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Sample records for rat liver transplantation

  1. Liver transplant

    Science.gov (United States)

    Hepatic transplant; Transplant - liver; Orthotopic liver transplant; Liver failure - liver transplant; Cirrhosis - liver transplant ... The donated liver may be from: A donor who has recently died and has not had liver injury. This type of ...

  2. Liver Transplant

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    ... The Progression of Liver Disease Diagnosing Liver Disease – Liver Biopsy and Liver Function Tests Clinical Trials Liver Transplant ... The Progression of Liver Disease Diagnosing Liver Disease: Liver Biopsy and Liver Function Tests Clinical Trials Liver Transplant ...

  3. Liver Transplantation

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    ... put you on a waiting list for a liver transplant. Doctors do liver transplants when other treatment cannot keep a damaged liver working. During a liver transplantation, the surgeon removes the diseased liver and replaces ...

  4. Establishment of animal model of dual liver transplantation in rat.

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    Ying Zhang

    Full Text Available The animal model of the whole-size and reduced-size liver transplantation in both rat and mouse has been successfully established. Because of the difficulties and complexities in microsurgical technology, the animal model of dual liver transplantation was still not established for twelve years since the first human dual liver transplantation has been made a success. There is an essential need to establish this animal model to lay a basic foundation for clinical practice. To study the physiological and histopathological changes of dual liver transplantation, "Y" type vein from the cross part between vena cava and two iliac of donor and "Y' type prosthesis were employed to recanalize portal vein and the bile duct between dual liver grafts and recipient. The dual right upper lobes about 45-50% of the recipient liver volume were taken as donor, one was orthotopically implanted at its original position, the other was rotated 180° sagitally and heterotopically positioned in the left upper quadrant. Microcirculation parameters, liver function, immunohistochemistry and survival were analyzed to evaluate the function of dual liver grafts. No significant difference in the hepatic microcirculatory flow was found between two grafts in the first 90 minutes after reperfusion. Light and electronic microscope showed the liver architecture was maintained without obvious features of cellular destruction and the continuity of the endothelium was preserved. Only 3 heterotopically positioned graft appeared patchy desquamation of endothelial cell, mitochondrial swelling and hepatocytes cytoplasmic vacuolization. Immunohistochemistry revealed there is no difference in hepatocyte activity and the ability of endothelia to contract and relax after reperfusion between dual grafts. Dual grafts made a rapid amelioration of liver function after reperfusion. 7 rats survived more than 7 days with survival rate of 58.3.%. Using "Y" type vein and bile duct prosthesis, we

  5. [Effect of emodin on rejection of liver transplantation in rats].

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    Jing, He; Lin, Shengzhang; Yang, Xiao

    2009-06-01

    To investigate the mechanism of Emodin on the role of acute rejection in rat liver transplantation. Forty-eight pairs of orthotopic liver transplantation model were established with inbred rats which were randomly divided into 3 groups: Control group (BN --> BN), acute rejection group (Lewis --> BN) and emodin group (Lewis --> BN). Six recipients in each group were randomly collected and contents of TNF-alpha and IL-10 in the peripheral blood were detected with ELISA on Day 1, 3, 5 and 7 separately after transplantation and histopathological evaluation was made to detect the differences among groups after the livers were taken out on day 7. The other 10 in each group were protected to evaluate the animation and life time. The average meso-life time in emodin group (25.6 days) is significantly longer (P < 0.05) than acute rejection group (10.9 days). Compared with the acute rejection group, Emodin group shows up less rejection in the histopathological evaluation (P < 0.01), less TNF-alpha (P < 0.05) and a significant up-regulation of IL-10 in the peripheral blood (P < 0.05 after day 3). Emodin can inhibit the acute rejection of liver transplantation in rats model effectively and it may play the role with reduction of TNF-alpha and upregulation of IL-10.

  6. Liver fibrosis impairs hepatic pharmacokinetics of liver transplant drugs in the rat model.

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    Zou, Yu-Hong; Liu, Xin; Khlentzos, Alexander M; Asadian, Peyman; Li, Peng; Thorling, Camilla A; Robertson, Thomas A; Fletcher, Linda M; Crawford, Darrell H G; Roberts, Michael S

    2010-01-01

    This study aims to investigate hepatic pharmacokinetics of the four most common drugs (metoprolol, omeprazole, spironolactone, and furosemide) given to patients undergoing liver transplantation before surgery. The investigation was carried out in CCl(4)-induced fibrotic perfused rat livers and the results were compared to those in normal rat liver. Drug outflow fraction-time profiles were obtained after bolus injection into a single-pass-perfused normal or fibrotic rat liver. The pharmacokinetic parameters were estimated using previously developed barrier-limited and space-distributed models. The results showed a marked increase in the liver fibrosis index for CCl(4)-treated rats compared to controls (pdrugs were significantly lower (pdrugs were significantly longer (pdrugs across the basolateral membrane and their metabolic clearance and were in a manner similar to those previously found for another group of drugs.

