| Pretransplant severe hepatic encephalopathy, peritransplant sodium and post-liver transplantation morbidity and mortality. | |
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MedLine Citation:
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PMID: 22098119 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: Hepatic encephalopathy (HE) does not enhance the prediction of model of end-stage liver disease (MELD) wait-list mortality, but its influence on post-liver transplantation (LT) morbidity and mortality is largely unknown. AIMS: To examine the association between severe pre-LT HE and peri-LT serum sodium levels as well as post-LT length of stay (LOS) and survival. METHODS: A retrospective cohort of 393 adult patients undergoing first LT for end-stage liver disease and followed for a median of 4 years post-LT was performed to evaluate the association between severe HE within the 30 days prior to LT and selected in-hospital post-LT outcomes. RESULTS: Thirty-nine (10%) of the cohort had severe HE pre-LT. Patients with severe HE more frequently had Na changes of ≥15 mmol/L in the peri-LT period (P = 0.002). LOS was significantly longer for severe HE than non-severe HE patients (16 vs. 8 days, P < 0.0001) and this association was independent of MELD, presence of hepatocellular carcinoma, pre-LT nadir serum sodium and pre- to post-LT change in serum sodium. The 1-year mortality was 15% in the severe HE vs. 7% in the non-severe HE groups (HR = 2.19, P = 0.08), and this difference was attenuated by adjusting for pre-LT severe hypernatremia, but increased by adjusting for donor risk index. CONCLUSION: Severe HE mainly affects LOS, and this association is independent of MELD. Whether the large changes in peri-LT serum Na, more frequently seen in the severe HE group, contribute to post-LT morbidity requires further study. |
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Authors:
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Danielle Brandman; Scott W Biggins; Bilal Hameed; John P Roberts; Norah A Terrault |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-9-6 |
Journal Detail:
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Title: Liver international : official journal of the International Association for the Study of the Liver Volume: - ISSN: 1478-3231 ISO Abbreviation: - Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-11-21 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101160857 Medline TA: Liver Int Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 John Wiley & Sons A/S. |
Affiliation:
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Department of Medicine, University of California San Francisco, San Francisco, CA, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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