The age of liver donors has been increasing in the past several years because of a donor shortage. In the United States, 33% of donors are age 50 years or older, as are more than 50% in some European countries. The im...The age of liver donors has been increasing in the past several years because of a donor shortage. In the United States, 33% of donors are age 50 years or older, as are more than 50% in some European countries. The impact of donor age on liver transplantation(LT) has been analyzed in several studies with contradictory conclusions. Nevertheless, recent analyses of the largest databases demonstrate that having an older donor is a risk factor for graft failure. Donor age is included as a risk factor in the more relevant graft survival scores, such as the Donor Risk Index, donor age and Model for End-stage Liver Disease, Survival Outcomes Following Liver Transplantation, and the Balance of Risk. The use of old donors is related to an increased rate of biliary complications and hepatitis C virus-related graft failure. Although liver function does not seem to be significantly affected by age, the incidence of several liver diseases increases with age, and the capacity of the liver to manage or overcome liver diseases or external injuries decreases. In this paper, the importance of age in LT outcomes, the role of donor age as a risk factor, and the influence of aging on liver regeneration are reviewed.展开更多
Introduction Autoimmune diseases result from a breach of immunological self-tolerance and tissue damage by autoreactive T lymphocytes.Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is characteriz...Introduction Autoimmune diseases result from a breach of immunological self-tolerance and tissue damage by autoreactive T lymphocytes.Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is characterized by an inflammatory dysregulation that has been associated with the development of autoimmune processes[1].展开更多
背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出...背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出现的并发症,包括死亡、肠梗阻、吻合口漏、消化道出血、腹腔脓肿、切口感染、导管相关感染及其他腹腔外感染。结果:364例患者纳入分析,手术时患者的中位年龄38岁,男性占50%。手术适应证:狭窄型占46.4%,穿透型占31.3%,狭窄+穿透型占14.0%,药物难治性占5.8%。100例(27.5%)出现术后近期并发症,其中切口感染、腹腔脓肿和吻合口漏最为常见。出现并发症的患者其中位住院时间较未出现并发症者显著延长(16 vs 9天,P<0.001)。术后并发症更多发生于穿透型病变(36/114,31.6%)和药物难治性(9/21,42.9%)患者,而狭窄型(45/169,26.6%)和狭窄+穿透型(6/51,11.8%)患者并发症发生率相对较低(P=0.040)。术中才作出诊断的患者,术后并发症发生率较术前已明确诊断者显著升高[48.4%(15/31)vs.25.7%(85/331),P=0.013)。手术期间接受药物治疗并不会影响并发症发生率。结论:约四分之一的克罗恩病患者行回结肠切除术后会出现近期并发症,其中穿透型病变和急诊手术患者术后并发症风险增高。展开更多
Portal hypertension in patients with cirrhosis is common and can lead to severe complications that are associated with decreased survival.Among these complications,portal hypertensive bleeding and refractory ascites i...Portal hypertension in patients with cirrhosis is common and can lead to severe complications that are associated with decreased survival.Among these complications,portal hypertensive bleeding and refractory ascites in many cases can be managed with the placement of a transjugular intrahepatic portosystemic shunt(TIPS).Current indications of TIPS placement include variceal hemorrhage refractory or recurrent to standard therapy with vasoactive drugs and endoscopic variceal ligation[1].Also,in carefully selected patients(i.e.Child-Pugh class C cirrhosis with score 10-13 and Child Turcotte Pugh(CTP)class B with active bleeding on endoscopy),early TIPS(placed within 72 hours of admission)after vasoactive drugs and endoscopic band ligation improves outcomes.This intervention reduces the risk of rebleeding among this group of high-risk patients and is associated with increased survival[2].TIPS is also a treatment of choice in patients bleeding from cardiofundal varices(GOV2 and IGV1)and ectopic varices[1].Refractory ascites is also an indication for TIPS placement.However,its efficacy is controversial in this setting.It is clear that TIPS is associated with a better control of ascites than large-volume paracentesis.That said,TIPS is followed by a greater incidence of hepatic encephalopathy.Controversial results regarding the survival benefits of TIPS have emerged and are still a matter of intense debate[3].In summary,a careful selection of candidates for TIPS placement is necessary if refractory ascites is the indication for TIPS.Specifically,TIPS can be detrimental in older patients with cardiopulmonary disease as well as in patients in CTP class C and higher Model for End Stage Liver Disease(MELD)scores.It has to be noted that most of the randomized trials evaluating survival of TIPS have been performed using bare stents[4].展开更多
文摘The age of liver donors has been increasing in the past several years because of a donor shortage. In the United States, 33% of donors are age 50 years or older, as are more than 50% in some European countries. The impact of donor age on liver transplantation(LT) has been analyzed in several studies with contradictory conclusions. Nevertheless, recent analyses of the largest databases demonstrate that having an older donor is a risk factor for graft failure. Donor age is included as a risk factor in the more relevant graft survival scores, such as the Donor Risk Index, donor age and Model for End-stage Liver Disease, Survival Outcomes Following Liver Transplantation, and the Balance of Risk. The use of old donors is related to an increased rate of biliary complications and hepatitis C virus-related graft failure. Although liver function does not seem to be significantly affected by age, the incidence of several liver diseases increases with age, and the capacity of the liver to manage or overcome liver diseases or external injuries decreases. In this paper, the importance of age in LT outcomes, the role of donor age as a risk factor, and the influence of aging on liver regeneration are reviewed.
