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Item type:Publication, Research Progress of Limb Preservation Methods: A Review(2024-08-01) ;Shi Zhuang ;Dulan; ; The effects of the survival rate of replanted limbs and postoperative functional recovery is closely related to the correctness and rationality of the limb preservation methods. However, the limb preservation methods can extend the activity of tissues and cells in different levels, reduce ischemia-reperfusion injury and improve the replant survival rate and functional recovery. Is it important to consider the injury situation, the environment and the requirements of replanting of limbs, how to preserve it organically and replant reasonably, and to develop strengths and avoid weaknesses of various methods and techniques that are most suitable for limb preservation? This review describes the research progress and analyzes the effects of different methods of limb preservation. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, P.353: Impact factors leading to renal impairment after liver transplantation: a single center consecutive 12 years’ experience.(Wolters Kluwer, 2024-09-01); ; ;Chuluunbileg Batbold ;Fidel López‐VerdugoJade M. NunezIntroduction: Renal impairment (RI) is a common life-threatening complication of cirrhosis, affecting one in every five patients. Although LT is a lifeline for cirrhotic patients with impaired renal function, postoperative acute RI is not uncommon and is influenced by multiple factors, leading to poor outcomes. Hepatitis B virus (HBV) infection has been associated with increased risk of developing chronic kidney disease in some studies. The potential role of HBV infection in post-LT RI is unknown. This is likely due to the low prevalence of HBV infection amongst liver transplant recipients, which has been reported to be around 5% in the USA. Low- and Middle income country like Mongolia has the highest rate of hepatocellular carcinoma and hepatitis B in the world. Mongolian First liver transplant (LT) performed at First Central Hospital of Mongolia (FCHM) in September 2011 in a collaborative effort with South Korea’s Asan Medical Center. In this context, the aim of our study is identify the role of HBV infection on the incidence of renal impairment after liver transplantation. We hypothesize that patients with HBV infection will have a higher rate of RI post-LT. Methods: To determine the changes of renal function of peri- and post-LT as well as to identify risk factors for RI, we analyzed the First Central Hospital of Mongolia (FCHM) Liver Transplantation Database retrospectively, which includes patients who received LT between September 21, 2011, and December 31, 2022. Early RI was identified by measuring glomerular filtration rates by Cockcroft-Gault creatinine clearance formulation at pretransplantation, intraoperatively, 24h, 72h, 7d, 14d and 28d post LT. Results: The results revealed that female gender (OR=3.06; 95% CI=1.58–5.91), Child-Tucotte-Pugh (CTP) score B and C (OR=4.23; 95% CI=0.92–19.41), (OR=7.68; 95% CI=1.67–35.30), preoperative continuous renal replacement therapy (CRRT) (OR=5.86; 95% CI=1.1–31.21), high graft to recipient weight ratio (GRWR) (OR=3.45; 95% CI=1.23–9.63) increased the risk of RI among recipients. Moreover, recipients’ age (OR=1.07; 95% CI=1.03–1.11), Model for End-Stage Liver Disease (MELD) score (OR=1.09; 95% CI=1.03–1.16), intraoperative leukoreduced red blood cells (LR-RBC) (OR=1.09; 95% CI=1.04–1.14), platelet (PLT) (OR=1.06; 95% CI=1.00–1.12+), fresh frozen plasma (FFP) (OR=1.07; 95% CI=1.02–1.11) and postoperative LR-RBC (OR=1.09; 95% CI=1.04–1.14), cryoprecipitate transfusion (OR=1.1; 95% CI=1.01–1.19), intubated hours (OR=1.04; 95% CI=1.01–1.07) increased slightly the risk of RI. Conclusions: Female gender, high Child Pugh score, preoperative CRRT and high graft to recipient weight ratio are the primary risk factors RI after liver transplant surgery in Mongolia. The liver transplantation team at the FCHM expresses our gratitude to Prof. Sung-Gyu Lee and Liver transplantation team from the Asan Medical Center, Seoul, South Korea. Their contribution was invaluable in the form of guidance and precious knowledge transfer for developing the robust liver transplantation program in