRODUCTION: Segmental duodenal resections (DR) have been increasingly performed for the treatment of primary duodenal tumours. The aim of the study is to review the indications for, clinical and operative details, and outcomes of patients undergoing elective DR. MATERIAL AND METHODS: We retrospectively reviewed all patients who underwent elective segmental DR for the treatment of primary duodenal tumours, at a single institution between January 2007 and December 2013. Demographic data, clinical presentation, preoperative investigations, operative details, postoperative complications/mortality and histopathological results were recorded. RESULTS: In the study period, 11 duodenal resections were performed (7 male, median age 61 years). Thirty-six percent of the patients presented with anaemia. Surgical resection included two or more segments in seven patients. The most frequently resected part of the duodenum was segment 3 (n = 7). Median operative time was 191 min and blood loss was 675 ml. End-to-end and end-to-side anastomoses were performed in equal numbers. The pathology of resected specimens included adenocarcinoma (n = 4), gastrointestinal stromal tumour (GIST) (n = 1), adenoma (n = 5) and lymphoma (n = 1). Median hospital stay was 14 days. Overall, 30-day morbidity rate was 82% (78% Clavien 2 or less). CONCLUSIONS: Segmental duodenal resection is a safe and effective surgical technique for the resection of primary duodenal tumours.


Assuntos
Adenocarcinoma/cirurgia , Adenoma/cirurgia , Neoplasias Duodenais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Neoplasias Duodenais/patologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Resultado do Tratamento
6.
Ir J Med Sci ; 183(4): 677-80, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25056586

RESUMO

BACKGROUND: Metastatic tumours of the pancreas are rare and the optimal management of these tumours remains unclear, given the paucity of data existing in the literature. We report our experience of pancreatic metastasectomy. METHODS: Data were reviewed on all patients who underwent pancreatic resection for pathologically confirmed metastatic lesions over a consecutive 7-year period. RESULTS: Seven patients (two men and five women) underwent a pancreatectomy for a metastatic pancreatic tumour. The primary tumours were renal cell carcinoma (n = 3), colorectal carcinoma (n = 2) and leiomyosarcoma (n = 2). There was no operative mortality. Postoperative morbidities occurred in two patients. The median follow-up was 49 months (range 17-76). Overall 1- and 2-year survivals were 100 and 86 %, respectively, with a 2-year disease-free survival of 72 %. CONCLUSIONS: Our series further supports that pancreatic metastasectomy can be performed safely and achieves acceptable survival outcomes.


Assuntos
Carcinoma de Células Renais/cirurgia , Carcinoma/cirurgia , Neoplasias Colorretais/patologia , Neoplasias Renais/patologia , Leiomiossarcoma/cirurgia , Metastasectomia , Neoplasias Pancreáticas/cirurgia , Idoso , Carcinoma/secundário , Carcinoma de Células Renais/secundário , Intervalo Livre de Doença , Feminino , Humanos , Leiomiossarcoma/secundário , Masculino , Metastasectomia/efeitos adversos , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Neoplasias Pancreáticas/secundário , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos , Taxa de Sobrevida
7.
Transplant Proc ; 46(7): 2430-2, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24998305

RESUMO

INTRODUCTION: Exertional heatstroke with liver involvement is a rare and potentially fatal condition. In this setting, fulminant hepatic failure (FHF) occurs as a result of severe hypoxic hepatitis. CASE REPORT: We report the case of a young male athlete who developed exertional heatstroke associated with rhabdomyolysis and hypoxic hepatitis while running the final stages of an ultra-marathon (62 km). The patient rapidly developed multiorgan failure, including fulminant hepatic failure, requiring intensive care admission for mechanical ventilation, hemodialysis, and inotropic support. He failed to improve with supportive measures and underwent an emergency hepatectomy followed by orthotopic liver transplant, after which he recovered completely. CONCLUSIONS: We discuss the rationale for liver transplantation in this setting, possible alternative treatments, and the pathophysiology of fulminant liver failure in this rare case.


