جستجوی مقالات مرتبط با کلیدواژه « پیوند کبد » در نشریات گروه « پزشکی »

 Various factors, including viruses, are involved in developing liver cirrhosis. Although the association of human herpesvirus-8 (HHV-8) with liver cirrhosis remains poorly understood, a significant increase in the titer of antibodies against this virus has been observed in cirrhotic patients. The present study aimed to evaluate the frequency of HHV-8-immunoglobulin G (HHV-8 IgG) in Iranian patients with liver cirrhosis.

In this cross-sectional study, 30 healthy blood donors and 30 patients with liver cirrhosis related to hepatitis B (n=20) and hepatitis C (n=10) viruses from those waiting for liver transplantation were included. The serum seropositivity of HHV-8 IgG antibody was evaluated using the enzyme-linked immunosorbent assay (ELISA) technique.

The seropositivity of HHV-8 IgG antibodies in patients and healthy groups was 6.7% (2 patients) and 3.3% (1 case), respectively, which did not show a significant difference between the two groups (P=0.554). In addition, the infection was not significantly related to the age and gender of the patients (P>0.05).

Considering the low prevalence of HHV-8 infection in Iranian patients with liver cirrhosis, it can be concluded that HHV-8 may not be associated with the incidence and progression of liver cirrhosis. Therefore, HHV-8 monitoring will not raise the concern about the development or worsening of liver disorders.

In recent years, tremendous progress has been made in organ transplantation; as a result, the legal issues associated with it have become more visible, too. Furthermore, transplant patients need more exact knowledge and observing patient rights is more crucial to them, considering their special condition. Therefore, the present study was conducted with the aim of investigating the level of observing Patient Rights Charter in Montaserieh Hospital, Mashhad in 2017 from the perspective of the transplant patients.

The current research is a descriptive cross-sectional study conducted on 99 liver and kidney transplant patients during the first 3 months of 2017 at Montaserieh Hospital, Mashhad. In order to investigate the level of observing Patient Rights Charter from the perspective of transplant patients, the researcher made a questionnaire consisting of 28 questions, based on the 5 dimensions of Patient Rights Charter in Iran. The data was analyzed using descriptive statistics in SPSS software version 16.

Ethical Considerations: 

Sufficient explanations regarding the objectives of the research were given to the subjects and data confidentiality was ensured.

The mean score of observing Patient Rights Charter was 100.05±20.24. From the perspective of the transplant patients, the second dimension (the right to receive sufficient information in a desirable manner), with the mean of 36.53±7.88 and the fifth dimension (the right to access an efficient complaint-handling system), with the mean of 5±3.70 were, respectively, the rights observed the most and the least.

Surveying the patients, it was found that the dimensions of patients’ right to have freedom of choice and making decisions around receiving healthcare services and the right to have access to an effective complaint-handling system have been observed less frequently than others. Therefore, it is recommended that healthcare centers provide patients with sufficient explanations regarding the treatment plan so that they can participate in choosing their treatment methods. In addition, certain guidelines should be developed to ensure access to an efficient complaint-handling system.

In liver transplant patients, the occurrence of postoperative complications increases the length of hospitalization, care of patients and the costs of treatment. The aim of this study was to predict the complications of hepatic encephalopathy in liver transplant patients using the support vector machine (SVM) algorithm in active middle-aged women.

The statistical population included 652 patients, among them, 165 active middle-aged women with encephalopathy symptoms who underwent liver transplantation during 2011-2022 were included. SVM algorithm was used to predict the complications of hepatic encephalopathy in liver transplant patients and MATLAB software was used for data analysis.

Using 14 features related to laboratory, anthropometry and lifestyle data, the SVM algorithm can predict people with and without hepatic encephalopathy complications with 81.2% accuracy and 74.6% precision.

According to the accuracy of the SVM algorithm on the data, it seems that this system may help physicians predict the risk of hepatic encephalopathy complications after transplantation with high accuracy and the lowest cost. Computer-based decision support systems can reduce poor clinical decisions and also minimize costs associated with unnecessary clinical trials.

Hemodynamic changes are one of the most important risk factors for complications in rhinoplasty. The aim of this study was to compare the effect of remifentanil and nitroglycerin on intraoperative blood pressure and other complications during and after rhinoplasty in surgical center.

