Hypothalamic-pituitary-gonadal function in men with liver cirrhosis before and after liver transplantation / Função do eixo hipotálamo-hipófise-gonadal em homens cirróticos antes e após o transplante hepático

Objective: To evaluate the influence of end-stage liver disease and orthotopic liver transplantation in the pituitary function and hormone metabolism before and after liver transplantation. Methods: In a prospective study, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) of 30 male patients with cirrhosis were determined two to four hours before and six months after liver transplantation. The results were compared according to the Model for End-stage Liver Disease (MELD). Results: male patients with liver cirrhosis have hypogonadism. FSH was normal, but inappropriately low due to androgen failure; E2 and PRL, on their turn, were high. After liver transplantation, FSH and LH levels increased (p < 0.05), whereas E2 and PRL normalized (p < 0.05). The MELD score did not influence changes in FSH, PRL and LH, however, the more severe the cirrhosis was, the more significant was the normalization of E2 (p = 0.01). Conclusion: Patients with cirrhosis and male hypogonadism have inappropriately normal levels of FSH and LH, associated with an increase in E2 and LRP. After liver transplantation, FSH and LH increased, while E2 and PRL returned to normal. Changes in E2 levels were most pronounced in patients with MELD > 18. The severity of cirrhosis had no influence on FSH, PRL and LH. .

Objetivo: avaliar a influência da doença hepática terminal e do transplante hepático ortotópico na função hipofisária e no metabolismo hormonal através da aferição dos níveis séricos dos hormônios folículo estimulante (FSH), hormônio luteinizante (HL), estradiol (E2) e prolactina (PRL) antes e após o transplante hepático. Métodos: em um estudo prospectivo, níveis séricos dos hormônios folículo estimulante (FSH), hormônio luteinizante (HL), estradiol (E2) e prolactina (PRL) de 30 paciente masculinos com cirrose foram determinados duas a quatro horas antes e seis meses após o transplante hepático. Os resultados foram comparados de acordo com o Model for End-stage Liver Disease (MELD). Resultados: acientes masculinos com cirrose hepática apresentam hipogonadismo. O FSH encontravam-se normais, porém inapropriadamente baixos devido à falência androgênica; já o E2 e o PRL estavam elevados. Após o transplante hepático, os níveis de FHS e HL aumentaram (p < 0,05), enquanto o E2 e o PRL normalizaram (p < 0,05). O MELD não influenciou as alterações no FSH, HL ou PRL, todavia, quanto mais grave a cirrose, mais significante foi a normalização do E2 (p=0,01). Conclusão: pacientes masculinos com cirrose e hipogonadismo apresentam níveis inapropriadamente normais de FSH e HL, associados com elevação do E2 e PRL. Após o transplante hepático, FSH e HL aumentaram, enquanto E2 e PRL retornaram aos valores normais. As alterações nos níveis de E2 foram mais pronunciadas em pacientes com MELD > 18. A gravidade da cirrose não teve influência no FSH, HL e PRL. .

Hypothalamic-pituitary-gonadal function in men with liver cirrhosis before and after liver transplantation.

OBJECTIVE: To evaluate the influence of end-stage liver disease and orthotopic liver transplantation in the pituitary function and hormone metabolism before and after liver transplantation. METHODS: In a prospective study, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and prolactin (PRL) of 30 male patients with cirrhosis were determined two to four hours before and six months after liver transplantation. The results were compared according to the Model for End-stage Liver Disease (MELD). RESULTS: male patients with liver cirrhosis have hypogonadism. FSH was normal, but inappropriately low due to androgen failure; E2 and PRL, on their turn, were high. After liver transplantation, FSH and LH levels increased (p < 0.05), whereas E2 and PRL normalized (p < 0.05). The MELD score did not influence changes in FSH, PRL and LH, however, the more severe the cirrhosis was, the more significant was the normalization of E2 (p = 0.01). CONCLUSION: Patients with cirrhosis and male hypogonadism have inappropriately normal levels of FSH and LH, associated with an increase in E2 and LRP. After liver transplantation, FSH and LH increased, while E2 and PRL returned to normal. Changes in E2 levels were most pronounced in patients with MELD > 18. The severity of cirrhosis had no influence on FSH, PRL and LH.

Insulin-like growth factor I correlates with MELD and returns to normal level after liver transplantation.

