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Predicting Mortality Following Liver Transplantation: Role of Renal Biomarkers
January 2017 BACKGROUND: Incidence of Portal vein thrombosis (PVT) in
cirrhosis patients varies from 0.6% to 15%, which primarily reflects the incidence of chronic PVT. However, the incidence, natural history and management of Acute PVT in cirrhosis remains largely underreported. METHODS AND RESULTS: A 61 year-old female with Hepatitis C-related Child A cirrhosis was on sofosbuvir therapy. During an episode of endoscopic variceal ligation(EVL), she had recurrent massive bleed from post-banding ulcer. Sengstaken-Blakemore tube was deployed and she was transferred to our intensive care unit. At admission, she was having advanced hepatic encephalopathy and moderate ascites. An emergency bedside ultrasound performed in our unit revealed an acute portal vein thrombosis. Following the onset of acute PVT, liver decompensation had set in with rising bilirubin (>10 mg/dL) and high international normalised ratio (>3.5). In view of persistent bleed and coagulopathy, we could not start anticoagulation therapy for acute PVT. Transjugular intrahepatic portosystemic shunting (TIPS) could not be offered as there was worsening encephalopathy and high bilirubin. Hence, after thorough family discussion and informed consent, urgent living related liver transplantation was performed. The graft was the right lobe of liver donated by her son. Intraoperatively, there was complete portal vein thrombosis extending into superior mesenteric vein. Portal vein thrombectomy was done and soft clots removed re-establishing good portal flow of 1.6 litres per minute. Her post-operative period was uneventful and was started on anticoagulation therapy. She was discharged 3 weeks following transplantation and presently doing well. CONCLUSION: Liver transplantation has a role in the management of acute portal vein thrombosis. It has to be done on an urgent basis to prevent irreversible hepatic decompensation. Conflicts of interest: The authors disclose no conflicts.
Predicting Mortality Following Liver Transplantation: Role of Renal Biomarkers Madhusudhanan Jegadeesan, Neerav Goyal, and Subash Gupta Centre for Liver and Biliary Sciences, Indraprastha Apollo Hospitals, Delhi Mathura Road, Sarita Vihar, New Delhi, India BACKGROUND: In cirrhotic patients, renal dysfunction is a
marker of advanced liver disease and a predictor of mortality following liver transplantation. Serum creatinine (SCr) and spot protein-to-creatinine ratio (SPCR) in urine represent baseline tests in assessment of renal function. We analysed the utility of these biomarkers in predicting in-hospital mortality following living donor liver transplantation (LDLT). METHODS: All patients more than 18 years of age who underwent living donor liver transplantation in our unit from January to December 2015 were included in the
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study. Patients with end-stage renal disease who underwent combined liver kidney transplantation and patients with significant hematuria were excluded. A SPCR of 0.5 correlates with approximately 500mg proteinuria per day. RESULTS: A total of 329 patients underwent LDLT during the study period, among them, 248 patients met the inclusion criteria. Among them, 35 patients had serum creatinine 1.5 mg/dL and 89 patients had SPCR 0.5. Patients with SCr value of 1.5 had a mortality rate of 22% compared to 6% among patients with S Cr < 1.5 (p ¼ 0.0009). Among patients with SCr 1.5, SPCR was 0.5 in 17 patients and < 0.5 in 13 patients with no significant difference in the mortality rates between the two groups (23% and 23% respectively, p ¼0.97). Among patients with SCr < 1.5, SPCR was 0.5 in 72 patients and <0.5 in 114 patients with no significant difference in mortality rates between the two groups (9.7% and 5.2% respectively, p¼0.24). CONCLUSION: Among patients undergoing liver transplantation, SCr value of 1.5 is associated with high risk of postoperative mortality. Even though, proteinuria is a marker of renal dysfunction, spot protein-to-creatinine ratio does not predict renal-related mortality. Conflicts of interest: The authors disclose no conflicts.