This was a quasi-experimental double-blind study performed on patients referred to Imam Ali Clinic of Shahrekord University of Medical Sciences, Iran, for rhinoplasty in year 2017. 50 rhinoplasty candidates with class one and two American Society of Anesthesiologists (ASA) were randomly divided into two groups of 25. Simultaneously, with the administration of anesthesia in the first group, remifentanil (0.1-0.3 μg/kg/minute) and in the second group, nitroglycerin (0.5-1 μg/kg/minute) were administered. During the surgery, heart rate, bleeding, systolic and diastolic blood pressure, were recorded. Moreover, the amount and degree of ecchymosis and edema were determined.

There was no significant difference between the two groups in terms of duration of surgery, bleeding during surgery, mean heart rate, ecchymosis, edema, and diastolic blood pressure at different times. Mean heart rate and diastolic blood pressure at different time were not significantly different between the two groups, too. But, the amount of reducing in systolic blood pressure at 5 minutes in remifentanil group (17.64 ± 14.39 mmHg) was significantly lower than nitroglycerin group (25.60 ± 7.09 mmHg).

The results indicate similar function of remifentanil and nitroglycerin in reducing intraoperative bleeding and complications during and after rhinoplasty surgery.

Compliance of patients in need of liver transplantation is impaired due to many reasons, and this affects the pre and post outcomes and complications of transplantation. Therefore, the aim of this study was to evaluate the effect of a care program on the compliance of patients awaiting liver transplantation.

This quasi-experimental study was conducted in 2018 on 117 patients waiting liver transplantation in Imam Khomeini Hospital of Tehran. Based on entry criteria, the samples were selected purposefully and their compliance was evaluated. Then, a care program was implemented for them. The data collection tool was a compliance questionnaire, which was completed before and six weeks after the intervention. Data analysis was done by SPSS software.

The results showed that, the compliance of diet and medication improved after the implementation of care program in patients waiting for liver transplantation (P<0.01). But there was no significant relationship with physical activity.

The results of this study indicated a positive effect of the care program on improving the compliance of diet and medication in patients awaiting liver transplantation. Eliminating the problems of these patients requires the attention and support of planners and the cooperation of managers in order to develop care programs that can be used by healthcare professionals, especially nurses.

The only option for treatment of end stage liver diseases is liver transplantation. Afzalipour Hospital in Kerman, Iran is the third largest liver transplantation center in Iran. In this study, the outcomes of this center have been studied during the past 5 years.

In this cross-sectional study, the pre and post transplantation’s clinical, demographic and outcome data of all patients who received liver transplant at Afzalipour Hospital during the past 5 years have been collected and reviewed. SPSS software ver. 16 was used to analyze the data.

Forty-three patients have received liver transplantation during this time interval. The 3-year survival rate of patients was 77%. The most common cause of death was primary nonfunction graft after transplantation. The most common complication was acute rejection (15%), all of which were successfully treated with corticosteroids.

 Due to increment of cases of acute and chronic liver failure in the community and since the final treatment of these cases is liver transplantation, so there is need to develop liver transplant centers in the future. Quantitative and qualitative study of the activity of centers based liver transplant in Iran is necessary to set up successful centers.

 Giant hemangiomas are less likely to be present at birth. This syndrome is caused by obstruction of the portal veins of the liver and requires surgical intervention. Treatment of hepatic hemangiomas varies depending on the symptoms, location and size. In this study, giant hepatic hemangioma in a patient with Budd-Chiari syndrome was reported.

CASE REPORT:

 The patient is a 57-year-old woman with a giant hemangioma in the liver who has referred to Montaserieh Hospital in Mashhad with symptoms of liver failure, anorexia and early satiety and obstruction of hepatic portal veins. She did not mention any specific drug or food allergies. Except for the heartbeat, all other vital signs were in the normal range. Initial examinations diagnosed giant liver hemangiomas and ascites. After performing the required diagnostic tests, the liver weighing about 10 kg was removed and a liver transplant was performed. After 13 days, the patient was discharged in good general condition.

 One of the rare indications for liver transplantation is giant hepatic hemangioma, which causes liver dysfunction and Budd-Chiari syndrome. Liver transplantation in these patients improves their life and shows good results.

