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https://read.qxmd.com/read/30861294/current-status-of-simultaneous-liver-kidney-transplantation-in-the-united-states
#1
Erik L Lum, Andres Cardenas, Paul Martin, Suphamai Bunnapradist
Liver transplantation (LT) is definitive therapy for individuals with end stage liver disease and acute liver failure. Pre-transplant renal dysfunction is common in patients with advanced decompensated cirrhosis and increases mortality in wait-listed LT candidates. Chronic kidney disease (CKD) in LT recipients is a common complication, and is associated with reduced survival, especially if a LT recipient requires long-term dialysis following transplantation (1-6). Kidney transplantation (KT) following LT improves survival in LT recipients with kidney disease; however, a LT recipient may wait years before receiving a deceased donor KT, mitigating its benefit in LT...
March 12, 2019: Liver Transplantation
https://read.qxmd.com/read/30785676/-hepatorenal-syndrome-something-new
#2
Hannah Wozniak, Patrick Saudan, Pierre-Yves Martin, Belen Ponte
Hepatorenal syndrome is a serious and frequent complication in patients suffering from liver cirrhosis. Its most severe type is characterized by the rapid occurrence of a functional acute kidney injury. However it is mainly an exclusion diagnosis. Although the pathophysiology is not yet fully understood, the principal hypothesis is a splanchnic vasodilatation leading to a systemic and renal vasoconstriction associated with sodium and water retention and progressive cardiac failure. Intravenous albumin associated with systemic vasoconstrictors, terlipressin or noradrenaline, is recommended...
February 20, 2019: Revue Médicale Suisse
https://read.qxmd.com/read/30724682/the-burden-of-illness-of-hepatorenal-syndrome-hrs-in-the-united-states-a-retrospective-analysis-of-electronic-health-records
#3
Khurram Jamil, Xingyue Huang, Belinda Lovelace, An T Pham, Kunal Lodaya, George Wan
OBJECTIVES: Hepatorenal Syndrome (HRS) is characterized by renal failure in patients with advanced chronic liver disease (CLD) and is the leading cause of hospitalizations in CLD. This study examines the clinical and economic burden, outcomes, and unmet need of HRS treatment in US hospitals. METHOD: A retrospective cohort study was conducted based on a large electronic health records database (Cerner HealthFacts) with records for hospitalized HRS patients from January 2009 - June 2015...
February 6, 2019: Journal of Medical Economics
https://read.qxmd.com/read/30705142/mutation-in-itch-gene-can-cause-syndromic-multisystem-autoimmune-disease-with-acute-liver-failure
#4
Nicola Kleine-Eggebrecht, Christian Staufner, Simone Kathemann, Magdeldin Elgizouli, Robert Kopajtich, Holger Prokisch, Elke Lainka
Pediatric intractable autoimmune hepatitis is rare and may be responsible for acute liver failure. Mutations in the itchy E3 ubiquitin protein ligase ( ITCH ) gene (located on chromosome 20q11.22) can lead to a deficiency of the encoded protein, resulting in increased T-cell activity with lack of immune tolerance and manifestation of a complex systemic autoimmune disease. A 1-year-old girl of consanguineous parents received a liver transplant (LT) because of acute liver failure attributed to a drug-induced hypereosinophilic syndrome with positive liver-kidney-mikrosome-2 antibodies...
January 31, 2019: Pediatrics
https://read.qxmd.com/read/30676329/acute-kidney-injury-in-cirrhosis-implications-for-liver-transplantation
#5
Andrew J MacDonald, Mitra K Nadim, François Durand, Constantine J Karvellas
PURPOSE OF REVIEW: Acute kidney injury (AKI) in cirrhosis consists of varying phenotypes, with hepatorenal syndrome (HRS) representing a single entity. Prompt recognition and diagnosis of AKI cause identifies appropriate therapeutic measures. This review provides an overview of AKI definitions, highlights challenges in quantifying renal impairment in cirrhosis, lists novel diagnostic AKI biomarkers, and summarizes transplantation implications. RECENT FINDINGS: Biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, interleukin-18, and liver-type fatty acid-binding protein) may assist in the identification of underlying acute tubular necrosis...
