Diabetes With or Without Hypertension Does Not Affect Graft Survival and All-cause Mortality After Liver Transplant: A Propensity Score Matching Analysis.

BACKGROUND: Many studies have reported the negative influence of diabetes and hypertension on morbidity and mortality in the general population. In liver transplantation (LT) recipients, prevalence of nonalcoholic fatty liver disease and metabolic syndrome is increasing. Hence, concerns over the negative influence of metabolic syndrome, including diabetes and hypertension, are growing. However, there have been few studies about the outcomes of LT recipients with diabetes with/without hypertension. We aimed to evaluate the impact of diabetes with/without hypertension on the outcomes of LT. METHODS: Between May 2010 and October 2015, 814 LT recipients (median age, 51 [46-55] years; median MELD score, 13 [9-18]), without overt cardiovascular disease were retrospectively evaluated. To rigorously adjust for clinically confounding factors, a 1:2 propensity score matching analysis was performed. Kaplan-Meier survival curves and Cox proportional hazard regression analysis were performed to examine the association between diabetes with/without hypertension and all-cause mortality or graft survival rate. RESULTS: There were 77 (9.5%) graft failures and 71 (8.7%) deaths during a median follow-up of 2.4 years. After 1:2 matching of 173 (21.3%) diabetic patients, no significant differences were evident in graft survival rate (log-rank test, P = .46; and hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.55-2.06; P = .865) and all-cause mortality (log-rank test, P = .59; and HR, 1.06; 95% CI, 0.55-2.06; P = .727). Separate 1:2 matching was applied to a subgroup of 43 (5.3%) patients with diabetes and hypertension. This matching also showed no difference in graft survival rate (log-rank test, P = .45; and HR, 1.35; 95% CI, 0.43-4.27; P = .613) and all-cause mortality (log-rank test, P = .25; and HR, 1.87; 95% CI, 0.54-6.50; P = .325). CONCLUSION: Diabetes with/without hypertension does not have an impact on graft survival rate or all-cause mortality in LT recipients.

Intracellular survival of virulence and low-virulence strains of Vibrio parahaemolyticus in Epinephelus awoara macrophages and peripheral leukocytes.

In this study, we examined the virulence factors and pathogenesis of Vibrio parahaemolyticus in Epinephelus awoara. The chemotactic motility of V. parahaemolyticus for phagocytosis and intracellular survival in fish macrophages was determined using virulence strains and low-virulence strains of V. parahaemolyticus. We found that the intracellular mean number of virulence strains of V. parahaemolyticus ranged from 0-180 min after co-incubation with macrophages and peripheral leukocytes, was relatively low, and decreased steadily over the observation period. Low-virulence strains of V. parahaemolyticus were unable to survive in peripheral leukocytes and macrophages. Cell viability in response to V. parahaemolyticus was assessed using the MTT assay. Low-virulence V. parahaemolyticus strains exhibited lower cytotoxicity compared to virulent strains. The average percent of live macrophages and peripheral leukocytes infected by V. parahaemolyticus ranged from 13.50-79.20%. These results indicate that V. parahaemolyticus in E. awoara is a facultative intracellular bacterium that may be involved in virulence.

Preoperative echocardiographic indices associated with elevated brain natriuretic peptide in liver transplant recipients.

BACKGROUND: Cardiac dysfunction may be present in patients with liver cirrhosis. Brain natriuretic peptide (BNP) concentration is a widely used biomarker for heart failure. We evaluated whether elevated BNP reflects cardiac dysfunction, as assessed by preoperative echocardiography, in liver transplant recipients. METHODS: We assessed 122 liver transplant recipients (94 males, 28 females; age, 50 ± 8 years). All underwent preoperative echocardiography, including measurements of heart chamber size, mass, ejection fraction, systolic pressure gradient between right ventricle and right atrium (PGsys [RV - RA]), mitral inflow velocities including early (E) and late (A) transmitral flow velocities, E/A, and deceleration time of E. Tissue Doppler imaging (TDI) was also performed to evaluate systolic (S'), early diastolic (E'), and late diastolic (A') myocardial velocities, E'/A', EAS index: E'/(A' × S'), and E/E'. Univariate and multivariate logistic regression analyses were performed to determine echocardiographic indices for predicting BNP ≥ 100 pg/mL. RESULTS: Of 122 recipients, 87 (71%) had BNP < 100 pg/mL (median, 32.0 pg/mL; interquartile range [IQR], 18.0-50.0), and 35 (29%) had BNP ≥ 100 pg/mL (median, 163.0 pg/mL; IQR, 136.0-479.0). Univariate analysis showed that E (P < .001), PGsys (RV-RA) (P < .001), and E/E' (P = .038) were significantly associated with BNP ≥ 100 pg/mL. Multivariate analysis showed that PGsys (RV - RA) was the only independent predictor of BNP ≥ 100 pg/mL (odds ratio, 1.171; 95% confidence interval, 1.091-1.258; P < .001). CONCLUSION: PGsys (RV - RA) is an echocardiographic index independently associated with BNP ≥ 100 pg/mL, suggesting that elevated BNP in patients with end-stage liver disease may reflect increased pulmonary arterial pressure, rather than systolic and diastolic dysfunction assessed by TDI.

Factors associated with changes in coagulation profiles after living donor hepatectomy.

BACKGROUND: Hepatic resection may be associated with postoperative coagulopathy. However, there is limited information about the predictors affecting coagulopathy after donor hepatectomy. We evaluated the contributors of maximal changes in prothrombin time (PT), activated thromboplastin time (aPTT), and platelet count in the development of postoperative coagulopathy. METHODS: We retrospectively analyzed 864 living donors, all of whom received general anesthesia using desflurane, isoflurane, or sevoflurane. A coagulation derangement was defined as one or more of the following events postoperatively: peak PT >1.5 international normalized ratio (INR; highest quartile of PT), peak aPTT >46 seconds (highest quartile of aPTT), or nadir platelet count <100 × 10(9)/L. Factors were evaluated by univariate and multivariate logistic regression analysis to identify predictors of coagulopathy. RESULTS: Mean postoperative peak PT, peak aPTT, and nadir platelet count were 1.4 ± 0.2 INR, 43.8 ± 23.7 seconds, and 155.9 ± 37.3 × 10(9)/L, respectively, with 39.4% of donors being at the risk for coagulation derangement. Multivariate logistic regression analysis revealed that predictors of such derangement included anesthesia duration, remnant liver volume, and body mass index (BMI). However, coagulation derangement was not independently associated with age, gender, volatile anesthetics, central venous pressure, fatty change in the liver, estimated blood loss, or intraoperative hypotensive episodes. CONCLUSION: We found that long anesthesia duration, low BMI, and small remnant liver volume were predictors of coagulation derangement. These results provide a better understanding of risk factors affecting changes in coagulation profiles after living donor hepatectomy.