Blood Safety Surveillance and Health Care Acquired Infection Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario. email@example.com
Liver transplantation is an important health care issue for Canadians. Very few studies have assessed survival and determinants of survival in liver transplant patients in Canada.
We carried out an epidemiological analysis of 1 year survival and determinants of 1 year survival in liver transplant patients, using Canadian Organ Replacement Registry data (1997-2002). Survival curves were plotted by the Kaplan-Meier method. Cox proportional hazards analysis was applied to evaluate hazard ratios with different age groups, gender, ethnicity, blood groups, donor type, pretransplantation medical status, and HBV infection status.
A total of 1164 liver transplant patients were included in the analysis. One-year survival rate was 84.7%. Male recipients had a 21% higher risk of developing organ failure than females. Recipients over 60 years of age had a 5% lower survival probability in comparison with recipients below 20 years of age. Pacific Islanders and Aboriginals had 32% and 9% lower survival probabilities, respectively, in comparison with Caucasians. Type B blood recipients had a 12% higher survival probability, whereas type AB blood recipients had a 7% lower survival probability compared with type O blood recipients. Twenty-six live organ recipients had 40% higher survival probabilities than 1138 cadaveric organ recipients. Patients with fulminant hepatitis (status 3F) had the highest survival, while patients with fulminant failure in ICU with intubation/ventilation (status 4F) had the lowest survival. One hundred sixty-seven recipients with positive HBsAg antigen showed 10% lower survival probability than 997 cases with negative HBsAg antigen.
In Canada, the first year survival rate is about 85%, which is comparable with other industrialized countries. Type of donor organs and recipient gender, ethnicity, ABO blood group, pretransplantation medical status, and HBV infection status had significant affects on the recipient survival.
From the aSection of Social Medicine, Department of Public Health, University of Copenhagen, Denmark; bAstraZeneca, Nordic Baltic MC, Medical & Regulatory Nordic Baltic, Södertälje, Sweden; cFundacao Oswaldo Cruz, Brazil; dSection of Biostatistics, Department of Public Health, University of Copenhagen, Denmark; eCenter for Statistical Science, Peking University; fResearch Center for Prevention and Health, Rigshospitalet-Glostrup University Hospital, Denmark; gDepartment of Cardiology and the Copenhagen City Heart Study, Bispebjerg University Hospital, Denmark; and hThe Danish Cancer Society Research Centre, Copenhagen Ø, Denmark.
Alcohol-related mortality is more pronounced in lower than in higher socioeconomic groups in Western countries. Part of the explanation is differences in drinking patterns. However, differences in vulnerability to health consequences of alcohol consumption across socioeconomic groups may also play a role. We investigated the joint effect of alcohol consumption and educational level on the rate of alcohol-related medical events.
We pooled seven prospective cohorts from Denmark that enrolled 74,278 men and women age 30-70 years (study period, 1981 to 2009). We measured alcohol consumption at baseline using self-administrated questionnaires. Information on highest attained education 1 year before study entry and hospital and mortality data on alcohol-related medical events were obtained through linkage to nationwide registries. We performed analyses using the Aalen additive hazards model.
During follow-up (1,085,049 person-years), a total of 1718 alcohol-related events occurred. The joint effect of very high alcohol consumption (>21 [>28] drinks per week in women [men]) and low education on alcohol-related events exceeded the sum of their separate effects. Among men, we observed 289 (95% confidence interval = 123, 457) extra events per 100,000 person-years owing to education-alcohol interaction (P
OBJECTIVES: To assess homozygous alpha 1-antitrypsin deficiency (PiZZ) as a risk factor for cirrhosis, hepatocellular carcinoma (HCC) and gallstone disease, and to analyse the respective interrelation-ships and those suggested to exist between PiZZ, alpha 1-antitrypsin and chronic hepatitis B and C. DESIGN/METHODS: This study was based on 31 autopsied adults with severe alpha 1-antitrypsin deficiency diagnosed during the period 1963-94, in the city of Malm?, Sweden. For each autopsied PiZZ individual, four age- and sex-matched controls were selected from the same autopsy register. The autopsy rate during the study period was 57.2% of all deaths in the city and 85% of deaths at the hospital. Relative risks were estimated in terms of Mantel-Haenszel odds ratios (ORmh). RESULTS: In the PiZZ group, we found 13 cases of cirrhosis (ORmh = 8.3; 95% CI, 3.8-18.3; P
The association between parity and hepatocellular carcinoma (HCC) was studied using a data-base generated by linking 2 Swedish nation-wide registries; the Cancer Registry and the Fertility Registry. Among women born between 1925 and 1960, 133 patients with HCC recorded in the Cancer Registry between 1958 and 1984 were compared with 665 age-matched controls. In this nested case-control study there was no positive association between parity, age at first birth or frequency of twinning on the one hand, and risk of HCC on the other. It appears that the positive association between parity and HCC previously reported is limited to cases of HCC caused by chronic infection with hepatitis B virus; these cases represent only a small fraction of HCC cases in Sweden.
