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Relationship between the diagnosis, preoperative evaluation, and prognosis after orthotopic liver transplantation

Adler, M and Gavaler, JS and Duquesnoy, R and Fung, JJ and Svanas, G and Starzl, TE and Van Thiel, DH (1988) Relationship between the diagnosis, preoperative evaluation, and prognosis after orthotopic liver transplantation. Annals of Surgery, 208 (2). 196 - 202. ISSN 0003-4932

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Abstract

The purpose of this study was to identify which of the biochemical, immunological, or functional parameters derived before surgery as part of a systemic evaluation were helpful in predicting the frequency of rejection episodes, the chance of survival, and the cause risk of death (should death occur) of patients after orthotopic liver transplantation (OLTx). Ninety-eight adult patients who had an extensive preoperative protocol evaluation were studied before OLTx. The biochemical parameters assessed were albumin, prothrombin time, bilirubin, and ICG clearance. The immunologic parameters assessed included total lymphocytes, T3 cells, T4 cells, T8 cells, and the T4/T8 ratio. The degree of histocompatibility antigen (HLA) matching between the donor and the recipient was also evaluated in 80 of the 98 patients studied. Most postoperative deaths occurred within 12 weeks of the procedure (24%; 24 of 98 patients); 13 patients (13%) died within the first 6 postoperative weeks, of either bacterial or fungal sepsis. An additional 14 patients (14%) died after the initial 6 postoperative weeks due, primarily of an acquired viral and/or protozoan infection (p < 0.01). During the first 6 weeks, survival was better for patients with cholestatic liver disease (ChLD, 93%, n = 45) and miscellaneous liver diseases (MISC, 100%, n = 10) than it was for those with parenchymal liver diseases (PLD, 77%, n = 43). Although albumin, prothrombin time, T4/T8 ratios, and per cent T8 cells were statistically different in patients with PLD as compared with those with ChLD, these parameters, as well as the per cent T4 cells, serum bilirubin level, per cent retention of ICG at 15 minutes, and the plasma ICG disappearence rate were not found to be of substantial help in predicting patient survival or nonsurvival. Moreover, neither the degree of HLA matching nor the number of rejection episodes differed between surviving and nonsurviving patients. The results of this study suggest that patients with PLD are at increased risk of early postoperative death after OLTx because of bacterial and/or fungal sepsis, as compared with patients operated upon for ChLD. Better pre-, intra-, and postoperative predictors of risk of death and complications are needed to reduce the early mortality observed after orthotopic liver transplantation.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Adler, M
Gavaler, JS
Duquesnoy, R
Fung, JJ
Svanas, G
Starzl, TEtes11@pitt.eduTES11
Van Thiel, DH
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1988
Date Type: Publication
Journal or Publication Title: Annals of Surgery
Volume: 208
Number: 2
Page Range: 196 - 202
DOI or Unique Handle: 10.1097/00000658-198808000-00011
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0003-4932
Other ID: uls-drl:31735062130517, Starzl CV No. 901
Date Deposited: 08 Apr 2010 17:15
Last Modified: 02 Feb 2019 13:57
URI: http://d-scholarship.pitt.edu/id/eprint/4287

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