Safety and outcomes of hip and knee replacement surgery in liver transplant recipients

BACKGROUND Liver transplant(LT)is becoming increasingly common with improved life expectancy.Joint replacement is usually a safe procedure;however,its safety in LT recipients remains understudied.AIM To evaluate the mortality,outcome,and 90-d readmission rate in LT patients undergoing hip and knee replacement surgery.METHODS Patients with history of LT who underwent hip and knee replacement surgery between 2016 and 2019 were identified using the National Readmission Database.RESULTS A total of 5046119 hip and knee replacement surgeries were identified.3219 patients had prior LT.Mean age of patients with no history of LT was 67.51[95%confidence interval(CI):67.44-67.58],while it was 64.05(95%CI:63.55-64.54)in patients with LT.Patients with history of LT were more likely to have prolonged length of hospital stay(17.1%vs 8.4%,P<0.001).The mortality rate for patients with no history of LT was 0.22%,while it was 0.24%for patients with LT(P=0.792).Patients with history of LT were more likely to have re-admissions within 90 d of initial hospitalization:11.4%as compared to 6.2%in patients without history of LT(P<0.001).The mortality rate between both groups during readmission was not statistically different(1.9%vs 2%,P=0.871)respectively.CONCLUSION Hip and knee replacements in patients with history of LT are not associated with increased mortality;increased readmissions were more frequent in this cohort of patients.Chronic kidney disease and congestive heart failure appear to predict higher risk of readmission.

The Author Reply

I have read with interest the comment on our manuscript[1]on different outcomes following cava reconstruction in liver transplantation using either cava replacement or piggy-back technique.Since its initial publication by Tsakis in 1989,2]the piggy-back technique has been variously modified.The

Infective Endocarditis-induced Crescentic Glomerulonephritis Dramatically Improved after Removal of Vegetations and Valve Replacement

Infective endocarditis （IE） is associated with poor prognosis and higher mortality. IE-induced glomerulonephritis, especially crescentic glomerulonephritis （IE-CGN） with renal dysfunction, is an independent risk factor for mortality For the treatment of IE-CGN, many therapeutic strategies including antibiotics alone, antibiotics combined with corticosteroid, immunosuppressive agents, plasmapheresis, or cardiac surgery have been applied and obtained various results.C21 Here, we reported a case of CGN with progressive renal failure secondary to IE in which the renal function was dramatically improved by the treatment of surgical valve replacement and antibiotics.

Intraoperative application of three-dimensional printed guides in total hip arthroplasty: A systematic review

BACKGROUND Acetabular component positioning in total hip arthroplasty(THA)is of key importance to ensure satisfactory post-operative outcomes and to minimize the risk of complications.The majority of acetabular components are aligned freehand,without the use of navigation methods.Patient specific instruments(PSI)and three-dimensional(3D)printing of THA placement guides are increasingly used in primary THA to ensure optimal positioning.AIM To summarize the literature on 3D printing in THA and how they improve acetabular component alignment.METHODS PubMed was used to identify and access scientific studies reporting on different 3D printing methods used in THA.Eight studies with 236 hips in 228 patients were included.The studies could be divided into two main categories;3D printed models and 3D printed guides.RESULTS 3D printing in THA helped improve preoperative cup size planning and post-operative Harris hip scores between intervention and control groups(P=0.019,P=0.009).Otherwise,outcome measures were heterogeneous and thus difficult to compare.The overarching consensus between the studies is that the use of 3D guidance tools can assist in improving THA cup positioning and reduce the need for revision THA and the associated costs.CONCLUSION The implementation of 3D printing and PSI for primary THA can significantly improve the positioning accuracy of the acetabular cup component and reduce the number of complications caused by malpositioning.

The prognostic role of postoperative serum creatinine(within 24 hours)for in-hospital and one-year mortality in middle-aged and aged patients with rheumatic heart disease

Background Increased serum creatinine(SCr)was common after cardiac surgery and associated with poor outcomes.However,the prognostic role of postoperative SCr level measured on the morning of the first day was unclear in middle-aged and aged patients with rheumatic heart disease(RHD)undergoing valve replacement surgery(VRS).Methods Consecutive middle-aged and aged patients(age≥45 years)diagnosed with RHD undergoing at least one valve replacement were enrolled.Patients were routinely taken into the intensive care unit(ICU)for special care within 1 hour after VRS.SCr was measured at ICU admission and on the first day morning(within 24 hours).Association of postoperative SCr level with in-hospital and one-year mortality was analyzed.Results 3919 patients were finally included and divided into 4 groups according to the quartiles of postoperative SCr level on the first day morning:<1.0 mg/d L(n=1064),1.0-1.2 mg/d L(n=892),1.2-1.5 mg/d L(n=956)and≥1.5 mg/d L(n=1007).SCr level measured on the first day morning following surgery was an independent predictor for in-hospital mortality(adjusted OR:3.42,95%CI:2.52-4.63,P<0.001)and 1-year mortality(adjusted HR:2.99,95%CI:2.32-3.86,P<0.001).SCr level measured at this time had a greater predictive power for inhospital mortality than that measured at the time of ICU admission after surgery(P<0.001).Cumulative one-year mortality was significantly higher in patients with upper postoperative SCr quartiles on the first day morning(Logrank:125.75,P<0.001).Conclusions Postoperative SCr level measured on the first day morning could serve as an early and powerful prognostic marker for in-hospital and one-year mortality in middle-aged and aged RHD patients undergoing VRS.Attention should be paid to RHD patients with increased postoperative SCr level within24 hours after surgery.