Analysis of donor criteria for the prediction of outcome in clinical liver transplantation.

The results of 219 orthotopic human liver transplants performed during 1985 at the University of Pittsburgh were reviewed to determine whether donor parameters could be used to predict the quality of early graft function. Multivariate discriminant analysis demonstrated that traditional parameters of donor assessment are unreliable predictors of poor graft function. Furthermore, 56% of the donors considered poor by conservative selection criteria produced livers with good early posttransplant function. Survival of recipients of primary allografts from donors rated poor was no different than survival of recipients of allografts from donors rated good

A long-term survivor of repeated inguinal nodes recurrence of papillary serous adenocarcinoma of CUP: case report

BACKGROUND: Tumor spread beyond the peritoneal cavity in cases of papillary serous adenocarcinoma of the unknown primary (CUP) is a rare late event and carries a poor prognosis. CASE PRESENTATION: A 71-year-old female was referred to our hospital because of a large right inguinal tumor with biopsy evidence of carcinoma as well as an elevated serum CA125 (cancer antigen 125). She underwent complete resection of the right inguinal tumor and multiple pelvic tumors, which involved the rectum, ovary and uterus. Pathological examination revealed the tumors to be metastases of a papillary serous adenocarcinoma with a psammoma body of CUP. On the 28th postoperative day, newly developed asymptomatic small left inguinal node metastases in the setting of a normal CA125 level were removed. Four and a half years after the primary resection, the CA125 level increased again and newly developed asymptomatic metastases were found in the right deep inguinal nodes and extirpated at that time. All surgical resections followed the modified FAM (5FU, Adriamycin; ADM, MMC) regimen, including protracted dairy oral administration of UFT or 5'-FDUR, Cimetidine and PSK (protein-bound polysaccharide K) as an immunomodulator or biological response modifier in conjunction with intermittent one-day continuous infusion (ADM+MMC) or intermittent single bolus injection of ADM+MMC. At present, the patient has been living in good health for almost 7 years with no evidence of relapse. CONCLUSION: Aggressive resection surgery followed by effective adjuvant chemotherapy is necessary for surviving long time without relapse of poorly prognostic patients with metastases outside of the abdominal cavity from peritoneal papillary serous adenocarcinomas

Consequences of Cold-Ischemia Time on Primary Nonfunction and Patient and Graft Survival in Liver Transplantation: A Meta-Analysis

Introduction: The ability to preserve organs prior to transplant is essential to the organ allocation process. Objective: The purpose of this study is to describe the functional relationship between cold-ischemia time (CIT) and primary nonfunction (PNF), patient and graft survival in liver transplant. Methods: To identify relevant articles Medline, EMBASE and the Cochrane database, including the non-English literature identified in these databases, was searched from 1966 to April 2008. Two independent reviewers screened and extracted the data. CIT was analyzed both as a continuous variable and stratified by clinically relevant intervals. Nondichotomous variables were weighted by sample size. Percent variables were weighted by the inverse of the binomial variance. Results: Twenty-six studies met criteria. Functionally, PNF%=-6.678281+0.9134701*CIT Mean+0.1250879*(CIT Mean-9.89535) 2 - 0.0067663*(CIT Mean-9.89535) 3, r2=.625, p<.0001. Mean patient survival: 93 % (1 month), 88 % (3 months), 83 % (6 months) and 83 % (12 months). Mean graft survival: 85.9 % (1 month), 80.5 % (3 months), 78.1 % (6 months) and 76.8 % (12 months). Maximum patient and graft survival occurred with CITs between 7.5-12.5 hrs at each survival interval. PNF was also significantly correlated with ICU time, % first time grafts and % immunologic mismatches. Conclusion: The results of this work imply that CIT may be the most important pre-transplant information needed in the decision to accept an organ. © 2008 Stahl et al

Lactate/platelet ratio after liver transplantation; A novel predictor for short-term graft failure

Background; Recently, platelet count and lactate level after liver transplantation (LT) have been both separately reported as predictors of graft failure. In this study, we discovered a novel combination of these two parameters, “lactate level immediately post-LT (mmol/L)/platelet count on postoperative day 5 (x 1,000/ uL) ratio (LPR)” to predict short-term graft failure. Method; We retrospectively reviewed 434 deceased donor LT between January 2008 and December 2014. Using ROC analysis, cutoff values of LPR immediately post-LT for 90-days graft survival were determined. Risk factors for graft failure at 90-days and 1-year post-LT were analyzed by Cox regression model. Further, risk factors for high LPR combined with early allograft dysfunction (EAD) were determined by logistic regression model. EAD was defined as a peak values of aminotransferase\u3e2000 IU/mL during the first week or an international normalized ratio≥1.6 and/or bilirubin≥10 mg/dL at day 7. Results;Cut-off value for LPR to predict 90-day graft loss was 0.12 with AUC of 0.80 (sensitivity 71% and specificity 79%). On multivariate analysis, reoperation within 30 days (HR =2.97, P =0.03), EAD (HR =5.80, P =0.003) and LPR \u3e0.12 (HR =3.99, P =0.01) were independent risk factors for 90-days graft failure. Also, reoperation within 30 days (HR =2.15, P =0.02), EAD (HR =2.91, P =0.001), and LPR \u3e0.12 (HR =2.41, P =0.01) were independent risk factors for 1-year graft failure. Scoring system using EAD (0 or 1) and high LPR (0 or 1) stratified 90 days and 1 year graft survival (P \u3c0.001, [Figure 1]). Reoperation within 7 days (Odds ratio [OR] =7.24, P \u3c0.001), liver donor risk index \u3e1.70 (OR =2.92, P =0.02), and warm ischemia time \u3e45 minutes (OR =2.26, P =0.04) were considered independent risk factors for EAD with high LPR (\u3e0.12). Conclusions; Our results suggested that high LPR (\u3e0.12) might be a reliable predictor for early graft failure after LT, especially combined with EAD. Further investigation is warranted to elucidate the clinical implication of LPR