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1. Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome

Author

Irfan Younis, Shahid Sarwar, Zeeshan Butt, Sheharyar Tanveer, Adnan Qaadir, and Nauman Arif Jadoon

Subjects
Chronic liver disease, Hypoxemia, Mortality, Platypnea, Specialties of internal medicine, RC581-951
Abstract

Background. Hepatopulmonary syndrome (HPS) is a complication of advanced liver disease. The impact of HPS on survival is not clearly understood.Material and methods. A prospective study was carried out at Department of Medicine, King Edward Medical University Lahore from June 2011 to May 2012. Patients with cirrhosis of liver were evaluated for presence of HPS with arterial blood gas analysis and saline bubble echocardiography. All patients were followed for 6 months for complications and mortality. Cox regression analysis was done to evaluate role of HPS on patient survival.Results. 110 patients were included in the study. Twenty-nine patients (26%) had HPS. MELD score was significantly higher (p < 0.01) in patients with HPS (18.93 ± 3.51) as compared to that in patients without HPS (13.52 ± 3.3). Twenty two (75.9%) patients of Child class C, 5 (17.2%) patients of Child class B and 2 (6.9%) patients of Child class A had HPS (P 0.03). The clinical variables associated with presence of HPS were spider nevi, digital clubbing, dyspnea, and platypnea. HPS significantly increased mortality during six month follow up period (HR: 2.47, 95% CI: 1.10-5.55). Child-Pugh and MELD scores were also associated with increased mortality. HPS was no longer associated with mortality when adjustment was done for age, gender, Child-Pugh, and MELD scores (HR: 0.44, 95% CI: 0.14-1.41). Both the Child-Pugh and MELD scores remained significantly associated with mortality in the multivariate survival analysis.Conclusions. HPS indicates advanced liver disease. HPS does not affect mortality when adjusted for severity of cirrhosis.

Published
2015
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2. Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome

Author

Zeeshan Butt, Sheharyar Tanveer, Irfan Younis, Adnan Qaadir, Nauman A Jadoon, and Shahid Sarwar

Subjects
Male, medicine.medical_specialty, Cirrhosis, Specialties of internal medicine, Chronic liver disease, Hypoxemia, Liver disease, Internal medicine, Cause of Death, medicine, Humans, Prospective Studies, Platypnea, Mortality, Prospective cohort study, Hepatopulmonary syndrome, Cause of death, Hepatology, integumentary system, business.industry, Proportional hazards model, General Medicine, Middle Aged, medicine.disease, Prognosis, eye diseases, Surgery, Survival Rate, RC581-951, Female, business, Complication, Follow-Up Studies, Hepatopulmonary Syndrome
Abstract

Background. Hepatopulmonary syndrome (HPS) is a complication of advanced liver disease. The impact of HPS on survival is not clearly understood. Material and methods. A prospective study was carried out at Department of Medicine, King Edward Medical University Lahore from June 2011 to May 2012. Patients with cirrhosis of liver were evaluated for presence of HPS with arterial blood gas analysis and saline bubble echocardiography. All patients were followed for 6 months for complications and mortality. Cox regression analysis was done to evaluate role of HPS on patient survival. Results. 110 patients were included in the study. Twenty-nine patients (26%) had HPS. MELD score was significantly higher (p < 0.01) in patients with HPS (18.93 ± 3.51) as compared to that in patients without HPS (13.52 ± 3.3). Twenty two (75.9%) patients of Child class C, 5 (17.2%) patients of Child class B and 2 (6.9%) patients of Child class A had HPS (P 0.03). The clinical variables associated with presence of HPS were spider nevi, digital clubbing, dyspnea, and platypnea. HPS significantly increased mortality during six month follow up period (HR: 2.47, 95% CI: 1.105.55). Child-Pugh and MELD scores were also associated with increased mortality. HPS was no longer associated with mortality when adjustment was done for age, gender, Child-Pugh, and MELD scores (HR: 0.44, 95% CI: 0.14-1.41). Both the Child-Pugh and MELD scores remained significantly associated with mortality in the multivariate survival analysis. Conclusions. HPS indicates advanced liver disease. HPS does not affect mortality when adjusted for severity of cirrhosis.