Assuntos
Golpe de Calor/complicações , Falência Hepática Aguda/cirurgia , Transplante de Fígado , Adulto , Humanos , Falência Hepática Aguda/fisiopatologia , Masculino , Insuficiência de Múltiplos Órgãos/etiologia , Rabdomiólise/etiologia
8.
Eur J Surg Oncol ; 40(4): 379-86, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24462547

RESUMO

AIM: Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes. METHODS: A literature search was performed using the PubMed and Cochrane databases and the reference lists of relevant articles, searching for sizeable case series of pancreatic metastasectomy with curative intent. Data extracted included basic demographics, histological primary tumour, presentation, operative management, complications and survival, while the MINORS index was used to assess study quality. RESULTS: 18 studies were found which met our inclusion criteria, involving 399 patients. Renal cell carcinoma (RCC) was the commonest malignancy metastasising to the pancreas, responsible for 62.6% of cases, followed by sarcoma (7.2%) and colorectal carcinoma (6.2%). While survival data was not uniformly reported, the median survival post-metastasectomy was 50.2 months, with a one-year survival of 86.81% and five-year survival of 50.02%. Median survival for RCC was 71.7 months with 70.4% five-year survival. Median survival was similar in patients with synchronous and metachronous pancreatic metastases, but patients with additional extrapancreatic metastases had a significantly shorter survival than patients with isolated pancreatic metastases (26 versus 45 months). Study quality was poor, with a median MINORS score of 10/16. CONCLUSIONS: Within the limitations of a review of non-randomised case series, it would appear that pancreatic metastasectomy confers a survival benefit in selected patients. Better evidence is required, but may prove difficult to acquire.


Assuntos
Metastasectomia , Pancreatectomia , Neoplasias Pancreáticas/secundário , Neoplasias Pancreáticas/cirurgia , Carcinoma/secundário , Carcinoma/cirurgia , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Neoplasias Colorretais/patologia , Humanos , Neoplasias Renais/patologia , Neoplasias Pancreáticas/mortalidade , Sarcoma/secundário , Sarcoma/cirurgia , Análise de Sobrevida , Resultado do Tratamento
9.
Case Rep Surg ; 2014: 713049, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25587480

RESUMO

Up to 3.2% of patients with testicular germ cell tumours represent with late-relapsing disease. Aggressive surgical resection confers the greatest chance of cure in this patient group. We present the case of a late and extensively relapsed nonseminomatous germ cell tumour with thrombus present along the entire length of the inferior vena cava, as well as in the right hepatic vein. Techniques practised in liver transplantation were used to achieve complete resection of the tumour thrombus. This case illustrates the enhanced potential for tumour resection through a fusion of principles derived from surgical oncology and liver transplantation.

10.
Am J Transplant ; 11(4): 759-66, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21446978

RESUMO

Although domino liver transplantation (LT) is an established procedure, data about the operative risks are limited. This study aimed at evaluating the operative risks of domino LT. Two retrospective analyses were conducted (comparison of familial amyloid polyneuropathy [FAP] liver donors [61 patients] vs. FAP nondonors [39 patients] and FAP liver recipients [61 patients] vs. deceased donor liver recipients [61 patients]). First analysis showed a 60-day mortality of 6.6% for FAP donors and 7.7% for FAP nondonors (p = 1.0). No patient developed primary graft nonfunction. Acute rejection was higher in FAP nondonors compared to FAP donors (38.5% vs. 13.1%). Both groups had similar vascular and biliary complication rates. ICU stay was similar, whereas total hospitalization was longer for FAP nondonors. Both groups had similar 1- and 5-year patient and graft survival rates (83.4% vs. 87.2%, and 79.8% vs. 71.8%, p = 0.7) and (83.3% vs. 87.2%, and 79.1% vs.71.8%, p = 0.7). The second analysis showed a 1.6% mortality for FAP liver recipients vs. 3.2% of the control group (p = 1). Both groups had similar morbidity and technical complication rates (18.0% vs. 13.1%, p = 0.45) and (0.18 vs. 0.15, p = 0.65). The domino procedure does not add any risk to FAP donor or recipient. It increases the organ pool allowing transplantation of marginal recipients who otherwise are denied deceased donor liver transplantation.


Assuntos
Neuropatias Amiloides Familiares/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Cadáver , Estudos de Coortes , Feminino , Humanos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Coleta de Tecidos e Órgãos
11.
Am J Transplant ; 11(1): 101-10, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21199351

RESUMO

The lack of use of a common grading system in reporting morbidity impedes estimation of the true risk to a right lobe living donor (RLLD). We report outcomes in 91 consecutive RLLD's using the validated 5-tier Clavien grading and a quality of life (QOL) questionnaire. The median follow-up was 79 months. The donors were predominantly female (66%), 22 (24%) received autologous blood transfusions. Fifty-three complications occurred in 43 donors (47% morbidity), 19 (37%) were ≥ Grade III, biliary fistula (14%) was the most common. There was no donor mortality. Two intraoperative complications could not be graded and two disfiguring complications in female donors were graded as minor. Two subgroups (first 46 vs. later 45 donors) were compared to study the presence if any, of a learning curve. The later 45 donors had lesser autologous transfusions, lesser rehospitalization and no reoperation and a reduction in the proportion of ≥ Grade III (major) complications (24% vs. 50%; p = 0.06). In the long term, donors expressed an overall sense of well being, but some sequelae of surgery do restrain their current lifestyle. Our results warn against lackadaisical vigilance once RLLD hepatectomy becomes routine.


