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Papers by victor pirvu
Bulletin of the Academy of Sciences of Moldova. Medical Sciences
Liver transplantation is an important treatment for acute liver failure and end-stage liver disea... more Liver transplantation is an important treatment for acute liver failure and end-stage liver disease. In 2002, the model for end-stage liver disease (MELD) was incorporated to prioritize patients awaiting liver transplantation. While there are data on how the MELD score affects wait time, there is a dearth of literature regarding other components. We aimed to evaluate the factors affecting the waiting time for TH. Using the database from the Republic of Moldova, patients aged 18- 65 listed for liver transplants in the period 2013-2022 were included. Variables tested in the model included patient characteristics, biochemical analyses, MELD score, and ABO blood group. The MELD score is used in prioritizing liver allocation and was expected to predict time on the waiting list. Mechanical ventilation and other markers of disease severity are associated with higher MELD scores, thus shorter waiting time. Further research is needed to address the reasons for ariation in waiting time in an ...
This subject underlines the most important perioperative factors that predispose to early post-li... more This subject underlines the most important perioperative factors that predispose to early post-liver transplant respiratory complications. Despite advances in surgical techniques and anesthesiological management the lung may still suffer throughout the perioperative period from various types of injury, with different ensuing ventilatory impairments, and different clinical outcomes. The incidence, etiology, pathophysiological features, clinical manifestations, preventing measures, and outcomes of post-operative respiratory disorders in this setting are also reported.
World journal of gastroenterology, Jan 28, 2016
Acute liver failure is a critical medical condition defined as rapid development of hepatic dysfu... more Acute liver failure is a critical medical condition defined as rapid development of hepatic dysfunction associated with encephalopathy. The prognosis in these patients is highly variable and depends on the etiology, interval between jaundice and encephalopathy, age, and the degree of coagulopathy. Determining the prognosis for this population is vital. Unfortunately, prognostic models with both high sensitivity and specificity for prediction of death have not been developed. Liver transplantation has dramatically improved survival in patients with acute liver failure. Still, 25% to 45% of patients will survive with medical treatment. The identification of patients who will eventually require liver transplantation should be carefully addressed through the combination of current prognostic models and continuous medical assessment. The concerns of inaccurate selection for transplantation are significant, exposing the recipient to a complex surgery and lifelong immunosuppression. In thi...
BMC Medicine, 2018
Background: The results of liver transplantation are excellent, with survival rates of over 90 an... more Background: The results of liver transplantation are excellent, with survival rates of over 90 and 80% at 1 and 5 years, respectively. The success of liver transplantation has led to an increase in the indications for liver transplantation. Generally, priorities are given to cirrhotic patients with a high Model for End-Stage Liver Disease (MELD) score on the principle of the sickest first and to patients with hepatocellular carcinoma (HCC) on the principle of priority points according to the size and number of nodules of HCC. These criteria can lead to a 'competition' on the waiting list between the above patients and those who are cirrhotic and have an intermediate MELD score or with life-threatening liver diseases not well described by the MELD score. For this latter group of patients, 'MELD exception' points can be arbitrarily given. Discussion: The management of patients on the waiting list is of prime importance to avoid death and drop out from the waiting list as well as to improve post-transplant survival rates. For the more severe cases who may swiftly access liver transplantation, it is essential to rapidly determine whether liver transplantation is indeed indicated, and to organise a fast workup ahead of this. It is also essential to identify the ideal timing for liver transplantation in order to minimise mortality rates. For patients with HCC, a bridge therapy is frequently required to avoid progression of HCC and to maintain patients within the criteria of liver transplantation as well as to reduce the risk of post-transplant recurrence of HCC. For patients with cirrhosis and intermediate MELD score, waiting time can exceed 1 year; therefore, regular follow-up and management are essential to maintain the patient alive on the waiting list and to achieve a good survival after liver transplantation. Conclusion: There is a diversity of patients on the waiting list for transplantation and equity should be preserved between those with cirrhosis of high and intermediate severity and those with HCC. The management of patients on the waiting list is an essential component of the success of liver transplantation.
