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Biomedical subjects

P McMaster

Publications and source records attributed to P McMaster.

At least 199 records · Page 11Linked to original sources
PubMed1989

Prognosis after liver transplantation for primary biliary cirrhosis.

Timing of transplantation for patients with primary biliary cirrhosis (PBC) requires identification not only of individual risk factors for the operation but estimation of survival with and without transplantation. To identify those risk factors and develop a prognostic model, 82 patients grafted for PBC since 1980 in the Birmingham and Cambridge/King's College Hospital series have been analyzed. Using logrank tests it was found that treatment with diuretics, hemoglobin above 10 g/dl, prothrombin time less than 5 sec prolonged, serum sodium above 130 mmol/L and serum bilirubin less than 350 mumol/L were all individually associated with a better prognosis. Using Cox regression analysis to identify independent variables, it was found that year of transplant, serum bilirubin, serum urea, and diuretic responsive ascites had a significant association with survival. Using these four variables, it was possible to develop a model to identify those patients with a good and a poor probability of survival after transplantation.

Bilirubin↗
PubMed1989

Massive haemorrhagic necrosis of the liver after liver transplantation.

Six of the first 85 patients who received the first 100 liver transplantations carried out in Birmingham developed a syndrome of fulminant liver failure with distinctive clinical and pathological features. The typical clinical presentation was of an uneventual initial postoperative period, followed by a sudden deterioration in graft function, progressing rapidly to graft failure. All six patients died. The characteristic pathological changes were those of massive haemorrhage and hepatocyte necrosis with only mild inflammation and without occlusive lesions in large arteries or veins. These distinctive features differed from other recognised patterns of graft damage and seemed to comprise a specific post-transplant syndrome. The pathogenesis was not clear and in the absence of any definite aetiology it is suggested that the term "massive haemorrhagic necrosis" be used to describe these cases. Additional findings seen in five of the six cases were venoocclusive lesions (n = 4) and a combination of ductopenia and foam cell arteriopathy (n = 2). The presence of these associated lesions suggests that there may be an overlap with other types of graft damage.

Adult↗
PubMed1988

The accuracy of aspiration cytology in the diagnosis of rejection following orthotopic liver transplantation.

The role of aspiration cytology (AC) and the total corrected increment (TCI) in the diagnosis of hepatic rejection was assessed in 30 patients following 36 liver transplants. A total of 174 AC specimens were "blindly" evaluated. Patients underwent protocol AC twice weekly and when biochemical or clinical parameters suggested rejection. Hepatic rejection was only confirmed when clinical and biochemical changes were accompanied by positive histological diagnosis. In all, 103 specimens were matched against histology, the remainder assessed against retrospective clinical and biochemical diagnoses. There were 80 cytological diagnoses of rejection, confirmed in 69 specimens, and 94 diagnoses of no rejection, confirmed in 73 specimens. These figures give a sensitivity of 76.7%, a specificity of 86.9% and a positive predictive value of 86.3%. Overall, 39.7% of specimens taken more than 2 months after grafting proved to be incorrectly diagnosed. However, the accuracy was higher in 145 specimens taken within 8 weeks of transplantation, with a sensitivity of 81.3%, a specificity of 90%, a positive predictive value of 89.7% and an accuracy of 85.5%. Although histology remains the gold standard in the diagnosis of acute rejection after hepatic grafting, AC using a TCI with a positive predictive value of 86.3% may prove to be of value in monitoring liver transplant patients in the first 2 months after grafting.

Adolescent↗
PubMed1988

Transplantation of the liver in adults and children with fulminant hepatic failure.

Fulminant hepatic failure has a high mortality rate despite intensive medical treatment. Urgent hepatic transplantation was considered over a 3 year period in 26 (36%) of 73 patients with the worst prognostic features of fulminant hepatic failure. The criteria for patient selection were based on the duration of advanced hepatic coma and the deterioration of liver function. Sixteen patients were transplanted, and 9 (56%) are currently alive. The median duration of follow-up is 16 months and actuarial 1 year survival 55%. Six patients died because of the absence of offers of organ donation. Twenty-two (85%) of the 26 patients considered were referred with advanced encephalopathy or hepatorenal syndrome. Of the 57 patients not transplanted, 18 (95%) of 19 patients with grade I/II encephalopathy survived compared to 13 (34%) of 38 patients with grade III/IV encephalopathy. Transplantation does improve the chance of survival in selected patients with fulminant hepatic failure, early referral and availability or organ donation being important factors.

Adolescent↗
PubMed1988

Indocyanine green clearance in acute rejection after liver transplantation.

Previous animals studies have demonstrated a fall in liver blood flow associated with acute rejection after liver transplantation. To study the relationship between rejection and liver blood flow in humans after liver transplantation indocyanine green (ICG) clearance was measured serially in 7 patients with clinical and histological features of acute rejection. There was a consistent pattern of satisfactory initial ICG clearance that fell in association with acute rejection and rose with successful treatment of the episode of rejection. In one patient there was no improvement in ICG clearance after treatment with additional immunosuppression, and she subsequently required retransplantation for chronic rejection. The volume of distribution of ICG was also estimated and fell considerably during the first weeks after transplantation. These results show that rejection is associated with a reduction in ICG clearance that may be due to a fall in liver blood flow, and that graft ischemia and rejection may therefore be interrelated, and important in one another's etiology.

Blood Volume↗
PubMed1988

Liver transplantation: the first 200 grafts in Birmingham.

Improvements in perioperative management in this series have been balanced by an increase in the proportion of high-risk patients grafted, such that no overall improvement in survival has occurred. We suggest that for each patient 2 separate groups of risk factors are relevant: 1. Risk factors related to the transplant procedure itself: These include previous major upper abdominal surgery, marked cerebral edema due to fulminant hepatic failure, and severe portal hypertension including patients with recent major variceal bleeding. 2. Risk factors related to the recovery phase: These include patients in hepatorenal failure before grafting and those with severe muscle wasting. Greater experience and refinements in surgical technique have improved the outcome for patients with risk factors limited to the first group. However, those with risk factors in both groups remain a difficult problem and a significant proportion of the fatalities occur in patients who have come through the operation only to be lost from complications in the postoperative period. We feel this is one of the most important areas for future efforts if the results of liver replacement are to improve sufficiently to merit a wider application.

England↗