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2.
Hepatol Commun ; 7(4)2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-36996004

RESUMO

Patients with cirrhosis have an increased perioperative risk relative to patients without cirrhosis. This is related to numerous cirrhosis-specific factors, including severity of liver disease, impaired synthetic function, sarcopenia and malnutrition, and portal hypertension, among others. Nonhepatic comorbidities and surgery-related factors further modify the surgical risk, adding to the complexity of the preoperative assessment. In this review, we discuss the pathophysiological contributors to surgical risk in cirrhosis, key elements of the preoperative risk assessment, and application of risk prediction tools including the Child-Turcotte-Pugh score, Model for End-Stage Liver Disease-Sodium, Mayo Risk Score, and the VOCAL-Penn Score. We also detail the limitations of current approaches to risk assessment and highlight areas for future research.


Assuntos
Doença Hepática Terminal , Humanos , Índice de Gravidade de Doença , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Fatores de Risco , Medição de Risco
4.
Am J Transplant ; 20(1): 213-219, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31420967

RESUMO

We sought to characterize the trend in alanine aminotransferase elevations prior to transplant and the impact on the pattern of enzyme elevations on organ utilization and graft function. We performed a retrospective cohort study of UNOS data on all deceased donors between 2007 and 2016. Serum alanine aminotransferase (ALT) was categorized into six study groups with peak ALT < 499, 500-749, 750-999, 1000-1999, 2000-2999, and >3000 IU/L. The change from peak ALT to terminal ALT prior to transplant was categorized as no change/increasing at time transplant, 0.1-9.9%, 10-24.9%, 25-49.9%, 50-74.9% and >75% change. In multivariable models evaluating liver utilization, the interaction between peak ALT and percent change in ALT was most pronounced at the highest peak ALT levels, where liver utilization varied markedly as a function of percentage drop from peak to terminal ALT. There was no increased risk of graft failure based on peak ALT. Markers of ischemic liver injury and recovery are significantly associated with liver utilization, yet among transplanted livers they were not associated with graft outcomes and may represent an area to expand the donor pool.


Assuntos
Seleção do Doador/tendências , Rejeição de Enxerto/diagnóstico , Sobrevivência de Enxerto , Hepatopatias/cirurgia , Transplante de Fígado/efeitos adversos , Doadores de Tecidos/provisão & distribuição , Transaminases/metabolismo , Adulto , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Humanos , Hepatopatias/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
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