Recurrence of primary sclerosing cholangitis after liver transplantation – analysing the European Liver Transplant Registry and beyond

Liver transplantation for primary sclerosing cholangitis (PSC) can be complicated by recurrence of PSC (rPSC). This may compromise graft survival but the effect on patient survival is less clear. We investigated the effect of post-transplant rPSC on graft and patient survival in a large European cohort. Registry data from the European Liver Transplant Registry regarding all first transplants for PSC between 1980 and 2015 were supplemented with detailed data on rPSC from 48 out of 138 contributing transplant centres, involving 1,549 patients. Bayesian proportional hazards models were used to investigate the impact of rPSC and other covariates on patient and graft survival. Recurrence of PSC was diagnosed in 259 patients (16.7%) after a median follow-up of 5.0 years (quantile 2.5%-97.5%: 0.4–18.5), with a significant negative impact on both graft (HR 6.7; 95% CI 4.9–9.1) and patient survival (HR 2.3; 95% CI 1.5–3.3). Patients with rPSC underwent significantly more re-transplants than those without rPSC (OR 3.6, 95% CI 2.7–4.8). PSC recurrence has a negative impact on both graft and patient survival, independent of transplant-related covariates. Recurrence of PSC leads to higher number of re-transplantations and a 33% decrease in 10-year graft survival

Barotrauma associated with mechanical ventilation [Mekanik ventilasyon ilişkili barotravma]

Objective: The incidence of barotrauma in patients who received mechanical ventilation (MV) has decreased due to protective MV strategies. This study aimed to assess the incidence, treatment, and prognosis of barotrauma in patients who received MV in our tertiary intensive care unit (ICU) and to discuss with the literature. Material and Methods: Patients hospitalized between January 2008 and December 2014 were assessed. Those who had barotrauma were retrospectively analyzed. Results: Invasive MV was performed in 861 of 1341 patients. Barotrauma was seen in 19 (2.2%) patients. These patients’ (mean age, 63.2±18.2 years; 14 males) median APACHE II score was 18, and their median duration of MV was 168 h. Acute Respiratory Distress Syndrome(ARDS) was diagnosed in 57.9% of the patients at admission, and volume-controlled ventilation was mostly used (47.4%). Barotrauma occurred on day 8 (median; range, day 4–21). Pneumonia was diagnosed in 84.2% of the patients. Pressure support ventilation was mostly used (47.4%) at the time of barotrauma. All patients had pneumomediastinum. Pneumothorax was diagnosed in 16 (84.2%) patients (bilaterally in 3 patients). Subcutaneous emphysema was seen in 11 patients (57.9%). Pneumothorax was treated by tube thoracostomy in 15 patients (83.3%). While the mortality rate was 26.3% in first 24 h, the overall mortality rate was 100%. Conclusion: The incidence of barotrauma was lower among our ICU patients who received MV, but the prognosis of these patients was poor. © 2017 by Turkish Society of Medical and Surgical Intensive Care Medicine

Solunumsal yoğun bakım ünitesinde mekanik ventilasyon uygulanan olgularda üst gastro-intestinal sistem kanamaları

Aim: The aims of this study were to evaluate the frequency, risk factors and outcomes of upper gastro-intestinal system (GIS) bleeding in respiratory intensive care unit (ICU) patients who received mechanical ventilation. Material and Methods: Fifty-six patients (39 males, mean age 64.2;plusmn;16.6 years), who were treated in the respiratory ICU for more than 5 days were included in the study. Risk factors and clinical outcomes of patients with gastrointestinal bleeding were evaluated. Results: Out of 56 patients, 10 (17.9%) developed upper GIS bleeding and 30 (53.6%) had ventilator associated pneumonia (VAP) and 22 of them (39.3%) died. There was no relationship between stress ulcer prophylaxis, feeding type and upper GIS bleeding, VAP. In patients with upper GIS bleeding, the frequency of VAP was higher (p=0.011), the duration of mechanical ventilation, stay in ICU and hospital were longer (p=0.05, p=0.023 and p=0.038, respectively) and mortality rate was found to be higher (p=0.006). There was no relationship between upper GIS bleeding and disease severity on admission, use of systemic corticosteroid, anti-coagulant therapy and coagulation disorders. Conclusion: Upper GIS bleeding increases the risk of VAP and mortality; prolongs the durations of stay in the ICU and hospital. Therefore, we conclude that upper GIS bleeding is a poor prognostic factor for respiratory ICU patients.Amaç: Bu çalışmada, mekanik ventilasyon uygulanan solunumsal yoğun bakım ünitesi (YBÜ) olgularında gelişen üst gastro-intestinal sistem (GİS) kanaması sıklığının, risk faktörlerinin ve sonuçlarının araştırılması amaçlanmıştır. Yöntem ve Gereç: Çalışmaya, solunumsal YBÜ'de beş günden uzun süre izlenen 56 olgu (39'u erkek, yaş ortalaması 64.2±16.6) alınmıştır. Gastro-intestinal sistem kanaması gelişen olguların risk faktörleri ve klinik sonuçları değerlendirilmiştir. Bulgular: 54 olgunun, 10'unda (% 17.9) üst GİS kanaması, 30'unda (% 53.6) ventilatör ilişkili pnömoni (VİP) gelişmiş ve 22'si (% 39.3) eksitus olmuştur. Stres ülser profilaksisi ve beslenme tipi ile üst GİS kanaması ve VİP gelişmesi arasında ilişki saptanmamıştır. Üst GİS kanaması ortaya çıkan olgularda; VİP gelişme oranı daha fazla (p=0.011), mekanik ventilasyon (MV) uygulama, YBÜ ve hastanede yatış süreleri daha uzun (sırasıyla, p=0.05, p=0.023 ve p=0.038) ve mortalite oranı daha yüksek (p=0.006) bulunmuştur. Başvurudaki hastalık ciddiyeti, sistemik kortikosterod kullanımı, anti-koagülan tedavi ve koagülasyon bozuklukları ile üst GİS kanaması arasında ilişki saptanmamıştır. Sonuç: Üst GİS kanaması VİP gelişme ve mortalite oranlarını artırmakta, YBÜ ve hastanede yatış sürelerini uzatmaktadır. Bu nedenle, solunumsal YBÜ olguları için üst GİS kanamasının kötü prognostik faktör olduğu sonucuna varılmıştır