BACKGROUND: Insulin-like growth factor I (IGF-I) is produced almost entirely by the liver and is the main promoter of anabolic growth hormone (GH) effects on protein, carbohydrate, and lipid metabolism. IGF-I is significantly decreased in patients with liver cirrhosis. Our objective was to determine the relationship between circulating IGF-I and MELD (Model for End-stage Liver Disease) in cirrhotics subjected to orthotopic liver transplantation (OLT). We also assessed the changes of IGF-I and its major binding protein (IGF-binding protein-3 or IGFBP-3) after OLT. MATERIAL AND METHODS: In a prospective study, serum levels of IGF-I and IGFBP-3 of 25 male adult patients with end-stage liver disease were measured 2 to 4 hours before and 6 months after orthotopic liver transplantation. Seven age-matched healthy male volunteers with normal liver enzymes, albumin, and prothrombin time served as controls. MELD was determined on the day of OLT. For this analysis, extra points were not added for patients with hepatocarcinoma. RESULTS: The cirrhotic group had significantly lower IGF-I (46.7±21.6 ng/mL) and IGFBP-3 (1.0±0.9 ng/mL) levels in the pre-transplant period compared with the controls (208.6±76.5 ng/mL and 4.62±0.93 ng/mL, respectively) (p<0.05). There was a negative correlation between IGF-I or IGFBP-3 and MELD (p<0.001) (ß=-1.750; standard error =2.5054 and ß=-0.038; standard error <0.0001, respectively). IGF-I e IGFBP-3 increased to normal levels after OLT (207.7±82.8 and 4.14±1.1 ng/mL, respectively) (p<0.001). CONCLUSIONS: Low levels of IGF-I and IGFBP-3 observed in patients with advanced liver cirrhosis are corrected after OLT. IGF-I and IGFBP-3 correlate negatively with MELD.

Donor complications including the report of one death in right-lobe living-donor liver transplantation.

BACKGROUND/AIMS: Our objective is to assess donor complications in all right hepatic lobe living-donor liver transplantation (LDLT) at our center. METHODS: Of a total of 352 liver transplantations performed, 60 were right-lobe LDLT. Most donors (88.3%) were related to the recipients. RESULTS: Mean hospital stay was 5.4+/-0.6 days. No complications occurred due to preoperative evaluation. Most donors received one or two units of autologous blood transfusion. Only 5 (8.3%) needed nonautologous blood transfusion. Most complications were minor and treated conservatively. Bile leaks from the cut surface of the liver occurred in 5 donors (8.3%). Two patients had potentially fatal complications: perforated duodenal ulcer and portal vein thrombosis (PVT). The donor with perforated ulcer developed septicemia and multiple organ failure. He was discharged from the hospital with hemiparesis due to cerebral ischemia. The patient with PVT remained asymptomatic and the portal vein was recanalized by the 3rd postoperative month. One donor died in the immediate postoperative period of cardiac arrest due to cardiac arrhythmia. CONCLUSION: Right hepatectomy for LDLT may be associated with significant morbidity, including death and it should be performed only by surgeons with great experience.

Avaliação do nível de estresse dos enfermeiros da Unidade de Transplante Hepático / Evaluation of the stress level among nurses in the Liver Transplant Unity

A convivência com o dor, perdas, mutilações e morte são inerentes à atividade de enfermagem, despertando uma variedade de atitudes e emoções. O objetivo do presente estudo foi verificar a presença e intensidade do estresse físico e emocional nos profissionais da equipe de enfermagem que atuam na Unidade de Transplante Hepático do Hospital das Clínicas da Universidade Federal do Paraná. Doze profissionais foram avaliados pelo Inventário de Sintomas de estresse para Adultos de Lipp (ISSL) e responderam uma pergunta aberta 'Como você lida com a morte dos pacientes?', abrindo espaço para falarem de sua subjetividade. Os dados encontrados indicam que 50 por cento dos indivíduos avaliados apresentam sinais de estresse. Constatou-se a exixtência de sofrimento psíquico entre a equipe quando o paciente vai a óbito, com variação de intensidade destes sentimentos de acordo com os aspectos psicológicos de cada um. Conhecer essa realidade e oferecer suporte psicológico adequado podem minimizar o impacto sobre a qualidade de vida da equipe de enfermagem. (AU)

[Cause of late death in liver transplant recipients]. / Causa de óbito tardio em transplantados de fígado.