Mongolia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Health-related quality of life after liver transplantationBackground: Mongolian citizens in need of liver transplant treatment have been receiving the treatment abroad since 2004, and in Mongolia since 2011. As the number of years of life after liver transplantation increases, it is important to better understand the factors that influence patient’s quality of life during those years, and what can be done to modify them. (1) Quality of life reflects how the interaction between socio-economic and environmental factors influences social and human development. (2) Studies on work capacity have shown that 6% of people after liver transplantation are classified as unable to work based on functional and international disability assessments, (3) while 23-61% are fully employed after liver transplantation. (4)(5) There is a lack of research examining the physical, psychological, and social well-being of patients after liver transplant treatment in Mongolia. Methods: Data were collected from 144 liver transplant cases using descriptive research design and questionnaire method. The study used the SF-36 Health Assessment Questionnaire, which was grouped into 8 groups and the scores were averaged according to the scale. The results of the study were analyzed using SPSS 25.0 software using Pearson’s Chi-square test for differences between groups. Results: Of the total 144 cases included in the study, 81 (56.3%), were male and 63 (43.8%) were female. By age group, 120 (83.3%) are between the ages of 19-60, or working age, and 24 (16.7%) are over 60. Employment after liver transplantation was 41 (28.5%) full-time, 19 (13.2%) part-time, 84 (58.3%) unemployed or there was no statistically significant difference between groups (P=0.024), of which 62 (43%) were willing to work, 17 (12%) were unwilling to work, and 65 (45%) were unknown (0.173) with no statistically significant difference. When assessing health-related quality of life, physical activity was 65.7±27.1, health-related limitations 38.5±40.1, psychological limitations 41.9±43.0, pain 65.5±27.2, psychological average 71.7±19.2, physical energy average 57.8±21.2, moderate, social participation average 68.1±20.6, and health change 85±22.2, indicating that citizens who underwent liver transplant treatment had good health-related quality of life and health change indicators. Conclusion: People who have undergone liver transplant treatment have good health-related quality of life and health-related changes. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, P.389: No difference in recurrent hepatocellular carcinoma rates in liver transplanted patients receiving mTOR inhibitors compared to non-mTOR group.(Wolters Kluwer, 2024-09-01) ;Anar Ganbold ;Margad-Erdene Erdenechuluun ;Bayarmaa Ochirkhuree ;Urnultsaikhan GanboldUlzii-Orshikh NamkhaiIntroduction: A liver transplantation (LT) is a first line therapeutic choice for patients with hepatocellular carcinoma (HCC). Mammalian Target of Rapamycin (mTOR) inhibitors act as immunosuppressant and indicated against HCC recurrence in LT patients. The efficacy of mTOR inhibitors in preventing HCC recurrence remains contentious. Methods: We retrospectively enrolled 45 patients (average age 50, M/F:29/16) who had a history of HCC at the time of LT operation at a single center (2011-2023) and divided into a mTOR and non-mTOR groups. Initial Alfa-fetoprotein (AFP), Protein induced by vitamin K absence-II (PIVKA-II) levels, contrast-enhanced abdominal computer-assisted tomography (CT) scans were compared to most recent results, explant histology was also assessed for HCC extent. Decision to transplant was made based on Milan criteria. Student t-test was used to determine statistical significance (p<0.05). Results: In the mTOR group (n=23, average age 52.7) there were 2 confirmed HCC recurrences with elevated markers and positive CT scans. In the non-mTOR group (n=22, average age 47.4) there was 1 confirmed case of HCC. A recurrence rate of 6.67% was recorded overall, 8.7% and 4.55% for mTOR and non-mTOR (p=0.28), respectively. All three recurrences were detected within 24 months of the operation. For recurrent HCCs, the average levels of PIVKA-II and AFP were 27010mAU/ml and 2842.7ng/ml, respectively. There was no difference in number and mode of pre-LT bridging therapies (TACE or RFA) with regards to recurrence. There were two cases of elevated PIVKA-II without a radiologic confirmation. Conclusion: Adherence to the Milan criteria and application of pre-LT bridging therapies will keep the recurrence rate below 10%. Any possible recurrence will be diagnosed within 24 months of LT. Administration of mTOR inhibitors can be stopped after 2 years as part of the physician-guided minimization of immune suppression regimen. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, P.402: The role of complement C4 and Alt level for acute rejection after liver transplantation.(Wolters Kluwer, 2024-09-01); ; ; ; Acute liver graft rejection is still a common complication after liver transplantation. Diagnosis of acute cellular rejection (ACR) requires a liver biopsy with attendant expense, and risk, especially for developing countries. Measurements of serum complement components C3 and C4 are useful in the diagnosis and monitoring of immune complex disease. The normal adult range of C4 is 20-50mg/dl. Low levels of C4 strongly suggest immune complex disease. The combination C4 and ALT levels are highly predictive of acute cellular rejection (ACR) in liver transplant recipients. A lowered concentration or the complete absence of C4 occurs in immunocomplex diseases, systemic lupus erythematosus (SLE), autoimmune thyroiditis and juvenile dermatomyositis. Patients and Methods: Our study has two groups, one group comprised 8 liver transplant recipients, who has predictive diagnosis of ACR. The other group comprised 8 liver transplant recipients, who has not prediction of ACR. Pathologist evaluated the ACR by Banff grading schema. Serum C4 was checked Cobas 6000/c501/ analyzer. Results: ACR patients had an average of C4 ≤ 0.22 gm/L test, ALT ≥ 124 IU/ml. The patients without ACR had an average of C4 ≥0.61 gm/L test, ALT ≤ 87 IU/ml. The ACR patients had done needle biopsy, which showed liver rejection.Conclusion: To detect serum C4 in blood is a relatively non-invasive, inexpensive, easy to measure and quick marker. Especially for developing countries like Mongolia, preliminary diagnosis of ACR, which revealed decreasing C4 and increasing ALT convenient to biopsy results. Organ Transplantation Team of Mongolia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, P.367: Outcomes of liver transplantation: A single-center experience. (First Central Hospital of Mongolia).(Wolters Kluwer, 2024-09-01); ; ; ; Methods: This study was conducted in Transplantation Center of the First Central Hospital of Mongolia between September 2011 and May 2023 on a total 200 patients have undergone liver transplantation. Results: There were 105 female patients out of 200, age between 18 months to 62 years old, and the average MELD score was 15±5.5, length of hospital stay were 31±13.94. These transplants were for liver (living donor=189, deceased donor=11, pediatric=7). The most causes of liver transplantation were liver cirrhosis due to HBV/HDV (59.5%), hepatocellular carcinoma (22.5%), primary biliary cirrhosis (5%), and only HBV related cirrhosis, alcoholic cirrhosis. There were 23(11.5%) biliary complication, 17 (8.5%) acute cellular rejection, hepatic artery thrombosis 2 (1%), and 3 cases retransplanted. The five year survival was 87%. Conclusions: This study provides the process of liver transplantation in First Central Hospital of Mongolia, and these positive outcomes support LT as an important therapy for end-stage liver disease and early hepatocellular carcinomas. Introduction: Liver transplantation (LT) is a main treatment of end-stage liver disease. Specially developing country like Mongolia has high prevalence of HBV, HDV, and hepatocellular cancer. Liver transplant is the second-most common solid organ transplant procedure in Mongolia. This study aimed to evaluate the efficacy of liver transplantation in the First Central Hospital of Mongolia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Элэг шилжүүлэн суулгах эмчилгээ хийлгэсэн иргэдийн ажил эрхлэлтийн байдал, эрүүл мэндээс шалтгаалсан амьдралын чанарыг судалсан дүн(2025-01-01) ;Ц.