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Challenges in liver transplantation in the context of a major pandemic

World Journal of Transplantation 2022年第11期12卷 347-358页

作者： eleni theocharidou Danielle Adebayo 2^(nd)Department of Internal Medicine Aristotle University of ThessalonikiKonstantinoupoleos 4954642ThessalonikiGreece Department of Gastroenterology and Hepatology Royal Berkshire NHS Foundation TrustLondon RoadReadingRG15ANUnited Kingdom

Coronavirus disease-2019(COVID-19)has led to a temporary suspension of liver transplant activity across the world and the remodeling of care for patients on the waiting list and transplant recipients with the increasing use of remote *** evidence shows that patients with more advanced liver disease are at increased risk of severe COVID-19 and death,whereas transplant recipients have similar risk with the general population which is mainly driven by age and metabolic *** immunosuppression might have a protective role in the post-transplant *** that have become rapidly available seem to be safe in liver patients,but the antibody response in transplant patients is likely *** transplant centers were gradually able to resume activity soon after the onset of the pandemic and after modifying their pathways to optimize safety for patients and *** evidence regarding utilizing grafts from positive donors and/or transplanting recently recovered or infected recipients under certain circumstances is encouraging and may allow offering life-saving transplant to patients at the greatest *** review summarizes the currently available data on liver transplantation in the context of a major pandemic and discusses areas of uncertainty and future *** learnt from the COVID-19 pandemic might provide invaluable guidance for future pandemics.

关键词： COVID-19 Pandemic Liver transplantation Chronic liver disease Immunosuppression Vaccines

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Human albumin solution for patients with cirrhosis and acute on chronic liver failure: Beyond simple volume expansion

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World Journal of Hepatology 2016年第7期8卷 345-354页

作者： Christopher Valerio eleni theocharidou Andrew Davenport Banwari Agarwal Intensive Care Unit Royal Free Hospital Royal Free Hampstead NHS Trust University College London the Royal Free Sheila Sherlock Liver Centre Royal Free Hospital Royal Free Hampstead NHS Trust and Institute of Liver and Digestive Health University College London UCL Centre for Nephrology Royal Free Hospital

To provide an overview of the properties of human serum albumin(HSA), and to review the evidence for the use of human albumin solution(HAS) in critical illness, sepsis and cirrhosis. A MEDLINE search was performed using the terms "human albumin", "critical illness", "sepsis" and "cirrhosis". The references of retrieved articles were reviewed manually. Studies published between 1980 and 2014 were selected based on quality criteria. Data extraction was performed by all authors. HSA is the main plasma protein contributing greatly to its oncotic pressure. HSA demonstrates important binding properties for endogenous and exogenous toxins, drugs and drug metabolites that account for its anti-oxidant and anti-inflammatory properties. In disease states, hypoalbuminaemia is secondary to decreased HSA production, increased loss or transcapillary leakage into the interstitial space. HSA function can be also altered in disease with reduced albumin binding capacity and increased production of modified isoforms. HAS has been used as volume expander in critical illness, but received criticism due to cost and concerns regarding safety. More recent studies confirmed the safety of HAS, but failed to show any survival benefit compared to the cheaper crystalloid fluids, therefore limiting its use. On the contrary, in cirrhosis there is robust data to support the efficacy of HAS for the prevention of circulatory dysfunction post-large volume paracentesis and in the context of spontaneous bacterial peritonitis, and for the treatment of hepato-renal syndrome and hypervolaemic hyponatraemia. It is likely that not only the oncotic properties of HAS are beneficial in cirrhosis, but also its functional properties, as HAS replaces the dysfunctional HSA. The role of HAS as the resuscitation fluid of choice in critically ill patients with cirrhosis, beyond the established indications for HAS use, should be addressed in future studies.

关键词： Human serum albumin Human albumin solution Critical illness Cirrhosis Resuscitation fluid Large-volume paracentesis Hepatorenal syndrome Spontaneous bacterial peritonitis

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Setting up an integrated service for PSC-IBD patients:A quality improvement project

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iLIVER 2024年第2期3卷 11-15页

作者： Sreelakshmi Kotha Ioannis Koumoutsos Ben Warner eleni theocharidou Joel Mawdsley Philip Berry Department of Gastroenterology Guy's and St Thomas'Foundation TrustLondon SE17EHUnited Kingdom

Background and aims:Primary sclerosing cholangitis(PSC)often co-exists with inflammatory bowel disease(IBD)and together they are associated with increased risk of complications,including cancer(hepatobiliary,colorectal,gallbladder)and *** for follow up and surveillance vary,but our local guidelines advise annual surveillance with magnetic resonance cholangiopancreatography(MRCP),colonoscopy and ultrasound(US)(6 monthly if cirrhotic).We aimed to assess the quality of care in our PSC-IBD patients,including adherence to local surveillance guidelines,and resultant detection of complications,before and after the introduction of an integrated PSC and IBD out-patient ***:Data on management of PSC-IBD patients was collected retrospectively before,and prospectively following,the introduction of an integrated *** comparisons of diagnoses,adherence to planned surveillance and outcomes were made between cohorts pre-and post-service ***:Prior to the service re-design there was significant variability in care and poor adherence to *** of an integrated PSC-IBD service led to 89 referrals with possible PSC-IBD at 36 months after service *** review led to appropriate identification of 68 PSC-IBD *** was significant improvement in surveillance with annual colonoscopy in 90%,MRI/MRCP in 81%,US in 35%,compared to 55%,55%and 7%respectively in the baseline *** translated to diagnosis and appropriate treatment of colonic dysplasia in 4 patients,colorectal cancer(CRC)in 4 patients and cholangiocarcinoma(CCA)in 2 ***:Establishment of an integrated out-patient service for PSC-IBD patients results in better compliance with guidelines,effective detection of complications,and appropriate management.

关键词： Endoscopy Hepato-biliary disease Inflammatory bowel disease

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