Bulletin of the Academy of Sciences of Moldova. Medical Sciences
Liver transplantation is an important treatment for acute liver failure and end-stage liver disea... more Liver transplantation is an important treatment for acute liver failure and end-stage liver disease. In 2002, the model for end-stage liver disease (MELD) was incorporated to prioritize patients awaiting liver transplantation. While there are data on how the MELD score affects wait time, there is a dearth of literature regarding other components. We aimed to evaluate the factors affecting the waiting time for TH. Using the database from the Republic of Moldova, patients aged 18- 65 listed for liver transplants in the period 2013-2022 were included. Variables tested in the model included patient characteristics, biochemical analyses, MELD score, and ABO blood group. The MELD score is used in prioritizing liver allocation and was expected to predict time on the waiting list. Mechanical ventilation and other markers of disease severity are associated with higher MELD scores, thus shorter waiting time. Further research is needed to address the reasons for ariation in waiting time in an ...
This subject underlines the most important perioperative factors that predispose to early post-li... more This subject underlines the most important perioperative factors that predispose to early post-liver transplant respiratory complications. Despite advances in surgical techniques and anesthesiological management the lung may still suffer throughout the perioperative period from various types of injury, with different ensuing ventilatory impairments, and different clinical outcomes. The incidence, etiology, pathophysiological features, clinical manifestations, preventing measures, and outcomes of post-operative respiratory disorders in this setting are also reported.
World journal of gastroenterology, Jan 28, 2016
Acute liver failure is a critical medical condition defined as rapid development of hepatic dysfu... more Acute liver failure is a critical medical condition defined as rapid development of hepatic dysfunction associated with encephalopathy. The prognosis in these patients is highly variable and depends on the etiology, interval between jaundice and encephalopathy, age, and the degree of coagulopathy. Determining the prognosis for this population is vital. Unfortunately, prognostic models with both high sensitivity and specificity for prediction of death have not been developed. Liver transplantation has dramatically improved survival in patients with acute liver failure. Still, 25% to 45% of patients will survive with medical treatment. The identification of patients who will eventually require liver transplantation should be carefully addressed through the combination of current prognostic models and continuous medical assessment. The concerns of inaccurate selection for transplantation are significant, exposing the recipient to a complex surgery and lifelong immunosuppression. In thi...
BMC Medicine, 2018
Background: The results of liver transplantation are excellent, with survival rates of over 90 an... more Background: The results of liver transplantation are excellent, with survival rates of over 90 and 80% at 1 and 5 years, respectively. The success of liver transplantation has led to an increase in the indications for liver transplantation. Generally, priorities are given to cirrhotic patients with a high Model for End-Stage Liver Disease (MELD) score on the principle of the sickest first and to patients with hepatocellular carcinoma (HCC) on the principle of priority points according to the size and number of nodules of HCC. These criteria can lead to a 'competition' on the waiting list between the above patients and those who are cirrhotic and have an intermediate MELD score or with life-threatening liver diseases not well described by the MELD score. For this latter group of patients, 'MELD exception' points can be arbitrarily given. Discussion: The management of patients on the waiting list is of prime importance to avoid death and drop out from the waiting list as well as to improve post-transplant survival rates. For the more severe cases who may swiftly access liver transplantation, it is essential to rapidly determine whether liver transplantation is indeed indicated, and to organise a fast workup ahead of this. It is also essential to identify the ideal timing for liver transplantation in order to minimise mortality rates. For patients with HCC, a bridge therapy is frequently required to avoid progression of HCC and to maintain patients within the criteria of liver transplantation as well as to reduce the risk of post-transplant recurrence of HCC. For patients with cirrhosis and intermediate MELD score, waiting time can exceed 1 year; therefore, regular follow-up and management are essential to maintain the patient alive on the waiting list and to achieve a good survival after liver transplantation. Conclusion: There is a diversity of patients on the waiting list for transplantation and equity should be preserved between those with cirrhosis of high and intermediate severity and those with HCC. The management of patients on the waiting list is an essential component of the success of liver transplantation.