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Iron metabolism imbalance at the time of listing increases overall and infectious mortality after liver transplantation 被引量:2
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作者 Elodie Fallet Michel Rayar +9 位作者 Amandine Landrieux Christophe Camus Pauline Houssel-Debry Caroline Jezequel Ludivine Legros Thomas Uguen Martine Ropert-Bouchet Karim Boudjema Dominique Guyader Edouard Bardou-Jacquet 《World Journal of Gastroenterology》 SCIE CAS 2020年第16期1938-1949,共12页
BACKGROUND Liver transplantation(LT)is the best treatment for patients with liver cancer or end stage cirrhosis,but it is still associated with a significant mortality.Therefore identifying factors associated with mor... BACKGROUND Liver transplantation(LT)is the best treatment for patients with liver cancer or end stage cirrhosis,but it is still associated with a significant mortality.Therefore identifying factors associated with mortality could help improve patient management.The impact of iron metabolism,which could be a relevant therapeutic target,yield discrepant results in this setting.Previous studies suggest that increased serum ferritin is associated with higher mortality.Surprisingly iron deficiency which is a well described risk factor in critically ill patients has not been considered.AIM To assess the impact of pre-transplant iron metabolism parameters on posttransplant survival.METHODS From 2001 to 2011,553 patients who underwent LT with iron metabolism parameters available at LT evaluation were included.Data were prospectively recorded at the time of evaluation and at the time of LT regarding donor and recipient.Serum ferritin(SF)and transferrin saturation(TS)were studied as continuous and categorical variable.Cox regression analysis was used to determine mortality risks factors.Follow-up data were obtained from the local and national database regarding causes of death.RESULTS At the end of a 95-mo median follow-up,196 patients were dead,38 of them because of infections.In multivariate analysis,overall mortality was significantly associated with TS>75%[HR:1.73(1.14;2.63)],SF<100μg/L[HR:1.62(1.12;2.35)],hepatocellular carcinoma[HR:1.58(1.15;2.26)],estimated glomerular filtration rate(CKD EPI Cystatin C)[HR:0.99(0.98;0.99)],and packed red blood cell transfusion[HR:1.05(1.03;1.08)].Kaplan Meier curves show that patients with low SF(<100μg/L)or high SF(>400μg/L)have lower survival rates at 36 mo than patients with normal SF(P=0.008 and P=0.016 respectively).Patients with TS higher than 75%had higher mortality at 12 mo(91.4%±1.4%vs 84.6%±3.1%,P=0.039).TS>75%was significantly associated with infection related death[HR:3.06(1.13;8.23)].CONCLUSION Our results show that iron metabolism imbalance(either deficiency or overload)is associated with post-transplant overall and infectious mortality.Impact of iron supplementation or depletion should be assessed in prospective study. 展开更多
关键词 Iron deficiency OVERLOAD Cirrhosis Infection Death FERRITIN TRANSFERRIN saturation
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Comparison of alternative arterial anastomosis site during liver transplantation when the recipient’s hepatic artery is unusable 被引量:3
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作者 Jean Marie Beaurepaire Francesco Orlando +11 位作者 Giovanni Battista Levi Sandri Caroline Jezequel Edouard Bardou-Jacquet Christophe Camus Mohamed Lakehal Veronique Desfourneaux Aude Merdrignac Elodie Gaignard Alexandre Thobie Damien Bergeat Bernard Meunier Michel Rayar 《Hepatobiliary Surgery and Nutrition》 SCIE 2022年第1期1-12,共12页
Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not usable.Methods:We retrospectively evaluated the outcomes of LT performed using the different alter... Background:Few studies have analyzed outcomes of liver transplantation(LT)when the recipient hepatic artery(HA)was not usable.Methods:We retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA.Results:Between 2002 and 2017,1,677 LT were performed in our institution among which 141(8.4%)with unusable recipient HA were analyzed.Four groups were defined according to the site of anastomosis:the splenic artery(SA group,n=26),coeliac trunk(CT group,n=12),aorta using or not the donor’s vessel(Ao group,n=91)and aorta using a vascular prosthesis(Ao-P group,n=12)as conduit.The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups(5,5,8.5 and 16 for SA,CT,Ao and Ao-P group respectively,P=0.002),as well as fresh frozen plasma(4.5,2.5,10,17 for the SA,CT,Ao and Ao-P groups respectively,P=0.001).Hospitalization duration was also significantly increased in the Ao and Ao-P groups(15,16,24,26.5 days for the SA,CT,Ao and Ao-P groups respectively,P<0.001).The occurrence of early allograft dysfunction(EAD)(P=0.07)or arterial complications(P=0.26)was not statistically different.Level of factor V,INR,bilirubin and creatinine during the 7th postoperative days(POD)was significantly improved in the SA group.No difference was observed regarding graft(P=0.18)and patient(P=0.16)survival.Conclusions:In case of unusable HA,intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta. 展开更多
关键词 Liver transplantation(LT) hepatic artery(HA) arterial anastomosis splenic artery(SA)
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