Published
2015

3. Health-Related Quality of Life Outcomes After Kidney Transplantation

Author

Jason A. Wertheim, Aneesha Shetty, and Zeeshan Butt

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, medicine.medical_treatment, Population, 030232 urology & nephrology, 030230 surgery, medicine.disease, End stage renal disease, Transplantation, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, Quality of life (healthcare), medicine, Intensive care medicine, education, business, Psychosocial, Kidney transplantation, Dialysis, Kidney disease
Abstract

Health-related quality of life (HRQOL) provides a measure of patients’ perception of their symptoms, overall health or disability, and treatment. As such, HRQOL is an important patient-centered outcome and transplant-oriented clinical research endpoint. HRQOL alone, or in tandem with other objective clinical outcome measures, is useful in monitoring clinical practice, informing treatment decisions, and guiding the allocation of healthcare resources. It comprises three domains: physical, mental, and psychosocial wellbeing; and can be measured by generalized or targeted instruments depending on the degree of specificity desired by the clinician or researcher. Patients with end stage renal disease requiring dialysis report diminished quality of life compared to the general population, which in turn is associated with an increased risk of hospitalization and death, particularly in those with a high comorbidity burden. Renal transplantation confers a global quality of life benefit. Physical symptoms like pain, poor sleep quality, and fatigue are perceived to be improved after transplantation by renal transplant recipients with a functioning allograft. Depression and anxiety also improve after transplantation as does social participation and integration. However, on average, HRQOL following renal transplant remains lower than in the general population, partly due to transplant related complications like infection and malignancy and the adverse effects of immunosuppression. Other factors that negatively impact HRQOL after transplant include older recipient age, deceased donor transplantation, female gender, lack of social support, and comorbid conditions such as diabetes and depression. Improved HRQOL after kidney transplantation, especially in the physical domain, has been associated with better patient and allograft survival. Hence it is imperative for transplant clinicians to familiarize themselves with the concepts, measurement, and interpretation of HRQOL as they strive to provide comprehensive care to kidney transplant patients.

Published
2017
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4. List of Contributors

