Gallstones in liver transplant recipients

master's thesis

• Title (croatian): Žučni kamenci kod primatelja jetrenog presatka
• Author: Rafael Martin Astudillo
• Mentor: Anna Mrzljak (mentor)
• Committee member: Rajko Ostojić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Anna Mrzljak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

BACKGROUND: Gallstone disease (GD) is the most frequent pathology of the biliary system and patients with end-stage liver disease (ESLD) are especially prone to develop it. It is difficult to treat such patients due to their poor general condition and decreased liver function. The aim of this study was to evaluate the prevalence of GD in liver transplant candidates and to investigate its associations with selected variables in the context of ESLD. ----- METHODS: This cross-sectional study included 101 non-diabetic adult cirrhotic patients transplanted between 2014 and 2017 at University Hospital Merkur, Zagreb. GD was confirmed postoperatively on the explanted specimens. Clinical and laboratory parameters were collected from the medical records. The insulin resistance index (IRI) values >1.7 were considered as insulin resistance (IR). ----- RESULTS: The prevalence of GD was 26.73%. The cohort consisted of 79 male and 22 female patients with a mean age of 57.39±8.79 years. Patients were divided into GS (gallstone)-present (n=27) and GS-absent groups (n=74). No statistically significant differences regarding age, gender, body mass index, aetiology or severity of liver disease (CTP or MELD score) between the two groups (p=ns) were noted. GS-present group had significantly higher alkaline phosphatase (ALP) 145 (range 44–306) IU/L and haemoglobin (Hgb) 113±25 g/L levels compared to the GS-absent group (ALP 109 (42–531) IU/L, p=0.031; Hgb 104±21 g/L, p=0.048). GD-present group had a significantly higher proportion of IR patients (IRI>1.7 31% vs IRI<1.7 5.9%) compared to the GS-absent group (IRI>1.7 69% vs IRI<1.7 94.1%) and higher fasting plasma glucose levels (5.44±0.74 mmol/L vs 5.22±0.62 mmol/L, p=0.029). ----- CONCLUSION: Liver transplant (LT) candidates have a high prevalence of GD (26.73%). IR is a hallmark of metabolic disturbances in cirrhosis, and may play an important role in the development of GD, which warrants further research.

Abstract (croatian)

UVOD: Žučni kamenci (ŽK) su najčešća patologija bilijarnog sustava, a bolesnici s terminalnom bolesti jetre osobito su skloni njihovom nastanku. Liječenje ŽK u bolesnika s cirozom je otežano zbog njihovog općeg lošeg stanja i narušene funkcije jetre. Cilj ove studije bio je utvrditi prevalenciju ŽK u kandidata za transplantaciju jetre i istražiti njihovu povezanost s određenim kliničkim i biokemijskim varijablama u kontekstu terminalne bolesti jetre. ----- METODE: Ova presječna studija uključivala je 101 odraslog ne-dijabetičara transplantiranog zbog ciroze jetre u periodu od 2014-2017 u Kliničkoj bolnici Merkur, Zagreb. ŽK potvrđeni su na postoperativnim eksplantacijskim uzorcima. Klinički i laboratorijski parametri prikupljeni su iz medicinske dokumentacije. Inzulinska rezistencija (IR) definirana je vrijednostima indeksa inzulinske rezistencije (IRI) >1.7. ----- REZULTATI: Prevalencija ŽK iznosila je 26.73%. Kohortu je sačinjavalo 79 muškaraca i 22 žene, prosječne starosti 57.39±8.79 godina. Bolesnici su podijeljeni u dvije skupine ŽK-prisutnu (n=27) i ŽK-odsutnu (n=74). Nisu utvrđene statistički značajne razlike između skupina vezano za dob, spol, indeks tjelesne težine, etiologiju ili težinu (CTP ili MELD)
jetrene bolesti (p=ns). ŽK-prisutni imali su značajno više razine alkalne fosfataze (ALP) 145 (44–306) IU/L i hemoglobina (Hgb) 113±25 g/L u usporedbi sa skupinom bez ŽK (ALP) 109 (42–531) IU/L, p=0.031; Hgb 104±21 g/L, p=0.048). Skupina sa ŽK imala je značajno višu proporciju bolesnika sa IR (IRI>1.7 31% vs IRI<1.7 5.9%) u odnosu na skupinu bez ŽK (IRI>1.7 69% vs IRI<1.7 94.1%) kao i više razine glukoze u serumu (5.44±0.74 mmol/L vs 5.22±0.62 mmol/L, p=0.029). ----- ZAKLJUČAK: Prevalencija žučnih kamenaca u kandidata za transplantaciju jetre je visoka (26.73%). Inzulinska rezistencija je glavno obilježje metaboličkih promjena ciroze te može imati ulogu u razvoju žučnih kamenaca, što usmjerava na daljnja istraživanja.

• Keywords: gallstones; liver transplant; liver cirrhosis; lithogenesis
• Keywords (croatian): žučni kamenci; transplantacija jetre; ciroza jetre; litogeneza
• Language: english
• URN:NBN: urn:nbn:hr:105:365031
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-04-30 11:19:19