Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
4 results
Search Results
Item Viscoelastic haemostatic test based management of coagulopathy in liver transplantation for cirrhosis(Sri Lanka College of Haematologists, 2021) Gunetilleke, B.; Welikala, N.; Görlinger, K.Management of coagulopathy is an important consideration in the management of liver transplantation (LT) for end stage liver disease due to cirrhosis. Blood loss and the volume of blood products transfused are key determinants of outcome following liver transplantation. Cirrhosis has traditionally been associated with hypocoagulability and haemorrhage. Greater understanding of the normal haemostatic processes and the derangement associated with cirrhosis has resulted in the concept of rebalanced haemostasis in cirrhosis. This rebalancing and reduction of haemostatic reserves results in an unpredictable and often pro thrombotic haemostatic state in cirrhosis. The predictive value of standard tests of coagulation is diminished in cirrhosis. In contrast, viscoelastic haemostatic tests have demonstrated superior diagnostic and bleeding predicting capabilities in cirrhosis. Bleeding management protocols including viscoelastic haemostatic test-based algorithms have reduced transfusion requirements without an increase in the incidence of bleeding or thrombotic complications in liver transplantation.Item Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 2](The College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Hettiarachchi, D.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Fernando, M.; Hettiarachchi, D.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; Wijesuriya, R.; Liyanage, C.; Siriwardana, R.; Dissanayake, J.; Wijesuriya, N.; Rodrigo, U.; Rodrigo, U.; Mudalige, A.; de Silva, J.Globally, an estimated one million deaths occur annually due to complications of cirrhosis. Cirrhosis with end stage liver disease [ESLD] is a leading cause death due to non- communicable diseases in Sri Lanka. Non-alcoholic fatty liver disease [NAFLD] and alcohol related liver disease [ARLD] are the principal causes of ESLD due to cirrhosis in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multiorgan dysfunction and hemodynamic instability characteristic of ESLD adds to the complexity of perioperative care in liver transplantation. Maintenance of stable hemodynamics including optimal hemostasis forms the core of the anaesthetic strategy in liver transplantation.Item Recurrence of graft steatosis after liver transplantation for cryptogenic cirrhosis in recently commenced liver transplant program(Springer India, 2016) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.A.H.; Gunetilleke, B.; de Silva, H.J.Non-alcoholic fatty liver disease (NAFLD) seems to recur in at least one third of patients transplanted for non-alcoholic steatohepatitis (NASH)-related cirrhosis. While, NASH recurrence does not seem to affect overall graft and patient survival up to 10 years, cardiovascular and infection-related morbidity and mortality seem to be increased in these patients. This report looks at the graft histology in patients who were transplanted for NASH-related cirrhosis after short-term follow up. We report a high prevalence of recurrent NAFLD in liver grafts post-transplant among five patients. The degree of steatosis noted among the recipients is alarming.Item Clinical characteristics and outcome of hepatocellular carcinoma in alcohol related and cryptogenic cirrhosis:a prospective study(Elsevier, 2015) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.; Gunetilleke, B.; Jayathunge, S.; de Silva, H.J.BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of chronic liver disease. Hepatocellular carcinoma (HCC) is one of its complications. Although the pathophysiology is unclear, it is reasonable to expect that cryptogenic cirrhosis related HCC (cryptogenic HCC) behaves differently to other types of HCC. This study prospectively compared patients with cryptogenic HCC and those with HCC related to alcoholic cirrhosis. METHODS: A total of 150 consecutive patients with HCC (89 cryptogenic HCC and 61 alcohol related HCC) referred to our unit over a 23-month period were studied. Their demographic data, liver function, tumor characteristics and outcomes were compared. RESULTS: Alcohol related HCC was seen only in males. Compared with cryptogenic HCC, alcohol related HCC had significantly higher aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (1.7 vs 1.4, P=0.002), model for end-stage liver disease score (13 vs 11, P=0.018) and Child's score (7 vs 6, P=0.037). No significant difference was seen in platelet counts, serum sodium and AST to platelet ratio index. Single nodular tumors were more common in cryptogenic HCC, while diffuse type tumors and macroscopic vascular invasion were common in alcohol related HCC. In patients who could not be offered any treatment because of advanced tumors or poor liver function, alcohol related HCC had a significantly lower median survival (5.3 months) compared with cryptogenic HCC (9.3 months, P=0.034). CONCLUSIONS: Compared with cryptogenic HCC, alcohol related HCC had worse liver function and aggressive tumor morphology at presentation, and a higher proportion was untreatable. In patients who could not be treated, median survival was lower in patients with alcohol related HCC than in those with cryptogenic HCC.