Outcome Of Liver Transplantation In Patients Research Articles

Poster 27: Acute rehabilitation: comparison of functional outcomes of liver transplant and stroke patients

Objectives: To determine the functional outcomes of liver transplant patients with acute rehabilitation and to compare outcomes with those of stroke patients. Design: Retrospective study. Setting: Acute rehabilitation unit in a university hospital. Participants: Inpatient charts of 13 liver transplant patients and 13 stroke patients were reviewed. Interventions: The charts of 13 patients who underwent inpatient rehabilitation after liver transplants were reviewed to assess their functional gains. Their functional progress was measured on the FIM™ instrument at admission, weekly, and at discharge. Progress was compared with 13 age-matched stroke patients. Main Outcome Measures: FIM efficiency ratio of liver transplant patients was obtained by dividing the total FIM gain by the length of stay (LOS). This ratio was compared with that of the stroke patients. Results: The average age of the liver transplant patients was 56 years and that of the stroke patients was 55 years. The average admission FIM scores for transplant patients was 50 and discharge FIM scores was 76, compared with 51 and 72, respectively, for the stroke patients. The average LOS of the transplant patients was 20 days; it was 21 days for the stroke patients. The efficiency ratio was 1.35 for transplant patients and 1.33 for the stroke patients. The Student t test, with 24 degrees of freedom, showed no statistically significant differences between the liver transplant and stroke patients for their average admission and discharge FIM scores and efficiency ratios. There was also no significant difference in the average LOS. Conclusion: Patients with liver transplants made functional gains similar to those of stroke patients of similar age.

Poster 29: Functional outcomes of liver transplant patients treated in an acute rehabilitation setting

Objective: To determine associations between categorical and continuous variables that characterize liver transplant patients and outcome variables measuring resource utilization and functional gains during inpatient rehabilitation. Design: Retrospective review. Setting: Inpatient acute rehabilitation unit and community follow-up. Participants: 13 liver transplant patients undergoing initial acute rehabilitation. Interventions: ≥3h/d of acute multidisciplinary rehabilitation treatment. Main Outcome Measures: Rasch-converted FIM™ instrument scores, and categorical and continuous clinical variables. Results: Patients of a mean age of 52±12.35 years were admitted at a mean of 34.77±18.27 days after transplant. 9 of 13 patients were discharged to a residential setting, with mean rehabilitation length of stay (LOS) of 15.9±13.1 days. The median hospital charge was $21,500 (range, $7137–$107,568). These patients had a mean Model for End-Stage Liver Disease (MELD) score of 24.17±11.26 and serum ammonia averaged 104.46±73.08μmol/L. The Wilcoxon signed-rank assessment of paired t tests for differences between time points (admission, discharge, follow-up) showed that motor scores ( P<.001) improved for all timed comparisons, but cognitive scores did not improve ( P<.99). Motor function at admission correlated with hypoalbuminemia (Spearman P=.01), while cognitive function correlated with low levels of total protein (Spearman P=.014) and low globulin (Spearman P=.059). Despite this, these patients did not differ in the degree of cognitive or motor gains across their stay. Subgroups characterized by other clinical characteristics (eg, alcoholism, gender, cigarette use, diabetes) did not differ in rehabilitation outcomes, although LOS varied by group. Conclusion: Patients with end-stage liver disease are among the most medically complex and debilitated in the hospital. Despite this, we found that liver transplantation patients demonstrated significant reduction in motor disabilities when rehabilitation was provided in an inpatient rehabilitation unit setting. Cognition did not improve during the study period.

Iron overload in cirrhosis-HFE genotypes and outcome after liver transplantation.