Serum Ghrelin and Leptin Levels of Patients With Inflammatory Bowel Disease Compared to a Control Group and its Association With Nutritional Status: A Case-Control Study Firas Ghomraoui,1 Sami Alotaibi,1 Meshal Alharthi,1 Saeed Asiri,1 Majid Almadi,2,3 Othman Alharbi,3 Nahla Azzam,3 Abdulrahman Aljebreen,3 Maria Saeed,4 Baraa Hajkhder,4 Waleed Saeed,4 and Mohammed Alzoghaibi5 1
Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia, 2Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, McGill University, Montreal, Quebec, Canada, 3Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, 4 Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia, and 5Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia BACKGROUND: Inflammatory Bowel Disease (IBD) is frequently associated with loss of appetite, where it is thought that the hormones ghrelin and leptin may play a role. We aim to gauge the diagnostic and therapeutic value of these markers in the management of IBD. METHODS: This case-control study was conducted between May 2015 and March 2016. 31 IBD cases were recruited from the endoscopy unit, which consisted of active and non-active cases. Both fasting and non-fasting healthy controls were recruited randomly from the blood bank and the phlebotomy lab respectively (41 participants). Ghrelin and leptin serum levels were determined using enzyme-immunoassay (EIA) technique, whereas the
cirrhosis patients varies from 0.6% to 15%, which primarily reflects the incidence of chronic PVT. However, the incidence, natural history and management of Acute PVT in cirrhosis remains largely underreported. METHODS AND RESULTS: A 61 year-old female with Hepatitis C-related Child A cirrhosis was on sofosbuvir therapy. During an episode of endoscopic variceal ligation(EVL), she had recurrent massive bleed from post-banding ulcer. Sengstaken-Blakemore tube was deployed and she was transferred to our intensive care unit. At admission, she was having advanced hepatic encephalopathy and moderate ascites. An emergency bedside ultrasound performed in our unit revealed an acute portal vein thrombosis. Following the onset of acute PVT, liver decompensation had set in with rising bilirubin (>10 mg/dL) and high international normalised ratio (>3.5). In view of persistent bleed and coagulopathy, we could not start anticoagulation therapy for acute PVT. Transjugular intrahepatic portosystemic shunting (TIPS) could not be offered as there was worsening encephalopathy and high bilirubin. Hence, after thorough family discussion and informed consent, urgent living related liver transplantation was performed. The graft was the right lobe of liver donated by her son. Intraoperatively, there was complete portal vein thrombosis extending into superior mesenteric vein. Portal vein thrombectomy was done and soft clots removed re-establishing good portal flow of 1.6 litres per minute. Her post-operative period was uneventful and was started on anticoagulation therapy. She was discharged 3 weeks following transplantation and presently doing well. CONCLUSION: Liver transplantation has a role in the management of acute portal vein thrombosis. It has to be done on an urgent basis to prevent irreversible hepatic decompensation. Conflicts of interest: The authors disclose no conflicts.
Predicting Mortality Following Liver Transplantation: Role of Renal Biomarkers Madhusudhanan Jegadeesan, Neerav Goyal, and Subash Gupta Centre for Liver and Biliary Sciences, Indraprastha Apollo Hospitals, Delhi Mathura Road, Sarita Vihar, New Delhi, India BACKGROUND: In cirrhotic patients, renal dysfunction is a
marker of advanced liver disease and a predictor of mortality following liver transplantation. Serum creatinine (SCr) and spot protein-to-creatinine ratio (SPCR) in urine represent baseline tests in assessment of renal function. We analysed the utility of these biomarkers in predicting in-hospital mortality following living donor liver transplantation (LDLT). METHODS: All patients more than 18 years of age who underwent living donor liver transplantation in our unit from January to December 2015 were included in the
Abstracts
e43
study. Patients with end-stage renal disease who underwent combined liver kidney transplantation and patients with significant hematuria were excluded. A SPCR of 0.5 correlates with approximately 500mg proteinuria per day. RESULTS: A total of 329 patients underwent LDLT during the study period, among them, 248 patients met the inclusion criteria. Among them, 35 patients had serum creatinine 1.5 mg/dL and 89 patients had SPCR 0.5. Patients with SCr value of 1.5 had a mortality rate of 22% compared to 6% among patients with S Cr < 1.5 (p ¼ 0.0009). Among patients with SCr 1.5, SPCR was 0.5 in 17 patients and < 0.5 in 13 patients with no significant difference in the mortality rates between the two groups (23% and 23% respectively, p ¼0.97). Among patients with SCr < 1.5, SPCR was 0.5 in 72 patients and <0.5 in 114 patients with no significant difference in mortality rates between the two groups (9.7% and 5.2% respectively, p¼0.24). CONCLUSION: Among patients undergoing liver transplantation, SCr value of 1.5 is associated with high risk of postoperative mortality. Even though, proteinuria is a marker of renal dysfunction, spot protein-to-creatinine ratio does not predict renal-related mortality. Conflicts of interest: The authors disclose no conflicts.
Serum Ghrelin and Leptin Levels of Patients With Inflammatory Bowel Disease Compared to a Control Group and its Association With Nutritional Status: A Case-Control Study Firas Ghomraoui,1 Sami Alotaibi,1 Meshal Alharthi,1 Saeed Asiri,1 Majid Almadi,2,3 Othman Alharbi,3 Nahla Azzam,3 Abdulrahman Aljebreen,3 Maria Saeed,4 Baraa Hajkhder,4 Waleed Saeed,4 and Mohammed Alzoghaibi5 1
Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia, 2Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital, McGill University, Montreal, Quebec, Canada, 3Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, 4 Department of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia, and 5Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia BACKGROUND: Inflammatory Bowel Disease (IBD) is frequently associated with loss of appetite, where it is thought that the hormones ghrelin and leptin may play a role. We aim to gauge the diagnostic and therapeutic value of these markers in the management of IBD. METHODS: This case-control study was conducted between May 2015 and March 2016. 31 IBD cases were recruited from the endoscopy unit, which consisted of active and non-active cases. Both fasting and non-fasting healthy controls were recruited randomly from the blood bank and the phlebotomy lab respectively (41 participants). Ghrelin and leptin serum levels were determined using enzyme-immunoassay (EIA) technique, whereas the