基金Instituto de Investigacion Biom-edica de Malaga-IBIMA,Hospital Universitario Virgen de la Victoria,Universidad de Malaga,Malaga,Spain,Centro de Investigacion Biomedica en Red de Enfermedades Hepa ticas y Digestivas(CIBERehd),Madrid,SpainGrants of Instituto de Salud CarlosⅢcofounded by Fondo Europeo de Desarrollo Regional-FEDER[contract numbers:PI18/00901,UMA18-FEDERJA-193],COST ACTION CA17112-Prospective European Drug-Induced Liver Injury Network and IMI2-Translational Safety Biomarker Pipeline(TransBioLine Horizonte 2020)CM21/00074(Rio Hortega contract:J.M.P.B.).
文摘Introduction Autoimmune diseases result from a breach of immunological self-tolerance and tissue damage by autoreactive T lymphocytes.Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is characterized by an inflammatory dysregulation that has been associated with the development of autoimmune processes[1].
文摘背景:本研究旨在分析克罗恩病患者回结肠切除术后近期并发症的发生率及危险因素。方法:对PRACTICROHN研究队列进行回顾性分析,纳入2007年1月至2010年12月间行回结肠切除一期吻合的成人克罗恩病患者。术后近期并发症定义为术后30天内出现的并发症,包括死亡、肠梗阻、吻合口漏、消化道出血、腹腔脓肿、切口感染、导管相关感染及其他腹腔外感染。结果:364例患者纳入分析,手术时患者的中位年龄38岁,男性占50%。手术适应证:狭窄型占46.4%,穿透型占31.3%,狭窄+穿透型占14.0%,药物难治性占5.8%。100例(27.5%)出现术后近期并发症,其中切口感染、腹腔脓肿和吻合口漏最为常见。出现并发症的患者其中位住院时间较未出现并发症者显著延长(16 vs 9天,P<0.001)。术后并发症更多发生于穿透型病变(36/114,31.6%)和药物难治性(9/21,42.9%)患者,而狭窄型(45/169,26.6%)和狭窄+穿透型(6/51,11.8%)患者并发症发生率相对较低(P=0.040)。术中才作出诊断的患者,术后并发症发生率较术前已明确诊断者显著升高[48.4%(15/31)vs.25.7%(85/331),P=0.013)。手术期间接受药物治疗并不会影响并发症发生率。结论:约四分之一的克罗恩病患者行回结肠切除术后会出现近期并发症,其中穿透型病变和急诊手术患者术后并发症风险增高。
文摘Portal hypertension in patients with cirrhosis is common and can lead to severe complications that are associated with decreased survival.Among these complications,portal hypertensive bleeding and refractory ascites in many cases can be managed with the placement of a transjugular intrahepatic portosystemic shunt(TIPS).Current indications of TIPS placement include variceal hemorrhage refractory or recurrent to standard therapy with vasoactive drugs and endoscopic variceal ligation[1].Also,in carefully selected patients(i.e.Child-Pugh class C cirrhosis with score 10-13 and Child Turcotte Pugh(CTP)class B with active bleeding on endoscopy),early TIPS(placed within 72 hours of admission)after vasoactive drugs and endoscopic band ligation improves outcomes.This intervention reduces the risk of rebleeding among this group of high-risk patients and is associated with increased survival[2].TIPS is also a treatment of choice in patients bleeding from cardiofundal varices(GOV2 and IGV1)and ectopic varices[1].Refractory ascites is also an indication for TIPS placement.However,its efficacy is controversial in this setting.It is clear that TIPS is associated with a better control of ascites than large-volume paracentesis.That said,TIPS is followed by a greater incidence of hepatic encephalopathy.Controversial results regarding the survival benefits of TIPS have emerged and are still a matter of intense debate[3].In summary,a careful selection of candidates for TIPS placement is necessary if refractory ascites is the indication for TIPS.Specifically,TIPS can be detrimental in older patients with cardiopulmonary disease as well as in patients in CTP class C and higher Model for End Stage Liver Disease(MELD)scores.It has to be noted that most of the randomized trials evaluating survival of TIPS have been performed using bare stents[4].
