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SIMAP500: A novel risk score to identify recipients at higher risk of hepatocellular carcinoma recurrence following liver transplantation

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World Journal of Transplantation 2024年第3期14卷 132-143页

作者： Amr Alnagar Nekisa Zakeri Konstantinos Koilias Rosemary E Faulkes Rachel Brown Owen Cain M thamara P R Perera Keith J Roberts Rebeca Sanabria-Mateos David C Bartlett Yuk Ting Ma Shivan Sivakumar Shishir Shetty Tahir Shah Bobby V M Dasari Department of HBP and Liver Transplantation Surgery Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152GWUnited Kingdom Centre for Liver Research Institute of Biomedical ResearchBirmingham B152TTUnited Kingdom Department of Hepatology Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152GWUnited Kingdom Department of Pathology University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of Oncology Queen Elizabeth HospitalUniversity Hospitals of BirminghamBirmingham B152GWUnited Kingdom

BACKGROUND Recurrence of hepatocellular carcinoma(HCC)following liver transplantation(LT)has a devastating influence on recipients’survival;however,the risk of recur-rence is not routinely *** stratification is vital with a long LT waiting time,as that could influence the recurrence despite strict listing *** This study aims to identify predictors of recurrence and develop a novel risk pre-diction score to forecast HCC recurrence following *** A retrospective review of LT for HCC recipients at University Hospitals Bir-mingham between July 2011 and February *** and multivariate analyses were performed to identify recurrence predictors,based on which the novel SIMAP500(satellite nodules,increase in size,microvascular invasion,AFP>500,poor differentiation)risk score was *** 234 LTs for HCC were performed with a median follow-up of 5.3 *** developed in 25 patients(10.7%).On univariate analyses,RETREAT score>3,α-fetoprotein(AFP)at listing 100-500 and>500,bridging,increased tumour size between imaging at the listing time and explant histology,increase in the size of viable tumour between listing and explant,presence of satellite nodules,micro-and macrovascular invasion on explant and poor differentiation of tumours were significantly associated with recurrence,based on which,the SIMAP500 risk score is *** SIMAP500 demonstrated an excellent predictive ability(c-index=0.803)and outper-formed the RETREAT score(c-index=0.73).SIMAP500 is indicative of the time to disease *** SIMAP500 risk score identifies the LT recipients at risk of HCC *** stratification allows patient-centric post-transplant surveillance *** validation of the score is recommended.

关键词： Liver transplantation Hepatocellular carcinoma Recurrence Survival

Diabetes Self-Care Activities and Glycaemic Control among Adults with Type 2 Diabetes in Sri Lanka: A Cross-Sectional Study

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Journal of Biosciences and Medicines 2019年第5期7卷 99-111页

作者： Meerigama Arachchige Rasoda Saumika thamara Dilhani Amarasekara Rasika Jayasekara Department of Nursing Faculty of Health Sciences The Open University of Sri Lanka Sri Lanka Department of Nursing& Midwifery Faculty of Allied Health Sciences University of Sri Jayewardenepura Sri Lanka School of Nursing and Midwifery University of South Australia South Australia Australia

The prevalence of Type 2 Diabetes Mellitus (T2DM) and its complications continue to rise across the globe including Sri Lanka. Diabetes Self-care activities (DSCA) are promising behaviors to reduce complications and to achieve good glycaemic control. There is a lack of data regarding DSCA and its association with glycaemic control among adults with T2DM in Sri Lanka. A descriptive cross-sectional study was conducted among purposively selected adults with T2DM (n = 300) in a teaching hospital, Sri Lanka to determine the association between DSCA and glycaemic control. Apre-tested interviewer-administered questionnaire which includes socio-demographic, diabetes-related information and Summary of Diabetes Self-care activities questionnaire was used to collect data. Data were analyzed by using descriptive statistics and Chi-square test. General diet (Healthy eating plan) (OR = 3.04, 95% CI = 1.04 - 8.88, p = 0.034), Physical activities (OR = 2.26, 95% CI = 1.29 - 3.97, p = 0.004), Medication adherence (OR = 2.87, 95% CI = 1.24 - 6.64, p = 0.011) were significantly associated with HbA1c. Medication adherence was significantly associated with poor fasting blood sugar (FBS) (OR = 1.90, 95% CI = 1.07 - 3.37, p = 0.028). The findings highlight the need for health professionals to implement health education programs on diabetes self-care activities for adults with T2DM to enhance their adherence to DSCA, as well as to maintain glycemic control.

关键词： Diabetes Self-Care Activities Glycemic Control Adults Type 2 Diabetes Mellitus Sri Lanka

Portal vein thrombosis in cirrhosis: Controversies and latest developments

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World Journal of Gastroenterology 2015年第22期21卷 6769-6784页

作者： Damian J Harding M thamara PR Perera Frederick Chen Simon Olliff Dhiraj Tripathi Liver Unit Queen Elizabeth HospitalBirmingham Department of Haematology Queen Elizabeth HospitalBirmingham Department of Imaging and Interventional Radiology Queen Elizabeth HospitalBirmingham

Portal vein thrombosis(PVT) is encountered in livercirrhosis, particularly in advanced disease. It has been a feared complication of cirrhosis, attributed to significant worsening of liver disease, poorer clinical outcomes and potential inoperability at liver transplantation; also catastrophic events such as acute intestinal ischaemia. Optimal management of PVT has not yet been addressed in any consensus *** review current literature on PVT in cirrhosis; its prevalence, pathophysiology, diagnosis, impact on the natural history of cirrhosis and liver transplantation,and management. Studies were identified by a search strategy using MEDLINE and Google Scholar. The incidence of PVT increases with increasing severity of liver disease: less than 1% in well-compensated cirrhosis, 7.4%-16% in advanced cirrhosis. Prevalence in patients undergoing liver transplantation is 5%-16%.PVT frequently regresses instead of uniform thrombus progression. PVT is not associated with increased risk of mortality. Optimal management has not been addressed in any consensus publication. We propose areas for future research to address unresolved clinical questions.

