Clinical outcomes of liver transplantation for polycystic liver disease: A single center experience
Natasha Chandok
, Julia Uhanova**, Paul Marotta*
,
Corresponding author
chandok.n@gmail.com
Correspondence and reprint request: Natasha Chandok, MD, Multi-Organ Transplant Program, Division of Gastroenterology, University of Western Ontario, 339 Windermere Road. London, Ontario. N6A 5A5 Canada, Tel.: 519-685-8500 x 34882. Fax: 519-663-3858
Correspondence and reprint request: Natasha Chandok, MD, Multi-Organ Transplant Program, Division of Gastroenterology, University of Western Ontario, 339 Windermere Road. London, Ontario. N6A 5A5 Canada, Tel.: 519-685-8500 x 34882. Fax: 519-663-3858
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The figure shows the prevalence of liver disease in patients with T2DM compared with patients without T2DM. Only cirrhosis was statistically significant whereas HCC showed a tendency towards significance. <span class="elsevierStyleBold">T2DM:</span> type 2 diabetes mellitus. <span class="elsevierStyleBold">HCV:</span> hepatitis C virus. <span class="elsevierStyleBold">HCC:</span> hepatocellular carcinoma. <span class="elsevierStyleBold">NAFLD:</span> nonalcoholic fatty liver disease. <span class="elsevierStyleBold">NASH:</span> nonalcoholic steatohepatitis. <span class="elsevierStyleBold">VHB:</span> hepatitis B virus.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ramón Arturo Kobashi-Margáin, Ylse Gutiérrez-Grobe, Guadalupe Ponciano-Rodríguez, Misael Uribe, Nahum Méndez-Sánchez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ramón" "apellidos" => "Arturo Kobashi-Margáin" ] 1 => array:2 [ "nombre" => "Ylse" "apellidos" => "Gutiérrez-Grobe" ] 2 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "Ponciano-Rodríguez" ] 3 => array:2 [ "nombre" => "Misael" "apellidos" => "Uribe" ] 4 => array:2 [ "nombre" => "Nahum" "apellidos" => "Méndez-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119316382?idApp=UINPBA00004N" "url" => "/16652681/0000000900000003/v1_201906230902/S1665268119316382/v1_201906230902/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119316369" "issn" => "16652681" "doi" => "10.1016/S1665-2681(19)31636-9" "estado" => "S300" "fechaPublicacion" => "2010-07-01" "aid" => "71322" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2010;9:271-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 68 "formatos" => array:3 [ "EPUB" => 9 "HTML" => 32 "PDF" => 27 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Short and long term outcome of kidney transplanted patients with chronic viral hepatitis B and C" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "277" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1723 "Ancho" => 1000 "Tamanyo" => 95182 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Cumulative graft survival according to antiHCV status (A) and HBsAg status (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ezequiel Ridruejo, Carlos Díaz, Mario Dávalos Michel, Gervasio Soler Pujol, Alfredo Martínez, Sebastián Marciano, Oscar G. Mandó, Antonio Vilches" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Ezequiel" "apellidos" => "Ridruejo" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Díaz" ] 2 => array:2 [ "nombre" => "Mario" "apellidos" => "Dávalos Michel" ] 3 => array:2 [ "nombre" => "Gervasio" "apellidos" => "Soler Pujol" ] 4 => array:2 [ "nombre" => "Alfredo" "apellidos" => "Martínez" ] 5 => array:2 [ "nombre" => "Sebastián" "apellidos" => "Marciano" ] 6 => array:2 [ "nombre" => "Oscar G." "apellidos" => "Mandó" ] 7 => array:2 [ "nombre" => "Antonio" "apellidos" => "Vilches" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119316369?idApp=UINPBA00004N" "url" => "/16652681/0000000900000003/v1_201906230902/S1665268119316369/v1_201906230902/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "titulo" => "Clinical outcomes of liver transplantation for polycystic liver disease: A single center experience" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "278" "paginaFinal" => "281" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Natasha Chandok, Julia Uhanova, Paul Marotta" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Natasha" "apellidos" => "Chandok" "email" => array:1 [ 0 => "chandok.n@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Julia" "apellidos" => "Uhanova" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Paul" "apellidos" => "Marotta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Division of Gastroenterology, Multi-Organ Transplant Program, London Health Sciences Center, University of Western Ontario." "etiqueta" => "*" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Section of Hepatology, John Buhler Research Center, University of Manitoba." "etiqueta" => "**" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request: Natasha Chandok, MD, Multi-Organ Transplant Program, Division of Gastroenterology, University of Western Ontario, 339 Windermere Road. London, Ontario. N6A 5A5 Canada, Tel.: 519-685-8500 x 34882. Fax: 519-663-3858" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Polycystic liver disease (PLD) is a celiopathy caused by defects in polycystin proteins. The autosomal dominant (AD) form of the disease is characterized by the development of multiple simple cysts in the liver that progress in size over time. Although an autosomal recessive (AR) form of PLD exists, this condition is rare and is associated with autosomal recessive polycystic kidney disease (ARPCKD), congenital hepatic fibrosis, intrahepatic biliary dilatation and a high mortality in infancy. As such, in adulthood only AD PLD is seen. Autopsy series suggest that the prevalence of PLD is 0.13%.