  7. Liver transplants

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    Sergio Mies

    2005-03-01

    Full Text Available Liver transplantation has always fascinated humanity, this fact issupported by historical reports of ancient civilizations. The firstliver transplant was performed in 1955, in experimental animals.Human liver transplant was first attempted by Thomas Starzl in1963, but was unsuccessful. Latter, in 1967, the same groupdescribed the first successful human ortotopic liver transplant inhistory. Many facts contributed for the triumph of this procedureand among them we can point out the improvements of surgicaltechniques, the development of preservation solutions, discoveryof better antibiotics, appearance of the concept of intensive careunit and the most important mark in transplant survival –cyclosporine as a new immunossuppression agent. In Brazil, thefirst human liver transplant with prolonged survival was in 1985and was fulfilled by the Liver Unit. This same team was latterresponsible for the world’s first description of living donor livertransplantation. Brazilian’s legislation has improved in order touse wisely the resources related to transplant programs and thisincludes the grafts that are so scarce for the demand of patientson our waiting lists. Another great necessity is to create aeducational effort aimed to general population and medical socialgroup to instruct and show the importance of organ donation, butall these efforts will be usefulness if public health policies fail toput in practice actions that will improve the organization andrationalization of equipment and human resources in emergencymedical centers.

  8. Disrupted Renal Mitochondrial Homeostasis after Liver Transplantation in Rats.

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    Qinlong Liu

    Full Text Available Suppressed mitochondrial biogenesis (MB contributes to acute kidney injury (AKI after many insults. AKI occurs frequently after liver transplantation (LT and increases mortality. This study investigated whether disrupted mitochondrial homeostasis plays a role in AKI after LT.Livers were explanted from Lewis rats and implanted after 18 h cold storage. Kidney and blood were collected 18 h after LT.In the kidney, oxidative phosphorylation (OXPHOS proteins ATP synthase-β and NADH dehydrogenase-3 decreased 44% and 81%, respectively, with marked reduction in associated mRNAs. Renal PGC-1α, the major regulator of MB, decreased 57% with lower mRNA and increased acetylation, indicating inhibited synthesis and suppressed activation. Mitochondrial transcription factor-A, which controls mtDNA replication and transcription, protein and mRNA decreased 66% and 68%, respectively, which was associated with 64% decreases in mtDNA. Mitochondrial fission proteins Drp-1 and Fis-1 and mitochondrial fusion protein mitofusin-1 all decreased markedly. In contrast, PTEN-induced putative kinase 1 and microtubule-associated protein 1A/1B-light chain 3 increased markedly after LT, indicating enhanced mitophagy. Concurrently, 18- and 13-fold increases in neutrophil gelatinase-associated lipocalin and cleaved caspase-3 occurred in renal tissue. Both serum creatinine and blood urea nitrogen increased >2 fold. Mild to moderate histological changes were observed in the kidney, including loss of brush border, vacuolization of tubular cells in the cortex, cast formation and necrosis in some proximal tubular cells. Finally, myeloperoxidase and ED-1 also increased, indicating inflammation.Suppression of MB, inhibition of mitochondrial fission/fusion and enhancement of mitophagy occur in the kidneys of recipients of liver grafts after long cold storage, which may contribute to the occurrence of AKI and increased mortality after LT.

  9. Transplantation of umbilical cord mesenchymal stem cells via different routes in rats with acute liver failure.

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    Zheng, Sheng; Yang, Juan; Yang, Jinhui; Tang, Yingmei; Shao, Qinghua; Guo, Ling; Liu, Qinghua

    2015-01-01

    This study aimed to compare the therapeutic efficacy of transplantation of human umbilical cord mesenchymal stem cells (hUCMSC) in different routes in acute hepatic failure (ALF) in rats. hUCMSCs were isolated and identified by detection of surface antigens via flow cytometry. In T group and H group, ALF rats received hUCMSC transplantation through the tail vein and intrahepatic injection, respectively. In hUCMSC group, healthy rats received hUCMSCs transplantation via the tail vein. In ALF group, rats received injection of normal saline through the tail vein. The TBil and ALT in ALF rats with and without transplantation were significantly higher than in healthy rats (Pcells, and liver pathology was improved in T group and H group as compared to ALF group. At 3 d after transplantation, CK18 expression was detectable in both H group and T group. At 1 w and 2 w, the mRNA expressions of CK8, CK18 and AFP in H group and T group were significantly different from those in ALF group (Pstem cells were comparable between H group and T group (P>0.05). hUCMSCs transplantation can improve the liver function and promote the liver repair following ALF. hUCMSCs transplantation via tail vein has similar therapeutic efficacy to that through intrahepatic injection.