Cancers of the digestive organs and peritoneum constituted 28% of all cancers in Denmark in 1943-87. The lack of a common trend in incidence rates for the different tumour types indicates different aetiologies. Survival is worst for cancer of the oesophagus and improves gradually for cancer of the stomach, cancer of the small intestine and colorectal cancers. Survival from these tumours differ little between the sexes, but females have a slightly more favourable prognosis, which is most pronounced for sites with the best survival. The changes in survival over the study period, 1943-87, show virtually no change in the prognosis for oesophageal cancer, very slight, if any, improvement in that for stomach cancer, a detectable improvement in survival from cancer of the small intestine and substantial improvements in survival from colorectal cancer. Survival rates after colorectal cancer appear to be lower in Denmark than those seen in the USA. This finding may be due to the exclusion of certain precancerous lesions from the Danish material, which is not possible in US studies. Cancers of the liver, gallbladder and pancreas all carry extremely high mortality rates, with five-year survival rates below 5%, and one-year survival rates below 5% for cancers of the liver and pancreas.
BACKGROUND: Studies of groups of patients given injections of the alpha-emitting x-ray contrast medium Thorotrast may provide information on human alpha-ray carcinogenesis. PURPOSE: We re-established a formerly identified cohort of neurological patients receiving injections of Thorotrast for cerebral arteriography and assessed their incidence of cancer. METHODS: Using the national population register, the Danish Cancer Registry, and other registers, we determined the incidence of cancer among Thorotrast-injected patients. Incidence ratios were standardized to the general population and computed for different cancer sites. RESULTS: The cumulative risk for cancer at all sites (excluding brain tumors where the standardized incidence ratio [SIR] was 28) reached 86% 50 years after Thorotrast injection. SIR was greatly elevated at all sites except the brain and CNS (3.3, 95% confidence interval = 3.0-3.7), mainly because of liver cancers (SIR = 126) as well as leukemia (SIR = 10) for which a relationship was found between the time since injection and the estimated dose (but not the age at injection). Other sites with significantly increased risks of cancer included the gallbladder and extrahepatic bile ducts (SIR = 14), peritoneum (SIR = 8.6), sites of multiple myeloma (SIR = 4.6), metastatic sites (SIR = 12), and unspecified sites (SIR = 11). Cancers of the lung and breast also occurred in significant excess, but no relationship between SIR and volume of injected Thorotrast or time since injection was observed. Cancer risk was increased at most other sites, although this increase was not statistically significant. CONCLUSION: Alpha radiation may account for the increased risk of tumors of the liver, gallbladder, and peritoneum as well as leukemia and multiple myeloma, whereas confounding factors most probably contribute to the increased risks at other sites.
INTRODUCTION: We evaluated the organisation, management and outcome for patients undergoing elective liver resection in Denmark in the period 2002-2007. MATERIAL AND METHODS: Nationwide data based on the National Patient Registry and discharge information from hospital departments in the period 1 January 2002 to 31 December 2007 were analysed. RESULTS: Twenty-three departments performed 818 resections with five departments performing 96% and 18 departments performing 4% of the operations. The amount of non-anatomical resections constituted 30% (248 of 818) of the resections. The median postoperative stay was nine days, and the hospital mortality rate was 3.9%, distributed between 2.4% for non-anatomical resections, 2.9% for segmental resections and 5.2% for right-sided hepatectomy. CONCLUSION: The number of treated patients was too small as was the number referred to highly specialised liver surgery units. Moreover, the amount of non-anatomical resections was too high as was the average postoperative stay and the hospital mortality rate. In future, we propose that liver resections be centralised in 2-3 hospitals each capable of providing all the following services: surgery, hepatology, oncology and interventional radiology.
A liver transplant program was established in Norway in 1984, and until March 1999 200 liver transplantations have been carried out. Data for these 200 consecutive patients are briefly outlined with emphasis on survival. Relevant data are also given from the Nordic Liver Transplant Registry (NLTR), the European Liver Transplant Registry (ELTR) and from United Network for Organ Sharing (UNOS). Future trends and potential advances in liver transplantation are briefly discussed. One-year and three-year survival rates for Norwegian patients have increased markedly over the years and were 85% and 75% respectively for the 1995-98 period. The number of liver transplantations per million population per year was 3.4 in Norway, 7.8 in Sweden, 5.7 in Finland and 5.4 in Denmark (1990-98). The low number of liver transplantations in Norway warrants attention. It is possible that some patients with end stage liver disease have not been offered this treatment modality. Monitoring of results and active participation in international liver transplant registries like NLTR and ELTR is an important quality control instrument.
The purpose of this study was to explore the accuracy of elevated liver function values, age, gender, pancreatitis and cholecystitis as predictors of common bile duct stones (CBDS).
All patients operated on for gallstone disease over a period of 3 years in a Swedish county of 302,564 citizens were registered prospectively. Intraoperative cholangiography (IOC) was used to detect CBDS.
A total of 1171 patients were registered; 95% of these patients underwent IOC. Common bile duct stones were found in 42% of patients with elevated liver function values, 20% of patients with a history of pancreatitis and 9% of patients with cholecystitis. The presence of CBDS was significantly predicted by elevated liver function values, but not by age, gender, history of acute pancreatitis or cholecystitis. A total of 93% of patients with normal liver function tests had a normal IOC. The best agreement between elevated liver function values and CBDS was seen in patients undergoing elective surgery without a history of acute pancreatitis or cholecystitis.
Although alkaline phosphatase (ALP) and bilirubin levels represented the most reliable predictors of CBDS, false positive and false negative values were common, especially in patients with a history of cholecystitis or pancreatitis, which indicates that other mechanisms were responsible for elevated liver function values in these patients.