Амаржаргал; Үндэслэл: Элэг шилжүүлэн суулгах эмчилгээ шаардлагатай иргэд 2004 оноос гадаад улсад, 2011 оноос Монгол улсад тус эмчилгээг хийлгэж эхэлсэн байна. Элэг шилжүүлэн суулгасны дараах амьдарсан жил нэмэгдэхийн хэрээр, тухайн жилүүдэд өвчтөний амьдралын чанарт нөлөөлж буй хүчин хүчин зүйлс, мөн тэдгээрийг өөрчлөх боломжтой зүйлсийг илүү ойлгох чухал юм. Хөдөлмөрийн чадварын талаарх судалгаагаар элэг шилжүүлэн суулгасны дараа иргэдийн 6% нь олон улсын хөгжлийн бэрхшээлийн үнэлгээнд үндэслэн ажил эрхлэх боломжгүй гэж тодорхойлсон байдаг бол элэг шилжүүлэн суулгах эмчилгээний дараа 2361% нь бүрэн ажил эрхэлж байна. Монгол улсад элэг шилжүүлэн суулгах эмчилгээний дараа өвчтөнүүдийн бие болоод сэтгэлзүй, нийгмийн хувьд хэр байгааг судалсан судалгаа хомс байна. Зорилго: Элэг шилжүүлэн суулгах эмчилгээний дараах амьдралын чанар, ажил эрхлэлтийн байдлыг судлах. Арга, аргачлал: Дескриптив судалгааны загвар, асуумжийн аргаар УНТЭ-т болон гадны оронд элэг шилжүүлэн суулгуулсан 144 тохиолдлоос мэдээллийг цуглуулсан. Судалгааг Эрүүл мэндийг үнэлэх ЗР-36 асуумжийг 8 бүлгээр бүлэглэн хуваарийн дагуу оноог дунджлан тооцоолсон. Үр дүн: Судалгаанд хамрагдсан нийт 144 тохиолдлын 81 (56.3%) нь эрэгтэй, 63 (43.8%) нь эмэгтэйчүүд байв. Насны бүлгээр 120 (83.3%) нь 1960 насны буюу хөдөлмөр эрхлэх насны, 24 (16.7%) нь 60-аас дээш насны иргэд байв. Элэг шилжүүлэн суулгах эмчилгээний дараах ажил эрхлэлт нь 41 (28.5%) нь бүтэн цагаар, 19 (13.2%) нь хагас цагаар, 84 (58.3%) нь ажил эрхлээгүй буюу группэд (р=0.024) статистик ач холбогдол бүхий ялгаатай, үүнээс 62 (43%) нь ажил эрхлэх хүсэлтэй, 17 ( 12 %) нь ажил эрхлэх хүсэлгүй, 65 (45%) нь тодорхойгүй (0.173) статистик ач холбогдол бүхий ялгаагүй байсан. Амьдралын чанарын үнэлгээг тооцоолоход бие махбодын үйл ажиллагааны үзүүлэлт ажил хийж байгаа эмчлүүлэгчдийн хувьд 63.52±25.32, ажил хийгээгүй байгаа эмчлүүлэгчдийн хувьд 52.90±25.75 (р=0.018), сэтгэлзүй байдлын үзүүлэлт нь ажил хийж байгаа эмчлүүлэгчдийн хувьд 64.94±14.53, ажил хийгээгүй байгаа эмчлүүлэгчдийн хувьд 53.63±17.87 (р<0.001) байсан бөгөөд статистик ач холбогдол бүхий ялгаатай байв. Дүгнэлт: Элэг шилжүүлэн суулгах эмчилгээний дараа ажил эрхэлж байгаа хүмүүсийн эрүүл мэндээс шалтгаалсан амьдралын чанар нь өндөр ба бие махбодын үйл ажиллагааны ерөнхий үзүүлэлт, сэтгэлзүйн ерөнхий үзүүлэлт эмчилгээний дараа буюу жил бүр нэмэгдэж байгаа нь тодорхойлогдлоо. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Гадаадын зарим улс орнуудад элэг шилжүүлэн суулгах эмчилгээ хийлгэсэн иргэдийн зардлын судалгаа(2024-01-28) ;Ц.Амаржаргал; Үндэслэл: 2004 оноос манай улсын иргэд гадаадад элэг шилжүүлэн суулгах эмчилгээг хийлгэж эхэлсэн бөгөөд одоогийн байдлаар гадаадад Монгол улсын иргэд элэг шилжүүлэн суулгуулсан 305 тохиолдол бүртгэгдсэн байна. Монгол улсад 2011 онд элэг шилжүүлэн суулгах эмчилгээ нэвтэрч эхэлсэн бөгөөд Эрүүл мэндийн сайдын 2017 оны тушаалаар Элэгний вирусын идэвхжил өндөр болон өмөнтэй реципентэд элэг шилжүүлэн суулгах эмчилгээг Монгол улсад эмчлэх боломжгүй өвчний жагсаалтад багтаасан ба гадаадад энэ төрлийн эмчилгээ хийлгэж буй иргэдийн тоо буурахгүй байна.1 Иймээс гадаад улс оронд элэг шилжүүлэн суулгах эмчилгээг хийлгэсэн иргэдээс гарсан зардлын судалгааг хийж, гадагшаа урсах мөнгөн урсгалын тооцооллыг судлах нь судалгааны үндэслэл болсон. Зорилго: Гадаадад элэг шилжүүлэн суулгах эмчилгээ хийлгэсэн иргэдийн зардлын тооцоог судлах. Арга, аргачлал: Асуумжийн аргаар судалгааны тоон мэдээллийг цуглуулсан. Улсын Нэгдүгээр төв эмнэлгийн хяналтад байгаа гадаад улсад Гадаадад элэг шилжүүлэн суулгуулсан үйлчлүүлэгчдээс санамсаргүй байдлаар түүвэрлэн бэлтгэсэн асуумжийн дагуу судалгааг авч, үр дүнг нэгтгэсэн. Үр дүн: Эмчилгээний дундаж зардал оноор харьцуулан үзвэл 20102015 онд гадаадад элэг шилжүүлэн суулгах эмчилгээний дундаж зардал 218 сая төгрөг, 2016-2020 онд дундаж зардал 253 сая төгрөг, 2021-2023 онд дундаж зардал 276 сая төгрөг байв. 2010 оноос 2023 оны хооронд гадаадад элэг шилжүүлэн суулгах эмчилгээний дундаж зардал 26%-иар өссөн байна. Монгол улсаас гадаадад элэг шилжүүлэн суулгах эмчилгээ хийлгэсэн иргэдээс дунджаар 249 сая төгрөгийн зардал гарсан бөгөөд 19 жилийн хугацаанд дунджаар 76.0 тэрбум төгрөгийг тус эмчилгээ хийлгэхэд гадны зарим улсуудад зарцуулсан байна. Дүгнэлт: Гадаадад элэг шилжүүлэн суулгах эмчилгээ хийлгэсэн иргэд дунджаар 249 сая төгрөгийг зарцуулсан бөгөөд 19 жилийн хугацаанд тооцож үзбэл нийт 76.0 тэрбум төгрөгийг зарцуулсан байна.