  10. Delayed and short course of rapamycin prevents organ rejection after allogeneic liver transplantation in rats.

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    Hamdani, Salim; Thiolat, Allan; Naserian, Sina; Grondin, Cynthia; Moutereau, Stéphane; Hulin, Anne; Calderaro, Julien; Grimbert, Philippe; Cohen, José Laurent; Azoulay, Daniel; Pilon, Caroline

    2017-10-14

    To test whether a delayed and short course of rapamycin would induce immunosuppressive effects following allogeneic orthotopic liver transplantation (OLT) in rats. Allogeneic OLTs were performed using Dark Agouti livers transplanted into Lewis recipients, and syngeneic OLTs were performed using the Lewis rat strain. Rapamycin (1 mg/kg per day) was administered by gavage from day 4 to day 11 post-transplantation. Lymphocyte cellular compartments were analyzed by flow cytometry in draining lymph nodes, non-draining lymph nodes and the spleen at days 11 and 42 in rapamycin-treated rats, untreated control rats and syngeneic grafted rats. Skin grafts from Dark agouti or from F344 RT were performed at day 30 on liver grafted rats treated with rapamycin. An 8-d course of rapamycin treatment initiated 4 d following transplantation resulted in the survival of grafted rats for more than 100 d. In contrast, untreated rats died of liver failure within 13 to 21 d. The analysis of the cellular compartment revealed an increase in two cellular subpopulations, specifically myeloid-derived suppressor cells (MDSCs) and CD8+CD45RClow T cells, without major modifications in the regulatory T cell (Treg) compartment in treated rats in the early stages after grafting. We evaluated the ability of treated rats to reject third-party allogeneic skin grafts to confirm their immune competence. In contrast, when skin was collected from rats syngeneic to the grafted liver, it was not rejected. Our results demonstrate that short and delayed rapamycin treatment allows for tolerance in allogeneic OLT. The results also allowed for the identification of the mechanisms of tolerance induced by rapamycin by identifying MDSCs and CD8+CD45RClow T cells as associated with the state of tolerance.

  11. NF-κB induced the donor liver cold preservation related acute lung injury in rat liver transplantation model.

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    An Jiang

    Full Text Available We have observed at our clinical work that acute lung injury (ALI often occurs in patients transplanted with donor livers persevered for long time. So, we conducted this study to investigate the influence of cold preservation time (CPT of donor liver on ALI induced by liver transplantation (LT, and further study the role of nuclear factor-κB (NF-κB in the process.Wistar rats were used as donors and recipients to establish orthotopic rat liver transplantation models. Donor livers were preserved at 4°C for different lengths of time. The effect of NF-κB inhibitor, ammonium pyrrolidinedithiocarbamate (PDTC, on ALI was detected. All samples were harvested after 3 h reperfusion. The severity of liver injury was evaluated first. The expressions of tumor necrosis factor-α (TNF-α and interleukin-1β (IL-1β in liver tissue and liver outflow serum were measured respectively. The severity indexes of ALI, the activity of NF-κB and inhibitor-κBα (I-κBα in lung/liver were measured accordingly.With the prolonged liver CPT, the liver damage associated indexes and ALI-related indexes all increased significantly. TNF-α and IL-1β in liver outflow serum increased accordingly, and the activity of NF-κB in liver/lung increased correspondingly. All these ALI-associated indexes could be partially reversed by the use of PDTC.Extended CPT aggravates the damage of donor liver and induces the expressions of TNF-α and IL-1β in liver. These inflammatory factors migrate to lung via liver outflow blood and activate NF-κB in lung, inducing ALI finally. NF-κB may play a critical role in LT-related ALI. Patients with or at risk of ALI may benefit from acute anti-inflammatory treatment with PDTC.