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">When PLD occurs in association with autosomal dominant polycystic kidney disease (ADPCKD), the pathogenesis involves defects of polycystin-1 or, less commonly, polycystin-2.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In contrast, when AD PLD has no concurrent renal involvement, mutations of the gene protein kinase substrate 80K-H (PR-KCSH), which encodes the protein hepatocystin, are implicated.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Polycystin proteins are integral to the function of cilia lining cholangiocytes. In the setting of defective cystoproteins in cilia, cyst formation occurs through a variety of mechanisms, including enhanced cell proliferation and apoptosis; increased secretion of fluid; and faulty cell adhesion and ciliary function.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Estrogens and a variety of growth factors also play a role in cyst proliferation and secretion.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">PLD has a broad spectrum of clinical manifestations. Clinically, PLD is defined as 5 or more simple cysts greater than I cm in diameter, in the absence of infection or trauma. Interestingly, patients with more severe liver involvement from PLD may be predisposed to more significant renal dysfunction from ADPCKD.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Conversely, patients with more extensive renal cystic disease develop more liver cysts.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> PLD is more severe in women, likely because of the hypothesized role played by female sex hormones in the pathogenesis of liver cyst formation.</p><p id="p0020" class="elsevierStylePara elsevierViewall">While liver failure is uncommon from PLD, and most patients require no radiologic or surgical intervention, in a minority of patients liver cysts cause significant morbidity.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Compressive symptoms produced by hepatic cysts can result in gastrointestinal obstruction, hepatic venous outflow obstruction, and compression of the inferior vena cava, portal vein and bile ducts. Other cyst complications include hemorrhage, infection, torsion or rupture.</p><p id="p0025" class="elsevierStylePara elsevierViewall">Although there are no proven medical treatments for PLD, surgical techniques involving hepatic volume reduction are the cornerstone of care for the rare patient with severe symptoms due to innumerable large cysts unsuitable for cyst aspiration and sclerosis. Operative techniques include partial hepa-tectomy with remnant cyst fenestration, cyst fenes-tration alone, or LT. While there are no strict criteria for LT for PLD, generally transplantation is reserved for patients with significant morbidity from severe cystic disease refractory to other radiologic and surgical techniques. Such patients typically have no intrinsic liver dysfunction but have a poor quality of life due to symptoms such as dyspnea, early satiety, and abdominal and back pain. Many liver transplantation allocation systems (e.g. United Network for Organ Sharing; Trillium Gift of Life Network Ontario) provide exception points for listing patients with PLD following careful consideration by a multidisciplinary committee on a case-by-case basis.</p><p id="p0030" class="elsevierStylePara elsevierViewall">As PLD is an uncommon albeit established indication for LT, there is limited information on immediate post-operative as well as long-term clinical outcomes. In a German series of 36 subjects, Kirch-ner et al reported that recipients transplanted for PLD reported an improved quality of life and had excellent long-term survival, although 5 (13.9%) subjects died of medical complications within 2 months of transplantation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Similarly, in amongst largest series published in North America to date of 13 subjects transplanted for PLD, Taner, <span class="elsevierStyleItalic">et αl.,</span> reported 3 deaths in the postoperative period, and 9 post-transplant surgical procedures for 5 patients due to surgical complications (bowel perforation, bile leak).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> If patients survived the post-surgical period, however, excellent long-term patient and graft survivals were seen.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="p0035" class="elsevierStylePara elsevierViewall">One may postulate that patients with PLD may have a complex operative course due to the challenges in resecting a massive native liver with distortion of vascular structures. Moreover, given the strong correlation of ADPCKD, it is conceivable that patients transplanted for PLD may experience higher rates of renal failure over time. Further data are needed to explore these hypotheses and corroborate with the findings of prior studies.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Aim</span><p id="p0040" class="elsevierStylePara elsevierViewall">The purpose of this study is to describe the postoperative and long-term clinical outcomes of all patients transplanted for PLD at a Canadian transplant center.