PubMed · 10914811
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J L Gray. 2000. When not to perform root coverage procedures.. https://doi.org/10.1902/jop.2000.71.6.1048
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BACKGROUND: The majority of liver transplant centers require a 6-month abstinence period before listing candidates for liver transplantation with alcoholic cirrhosis and a persistent sobriety thereafter. We attempted to identify risk factors for failure to comply with these requirements. METHODS: Ninety-nine consecutive patients with alcoholic cirrhosis were referred for liver transplant evaluation between September 1996 and May 1998. The mean age was 49 years, 74% were male, and 54% were hepatitis C virus positive. To be listed, patients had to meet the following requirements. All patients received extensive psychosocial evaluations and were frequently monitored with random urine and blood alcohol tests; patients found positive were excluded or removed from the liver transplant waiting list. Detailed patient information was entered into a computerized database, and 36 discreet variables were analyzed in relation to success (patient listed and remained on the list) or failure (not listed or removed from the list based on noncompliance). RESULTS: Forty-nine patients were successfully listed. Nineteen received a transplant, with a 95% 1-year patient and graft survival rate and 21% alcohol relapse rate after transplantation. Twenty-two patients had either medical contraindication and/or died before transplant listing. Twenty-four patients were never listed and four were removed from the list due to recurrent alcoholism, for a total of 28 failures. Our statistical analysis identified five significant risk factors for failure: (I) living arrangement (alone/family versus community/friend), P=0.006; (II) history of suicide ideation, P=0.03; (III) history of previous alcohol-related hospitalization, P=0.01; (IV) lack of previous alcoholic rehabilitation before transplant evaluation, P=0.001; and (V) failure to accept further alcoholic rehabilitation before orthotopic liver transplantation, P=0.01. CONCLUSIONS: Our experience confirms that transplantation can be extremely successful in properly selected patients with alcoholic cirrhosis. We identified several predictive psychosocial factors of early alcoholic recidivism in transplant candidates.
UNLABELLED: A substantive amendment to this systematic review was last made on 12 April 1999. Cochrane reviews are regularly checked and updated if necessary. BACKGROUND AND OBJECTIVES: To determine the effect of domiciliary oxygen therapy on survival and quality of life in patients with chronic obstructive pulmonary disease. SEARCH STRATEGY: Randomised controlled trials (RTCs) were identified using the Cochrane Airways Group Chronic Obstructive Pulmonary Disease (COPD) register using the search terms: home or domiciliary and oxygen. SELECTION CRITERIA: Any randomised controlled trial in patients with hypoxia and chronic obstructive pulmonary disease that compared long term domiciliary or home oxygen therapy with a control treatment. DATA COLLECTION AND ANALYSIS: Data extraction was performed independently by two reviewers. MAIN RESULTS: Four randomised controlled trials were identified. Data from none of these trials could be aggrigated because of differences in trial design and patient selection. Trial 1, continuous oxygen therapy versus nocturnal oxygen therapy: there was a significant improvement in mortality after 24 months (Peto odds ratio 0.45, 95% confidence interval 0.25 to 0.81). Trial 2, oxygen versus no oxygen: there was a significant improvement over five years in mortality in the group receiving oxygen (Peto odds ratio 0.42, 95% confidence interval 0.18 to 0.98). Trial 3, nocturnal oxygen versus no oxygen in patients with arterial desaturation at night: there was no difference in mortality at 36 months. Trial 4, long term oxygen versus no oxygen in moderate hypoxaemia: there was no effect on survival for up to three years of follow up. REVIEWERS' CONCLUSION: Long term oxygen therapy improves survival in a selected group of COPD patients with severe hypoxaemia (arterial PO2 less than 8.0 kPa). Long term oxygen does not appear to improve survival in patients with moderate hypoxia or those who only have arterial desaturation at night.