Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study(Springer, 2023) Maiwall, R.; Pasupuleti, S.S.R.; Choudhury, A.; Kim, D.J.; Sood, A.; Goyal, O.; Midha, V.; Devarbhavi, H.; Arora, A.; Kumar, A.; Sahu, M.K.; Maharshi, S.; Duseja, A.K.; Singh, V.; Taneja, S.; Rao, P.N.; Kulkarni, A.; Ghazinian, H.; Hamid, S.; Eapen, C.E.; Goel, A.; Shreshtha, A.; Shah, S.; Hu, J.; Prasad, V.G.M.; Yuemin, N.; Shaojie, X.; Dhiman, R.K.; Chen, T.; Ning, Q.; Panackel, C.; Niriella, M.A.; Lama, T.K.; Tan, S.S.; Dokmeci, A.K.; Shukla, A.; Sharma, M.K.; Sarin, S.K.BACKGROUND AND AIM: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients. METHODS: Prospectively collected data from the AARC database were analyzed. RESULTS: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild-moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille's model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12-0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14-0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63-4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell's C-index was 0.72 compared to other scores. CONCLUSION: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.Item A Case of persistent portal hypertension following ligation of a large porto - systemic shunt during cadaveric donor liver transplantation(Sri Lanka Medical Association., 2020) Siriwardana, R.C.; Shanthanayagam, N.; Gunetilleke, M.B.; Weerasuriya, A.P.; Niriella, M.A.; Dassanayake, A.S.; Dissanayake, R.No abstract availableItem Challenges for liver transplantation during recovery from the COVID-19 pandemic: Insights and recommendations(New York Stratton., 2020) Niriella, M.A.; Siriwardana, R.C.; Perera, M.T.P.R.; Narasimhan, G.; Chan, S.C.; Dassanayake, A.S.ABSTRACT: The coronavirus disease 2019 (COVID-19) pandemic is placing an increasing burden on liver transplant (LT) services worldwide. At the peak of the pandemic, many LT services worldwide reduced or halted their activities. With the gradual easing of lockdowns, LT teams face new challenges when restarting activities. The numbers of LTs are likely to drop in the immediate post-COVID era. Prolonged and intermittent lockdowns are likely to lead to a shortage of supplies, especially in poor resource settings. Special attention is needed to avoid nosocomial COVID-19 infection among cirrhotic patients awaiting transplant, post-transplant patients, and members of transplant teams. LT programs may have to revise existing strategies in selecting donors and recipients for transplants. Redesigning service provision, restructuring outpatient care, carefully screening and selecting donors and recipients, and performing LT with limited resources will have to be initiated in the post-COVID era if long-term recovery of LT services is to be expected. Costs involved with LT are likely to increase, considering the change in protocols of testing, quarantining, and interstate traveling. This paper discusses the different elements affecting and the widespread impact of the COVID-19 pandemic on LT and strategies to minimize the impact of these factors and to adapt so LT services can meet the health care needs during this pandemic and beyond.Item Liver transplantation for non-alcoholic steatohepatitis related cirrhosis(A future global epidemic already seen in current Sri Lankan practice)(Sage Journals, 2017) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Gunetilleke, B.; de Silva, H.J.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.