January 22, 2019: Current Opinion in Critical Care
https://read.qxmd.com/read/30666172/spontaneous-bacterial-peritonitis-in-patients-with-cirrhosis-incidence-outcomes-and-treatment-strategies
#6
REVIEW
Sebastián Marciano, Juan Manuel Díaz, Melisa Dirchwolf, Adrián Gadano
Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with cirrhosis. The reported incidence varies between 7% and 30% in hospitalized patients with cirrhosis and ascites, representing one of their main complications. Outcomes in patients with spontaneous bacterial peritonitis are poor since acute kidney injury, acute-on-chronic liver failure, and death occur in as much as 54%, 60%, and 40% of the patients, respectively, at midterm. Early antibiotic treatment of spontaneous bacterial peritonitis is crucial...
2019: Hepatic Medicine: Evidence and Research
https://read.qxmd.com/read/30665869/ramucirumab-after-sorafenib-in-patients-with-advanced-hepatocellular-carcinoma-and-increased-%C3%AE-fetoprotein-concentrations-reach-2-a-randomised-double-blind-placebo-controlled-phase-3-trial
#7
Andrew X Zhu, Yoon-Koo Kang, Chia-Jui Yen, Richard S Finn, Peter R Galle, Josep M Llovet, Eric Assenat, Giovanni Brandi, Marc Pracht, Ho Yeong Lim, Kun-Ming Rau, Kenta Motomura, Izumi Ohno, Philippe Merle, Bruno Daniele, Dong Bok Shin, Guido Gerkin, Christophe Borg, Jean-Baptiste Hiriart, Takuji Okusaka, Manabu Morimoto, Yanzhi Hsu, Paolo B Abada, Masatoshi Kudo
BACKGROUND: Patients with advanced hepatocellular carcinoma and increased α-fetoprotein concentrations have poor prognosis. We aimed to establish the efficacy of ramucirumab in patients with advanced hepatocellular carcinoma and α-fetoprotein concentrations of 400 ng/mL or higher. METHODS: REACH-2 was a randomised, double-blind, placebo-controlled, phase 3 trial done at 92 hospitals, clinics, and medical centres in 20 countries. Eligible patients were aged 18 years or older and had histologically or cytologically confirmed hepatocellular carcinoma, or diagnosed cirrhosis and hepatocellular carcinoma, Barcelona Clinic Liver Cancer stage B or C disease, Child-Pugh class A liver disease, Eastern Cooperative Oncology Group (ECOG) performance statuses of 0 or 1, α-fetoprotein concentrations of 400 ng/mL or greater, and had previously received first-line sorafenib...
January 18, 2019: Lancet Oncology
https://read.qxmd.com/read/30597709/characterization-of-inflammatory-response-in-hepatorenal-syndrome-relationship-with-kidney-outcome-and-survival
#8
Cristina Solé, Elsa Solà, Patricia Huelin, Marta Carol, Rebeca Moreira, Unai Cereijo, José-Manuel Mas, Isabel Graupera, Elisa Pose, Laura Napoleone, Gloria dePrada, Adrià Juanola, Núria Fabrellas, Ferran Torres, Manuel Morales-Ruiz, Judith Farrés, Wladimiro Jiménez, Pere Ginès
BACKGROUND: Several lines of evidence indicate that decompensated cirrhosis is characterized by the presence of systemic inflammation. Hepatorenal syndrome (HRS-AKI) is a unique type of renal failure that occurs at late stages of cirrhosis. However, confirmation of the presence and significance of such inflammatory response in HRS-AKI is lacking. AIM AND METHODS: To characterize the systemic inflammatory response, as estimated by measuring a large number of cytokines, in 161 patients hospitalized for an acute decompensation of cirrhosis: 44 patients without acute kidney injury (AKI), 63 patients with hypovolaemia-induced AKI and 58 patients with HRS-AKI...
December 29, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://read.qxmd.com/read/30586740/early-risks-of-death-stroke-systemic-embolism-and-major-bleeding-in-patients-with-newly-diagnosed-atrial-fibrillation-results-from-the-garfield-af-registry
#9
Jean-Pierre Bassand, Saverio Virdone, Samuel Z Goldhaber, A John Camm, David A Fitzmaurice, Keith A A Fox, Shinya Goto, Sylvia Haas, Werner Hacke, Gloria Kayani, Lorenzo G Mantovani, Frank Misselwitz, Karen S Pieper, Alexander G G Turpie, Martin van Eickels, Freek W A Verheugt, Ajay K Kakkar
BACKGROUND: Atrial fibrillation (AF) is associated with increased risks of death, stroke/systemic embolism (SE) and bleeding (incurred by antithrombotic therapy), which may occur early after diagnosis. METHODS: We assessed the risk of early events (death, stroke/SE and major bleeding) over 12 months and their relation to the time after diagnosis of AF in 52,014 patients prospectively enrolled in the GARFIELD-AF registry between March 2010 and August 2016. RESULTS: Over 12 months, 2140 patients died (mortality rate: 4...
