End Stage Liver Disease ; diagnosis ; Humans ; Liver Neoplasms ; diagnosis

End-stage liver disease (ESLD) is a life-threatening clinical syndrome with significantly increased mortality when the patients are complicated with infections. For patients with ESLD, infections can induce or aggravate the liver decompensation. In turn, infections are among the most common complication with the disease progression. Experts from Society of Infectious Diseases, Chinese Medical Association firstly formulated "Expert Consensus on Diagnosis and Treatment of End-Stage Liver Disease Complicated with Infection" in July 2018, which is extensively revised based on clinical evidence of recent three years. This consensus summarizes the up-to-date knowledge and experiences across Chinese colleagues, intending to provide principles and wording procedures for clinicians to diagnose and treat ESLD patient complicated with infections.
Consensus ; Disease Progression ; End Stage Liver Disease/complications* ; Humans

End Stage Liver Disease ; complications ; Humans ; Malnutrition ; etiology ; therapy

End-stage liver disease (ESLD) is a life threaten clinical syndrome with significantly increasing mortality when patients complicated with infections. For patients with ESLD, infections can induce or aggravate the occurrence of liver decompensation. In turn, infections are among the most common complications under, disease progression. There is lacking of working procedures for early diagnosis and appropriate management for patients of ESLD complicated with infections, neither guidelines nor consensus at home and abroad. This consensus assembled up-to-date knowledge and experience across Chinese colleagues, providing principles as well as working procedures for clinicians to diagnose and treat an ESLD patient complicated with infections.
Bacterial Infections/complications* ; Coinfection ; Consensus ; Disease Progression ; End Stage Liver Disease/therapy* ; Humans ; Liver Transplantation

With the enactment of the ‘Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life’ (Act No. 14013) in Korea, there is growing concern about the practicality of this law. In this review, we discuss definitions, ethics, and practical issues related to this law.
End Stage Liver Disease ; Ethics ; Hospices ; Humans ; Jurisprudence ; Korea ; Liver Cirrhosis* ; Liver* ; Palliative Care*

Living related liver transplantation(LRLT) is theoretically the best treatment option for end stage liver disease and nonresectable hepatocellular carcinomas. Anastomosed hepatic artery is at high risk in thrombosis after LRLT, which directly related to the patient's life. Usually, recipient hepatic artery is so friable and intimal separation and blood clot between intima and media were noted frequently. From December 2001 to June 2003, consecutive 30 hepatic arteries were harvested from 45 LRLTs patients with end stage liver disease. All hepatic artery were anastomosed with #9-0 nylon by plastic surgeon. All hepatic arteries were patent intraoperatively and postoperatively. In the histopathologic study of hepatic artery, some had intimal thickening, myxoid change and intimal hyperplasia in 14 out of 30 cases. Since pathologic changes may develop as a result of transarterial chemoembolization(TACE) and others causes, we postulated that the prevalence of hepatic arterial thrombosis, a catastrophic graft-threatening complication of LRLT, might be increased in this subset of LRLT patients who received TACE. But, in our study, patients who underwent hepatic arterial chemoembolization statistically do not show an increased risk of developing hepatic arterial thrombosis or other hepatic arterial complications after LRLT. And pathologic changes are statistically not correlate with the TACE.
Carcinoma, Hepatocellular ; End Stage Liver Disease ; Hepatic Artery* ; Humans ; Hyperplasia ; Liver Transplantation* ; Liver* ; Nylons ; Prevalence ; Thrombosis

Hyponatremia is common in end stage liver disease and central pontine myelinolysis (CPM) can occur after the rapid correction of hyponatremia. The blood sodium concentration can increase rapidly during the perioperative period of liver transplantation due to the administration of sodium-containing fluids and blood products. We experienced 5 cases of CPM after liver transplantation. Major changes in the blood sodium concentrations occurred during surgery in the first 3 cases while these changes occurred after surgery in the last 2 cases. We reviewed the blood sodium concentrations of these 5 patients and speculated on the correlation of CPM with a rapid increase in the blood sodium concentration.
End Stage Liver Disease ; Humans ; Hyponatremia ; Liver Transplantation* ; Liver* ; Myelinolysis, Central Pontine* ; Perioperative Period ; Sodium