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Methods</span><p id="p0045" class="elsevierStylePara elsevierViewall">A retrospective cohort study was conducted on all adult patients transplanted for PLD from January 1993 to February 2010 at London Health Sciences Center, London, Canada. All subjects provided consent, and approval was obtained by the institutional ethics committee. Patients were identified through the institutional liver transplant database. Using hospital health records, information was gathered on patient demographics (date of birth, race, sex, medical comorbidities), baseline liver and kidney function, date of LT, type of LT (deceased, deceased after cardiac death, or live donor), size and length of explanted liver, postoperative surgical and medical complications, re-operation (including re-transplantation), length of hospitali-zation, and re-admission within 3 months. Patient charts were also examined to document long-term medical complications, namely new onset renal failure (defined as need for hemodialysis or kidney transplantation). All subjected were contacted in April 2010 to verify their survival and their need, if any, for long-term hemodialysis or kidney transplantation. Descriptive statistics were reported as frequencies, means and ranges. Statistical analysis was performed using STATA 11.0.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="p0050" class="elsevierStylePara elsevierViewall">From January 1993 to February 2010, 14 patients underwent LT and 1 patient underwent combined kidney and LT for polycystic disease. Baseline characteristics are summarized in <a class="elsevierStyleCrossRef" href="#t0005">table 1</a>. All subjects were female, with mean age 49.0 (40.0-65.0) at the time of LT. No subjects underwent prior cyst fenestration and/or partial hepatectomy. All recipients received deceased grafts. 14 (93.37) subjects were Caucasian and 1 (6.7%) subject was Asian. 10 (66.7%) patients had concomitant ADPCKD. The mean creatinine just prior to LT was 112.9 umol/L (43-209).</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0055" class="elsevierStylePara elsevierViewall">The weight and length of the native liver following resection are summarized in <a class="elsevierStyleCrossRef" href="#t0010">table 2</a>. The mean weight of the explanted liver was 6830.7 g (2770.09119.0). The mean diameter of the explanted liver was 34.4 cm (22.0-45.0).</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0060" class="elsevierStylePara elsevierViewall">Postoperative complications are shown in <a class="elsevierStyleCrossRef" href="#t0015">table 3</a>. Overall, 5 of 15 subjects had vascular complications, including 3 (20%) and 2 (13.3%) subjects with hepatic artery thrombosis (HAT) and hepatic artery stenosis (HAS), respectively. No patients had portal vein thombosis (PVT) or bile leak. One (6.7%) patient had significant wound complications. Overall, 3 (20%) patients needed to return to the operating theatre for management of HAT. One subject required re-transplantation due to early graft loss from HAT at day 3 post-transplantation. The mean length of hospitalization was 18.8 (7-49) days. Postoperative medical complications were not observed at an increased frequency, and no patients were re-admitted to the hospital within 3 months of discharge.</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0065" class="elsevierStylePara elsevierViewall">All patients received long-term follow-up care. The mean follow-up was 66.7 months (3-200). The I and 5-year patient survival was 100%. The I and 5-year graft survival was 93.3%. One subject died 8 years after LT at the age of 57 due to trauma; and a second subject died 7 years after LT at the age of 67 due to natural causes, though no autopsy report was available. Thirteen subjects were contacted directly in April 2010 and their survival was verified. No patient, including those who have deceased, developed renal failure necessitating hemodialysis or kidney transplantation, or chronic hepatic allograft dysfunction warranting liver re-transplantation.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="p0070" class="elsevierStylePara elsevierViewall">In this series of 15 subjects transplanted for PLD, 1 patient experienced early graft loss due to HAT, but all subjects had excellent long-term survival. The 1-year and 5-year patient and graft survival was 100% and 93.3%, and 100% and 93.3%, respectively. This compares favorably to our center’s overall 1-year patient and graft survival of 91% and 88%, and 5-year patient and graft survival of 86% and 81%, respectively, from 1999 to 2008 (n = 619, unpublished data).</p><p id="p0075" class="elsevierStylePara elsevierViewall">However, subjects experienced a higher than expected rate of HAT at 20% and HAS at 13.3%; this compares unfavorably to our center’s overall rate of HAT of 5% from 1999-2008 (unpublished data). Given the retrospective nature of this study, a detailed analysis into the possible etiology of HAT was not feasible. Nevertheless, we postulate that because patients with PLD do not have an intrinsic coagulopa-thy like patients with hepatic dysfunction, perhaps the clamping of the hepatic artery during the transplantation may predispose to thrombosis. Furthermore, given the excess space in the abdominal cavity following resection of the native liver, there is a theoretical risk of torsion or volvulus of the hepatic graft, compromising hepatic artery blood flow. To minimize operative complications, in patients with extensive cysts incorporating the cava, caval interposition with veno-venous bypass may be preferred to the piggyback technique.