Canadian Liver Journal

Background: We evaluated an outpatient, nurse practitioner-led transitional care program with respect to its efficacy in reducing unplanned readmission rates for patients with liver disease. Methods: We conducted a retrospective cohort study using data from an academic health system in Toronto, Ontario. The study included all admissions associated with an ICD10 code of R18 (ascites), I85.0 or I98.3 (variceal bleeding), or K70–K77 (diseases of the liver). Patients were selected to receive the transitional care (intervention group) or not (no-intervention group) by discretion of the hepatologists. We used a proportional hazard model to estimate the associations between receiving the intervention and the marginal probability of 30-, 60-, and 90-day readmission in the presence of death as a competing risk. We conducted sensitivity analyses to examine the robustness of our estimates to various sources of bias, including adjusting for propensity of receiving the intervention estimated using a logistic regression model. Results: A total of 803 admissions were included. Receiving transitional care was associated with a reduction in risk of 30-day readmission (HR 0.51; 95% CI 0.30–0.85), 60-day readmission (HR 0.60; 95% CI 0.40–0.91), and 90-day readmission (HR 0.55; 95% CI 0.37–0.83). The negative associations remained statistically significant under the sensitivity analyses, except for the propensity-adjusted estimate for the 60-day outcome. Conclusions: A nurse practitioner-led transitional care program could be effective in reducing the risk of readmission for patients with liver disease. Future studies are needed to standardize the referral process and prospectively measure the effectiveness and financial value of the program.

Marjan Naghshbandi

Simon Y Huang

Hemant Shah

Colina Yim

Elizabeth Lee

Michael Caesar

Andrew Hope

Timothy CY Chan

Vahid Sarhangian

Evaluation of a nurse practitioner-led post-discharge transitional care program for patients with liver disease: A retrospective cohort study

护士主导的肝病患者出院后过渡期护理计划的评估：一项回顾性队列研究

Nabiha Faisal

Gerald Minuk

Response to Commentary on Ragheb et al.

对Ragheb等人评论的回应

Natasha Chandok

Eric M Yoshida

Coffee: nature's remedy for liver disease

咖啡：肝脏疾病的天然疗法

Early acute cellular rejection occurs commonly within the first month after liver transplantation, is easily reversible with treatment, and has little impact on long-term graft survival. In contrast, late allograft rejection, typically defined as occurring after 3-6 months post-transplantation, can lead to the development of chronic rejection and graft loss. Alloreactivity and the risk of rejection decreases with time, since transplantation and many long-term liver transplant recipients can maintain graft function with minimal immunosuppression. We describe a case of acute allograft rejection 22 years and 5 months after liver transplantation. The patient, transplanted for biliary atresia as a young child, had three prior episodes of allograft rejection: two within the first month of transplantation, and one 4 years after. Subsequent to this, she had normal liver biochemistry and was maintained on minimal immunosuppression for many years. Following a diagnosis of immune thrombocytopenic purpura and marginal zone lymphoma, she was switched from tacrolimus to mycophenolate monotherapy, and subsequently developed significantly elevated liver enzymes, and biopsy confirmed severe acute allograft rejection. Our experience demonstrates that despite the liver being an immunotolerant organ, which often can be maintained with minimal immunosuppression post-transplantation, acute allograft rejection can occur at any stage and should always be considered as a possible cause of liver biochemistry abnormalities.

Monica Dahiya

Michael Minkley

Daniel R. Owen

Trana Hussaini

Ben Cox

Vladimir Marquez

Daljeet Chahal

Eric M. Yoshida

Severe acute allograft rejection 22 years after liver transplantation

肝移植后22年严重急性同种异体移植物排斥反应

Introduction: Despite significant global efforts towards eliminating hepatitis C virus (HCV) infection, multiple challenges remain in achieving this goal. In this study, we assessed the impact of geographical variation on HCV diagnosis and treatment rates in Alberta, Canada. Methods: Adults aged ≥20 years with a positive HCV antibody were identified from the provincial administrative sources from the fiscal years 2012 through 2017. To assess the differences across Alberta's rural-urban continuum, high-resolution spatial analyses using global and local spatial autocorrelation were applied to the HCV age- and sex-standardized prevalence rate at the sub-local geographic area level. We compared and tested differences in HCV RNA tests, HCV RNA positivity rates, and HCV treatment status across the different areas. Results: Between 2012 and 2017, we identified 18,768 patients who had tested positive for HCV Ab. Within this cohort, only 63.1% had HCV RNA repetitive. The HCV RNA positivity rate was 42.1%, and 65.3% had received HCV treatment after testing as HCV RNA positive. HCV Ab positive case counts exhibited a spatial distribution consistent with that of the population at risk: 67.5% in metro, 11.1% in urban, 19.7% in rural, and 1.8% in remote areas. The metropolitan area of Edmonton's age-and sex-standardized prevalence of 8.2 (95% CI 8.0–8.4) per 1,000 persons was higher than Calgary's standardized prevalence of 5.0 (95% CI 5.1–5.4) per 1,000 persons ( p &lt; 0.001). HCV RNA and HCV treatment rates demonstrated significant spatial variation. Conclusions: HCV prevalence, diagnosis, and treatment exhibit significant spatial variation across rural-urban Alberta. Implementation of geographically oriented screening and treatment interventions would result in a time- and cost-efficient HCV elimination strategy.

Shubhreet Gill

Rizwan Shahid

Ranjani Somayaji

Mayur Brahmania

Jason Jiang

Jawad Chishtie

Stefania Bertazzon

Abdel-Aziz Shaheen

The effect of spatial variation on linkage to care and treatment rates among patients with hepatitis C: A Canadian population-based study

空间变化对丙型肝炎患者护理和治疗率的影响：一项基于加拿大人群的研究

Abbreviation
Journal Impact	0.89
Quartiles(Global)	GASTROENTEROLOGY & HEPATOLOGY(Q4)

Publication Information	Publisher: John Wiley and Sons Inc，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2018，Proportion of original research papers: 90.32%，Self Citation Rate:， Gold OA Rate: 1.09%

Canadian Liver Journal

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Evaluation of a nurse practitioner-led post-discharge transitional care program for patients with liver disease: A retrospective cohort study

Response to Commentary on Ragheb et al.

Coffee: nature's remedy for liver disease

Severe acute allograft rejection 22 years after liver transplantation

The effect of spatial variation on linkage to care and treatment rates among patients with hepatitis C: A Canadian population-based study

Evaluation of a nurse practitioner-led post-discharge transitional care program for patients with liver disease: A retrospective cohort study

Response to Commentary on Ragheb et al.

Coffee: nature's remedy for liver disease

Severe acute allograft rejection 22 years after liver transplantation

The effect of spatial variation on linkage to care and treatment rates among patients with hepatitis C: A Canadian population-based study

ISSN	2561-4444
h-index	8