Liver transplantation, which is done by spending a lot of resources and expenses at hospitals, is an important medical choice for patients suffering fulminant hepatitis and end stage liver diseases. So it is significant to find some ways to manage the patients more efficiently and to reduce caring expenses. The aim of this study is to determine the influential effects of lingering recipients’ length of stay at hospital after liver transplantation.

This study is a retrospective and the research community includes all patients under liver transplantation. 161 among them are chosen by availability method concerning inclusion and exclusion criteria. The study was located at Imam Khomeini Hospital Complex. All factors related to post liver transplantation have been based on forms including personal information, clinical and laboratory factors mentioned in patients’ files. These forms are made by researcher and their validity and reliability have been measured. Reliability analysis is tested through Spearman and Pearson Test. Also T-test and ANOVA are used to compare the average length of stay. To assess the simultaneous effect of variables on length of stay, multiple linear regression was used.

Single variable analysis results show that there is a meaningful relation between length of stay and Bacterial infection, pulmonary effusion, ascites, renal failure (hemodialysis), wound infection, Re-operation, psychiatric problems and re-transplantation (P value<0.05). Finally, a model for most effective factor on length of stay was presented by step-by-step analysis of these influential factors through multiple linear regression.

Among many factors of post liver transplantation, there was a meaningful relation between some factors and length of stay which also influences the treatment results and related expenses. Therefore, it is possible to shorten the length of stay after liver transplantation by designing necessary variables and moderating determinate factors mentioned in this study.

Prostate cancer is considered to be the most prevalent malignancy among males. Prostate specific antigen (PSA) is used for screening this malignancy. Serum levels of PSA is influenced by liver function. This study evaluated variations of serum levels of PSA amongst cirrhotic patients, before and after receiving liver transplantation.

All cirrhotic males older than 45 y/o in the waiting list of liver transplant, were enrolled in the study. After receiving a medical history and checking a total PSA (tPSA), patients who had abnormality were excluded from the study. So, 60 patients who underwent liver transplantation surgery, with a normal 3 month follow up liver function tests (LFT) participated in this study. Thereafter the tPSA level was checked again. Ultimately 30 patients performed the tPSA after a successful liver transplant.

The mean age of these 30 patient was 57, and average tPSA before liver transplant was 0.4 ng/dl (range: 0.07-1.6), and was 1.6 (range: 0.2-7.3) after transplant. Wilcoxon test revealed significant differences between pre and post-transplant PSA levels (P˂0.001, Z= -4.68).

Serum levels of PSA, rises after a successful liver transplant. In cirrhotic patients, PSA levels may not be authentic. In this study, PSA levels rose by 1.2 ng/dl post-transplant. This study revealed that tPSA may be neither reliable nor sensitive enough as a routine screening test for cirrhotic patients; and seems to do the screening there is a need for lower levels comparing to healthy people for the test.

We assessed different systolic cardiac indices to describe left and right ventricular dysfunction in cirrhotic patients before liver transplantation.
In this case-control study, eighty-one consecutive individuals with the confirmed hepatic cirrhosis and candidate for liver transplantation in the Imam Khomeini Hospital between March 2008 and March 2010 were selected. Thirty-two age and gender cross-matched healthy volunteers were also selected as the control group. A detailed two-dimensional and Doppler echocardiography was obtained in all patients and controls performed by the same operator on the day of admission.
Dimensions of both left and right atriums as well as left ventricular end-diastolic volume and basal right ventricular dimension in the cirrhotic group were significantly higher than control group. Left ventricular end-systolic dimensions as well as aortic annulus diameter were not different between the two study groups. Left ventricular outflow tract velocity time integral, isovolumic pre-ejection time, isovolumic relaxation time, stroke volume, left ventricular ejection fraction, IVCT⅔司, systolic velocity of tricuspid annulus, systolic velocity of basal segment of RV free wall, systolic velocity of basal segment of septal wall, peak strain of septal margin (base), peak strain of septal margin (midpoint), peak strain of lateral margin (midpoint), strain rate of septal margin (base), strain rate of septal margin (midpoint), strain rate of lateral margin (base), strain rate of lateral margin (midpoint), Tei index (left and right ventricles), systolic time interval and tricuspid annular plane systolic excursion were higher in cirrhotic group, significantly, (P In this study, the effects of liver on heart were volume overload, hyperdynamic state and systolic dysfunction in cirrhotic patients. These effects were due to chamber enlargement and we cannot use the most of cardiac indices for evaluation systolic function in cirrhotic patients. So, we suggest that systolic time interval and Tei index are useful indices in evaluation of systolic function in cirrhotic patients.