Assuntos
Hepatectomia/efeitos adversos , Transplante de Fígado/efeitos adversos , Doadores Vivos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Feminino , França/epidemiologia , Hepatectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida
12.
Clin Transplant ; 25(2): 297-301, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20412097

RESUMO

BACKGROUND: The clinical presentation of hepatic artery thrombosis (HAT) post-liver transplantation (LT) varies considerably. Doppler ultrasonography (Doppler US) is the first line investigation, with a diagnostic sensitivity for HAT as high as 92%. Because indocyanine green (ICG) elimination from the blood depends among other factors on the hepatic blood flow, we hypothesized that plasma disappearance rate of indocyanine green (PDR-ICG) can be influenced by the flow in the hepatic artery. Thus, we evaluated the role of PDR-ICG measurement in HAT diagnosis in post-LT patients. PATIENTS AND METHODS: Fourteen liver transplant patients with no visible flow in the hepatic artery (Doppler US) were identified. Of the 14, seven patients had HAT confirmed by CT-angiography. The PDR-ICG measurement, an investigation routinely used in our center, was performed in all 14 patients. RESULTS: The PDR-ICG in patients with HAT was significantly lower than in patients without HAT (5.8 ± 4.3 vs. 23.8 ± 7.4%/min, p= 0.0009). In patients with HAT, after the revascularization, the PDR-ICG value increased (5.8 ± 4.3 vs. 15.6 ± 3.5%/min, p = 0.006). CONCLUSION: The ICG elimination may be an adjunct diagnostic tool in the management of patients with suspected HAT following LT.


Assuntos
Corantes , Artéria Hepática/patologia , Verde de Indocianina , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias , Trombose/diagnóstico , Adulto , Corantes/farmacocinética , Feminino , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Humanos , Verde de Indocianina/farmacocinética , Masculino , Pessoa de Meia-Idade , Trombose/etiologia , Trombose/terapia , Distribuição Tecidual , Resultado do Tratamento , Ultrassonografia Doppler
13.
Eur J Surg Oncol ; 36(6): 568-74, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20413243

RESUMO

OBJECTIVES: To assess the general applicability of prognostic scores for colorectal liver metastases (CRLM). METHODS: Review of English language studies from 1980 to 2008 (Medline and Embase). Search keywords included "Colorectal neoplasms", "liver metastases", "liver resection", "prognostic scoring system". RESULTS: Six scoring systems and fourteen prognostic factors within these studies were identified. No prognostic factor was common in all scoring methods. Five scores retained the number of metastases as a prognostic factor. Size of metastases and time between the onset of the primary tumor and the discovery of metastases were present in four scores. Three scores predicted 5-year survival using carcinoembryonic antigen (CEA) and R1 resection. Only two scores were assessed preoperatively. Successive scoring methods had improved predictive accuracy compared to earlier systems. However, their applicability in general populations remains debatable. An evaluation of the scores applicability to different patient populations demonstrated that the models were minimally effective in predicting disease-specific survival and recurrence, suggesting that stratification of patients by clinical and pathologic factors alone, may be clinically unreliable and not applicable for selection of patients for surgery. CONCLUSION: The utility of prognostic models on general populations is inconsistent. Current clinicopathologic factors may be inadequate to determine disease prognosis in CRLM. Future attempts to develop prognostic scores should include additional biologic and clinical variables, and be validated in larger populations.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Humanos , Recidiva Local de Neoplasia , Valor Preditivo dos Testes , Prognóstico , Análise de Sobrevida
14.
Am J Transplant ; 10(1): 129-37, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20070666

RESUMO

Liver transplantation (LT) for cirrhotic/Hepatocellular carcinoma (HCC) is associated with reduced survival in patients with poor histological features. Preoperative levels of alphafetoprotein (AFP) could predict negative biological features. AFP progression could be more relevant than static AFP levels in predicting LT outcomes. A total of 252 cirrhotic/HCC patients transplanted between 1985 and 2005 were reviewed. One hundred fifty-three patients were analyzed, 99 excluded (for nonsecreting tumors and/or salvage transplantation). Using receiver operating characteristics analysis for recurrence after LT, 'progression' of AFP was defined by >15 microg/L per month before LT. A total of 127 (83%) were transplanted under and 26 (16%) over this threshold. After 45 months of follow-up (median), 5-year overall survival (OS) and recurrence free-survival (RFS) were 72% and 69%, respectively. Five-year survival in the progression group was lower than the nonprogression group (OS 54% vs. 77%; RFS 47% vs. 74%). Multivariate analysis showed progression of AFP>15 microg/L per month and preoperative nodules>3 were associated with decreased OS. Progression group and age>60 years were associated with decreased RFS. Male gender, progression of AFP and size of tumor>30 mm were associated with satellite nodules and/or vascular invasion. In conclusion, increasing AFP>15 microg/L/month while waiting for LT is the most relevant preoperative prognostic factor for low OS/DFS. AFP progression could be a pathological preoperative marker of tumor aggressiveness.


