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Medicine May 2020The aim of the present study was to investigate the role of intraoperative oxygen content on the development of early allograft dysfunction (EAD) in patients undergoing... (Meta-Analysis)
Meta-Analysis
Influence of intraoperative oxygen content on early postoperative graft dysfunction in living donor liver transplantation: A STROBE-compliant retrospective observational study.
The aim of the present study was to investigate the role of intraoperative oxygen content on the development of early allograft dysfunction (EAD) in patients undergoing living donor liver transplantation (LDLT).This retrospective review included 452 adult patients who underwent elective LDLT. Our study population was classified into 2 groups: EAD and non-EAD. Arterial blood gas analysis was routinely performed 3 times during surgery: during the preanhepatic phase (ie, immediately after anesthetic induction); during the anhepatic phase (ie, at the onset of hepatic venous anastomosis); and during the neohepatic phase (ie, 1 hour after graft reperfusion). Arterial oxygen content (milliliters per deciliters) was derived using the following equation: (1.34 × hemoglobin [gram per deciliters] × SaO2 [%] × 0.01) + (0.0031 × PaO2 [mmHg]).The incidence of EAD occurrence was 13.1% (n = 59). Although oxygen contents at the preanhepatic phase were comparable between the 2 groups, the oxygen contents at the anhepatic and neohepatic phases were lower in the EAD group than in the non-EAD group. Patients with postoperative EAD had lower oxygen content immediately before and continuously after graft reperfusion, compared to patients without postoperative EAD. After the preanhepatic phase, oxygen content decreased in the EAD group but increased in the non-EAD group. The oxygen content and prevalence of normal oxygen content gradually increased during surgery in the non-EAD group, but not in the EAD group. Multivariable analysis revealed that oxygen content during the anhepatic phase and higher preoperative CRP levels were factors independently associated with the occurrence of EAD (area under the receiver-operating characteristic curve: 0.754; 95% confidence interval: 0.681-0.826; P < .001 in the model). Postoperatively, patients with EAD had a longer duration of hospitalization, higher incidences of acute kidney injury and infection, and experienced higher rates of patient mortality, compared to patients without EAD.Lower arterial oxygen concentration may negatively impact the functional recovery of the graft after LDLT, despite preserved hepatic vascular flow. Before graft reperfusion, the levels of oxygen content components, such as hemoglobin content, PaO2, and SaO2, should be regularly assessed and carefully maintained to ensure proper oxygen delivery into transplanted liver grafts.
Topics: Blood Gas Analysis; Graft Survival; Humans; Liver Transplantation; Living Donors; Monitoring, Intraoperative; Observational Studies as Topic; Oxygen; Patient Compliance; Primary Graft Dysfunction
PubMed: 32481323
DOI: 10.1097/MD.0000000000020339 -
Iranian Journal of Kidney Diseases Jul 2010The efficacy and safety of pegylated and standard interferon (IFN) have been scrutinized in meta-analyses; however, factors associated with hepatitis C viral response in... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The efficacy and safety of pegylated and standard interferon (IFN) have been scrutinized in meta-analyses; however, factors associated with hepatitis C viral response in patients on hemodialysis are not well investigated.
MATERIALS AND METHODS
We evaluated factors that could be associated with sustained virological response (SVR) to pegylated or standard IFN monotherapy in patients on hemodialysis with chronic hepatitis C virus (HCV) infection, by performing a systematic review of the literature with a meta-analysis of clinical trials. We used both Mantel-Haenszel and DerSimonian and Laird random effects models, with heterogeneity and sensitivity analyses.
RESULTS
Twenty-one studies on IFN-alfa2a or IFN-alfa2b (491 patients) and 12 on pegylated-IFN-alfa2a or PEG-IFN-alfa2b (279 patients) were evaluated. The pooled SVR for standard and pegylated IFN monotherapy in random effects model was 39.1% (95% confidence interval [CI], 32.1 to 46.1) and 39.3% (95% CI, 26.5 to 52.1), respectively. Pooled dropout rates were 22.6% (95% CI, 10.4 to 34.8) and 29.7% (95% CI, 21.7 to 37.7), respectively. Female gender, HCV-RNA copies per milliliter, HCV genotype, alanine transaminase pattern, duration of infection, liver fibrosis stage, and treatment duration were not associated with SVR. Only an age less than 40 years was significantly associated with SVR in both models (odds ratio, 2.17; 95% CI, 1.03 to 4.50).
CONCLUSIONS
Additional benefit of monotherapy with pegylated IFN in patients on hemodialysis with HCV infection in terms of viral response and adverse events is still unclear. According the current literature, younger age was the only determinant of SVR.
Topics: Antiviral Agents; Hepatitis C, Chronic; Humans; Interferon alpha-2; Interferon-alpha; Polyethylene Glycols; Recombinant Proteins; Renal Dialysis
PubMed: 20622305
DOI: No ID Found