Previously, we found appreciable hepatic iron deposition in one third of our patients undergoing liver transplantation (LTx) with approximately 10% of cases having quantifiable iron in the range of that seen in hereditary hemochromatosis (HHC). The aim of this study was to compare clinical outcome in liver transplant patients with and without iron overload. We also sought to determine the prevalence of HFE mutations in liver transplant patients with iron overload. Of 456 consecutive liver transplants, 41 explants had an hepatic iron index (HII) greater than 1.9, and these cases were compared to 41 matched liver transplant recipients without increased hepatic iron. Posttransplantation complications, along with patient and graft survival were monitored. HFE gene testing was performed using DNA-based techniques. Kaplan-Meier 5-year patient survival after LTx was significantly lower in cases with hepatic iron overload compared to matched controls without iron excess (48% vs. 77%; P =.045). Fatal infections (especially fungal) were more common in patients with iron overload (24% vs. 7%; P =.03). Of the 41 patients with a liver explant HII greater than 1.9, only 4 were C282Y homozygotes. Patients with severe hepatic explant iron overload undergoing LTx have a reduced survival compared to liver transplant recipients without explant iron excess. The reduced survival was attributable mainly to fatal bacterial and fungal infections. Despite the iron overload, HFE gene mutations were uncommon in patients with hepatic explant hemosiderosis.

Comparison of Outcome between Pediatric Liver Transplantation for Metabolic Diseases and Biliary Atresia.

773 Children with metabolic diseases (MD) have a defined enzyme deficiency in an often normal liver. MD are, after biliary atresia (BA) the second largest indication for liver transplantation (LT) in children. Cure of the disease and prevention of secondary damage to other organs or malignant degeneration in the liver are the main goals for treatment. Most MD patients have a normal liver function and no signs of portal hypertension. Furthermore, pretransplant abdominal surgery in MD patients is uncommon. The outcome of LT in patients with MD is considered to be superior to that for other indications. The aim of this study was to compare the outcome of LT in terms of patient survival, graft survival, and morbidity in MD and BA patients. From November 1982 to June 1997 24 children were transplanted for MD and 52 for BA. The mean (SD) Child-Pugh score in MD patients was 8.3 (3.2) and 9.8 (2.1) in BA patients (p<0.05). All but two BA patients (96%) had previous abdominal surgery compared to only five (24%) of the MD patients (p<0.001). Median follow-up in the MD patients was 3.5 year (range 1-9.3) and 4.2 year (range 0.3-14.1) in BA patients. One and five year patient survival in the MD patients was 96% and 84% compared to 84% and 70% for BA patients (p=ns). One and five year graft survival in the MD patients was 75% and 58% compared to 75% and 64% in BA patients (p=ns). During follow up three patients (13%) in the MD group died compared to 15 (29%) in the BA group (p=ns). The percentage of patients who experienced postoperative bleeding, gastrointestinal, biliary, vascular, infectious, and neurological complications or rejections was not different between both groups. Furthermore, there was no difference observed in ICU stay, days on the ventilator, complication rate, and intervention rate. Seven (29%) children of the MD group were retransplanted compared to 11 (21%) of the BA group (p=ns). Conclusion: Despite their better pretransplant condition the outcome after LT for MD is not different from that after LT for BA.

Incidence, prevalence, and clinical outcome of hepatitis GB-C virus infection in liver transplant patients.

A novel RNA virus of the Flaviviridae family has been discovered recently and designated hepatitis GB-C virus (GBV-C). Previous studies have reported that GBV-C is associated with posttransfusion hepatitis, chronic viral hepatitis, and cryptogenic hepatitis. However, the clinical significance of GBV-C infection has been questioned increasingly in patients not undergoing transplantation. To investigate whether GBV-C infection under immunosuppression affects the clinical or the histological outcome in liver transplant recipients, we determined the prevalence and incidence of GBV-C infections and the clinical and histological signs in patients after orthotopic liver transplantation (OLT). The presence of GBV-C was tested in sera from patients before and in regular intervals up to 6 years after OLT by nested reverse transcription-polymerase chain reaction using primers derived from the NS3 region. A total of 72 patients were studied. Before OLT, 8 of 72 (11.1%) patients were positive for GBV-C. After OLT, 7 of 8 (87.5%) remained positive. Of 64 patients who were negative for GBV-C before OLT, 23 became positive after OLT, resulting in a de novo rate of GBV-C infection of 35.9%. We could not detect a higher rate of histologically proven hepatitis in GBV-C-positive patients (29.1%) than in GBV-C-negative patients (14.6%, P > 0.057). Comparing GBV-C-positive with GBV-C-negative liver transplant patients, we could not find any differences in age, gender, liver function tests, number of blood transfusions, histological degree of hepatitis, or number of rejection episodes. Survival was not negatively influenced by GBV-C positivity. In conclusion, the presence of GBV-C did not influence the clinical or histological outcome in liver transplant patients.