BACKGROUND: The objective is to present the causes of late death in patients subjected to liver transplantation. METHODS: A total of 209 patients were subjected to 223 liver transplantations (14 retransplantations). The computerized study protocol sheets were evaluated to determine the causes of late death (> 6 months after transplantation). RESULTS: Of the 209 patients, 30 had late death. Ductopenic rejection (chronic rejection) was the most common cause and it was observed in 10 patients. Time after transplantation at the moment of death of this group of patients varied from 11 to 57 months, with an average of 29 months. Seven patients died at the hospital admission of hepatic retransplantation. Other causes of late death were sepsis, lymphoproliferative disease, chronic renal insufficiency, and hepatic insufficiency. CONCLUSION: The most common cause of late death after liver transplantation is ductopenic rejection, followed by complications of retransplantation and sepsis. Death owing to ductopenic rejection may occur even many years after transplantation.

Avaliação do nível de estresse dos enfermeiros da Unidade de Transplante Hepático / Evaluation of the stress level among nurses in the Liver Transplant Unity

A convivência com a dor, perdas, mutilações e morte são inerentes à atividade de enfermagem, despertando uma variedade de atitudes e emoções. O objetivo do presente estudo foi verificar a presença e intensidade do estresse físico e emocional nos profissionais da equipe de enfermagem que atuam na Unidade de Transplante Hepático do Hospital das Clínicas da Universidade Federal do Paraná. Doze profissinais foram avaliados pelo Inventário de Sintomas de estresse para Adultos de Lipp (ISSL) e responderam uma pergunta aberta 'Como você lida com a morte dos pacientes?', abrindo espaço para falarem da sua subjetividade. Os dados encontrados indicam que 50

dos indivíduos avaliados apresentam sinais de estresse. Constatou-se a existência de sofrimento psíquico entre a equipe quando o paciente vai a óbito, com variação de intensidade destes sentimentos de acordo com os aspectos psicológicos de cada um. Conhecer essa realidade e oferecer suporte psicológico adequado podem minimizar o impacto sobre a qualidade de vida da equipe de enfermagem. (AU)

Causa de óbito tardio em transplantados de fígado / Cause of late death in liver transplant recipients

OBJETIVO: Apresentar as causas de óbito tardio dos pacientes submetidos à transplante hepático. MÉTODOS: Um total de 209 pacientes foram submetidos a 223 transplantes hepáticos (14 retransplantes). Os protocolos de estudos computadorizados foram avaliados para determinar as causas de óbito tardio (> 6 meses após o transplante). RESULTADOS: Dos 209 pacientes, 30 foram a óbito tardio. A rejeiçäo ductopênica (rejeiçäo crônica) foi a causa mais comum, sendo observada em 10 pacientes. O tempo de pós-transplante por ocasiäo do óbito desse grupo de pacientes variou de 11 a 57 meses, com uma média de 29 meses. Sete morreram durante a internaçäo hospitalar para realizaçäo de retransplante hepático. As outras causas de óbito foram sepse, doença linfoproliferativa, insuficiência renal crônica e insuficiência hepática. CONCLUSÄO: A causa mais comum de óbito após seis meses de transplante hepático é a rejeiçäo ductopênica, seguida das complicações de retransplante e sepse. Morte devido a rejeiçäo ductopênica pode ocorrer até muitos anos após transplante

Liver allograft iron accumulation in patients with and without pretransplantation hepatic hemosiderosis.

There is a paucity of data regarding hepatic allograft iron accumulation in patients undergoing orthotopic liver transplantation (OLT) in whom severe iron overload was present in the native explanted liver. Our aim is to evaluate the frequency and cellular distribution of stainable iron in early and late post-OLT hepatic allograft biopsy specimens from patients undergoing their first OLT who had excess iron in their native explanted liver. We compared iron-staining patterns in hepatic allograft biopsy specimens at approximately 1 month (early) and 1 to 2 years (late) post OLT in 41 patients with hepatic iron indices greater than 1.9 in the explanted liver (cases) with a selected group of matched controls without explant hemosiderosis. Our cases included 6 patients with a pre-OLT diagnosis of hereditary hemochromatosis and 35 patients with cirrhosis and secondary iron overload. Early iron deposition was mild in most cases, commonly affected Kupffer's cells, and was seen with similar frequency in cases and controls (41% v 27%; P =.29). Stainable iron was observed in 20 donor livers (12 cases, 8 controls), and all 20 subjects showed stainable iron in 1-month hepatic allograft biopsy specimens. Liver samples from 35 matched pairs were studied for late iron deposition. Iron deposition was observed in 43% of cases versus 17% of controls (P =.06). In conclusion, the frequency of stainable iron in early hepatic allograft biopsy specimens was not different between patients with versus without pre-OLT hepatic hemosiderosis. There was a suggestion that patients with severe pre-OLT hemosiderosis had a greater frequency of iron accumulation in late hepatic biopsy specimens.