November 28, 2018: Circulation
https://read.qxmd.com/read/30548094/simultaneous-liver-kidney-transplantation
#10
REVIEW
Ashwani K Singal, Song Ong, Sanjaya Satpathy, Patrick S Kamath, Russel H Wiesner
Kidney injury is frequently seen in patients with end stage liver disease from cirrhosis and liver failure. Among select patients, simultaneous liver kidney (SLK) transplantation provides improved post-transplant graft and patient outcomes compared to liver transplantation alone. We conducted review of the existing literature on SLK transplant criteria and outcomes. Since the introduction of the model for end-stage disease score in 2002, there has been an increased use of simultaneous liver kidney transplantation...
December 10, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
https://read.qxmd.com/read/30540727/-hepatopulmonar-syndrome-and-liver-transplantation-experience-in-the-transplantation-department-of-the-guillermo-almenara-irigoyen-national-hospital-essalud
#11
Bertha Cárdenas Ramírez, P Martin Padilla-Machaca, Omar Mantilla Cruzatti, José Rivera Romaní, Carlos Rondón Leyva, José-Carlos Chaman Ortiz
INTRODUCTION: Hepatopulmonary syndrome (HPS) is a serious complication of liver disease, which is characterized by the presence of intrapulmonary vasodilation and progressive hypoxemia. Liver transplantation is the only effective treatment. OBJECTIVE: To show our results of patients with hepatopulmonary syndrome undergoing liver transplantation. MATERIALS AND METHODS: Retrospective, descriptive and cross-sectional study. From March 2000 to December 2016; 226 liver transplants were performed...
July 2018: Revista de Gastroenterología del Perú: órgano Oficial de la Sociedad de Gastroenterología del Perú
https://read.qxmd.com/read/30486560/-the-clinical-characteristics-and-risk-factors-for-acute-kidney-injury-in-patients-with-cirrhosis
#12
W J Wang, Q Song, H G Ding
Objective: To investigate the clinical features and risk factors for acute kidney injury (AKI) in patients with cirrhosis. Methods: A total of 1 165 hospitalized patients with chronic liver diseases were enrolled. Among them, 94 patients had chronic hepatitis, while 1 071 patients were diagnosed as cirrhosis. The clinical data, renal and liver function were retrospectively analyzed. AKI was determined according to the criteria proposed by International Club of Ascites. Compared with chronic hepatitis group, the clinical features and risk factors for AKI in patients with cirrhosis were evaluated using logistic regression...
December 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://read.qxmd.com/read/30485886/kidney-injury-and-electrolyte-abnormalities-in-liver-failure
#13
Anthony Bonavia, Kai Singbartl
The liver and kidney are key organs of metabolic homeostasis in the body and display complex interactions. Liver diseases often have direct and immediate effects on renal physiology and function. Conversely, acute kidney injury (AKI) is a common problem in patients with both acute and chronic liver diseases. AKI in patients with acute liver failure is usually multifactorial and involves insults similar to those seen in the general AKI population. Liver cirrhosis affects and is directly affected by aberrations in systemic and renal hemodynamics, inflammatory response, renal handling of sodium and free water excretion, and additional nonvasomotor mechanisms...
October 2018: Seminars in Respiratory and Critical Care Medicine
https://read.qxmd.com/read/30485884/shock-etiologies-and-fluid-management-in-liver-failure
#14
Emmanuel Weiss, Catherine Paugam-Burtz, Samir Jaber
Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common...
October 2018: Seminars in Respiratory and Critical Care Medicine
https://read.qxmd.com/read/30481879/-study-on-characteristics-and-prognosis-of-organ-failure-in-patients-with-hepatitis-b-virus-associated-acute-on-chronic-liver-failure
#15
J Wu, L Jia, Y Y Li, J Li, H W Yu, Y K Zhu, Z J Hu, Q H Meng, F S Wang
Objective: To evaluate the incidence, and the characteristics of organ failure in relationship to prognosis in hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients using chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score for judgments of clinical treatment and prognosis. Methods: Clinical data of 316 patients who were diagnosed as HBV-ACLF during hospitalization from February 2015 to February 2016 were retrospectively analyzed. Intrahepatic and extrahepatic organ failures were assessed according to CLIF-SOFA score, and the relationship between clinical characteristics and prognosis was analyzed...