Author

Michael Abecassis, Ahmed Abed, Massimo Abelli, Sarwat Ahmad, Mario Alessiani, Aynaa Alsharidi, Fiorella Altruda, Gabriella Amorese, Andrea Angeletti, Mario Angelico, Roberta Angelico, Maria L. Angelotti, Robert J. Applegate, Anthony Atala, Chiara Attanasio, David Axelrod, Yanik Bababekov, Joydeep Basu, Francesca Becherucci, P. Matthew Belford, Enrico Benedetti, Valentina Benedetti, Ariela Benigni, Timothy A. Bertram, Oriol Bestard, Joshua Blake, Ugo Boggi, Lauren Brasile, Jonathan S. Bromberg, Sophie Brouard, Matthew Brovold, George W. Burke, Mirela Busic, Zeeshan Butt, Silvia Caddeo, Stefano Calzone, Josep M. Campistol, Irene Carmagnola, Fiona Carty, Diego Castanares-Zapatero, Christos E. Chadjichristos, Brooke E. Chambers, Sindhu Chandran, Christos Chatziantoniou, Ashton Chen, Linda Chen, Xiwu Chen, Valeria Chiono, Manuel Chiusa, Gaetano Ciancio, Gianluca Ciardelli, Gino Coletti, Elisabeth Coll, Christine Collienne, Robert B. Colvin, Monica Cortinovis, A. Benedict Cosimi, Paolo Cravedi, Giuseppe D’Amico, Stefano Da Sacco, Richard Danger, Jacques Dantal, Alan J. Davidson, Letizia De Chiara, Johannes W. De Fijter, Gloria de la Rosa, Francis L. Delmonico, Junhong Deng, Corinne Deurdulian, Abritee Dhal, Paolo Dionigi, Beatriz Domínguez-Gil, Marek Drozdzik, Jean-Claude Dussaule, Lauren Edgar, Maria Francesca Egidi, Hany El Hennawy, Karen English, Matthew J. Everly, Sharmila Fagoonee, Elvira Smeralda Famulari, Alan C. Farney, Marina Figliuzzi, Marialuisa Framarino-dei-Malatesta, David E. Fumo, Elena Gagliardini, Lorenzo Gallon, Sanjay K. Gandhi, Michael D. Gautreaux, Anna Geraedts, Domenico Giannese, Pier C. Giulianotti, Michael S. Goligorsky, Adam Griesemar, Josep M. Grinyó, Angelika C. Gruessner, Rainer W.G. Gruessner, Bulang He, Eliot Heher, Bing Ho, Sarah A. Hosgood, Kiyohiko Hotta, Atul Humar, H. David Humes, Giuseppe Iaria, Barbara Imberti, Juan Carlos Izpisua Belmonte, Ina Jochmans, Ravi Katari, Panagiotis Kavvadas, Tatsuo Kawai, Carlos Kengla, Tristan Keys, Amritha Kidiyoor, Kengo Kidokoro, Deepali Kumar, Michael A. Kutcher, Quirino Lai, Pierre-François Laterre, Céleste Lebbé, Christophe Legendre, Rachel Lennon, Peng Li, Jen-Jar Lin, Melissa H. Little, Xiongbing Lu, John W. Ludlow, Beatriz Mahíllo, Rosalinde Masereeuw, Rafael Matesanz, Mirjana S. Matovinovic, Benedetta Mazzinghi, Serge Cedrick Mbiandjeu Toya, Scott McEwen, Fabio Melandro, Loredana Melchiorri, Madhav C. Menon, Majid Mirzazadeh, Samantha Montag, Robert A. Montgomery, Virginie Montiel, Nuria Montserrat, Marina Morigi, Christian C. Morrill, Michel Mourad, Sean V. Murphy, Patricia Murray, Tiziana Nardo, Paolo A. Netti, Mark Nguyen, Michael L. Nicholson, John M. O’Callaghan, Linda Ohler, Giuseppe Orlando, Kenji Osafune, Tetsu Oura, Anna Peired, Andrea Peloso, Zhenzhen Peng, Norberto Perico, Laura Perin, Vittorio Perrone, Paul Persad, János Peti-Peterdi, Astgik Petrosyan, Andrea Pietrabissa, Christopher J. Pino, Jacques Pirenne, Francesco Pisani, Rutger J. Ploeg, Esteban Porrini, Ambra Pozzi, Alberto Pugliese, Luigi Pugliese, Ton J. Rabelink, Teresa Rampino, Michael A. Rees, Marlies E.J. Reinders, Andrea Remuzzi, Giuseppe Remuzzi, Anne Riquier-Brison, Raquel G. Roca, Jeffrey Rogers, Paola Romagnani, Ivy A. Rosales, Norman D. Rosenblum, Cinzia Rota, Piero Ruggenenti, Francesca Ruini, Junichiro Sageshima, Fadi El Salem, Shaifali Sandal, Veronika Sander, Ilaria Santeramo, Renato M. Santos, Minnie Sarwal, Jigesh Shah, Aneesha A. Shetty, Lorenzo Silengo, Eric Siskind, Anton Skaro, Renaud Snanoudj, Shay Soker, Andrew M. South, Goce Spasovski, Robert J. Stratta, Charles Strom, Bart Stubenitsky, Riccardo Tamburrini, Qizhi Tang, Ekamol Tantissattamo, Masayuki Tasaki, Hisham Tchelepi, Elena Ticozzelli, Opas Traitanon, Matias Trillini, Ivo Tzvetanov, María O. Valentín, Flavio Vincenti, Fabio Vistoli, Jelle Vriend, Stephen J. Walker, Jason A. Wertheim, David F. Williams, Bettina Wilm, Martijn J. Wilmer, Rebecca A. Wingert, Xavier Wittebole, Yun Xia, Christodoulos Xinaris, Kazuhiko Yamada, Takashi Yokoo, Shinya Yokote, Maarten L. Zandvliet, Roy Zent, Yuanyuan Zhang, David X. Zhao, Lihui Zhao, and Susan Y. Zhao

Published
2017
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