Sarcopenia-The Impact on Physical Capacity of Liver Transplant Patients.

Optimizing patients' condition before liver transplantation (LT) could potentially improve survival of LT patients. We focused on sarcopenia, as a common factor in liver transplant candidates that can impact their cardiopulmonary performance at the point of listing, morbidity, and mortality after LT. We performed a single-center cohort study on 98 consecutive patients with liver cirrhosis who were transplanted between March 2015 and December 2017. The third lumbar vertebra skeletal muscle index (L3SMI) was calculated using CT imaging to distinguish sarcopenia at listing for LT. Data regarding liver function, body mass index (BMI), cardiac biomarkers, the peak oxygen uptake (VO2) and LT outcome were collected and correlated to L3SMI. For data analysis the Dell Statistica (Version 13. Dell Inc., Rondrock, TX, USA) was used. In total, 98 cirrhotic patients were included. Fifty-five (56.1%) patients, mostly males, had sarcopenia according to L3SMI, with the lowest L3SMI in males with alcohol-related liver disease. Lower L3SMI correlated with lower BMI, lower VO2 peak, and higher NTproBNP (all p < 0.001) and revealed an essential correlation with prolonged ICU stay (r = -0.21, p < 0.05). 33 patients were unable to perform cardio-pulmonary exercise test, mostly sarcopenic (67%), with more advanced liver insufficiency (assessed with CPC and MELD scores) and longer stay at ICU after LT (all p < 0.001). Sarcopenia was common among LT recipients. It was associated with inferior result in cardio-pulmonary performance before LT and prolonged ICU stay after grafting.

Liver volume: a point of no return in liver transplantation?

INTRODUCTION: In patients with cirrhosis, only a 75% liver volume (LV) is expected compared with age­matched healthy individuals. Changes in LV might be an indicator of therapeutic effectiveness or disease progression. OBJECTIVES: To establish whether LV is a prognostic factor in chronic liver disease irrespective of etiology and LV impacts the outcomes of liver transplant (LT). PATIENTS AND METHODS: In total, 135 consecutive LT recipients were prospectively included in this study: 38 women and 97 men. The median (minimum-maximum) age was 51 (21-70) years; body mass index (BMI), 27.3 (17.3-39.2) kg/m2; Child-Pugh class (CPC), C; Model of End­Stage Liver Disease (MELD), 16 (7-47) points; and the third lumbar vertebra skeletal muscle index (L3SMI), 47.7 (19.7-73.4) cm2/m2. Liver volume and L3SMI were calculated based on computed tomography scans at listing for LT. The receiver operating characteristic (ROC) curve was analyzed to determine the accuracy of LV in mortality prediction after LT. RESULTS: Liver volume differed significantly among patients in terms of chronic liver disease etiology, with the lowest values noted in those with hepatitis C virus infection. Liver volume was neither a prognostic factor of disease progression and need for LT with respect to the CPC and MELD scores nor correlated with BMI and L3SMI (P >0.05). The area under the ROC curve of LV in mortality prediction was 0.573 (95% CI, 0.403-0.743). Liver volume smaller than the median tended to be positively associated with the risk of prolonged intensive care unit stay and death (P = 0.057 and P = 0.058, respectively). CONCLUSIONS: Low liver volume did not seem be a point of no return in LT candidates.

A clinical utility of a strip test for influenza A/B and comparison with detection by RT PCR.

INTRODUCTION AND OBJECTIVE: In June 2009 the World Health Organization announced influenza pandemic caused by A/H1N1/v virus. It became crucial to recognize new cases of A/H1N1/v infection. An effective screening diagnostic procedure was needed for patients suffering from influenza-like symptoms for making an initial diagnosis and analyzing epidemiological pattern of infection. We used a strip test for influenza A/B as a screening diagnostic procedure for patients suffering from influenza-like symptoms for making an initial diagnosis. For comparison, RT PCR for detecting A/H1N1/v was performed. The aim of this study was to assess the efficacy and sensitivity of the strip test and its value for making initial diagnosis of influenza A/H1N1/v. MATERIAL AND METHODS: Strip testing for the influenza A/B infection was performed on 1123 patients with influenza-like symptoms in the Admission Unit of the Regional Infectious Diseases Hospital in Warsaw. Strip test results were analyzed according to the age of patients and season of the year. For 97 patients strip test results for detecting A/H1N1 infection were compared with those obtained by RT PCR. RESULTS: There were no statistically significant differences found between the methods and strip testing demonstrated sensitivity of 61% and specificity of 71%. CONCLUSIONS: No statistically significant differences were found between the two methods, however, strip test had low sensitivity and specificity.