October 20, 2018: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://read.qxmd.com/read/30397601/bile-cast-nephropathy-a-pathologic-finding-with-manifold-causes-displayed-in-an-adult-with-alcoholic-steatohepatitis-and-in-a-child-with-wilson-s-disease
#16
Jose Torrealba, Nathan T Sweed, Daniel Burguete, Allen R Hendricks
Bile cast nephropathy (BCN) is seen in patients who have acute kidney injury and severe hyperbilirubinemia due to a wide range of hepatobiliary system diseases. Findings seen by renal biopsy include acute tubular injury with necrotic and sloughed epithelial cells, yellow-green pigment within tubular epithelial cells, and pigmented granular casts. Hall's special stain for bile turns these casts green. In recent years, BCN has been described in a small number of case reports and clinical studies primarily in the setting of severe liver dysfunction...
September 2018: Case Reports in Nephrology and Dialysis
https://read.qxmd.com/read/30375954/-severe-reversible-penile-ischaemia-after-terlipressin-treatment-of-hepatorenal-syndrome
#17
Lotte Borg Lange, Kristine Borg
This case report presents a 70-year-old man with alcoholic liver cirrhosis, who was hospitalised due to pulmonary oedema, and who developed acute renal injury. Though the criteria were not fulfilled, hepatorenal syndrome was suspected and treated with terlipressin, after which the patient developed severe penile ischaemia. Hepatorenal syndrome is one of many potential causes of acute kidney injury in patients with acute or chronic liver disease. The syndrome is an exclusion diagnosis, and other causes of liver and renal failure should be investigated, before treatment is started...
October 22, 2018: Ugeskrift for Laeger
https://read.qxmd.com/read/30345281/renal-failure-in-patients-with-liver-cirrhosis-novel-classifications-biomarkers-treatment
#18
REVIEW
Beate Appenrodt, Frank Lammert
Renal failure is a severe complication in patients with liver cirrhosis. It is associated with increased mortality and morbidity. Diagnosis is a challenge because it is mainly based on serum creatinine, which does not seem to be an ideal measure of renal function in cirrhosis. The definition of renal failure in these patients has been changed for optimizing treatment and for improving outcome and prognosis. The new criteria are based on the adapted KDIGO (Kidney Disease: Improving Global Outcomes) staging system...
August 2018: Visceral Medicine
https://read.qxmd.com/read/30250270/the-association-between-serum-sodium-concentration-hypertension-and-primary-cardiovascular-events-a-retrospective-cohort-study
#19
Nicholas I Cole, Rebecca J Suckling, Pauline A Swift, Feng J He, Graham A MacGregor, William Hinton, Jeremy van Vlymen, Nicholas Hayward, Simon Jones, Simon de Lusignan
The mechanisms underlying the adverse cardiovascular effects of increased salt intake are incompletely understood, but parallel increases in serum sodium concentration may be of importance. The aim of this retrospective cohort study was to investigate the relationship between serum sodium, hypertension and incident cardiovascular disease (CVD). Routinely collected primary care data from the Royal College of General Practitioners Research and Surveillance Centre were analysed. A total of 231,545 individuals with a measurement of serum sodium concentration at baseline were included...
September 24, 2018: Journal of Human Hypertension
https://read.qxmd.com/read/30167578/good-performance-of-liver-stiffness-measurement-in-the-prediction-of-postoperative-hepatic-decompensation-in-patients-with-cirrhosis-complicated-with-hepatocellular-carcinoma
#20
Bogdan Procopet, Petra Fischer, Adelina Horhat, Emil Mois, Horia Stefanescu, Mihai Comsa, Florin Graur, Adrian Bartos, Monica Lupsor-Platon, Radu Badea, Mircea Grigorescu, Marcel Tantau, Zeno Sparchez, Nadim Al Hajjar
The evaluation of patients with early hepatocellular carcinoma (HCC) referred for liver resection is still a matter of debate. Aims: 1) to compare liver stiffness measurement (LSM) by transient elastography with hepatic venous pressure gradient (HVPG) in the prediction of decompensation after liver resection in patients with cirrhosis and early HCC; 2) to identify which definition for posthepatectomy liver failure is better associated with survival. MATERIAL AND METHODS: Fifty-one patients (MELD score of 10±3) were included...
August 30, 2018: Medical Ultrasonography
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