</p><p id="p0080" class="elsevierStylePara elsevierViewall">Post-operative medical complications were not observed at an increased frequency. Subjects had a mean of 18.8 days in hospital. This length of hospi-talization is significantly longer than our mean length of stay of 8.5 days following an uncomplicated LT from 1999 to 2008 (unpublished data). The longer hospitalization was observed in subjects with postoperative vascular complications requiring surgical repair.</p><p id="p0085" class="elsevierStylePara elsevierViewall">None of the subjects had significant long-term renal impairment requiring hemodialysis or kidney transplantation, despite the fact that 2-thirds of the subjects had concomitant ADPCKD. We hypothesize that a possible reason for low rates of severe renal injury is our common practice to continue mycofeno-late mofitil and/or low dose prednisone long-term, and minimize calcineurine inhibitors in recipients at higher risk for renal injury.</p><p id="p0090" class="elsevierStylePara elsevierViewall">A strength of this study is that we report on a well-sized cohort of subjects who underwent LT for a relatively rare indication. Furthermore, all subjects received long-term follow up, thereby enabling accuracy in the reporting of clinical outcomes such as patient and graft survival, and the development of severe renal disease. A limitation of the study is that that the small sample size precludes multivaria-te analysis.</p><p id="p0095" class="elsevierStylePara elsevierViewall">A multicenter study to examine postoperative clinical outcomes following LT for PLD is needed to verify the findings of this study, especially the higher rate of HAT. In conclusion, despite increased rates of post-operative vascular complications in patients transplanted for PLD, high rates of patient and graft survival are seen. Furthermore, renal failure is not observed at an increased frequency, even among patients with co-existent PCKD.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Abbreviations</span><p id="p0100" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="li0005"><li class="elsevierStyleListItem" id="list0005"><span class="elsevierStyleLabel">•</span><p id="p0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AD:</span> Autosomal dominant.</p></li><li class="elsevierStyleListItem" id="list0010"><span class="elsevierStyleLabel">•</span><p id="p0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ADPCKD:</span> Autosomal dominant polycystic kidney disease.</p></li><li class="elsevierStyleListItem" id="list0015"><span class="elsevierStyleLabel">•</span><p id="p0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CI:</span> Calcineurin inhibitor.</p></li><li class="elsevierStyleListItem" id="list0020"><span class="elsevierStyleLabel">•</span><p id="p0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">DDLT:</span> Deceased donor liver transplantation.</p></li><li class="elsevierStyleListItem" id="list0025"><span class="elsevierStyleLabel">•</span><p id="p0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HAS:</span> Hepatic artery stenosis.</p></li><li class="elsevierStyleListItem" id="list0030"><span class="elsevierStyleLabel">•</span><p id="p0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HAT:</span> Hepatic artery thrombosis.</p></li><li class="elsevierStyleListItem" id="list0035"><span class="elsevierStyleLabel">•</span><p id="p0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LDLT:</span> Live donor liver transplantation.</p></li><li class="elsevierStyleListItem" id="list0040"><span class="elsevierStyleLabel">•</span><p id="p0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LT:</span> Liver transplantation.</p></li><li class="elsevierStyleListItem" id="list0045"><span class="elsevierStyleLabel">•</span><p id="p0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PCKD:</span> Polycystic kidney disease.</p></li><li class="elsevierStyleListItem" id="list0050"><span class="elsevierStyleLabel">•</span><p id="p0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PLD:</span> Polycystic liver disease.</p></li><li class="elsevierStyleListItem" id="list0055"><span class="elsevierStyleLabel">•</span><p id="p0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PVT:</span> Portal vein thrombosis.</p></li></ul></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Financial Disclosures</span><p id="p0160" class="elsevierStylePara elsevierViewall">None for all authors.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Acknowledgment</span><p id="p0165" class="elsevierStylePara elsevierViewall">The authors thank Dr. Mamoun Al-Basheer, Dr. William Wall, Mr. Paul Myers and Mr. Michael Blo-ch for their assistance in the preparation of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1211009" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abs0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1127293" "titulo" => "Key words" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Aim" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Methods" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Abbreviations" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Financial Disclosures" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Acknowledgment" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-05-24" "fechaAceptado" => "2010-06-28" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec1127293" "palabras" => array:6 [ 0 => "Polycystic liver disease" 1 => "Autosomal dominant" 2 => "Liver transplantation" 3 => "Survival" 4 => "Postoperative complications" 5 => "Hepatic artery thrombosis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abs0005" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Polycystic liver disease (PLD) is a celiopathy characterized by progressive growth of multiple hepatic cysts. In a minority of patients, severe symptomatic hepatomegaly necessitates liver transplantation (LT). The purpose of this study is to describe the postoperative and long-term outcomes of all patients transplanted for PLD at our center.