Assuntos
Carcinoma Hepatocelular/sangue , Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/sangue , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/sangue , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , alfa-Fetoproteínas/metabolismo , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Intervalo Livre de Doença , Feminino , Humanos , Cirrose Hepática/complicações , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Taxa de Sobrevida , Fatores de Tempo
15.
Eur J Surg Oncol ; 36(2): 125-9, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19646840

RESUMO

INTRODUCTION: Although there is general correlation between the TNM stage of colorectal cancer (CRC) and its prognosis, there is often significant variability of tumor behaviour and individual patient outcome, which is unaccounted for by pathologic factors alone. Our aim was to estimate perioperative tumor cell dissemination in patients with primary or CRC liver metastases as a possible factor influencing the outcome. METHODS: Forty patients were prospectively enrolled in the study from the year 2007 to 2008. Eighteen patients had histologically proven CRC (50% rectal, 44% colonic, 6% colonic and rectal). Sixteen patients (47%) had CRC liver metastases only. The remaining six patients who underwent colon or liver resection for benign conditions, acted as the control group. All patients with malignant pathologies had R0 resections. Blood samples were taken before the surgical incision (T0), immediately after tumor resection (T1) and at the end of the surgical intervention (T2). Data acquisition was performed using a dual-laser FACSCalibur flow cytometer. Circulating malignant cells were identified as being CD45-/cytokeratin+. RESULTS: The analysis of patients overall (CRC resection subgroup and hepatectomy subgroup) revealed that there was no statistically significant difference of the tumoral cell count in the blood per million of hematopoietic cells at T0, T1 and T2. CONCLUSIONS: This study demonstrates no differences in the detected circulating numbers of tumor cells at different stages of surgical intervention.


Assuntos
Neoplasias Colorretais/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Células Neoplásicas Circulantes/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Colectomia/efeitos adversos , Neoplasias Colorretais/patologia , Feminino , Citometria de Fluxo , Hepatectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
16.
Transplant Proc ; 38(7): 2097-8, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16980011

RESUMO

OBJECTIVES: The King's College Hospital (KCH) criteria are widely used for listing patients with acute liver failure (ALF) for liver transplantation (LT). Recent reports have suggested that the Model for End-Stage Liver Disease (MELD) score may be useful in assessing prognosis in ALF (nonparacetamol). This study compares prognostic accuracy of the two systems in patients with paracetamol (POD)-induced ALF treated in this unit. METHODS: Seventy-two patients (average age 38 years; F:M ratio 2:1) admitted from 1994 to 2005 with POD-related ALF were studied. Clinical and biochemical parameters were recorded. The effect of applying a MELD score of greater than 30 as listing criteria for LT was calculated and compared with the KCH criteria. Outcomes were defined as LT, death, or full recovery. RESULTS: Thirty-one patients (43%) recovered with medical therapy, 29 (40%) patients died, and 12 (17%) underwent LT. Sixty five percent of patients had a MELD > 30 and therefore could potentially be listed on admission; however, using KCH criteria only 24% patients were listed immediately. Sensitivity and negative predictive value of MELD was higher then KCH; however, we found KCH to have much higher specificity and positive predictive value. CONCLUSION: MELD has higher sensitivity and negative predictive value for POD-induced ALF than the KCH criteria. However, the high false-positive rate associated with MELD limits its clinical utility. The high negative predictive value of MELD score may allow it to be used in conjunction with KCH criteria to avoid unneeded LT in patients who will likely recover spontaneously.


Assuntos
Falência Hepática Aguda/classificação , Falência Hepática Aguda/cirurgia , Transplante de Fígado/estatística & dados numéricos , Listas de Espera , Adulto , Bilirrubina/sangue , Feminino , Encefalopatia Hepática/classificação , Encefalopatia Hepática/mortalidade , Encefalopatia Hepática/cirurgia , Humanos , Coeficiente Internacional Normatizado , Falência Hepática Aguda/mortalidade , Falência Hepática Aguda/terapia , Masculino , Seleção de Pacientes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
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