关键词： Portal vein thrombosis Liver cirrhosis Anticoagulation Transjugular intrahepatic portosystemicstent-shunt

Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

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World Journal of Gastroenterology 2023年第20期29卷 3066-3083页

作者： Manuel Durán Rafael Calleja Angus Hann George Clarke Ruben Ciria Anisa Nutu Rebeca Sanabria-Mateos María Dolores Ayllón Pedro López-Cillero Hynek Mergental Javier Briceño M thamara P R Perera Department of Liver Transplantation Reina Sofía University HospitalCórdoba 14004Spain The Liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for Liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft *** to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary *** problem continues to trouble clinicians,and may have catastrophic consequences for the graft and *** injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft ***,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial *** the warm and cold ischemic period duration appear to influence the onset of *** of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of *** clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to *** this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically *** with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation ***,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold *** evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.

关键词： Liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion Donation after circulatory death

Maternal Vitamin D Deficiency and Risk of Development of Gestational Diabetes Mellitus: A Scoping Review

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Journal of Biosciences and Medicines 2023年第4期11卷 220-238页

作者： Yureka Demini Wimalajeewa Usha Pushkala Kumari Hettiaratchi thamara Dilhani Amarasekara Shamini Prathapan Mathota Arachchilage Madura Mangala Jayawardane Department of Obstetrics & Gynaecology Faculty of Medical Sciences University of Sri Jayewardenepura Nugegoda Sri Lanka Department of Biochemistry Faculty of Medical Sciences University of Sri Jayewardenepura Nugegoda Sri Lanka Department of Nursing & Midwifery Faculty of Allied Health Sciences University of Sri Jayewardenepura Nugegoda Sri Lanka Department of Community Medicine Faculty of Medical Sciences University of Sri Jayewardenepura Nugegoda Sri Lanka

Background: Maternal vitamin D status is a critical determinant during pregnancy, because it plays an important role in the body not only in calcium homeostasis and bone remodeling, but also in the glucose metabolism. Vitamin D deficiency is associated with adverse pregnancy outcomes including gestational diabetes mellitus. Objective: To review evidence on the association between maternal vitamin D deficiency and incidence of gestational diabetes mellitus (GDM). Methods: PRISMA for scoping review guideline and scoping review guidelines of Arksey & O’Malley (2005) was followed in methodological process. A comprehensive search strategy was carried out across the Google Scholar and PubMed from January 2012 to December 2022, using the search terms of “gestational diabetes mellitus/pregnancy outcomes” combined with “vitamin D”, “cholecalciferol” or “25-hydroxyvitamin D” and/or “deficiency”. Articles were screened at the title and the abstract level and at full text by three co-investigators of the study independently with a fourth reviewer resolving discrepancies. Research studies published only in English language were selected. Research using pregnant mothers with multiple pregnancy and chronic diseases was excluded. Results: After screening 134 titles and abstracts, finally 55 original research articles were selected. It involved 48 observational studies and 7 Randomized Control Trials (RCT). Only 30 research articles had found an association between maternal vitamin D deficiency and GDM. Conclusion: As results of previous studies are mixed and inconclusive, further research including more RCTs is needed to clarify the exact mechanism of vitamin D on glucose metabolism during pregnancy.

关键词： Gestational Diabetes Mellitus Maternal Vitamin D Deficiency

Late post liver transplant protein losing enteropathy: Rare complication of incisional hernia

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World Journal of Gastroenterology 2013年第27期19卷 4409-4412页

作者： Jonathan D Evans M thamara PR Perera CY Pal James Neuberger Darius F Mirza The Liver Unit The Queen Elizabeth Hospital

Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.

关键词： Protein losing enteropathies Bacterial overgrowth Hypoproteinaemia Incarcerated hernia Liver transplantation.

Current status and recent advances of liver transplantation from donation after cardiac death

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World Journal of Gastrointestinal Surgery 2011年第11期3卷 167-176页

作者： M thamara PR Perera Simon R Bramhall The Liver Unit Queen Elizabeth HospitalEdgbaston Birmingham B15 2TH United Kingdom

The last decade saw increased organ donation activity from donors after cardiac death (DCD). This contributed to a signif icant proportion of transplant activity. Despite certain drawbacks, liver transplantation from DCD donors continues to supplement the donor pool on the backdrop of a severe organ shortage. Understanding the pathophysiology has provided the basis for modulation of DCD organs that has been proven to be effective outside liver transplantation but remains experimental in liver transplantation models. Research continues on how best to further increase the utility of DCD grafts. Most of the work has been carried out exploring the use of organ preservation using machine assisted perfusion. Both ex-situ and in-situ organ perfusion systems are tested in the liver transplantation setting with promising results. Additional techniques involved pharmacological manipulation of the donor, graft and the recipient. Ethical barriers and end-of-life care pathways are obstacles to widespread clinical application of some of the recent advances to practice. It is likely that some of the DCD offers are in fact probably "prematurely" of-fered without ideal donor management or even prior to brain death being established. The absolute benef its of DCD exist only if this form of donation supplements the existing deceased donor pool; hence, it is worthwhile revisiting organ donation process enabling us to identify counter remedial measures.

关键词： Non-heart beating donor Liver graft Pri- mary non-function Reperfusion injury Modulation