The main challenge in liver transplantation is shortage of donor organs, and using living donor live transplantation (LDLT) has been considered as a new strategy. This study aimed to explore the concept of liver transplantation in living donors’ experiences after donating.
A qualitative study with qualitative descriptive approach was conducted in 12 participants with 4 days to 12 years history of liver donation, who were selected using purposive sampling. Data was collected using unstructured in-depth interviews and was analyzed by content analysis and constant comparative analysis.
One main theme and five sub themes emerged. Participants described liver donation as a "life-saving and voluntary action with different aspects influencing life". From physical and emotional aspects, the liver transplantation was described as “a relatively hard surgery with unpleasant physical consequences after surgery which is required a continued home care” and “A combination of positive and negative feelings including hope, fear and concern”, respectively. The liver transplantation was identified as a humanitarian action, life-giving and beautiful, from the spiritual aspect. From the social dimension liver transplantation was explained as” a voluntary work with social prestige which needs the family and government support”, and from the economic aspects it was identified as” an expensive and time-consuming procedure”.
Although living donors have experienced numerous problems, donation was perceived as a voluntary lifesaving behavior. Even though, a low severity of physical complications, and gradual returning to previous healthy condition was reported by most of participants, further research is needed to recommend this operation. In addition to physical dimension, the other aspects of liver transplantation should be considered and supported by nurses and supportive organizations

Liver transplant is a unique and rare experience through which an individual gets a second chance to live. Awareness of liver transplant recipients’ experiences can improve our understanding of their needs and the quality of their care.
To assess the psychological experiences of liver transplant recipients.
In this qualitative phenomenological study, liver transplant recipients were purposefully selected from Afzalipour Hospital, Kerman, Iran. Data were collected through unstructured in-depth interviews with eight patients. The Colaizzi’s method was used for data analysis.
Four main themes emerged from data analysis. These themes were impatience, depression, fear, and tendency toward pious deeds.
The psychological problems identified in the studied liver transplant recipients emphasize the necessity of attention to these patients’ not only somatic symptoms, but also psychological needs. Therefore, these patients have to receive psychological counselling both before and after the surgery.

Identification of common infections and their effective factors among transplant recipients plays a major role in prevention and control of these disorders. This study aimed to survey post-transplant early infections and their major risk factors.
This prospective study was performed on 582 transplanted patients in Namazi transplant center from 2011 to 2013. These patients were followed up regarding the incidence of any kind of infection through Para clinical experiments for 6 months after transplantation. The patients who referred with clinical symptoms were followed, as well. The data were analyzed using the SPSS statistical software, version 19.
In this study, 140 patients experienced 194 types of infections during 6 months, 106 of whom had 133 kinds of infections which were mostly bacterial within the first month. Besides, 50 patients experienced 61 types of infections between the first and the sixth month. Bacterial infections comprised most of the cases within the first 6 months after transplantation. Among the risk factors, length of hospital stay (P=0.048 and OR=1.018) and MELD score (P=0.044 and OR=1.035) were significantly associated with post-transplant infections.
The study findings showed that MELD score and length of hospital stay were significantly related to increase in the incidence of post-transplant early infections. Besides, most of these infections occurred within the first month after transplantation due to treatment processes and hospital infections. After the first month, opportunistic infections were common among the patients. By knowing these common infections and their risk factors, we can increase the readiness of the transplantation team for preventing and controlling these infections.

Liver transplantation is the treatment of choice in end stage liver disease. Marginal graft is a criteria for selecting appropriate liver in many centers. Many studies indicated that SIG is a good predictor for outcome. Our primary objective was to find a correlation between SIG and graft function. Secondary objective was comparison between SIG and marginal graft criteria.

This study was performed in 61 liver recipients. All recipients were selected for transplantation by marginal graft criteria. Strong ion was measured and according to ionized portion SIG was calculated. According to cut of point of SIG=10 and marginal graft criteria, patients were divided into two groups and then compared with each other.