The purpose of this phenomenological study was to understand and describe the essence and the structure of lived experience of liver transplant recipient. Five individual interviews were conducted to gather data regarding their subjective experiences. About 130 significant statements were extracted and these were clusterd into 9 themes. End stage liver disease patients chose their last treatment - liver transplantation. After liver transplantation. recipients experience vague anxiety and uneaseness related to much information and life style change that they had to accept. And they feared to lose their health again. But they felt free from medication and restriction of food. And they satisfied with regaining their physical status. Most of the recipients also had financial difficulties and social restrictions. And they experience uncertainty about their future. But they restored their previous social life. And they experience psychological wellbeing and hope. The results of this study might help nurses who work with liver transplant recipient in establishing and implementing an effective nursing intervention by understanding their lived experience.
Anxiety ; End Stage Liver Disease ; Hope ; Humans ; Life Style ; Liver Transplantation ; Liver* ; Nursing ; Transplantation* ; Uncertainty

BACKGROUND: Patients undergoing liver transplantation may be a group predisposed to hypomagnesemia and bleeding tendency. There is evidence that magnesium is a crucial constituent of the blood coagulation cascade and has a pro-coagulant activity. The purpose of this study was to investigate the effect of magnesium therapy on thromboelastograph (TEG) findings and other clinical parameters in patients undergoing liver transplantation. METHODS: 27 patients scheduled for liver transplantation were included. 1.5 g of magnesium sulfate was diluted in 100 ml of normal saline and infused over a period of 5 minutes to all patients. TEG findings immediately before and after magnesium infusion were compared. Total blood transfused and CaCl2 requirements in these patients were compared with those of a group of patients who received liver transplantation without magnesium therapy. RESULTS: K time and coagulation time (r + k) showed significant reduction, and MA, A60 and TEG index showed significant increases after magnesium therapy (P < 0.05). R time reduced and alpha angle increased after magnesium therapy, but these were not statistically significant. Less blood and CaCl2 was required by these patients (P < 0.05). CONCLUSIONS: Magnesium therapy significantly improved TEG findings of general hypocoagulability in end stage liver disease. It was also associated with a reduced amount of total blood transfused and CaCl2 required during liver transplantation.
Blood Coagulation ; End Stage Liver Disease* ; Hemorrhage ; Humans ; Liver Transplantation ; Magnesium Sulfate ; Magnesium*

Objective: To investigate the ABC prognostic classification and the updated version of Model for End-stage Liver Disease (MELD) score 3.0 and Chinese Group on the Study of Severe Hepatitis B ACLF Ⅱ score (COSSH-ACLF Ⅱ score) to evaluate the prognostic value in acute-on-chronic liver failure (ACLF). Methods: ABC classification was performed on a 1 409 follow-up cohorts. The area under the receiver operating characteristic curve (AUROC) was used to analyze MELD, MELD 3.0, COSSH-Ⅱ and COSSH-Ⅱ score after 3 days of hospitalization (COSSH-Ⅱ-3d). The prognostic predictive ability of patients were evaluated for 360 days, and the prediction differences of different classifications and different etiologies on the prognosis of ACLF were compared. Results: The survival curve of 1 409 cases with ACLF showed that the difference between class A, B, and C was statistically significant, Log Rank (Mantel-Cox) χ²=80.133, P<0.01. Compared with class A and C, χ²=76.198, P<0.01, the difference between class B and C, was not statistically significant χ²=3.717, P>0.05. AUROC [95% confidence interval (CI)] analyzed MELD, MELD 3.0, COSSH-Ⅱ and COSSH-Ⅱ-3d were 0.644, 0.655, 0.817 and 0.839, respectively (P<0.01). COSSH-Ⅱ had better prognostic predictive ability with class A ACLF and HBV-related ACLF (HBV-ACLF) for 360-days, and AUROC (95% CI) were 0.877 and 0.881, respectively (P<0.01), while MELD 3.0 prognostic predictive value was not better than MELD. Conclusion: ACLF prognosis is closely related to ABC classification. COSSH-Ⅱ score has a high predictive value for the prognostic evaluation of class A ACLF and HBV-ACLF. COSSH-Ⅱ score has a better prognostic evaluation value after 3 days of hospitalization, suggesting that attention should be paid to the treatment of ACLF in the early stage of admission.
Humans ; Acute-On-Chronic Liver Failure ; Prognosis ; End Stage Liver Disease/complications* ; Retrospective Studies ; Severity of Illness Index