  12. Liver Transplant: Nutrition

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    ... code here Enter ZIP code here Liver Transplant: Nutrition for Veterans and the Public Nutrition Liver Transplant Patients with liver disease have to ... liver functioning and to maintain their overall health. Nutrition recommendations are customized for individual patients, both pre- ...

  13. Regeneration and Cell Recruitment in an Improved Heterotopic Auxiliary Partial Liver Transplantation Model in the Rat.

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    Ono, Yoshihiro; Pérez-Gutiérrez, Angelica; Yovchev, Mladen I; Matsubara, Kentaro; Yokota, Shinichiro; Guzman-Lepe, Jorge; Handa, Kan; Collin de l'Hortet, Alexandra; Thomson, Angus W; Geller, David A; Yagi, Hiroshi; Oertel, Michael; Soto-Gutierrez, Alejandro

    2017-01-01

    Auxiliary partial liver transplantation (APLT) in humans is a therapeutic modality used especially to treat liver failure in children or congenital metabolic disease. Animal models of APLT have helped to explore therapeutic options. Though many groups have suggested improvements, standardizing the surgical procedure has been challenging. Additionally, the question of whether graft livers are reconstituted by recipient-derived cells after transplantation has been controversial. The aim of this study was to improve experimental APLT in rats and to assess cell recruitment in the liver grafts. To inhibit recipient liver regeneration and to promote graft regeneration, we treated recipients with retrorsine and added arterial anastomosis. Using green fluorescence protein transgenic rats as recipients, we examined liver resident cell recruitment within graft livers by immunofluorescence costaining. In the improved APLT model, we achieved well-regenerated grafts that could maintain regeneration for at least 4 weeks. Regarding the cell recruitment, there was no evidence of recipient-derived hepatocyte, cholangiocyte, or hepatic stellate cell recruitment into the graft. Macrophages/monocytes, however, were consistently recruited into the graft and increased over time, which might be related to inflammatory responses. Very few endothelial cells showed colocalization of markers. We have successfully established an improved rat APLT model with arterial anastomosis as a standard technique. Using this model, we have characterized cell recruitment into the regenerating grafts.

  14. Role of NF-kappaB as effector of IPC in donor livers before liver transplantation in rats.

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    Li, X-C; Ma, Y-F; Wang, X-H

    2006-06-01

    The objective of this study was to investigate the effect of ischemic preconditioning (IPC) on NF-kappaB activity during reperfusion early after liver transplantation in rats. Male Sprague-Dawley (SD) rats were used as donors and recipients of orthotopic liver transplantations. The donor liver was stored 2 hours in Ringer's solution at 4 degrees C preimplantation. IPC was performed by clamping of the portal vein and hepatic artery of the donor for 10 minutes followed by reperfusion for 10 minutes before harvesting. At 1, 2, 4, and 6 hours after portal vein reperfusion, graft samples were obtained to determine hepatic levels of NF-kappaB activity, tumor necrosis factor (TNF)-alpha and intercellular adhesion molecule (ICAM)-1. Blood samples were obtained to measure serum alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). After liver transplantation without IPC, serum levels of ALT and LDH increased significantly compared with the sham-operated group. Among the IPC group, serum ALT and LDH decreased significantly. NF-kappaB activity in the graft increased within 6 hours after transplantation. Among the IPC group, NF-kappaB activity was significantly attenuated. Hepatic levels of TNF-alpha and ICAM-1 were significantly elevated in the non-IP group but both were reduced in the IPC group. IPC downregulated TNF-alpha and ICAM-1 expression in the graft, most likely through decreased NF-kappaB activation, and attenuated neutrophil infiltration after reperfusion.

  15. Correction of liver disease following transplantation of normal rat hepatocytes into Long-Evans Cinnamon rats modeling Wilson's disease.

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    Irani, A N; Malhi, H; Slehria, S; Gorla, G R; Volenberg, I; Schilsky, M L; Gupta, S

    2001-03-01

    To establish the efficacy of cell therapy in Wilson's disease, we used the Long-Evans Cinnamon (LEC) rat model with atp7b gene mutation and copper toxicosis. Several groups of LEC rats were established, including animals pretreated with retrorsine to exacerbate copper toxicosis and inhibit proliferation in native hepatocytes followed by partial hepatectomy to promote liver repopulation. Hepatocytes from normal, syngeneic LEA rats were transplanted intrasplenically. Animal survival, biliary copper excretion, and hepatic copper were determined. The magnitude of liver repopulation was demonstrated by measuring serum ceruloplasmin and hepatic atp7b mRNA. Long-term survival in LEC rats treated with retrorsine, partial hepatectomy, and cell transplantation was up to 90%, whereas fewer than 10% of animals pretreated with retrorsine, without cell therapy, survived, P Wilson's disease.