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">All patients who underwent LT for PLD were identified through our database. Using patient charts, data were extracted on patient demographics and medical history, postoperative surgical and medical complications, length of hospitalization, prevalence of chronic kidney failure, and patient and graft survival. Subjects were contacted in April 2010 to verify their survival and confirm their need, if any, for hemodialysis and/or kidney transplantation. Descriptive statistics for patient and graft survival were performed. From 1993 to 2010, 14 subjects underwent LT and 1 subject underwent combined kidney and LT; all subjects were female and the mean age was 49.0 years. 10 (66.7%) subjects had polycystic kidney disease. Patients experienced a high rate of vascular complications, including hepatic artery thrombosis (HAT) or stenosis in 3 (20%) and 2 (13.3%) subjects, respectively. One subject had early graft loss due to HAT and underwent re-transplantation. The mean length of hospitalization was 18.8 days. After a mean of 66.8 months of follow-up (3-200), 13 (86.7%) subjects are alive with satisfactory graft function, and no patients had renal failure.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">In conclusion, patients who underwent LT for PLD had a high rate of postoperative vascular complications. However, long-term patient and graft survival, and kidney function, is excellent.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "t0005" "etiqueta" => "Table 1." "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Frequency n=15(%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">• Female gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">• Race \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">White \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">14 (93.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Asian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">1 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">• Genetics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Isolated ADPLD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">5 (33.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Associated ADPCKD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">10 (67.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">• Combined liver/kidney transplant. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">1 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">• Prior kidney transplant. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">• Renal insufficiency prior to liver transplant. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">2 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2067323.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics.</p>" ] ] 1 => array:7 [ "identificador" => "t0010" "etiqueta" => "Table 2." "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Explant weight (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">6830.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">2770.0-9119.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Explant length (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">34.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">22.0-45.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2067322.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Native liver weight and length.</p>" ] ] 2 => array:7 [ "identificador" => "t0015" "etiqueta" => "Table 3." "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="middle" scope="col" style="border-bottom: 2px solid black">N of 15 (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Re-operation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">3 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Re-transplantation for graft loss \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">1 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">HAT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">3 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">HAS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">2 (13.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">PVT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Bile leak \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">Complicated surgical wound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="middle">1 (6.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2067324.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Postoperative complications.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Massive hepatomegaly in adult polycystic liver disease." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Kwok MK" 1 => "Lewin KJ" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "1988" "volumen" => "12" "paginaInicial" => "321" "paginaFinal" => "324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3281482" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polycystic liver diseases." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Onori P" 1 => "Franchitto A" 2 => "Mancinelli R" 3 => "Carpino G" 4 => "Álvaro D" 5 => "Francis H" 6 => "Alpini G" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.dld.2010.01.006" "Revista" => array:7 [ "tituloSerie" => "Dig Liver Dis" "fecha" => "2010" "volumen" => "42" "numero" => "4" "paginaInicial" => "261" "paginaFinal" => "271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20138815" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular characterization of hepatocystin, the protein that is defective in autosomal dominant polycystic liver disease." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Drenth JP" 1 => "Martina JA" 2 => "Te Morsche RH" 3 => "Jansen JB" 4 => "Bonifacino JS" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gastroenterol" "fecha" => "2004" "volumen" => "126" "paginaInicial" => "1819" "paginaFinal" => "1827" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liver changes and complications in adult polycystic kidney disease." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Grunfeld JP" 1 => "Albouze G" 2 => "Jungers P" 3 => "Landais P" 4 => "Dana A" 5 => "Droz D" 6 => "Moynot A" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Adv Nephrol Necker Hosp" "fecha" => "1985" "volumen" => "14" "paginaInicial" => "1" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2983516" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for the development of hepatic cysts in autosomal dominant polycystic kidney disease." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Gabow PA" 1 => "Johnson AM" 2 => "Kaehny WD" 3 => "Manco-Johnson ML" 4 => "Duley IT" 5 => "Everson GT" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "1990" "volumen" => "11" "paginaInicial" => "1033" "paginaFinal" => "1037" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2365280" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of polycystic liver disease: One size does not fit all." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Torres VE" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.ajkd.2007.04.009" "Revista" => array:6 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "2007" "volumen" => "49" "paginaInicial" => "725" "paginaFinal" => "728" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17533013" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome and quality of life in patients with polycystic liver disease after liver or combined liver-kidney transplantation." "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Kirchner GI" 1 => "Rifai K" 2 => "Cantz T" 3 => "Nashman B" 4 => "Terkamp C" 5 => "Becker T" 6 => "Strassburg C" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lt.20780" "Revista" => array:6 [ "tituloSerie" => "Liver Transpl" "fecha" => "2006" "volumen" => "12" "paginaInicial" => "1268" "paginaFinal" => "1277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16741930" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polycystic liver disease and liver transplantation: Single-institution experience." "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Taner B" 1 => "Willingham DL" 2 => "Hewitt WR" 3 => "Grewal HP" 4 => "Nguyen JH" 5 => "Hughes CB" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2009.05.043" "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2009" "volumen" => "41" "paginaInicial" => "3769" "paginaFinal" => "3771" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19917384" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000000900000003/v1_201906230902/S1665268119316370/v1_201906230902/en/main.assets" "Apartado" => array:4 [ "identificador" => "77721" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000000900000003/v1_201906230902/S1665268119316370/v1_201906230902/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119316370?idApp=UINPBA00004N" ]
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| 2024 January | 55 | 9 | 64 |
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| 2023 October | 47 | 10 | 57 |
| 2023 September | 32 | 6 | 38 |
| 2023 August | 36 | 5 | 41 |
| 2023 July | 44 | 3 | 47 |
| 2023 June | 41 | 3 | 44 |
| 2023 May | 76 | 7 | 83 |
| 2023 April | 66 | 1 | 67 |
| 2023 March | 68 | 2 | 70 |
| 2023 February | 36 | 2 | 38 |
| 2023 January | 26 | 6 | 32 |
| 2022 December | 30 | 2 | 32 |
| 2022 November | 32 | 4 | 36 |
| 2022 October | 36 | 16 | 52 |
| 2022 September | 27 | 31 | 58 |
| 2022 August | 30 | 13 | 43 |
| 2022 July | 31 | 12 | 43 |
| 2022 June | 19 | 7 | 26 |
| 2022 May | 25 | 7 | 32 |
| 2022 April | 33 | 12 | 45 |
| 2022 March | 25 | 9 | 34 |
| 2022 February | 29 | 7 | 36 |
| 2022 January | 70 | 7 | 77 |
| 2021 December | 35 | 7 | 42 |
| 2021 November | 18 | 5 | 23 |
| 2021 October | 19 | 7 | 26 |
| 2021 September | 40 | 9 | 49 |
| 2021 August | 20 | 3 | 23 |
| 2021 July | 32 | 8 | 40 |
| 2021 June | 7 | 6 | 13 |
| 2021 May | 9 | 8 | 17 |
| 2021 April | 37 | 16 | 53 |
| 2021 March | 22 | 7 | 29 |
| 2021 February | 9 | 4 | 13 |
| 2021 January | 10 | 9 | 19 |
| 2020 December | 5 | 4 | 9 |
| 2020 November | 5 | 7 | 12 |
| 2020 October | 5 | 4 | 9 |
| 2020 September | 11 | 7 | 18 |
| 2020 August | 5 | 3 | 8 |
| 2020 July | 9 | 3 | 12 |
| 2020 June | 6 | 1 | 7 |
| 2020 May | 5 | 2 | 7 |
| 2020 April | 4 | 3 | 7 |
| 2020 March | 12 | 1 | 13 |
| 2020 February | 5 | 1 | 6 |
| 2020 January | 5 | 1 | 6 |
| 2019 December | 5 | 6 | 11 |
| 2019 November | 2 | 1 | 3 |
| 2019 September | 1 | 0 | 1 |
| 2019 August | 1 | 1 | 2 |
| 2019 July | 1 | 6 | 7 |
| 2019 June | 7 | 4 | 11 |
Show all