This study was conducted on 61 liver recipients. 39 (63.9%) of them developed with transplantation complication. Only 3(4.9%) presented with PNF and 1 (1.6%) presented with DNF. Mean SIG was 18.41±1.71. 49.2% of livers was marginal. 68% of donors had SIG>10 and 32% had SIG> 10. No difference was seen in these two groups according to liver transplantation complication. (Pvalue: 0.286) In group SIG>10 mean AST was 297±730 and mean ALT was 292±438 and in group SIG<10 mean AST and ALT was 350±566 and 383±440 respectively. This difference is clinically significant. No difference was seen in marginal and non-marginal graft according to liver transplantation complication. (Pvalue:0.245)

SIG in donor is not an appropriate predictor for liver transplantation outcome.

The incidence of diabetes in liver transplant recipients is one of the common problems among these patients witha negative effect on the success of the transplant and the patient's life. Post Transplant Diabetes Mellitus (PTDM) has many similarities with type 2 diabetes from pathophysiplogical, clinical, and genetic viewpoints... One of the genotypes involved in PTDM is KCNJ11 (rs 5219) that has role in beta-cell function and has regulator effect on ATP sensitive K channels. The purpose of this study is to review the relation between this polymorphism and diabetes after liver transplantation in an Iranian population. This is a case-control study on 120 patients receiving liver transplant, including 60 patients with PTDM and 60 patients without PTDM. White blood cell samples were selected from the cell bank of organ transplantation research centre in Namazi Hospital from patients who had undergone liver transplantation during the years 2008 and2012. Frequency of genotypes in this population was determined by PCR-RFLP method. To express the results we used distribution indices and parametric statistical tests. Statistical analysis shows that there is a significant difference between the genotype and the allele frequencies of the two groups of case and control.. KK genotype (P=0.001; 95%CI (1.60-7.6); OR=1.19 increases the risk of PTDM. Our study shows that there is a relation between the incidence of PTDM and sex, age, prednisolone dosage, KCNJ11 polymorphism, and KK genotype.

Abstract Lymph proliferative is the popular disease after organ transplant. The prophylactic use of ganciclovir is one of the solutions in preventing this disease. In this study, the effect of prophylaxis ganciclovir in the prevention of PTLD in children was examined. In this cohort study, case group of children who had undergone a liver transplant in January 2011 to March 2012 have been received prophylaxis ganciclovir. The control group of children, who underwent liver transplantation from March 2009 to December 2010, not received prophylaxis ganciclovir. The incidence of PTLD and mortality in the two groups were compared. Patient follow-up in relation to lymph proliferative disease and its side effect was carried out. Background information was obtained from the patient’s file. The data was analyzed by SPSS software. In total, 203 children with liver transplant were entered into the study. Control group of 108 children, 45 girls and 63 boys. The mean age of control group was between 8.7± 5.6 and in the case group was between 9±5.6. Case group of 95 patients, 37 were girls and 58 were boys. In the control group, 12 (11.1%) and in case group 5 (5.3%), PTLD were diagnosed (p<0.02). The mortality rate in the control group was 5(4.6%) and in the case group was 0. The difference was significant (p<0.05). Prophylaxis ganciclovir is effective in decreasing the rate of PTLD and the mortality resulting from that in children after transplant.

The Shiraz Liver Transplant Audit collects information on all liver transplantations that are carried out in Iran. In this paper, we describe these transplantations and their outcomes in adult patients according to the primary liver disease diagnosis, type and period of transplantation. A prospective cohort study carried on 364 orthotropic liver transplantations in Shiraz Namazi hospital from June 2002 to July 2008. Actual survival rates, calculated using the Kaplan-Meier method, were compared using the log-rank test. To determine independent prognostic factors for survival, the Cox regression model was used. Among the 364 patients included in this study (age range: 13-39 years; 327 [68.1%] men), the most common causes of liver disease were hepatitis B and C virus infection (25.8). Overall patient survival rates at 1, 2, 5 and 6 years after Orthotopic Liver Transplantation (OLT) were 83.7%, 82%, 82% and 82%, respectively. Mean and SE of Survival time of patients were 64.6 ± 1.7 (CI95%: 61.2-67.9). Short time and long time survival of these patients in both sexes and between age groups were similar. Multivariable analysis demonstrated that these improvements only be explained by donors age between 20-40 years old. In summary, Orthotopic Liver Transplantation has developed into a safe and successful treatment for end-stage liver disease with satisfactory long-terms results. Our experience with liver transplantation indicates comparable success rate to similar reports.