Impact of Smoking on Postoperative Wound Healing
Modern surgery aims to shorten postoperative hospitalization by providing faster recovery from surgical consequences. Due to principles of asepsis and antisepsis, wound healing has significantly improved and the occurrence of infectious complications has decreased. However, smoking significantly prolongs recovery. We present new study results comparing wound healing in smokers and non-smokers.
A wide range of individuals today are undergoing hematopoietic cell transplantation. Among these are people with malignant and non-malignant diseases. It is important to note that these individuals often survive long term, and thus frequently encounter comorbidities. Complications can be particularly dangerous for patients with hepatitis C.
Risks of Hematopoietic Cell Transplantation in Patients with Hepatitis C
Following allogeneic hematopoietic cell transplantation, patients infected with the HCV virus often experience complications in the form of transient hepatitis. Immediately after the procedure, there is a higher risk of veno-occlusive disease and early cirrhosis. These complications, of course, increase morbidity and mortality rates among patients.
We present newly published information on the treatment of patients with hepatitis C undergoing hematopoietic cell transplantation. The article we are referencing was supported by the European Association for the Study of the Liver.
The Priority is Treating Viral Hepatitis
First and foremost, it is essential to point out that in people surviving long-term after allogeneic hematopoietic cell transplantation, the risk of complications gradually increases. Treating hepatitis C becomes crucial for their survival.
Recommended Approach
During the actual transplantation period, preventive administration of ribavirin is recommended. Combination therapy, considering the response to treatment, achieves better results than monotherapy but is associated with a higher incidence of hematologic complications. Anemia can usually be managed with erythropoietin administration and dose adjustments. However, thrombocytopenia often necessitates discontinuation of treatment. There has been no recorded case where interferon therapy caused or facilitated graft-versus-host disease.
Practical Advice
In clinical practice, a biopsy should be performed to determine the extent of liver damage. Treatment settings should depend on biopsy results. Combined interferon and ribavirin therapy is more suitable for patients with mild to moderately advanced fibrosis. Treatment is most effective if started at an optimal dose and frequently monitored, allowing for dose adjustments.
If possible, discontinuation of antiviral medication should be avoided. Good compliance is, of course, a prerequisite. The patient should be educated about side effects, such as the occurrence of depression. Continuation of treatment is often possible with the administration of growth factors and erythropoietin.
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Source: de Latour RP, et al. Allogenic hematopoietic cell transplant in HCV-infected patients. J Hepatol (2008), doi:10.1016/j.jhep.2008.03.003
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