  16. Disappearance of GFP-positive hepatocytes transplanted into the liver of syngeneic wild-type rats pretreated with retrorsine.

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    Maeda, Hiromichi; Shigoka, Masatoshi; Wang, Yongchun; Fu, Yingxin; Wesson, Russell N; Lin, Qing; Montgomery, Robert A; Enzan, Hideaki; Sun, Zhaoli

    2014-01-01

    Green fluorescent protein (GFP) is a widely used molecular tag to trace transplanted cells in rodent liver injury models. The differing results from various previously reported studies using GFP could be attributed to the immunogenicity of GFP. Hepatocytes were obtained from GFP-expressing transgenic (Tg) Lewis rats and were transplanted into the livers of wild-type Lewis rats after they had undergone a partial hepatectomy. The proliferation of endogenous hepatocytes in recipient rats was inhibited by pretreatment with retrorsine to enhance the proliferation of the transplanted hepatocytes. Transplantation of wild-type hepatocytes into GFP-Tg rat liver was also performed for comparison. All biopsy specimens taken seven days after transplantation showed engraftment of transplanted hepatocytes, with the numbers of transplanted hepatocytes increasing until day 14. GFP-positive hepatocytes in wild-type rat livers were decreased by day 28 and could not be detected on day 42, whereas the number of wild-type hepatocytes steadily increased in GFP-Tg rat liver. Histological examination showed degenerative change of GFP-positive hepatocytes and the accumulation of infiltrating cells on day 28. PCR analysis for the GFP transgene suggested that transplanted hepatocytes were eliminated rather than being retained along with the loss of GFP expression. Both modification of the immunological response using tacrolimus and bone marrow transplantation prolonged the survival of GFP-positive hepatocytes. In contrast, host immunization with GFP-positive hepatocytes led to complete loss of GFP-positive hepatocytes by day 14. GFP-positive hepatocytes isolated from GFP-Tg Lewis rats did not survive long term in the livers of retrorsine-pretreated wild-type Lewis rats. The mechanism underlying this phenomenon most likely involves an immunological reaction against GFP. The influence of GFP immunogenicity on cell transplantation models should be considered in planning in vivo experiments

  17. Alloimmune activation promotes anti-cancer cytotoxicity after rat liver transplantation.

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    Stéphanie Lacotte

    Full Text Available Liver transplantation for hepatocellular carcinoma (HCC results in a specific condition where the immune response is potentially directed against both allogeneic and cancer antigens. We have investigated the level of anti-cancer immunity during allogeneic immune response. Dark Agouti-to-Lewis and Lewis-to-Lewis rat liver transplantations were performed and the recipients anti-cancer immunity was analysed at the time of alloimmune activation. The occurrence of rejection in the allogeneic recipients was confirmed by a shorter survival (p<0.01, increased liver function tests (p<0.01, the presence of signs of rejection on histology, and a donor-specific ex vivo mixed lymphocyte reaction. At the time of alloimmune activation, blood mononuclear cells of the allogeneic group demonstrated increased anti-cancer cytotoxicity (p<0.005, which was related to an increased natural killer (NK cell frequency (p<0.05 and a higher monocyte/macrophage activation level (p<0.01. Similarly, liver NK cell anti-cancer cytotoxicity (p<0.005, and liver monocyte/macrophage activation levels (p<0.01 were also increased. The alloimmune-associated cytotoxicity was mediated through the NKG2D receptor, whose expression was increased in the rejected graft (p<0.05 and on NK cells and monocyte/macrophages. NKG2D ligands were expressed on rat HCC cells, and its inhibition prevented the alloimmune-associated cytotoxicity. Although waiting for in vivo validation, alloimmune-associated cytotoxicity after rat liver transplantation appears to be linked to increased frequencies and levels of activation of NK cells and monocyte/macrophages, and is at least in part mediated through the NKG2D receptor.

  18. Pediatric Liver Transplantation.

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    Rawal, Nidhi; Yazigi, Nada

    2017-06-01

    Excellent outcomes over the last 3 decades have made liver transplantation the treatment of choice for many advanced liver disorders. This success also opened liver transplantation to new indications such as liver tumors and metabolic disorders. The emergence of such new indications for liver transplantation is bringing a new stream of patients along with disease-specific challenges. The cumulative number of liver transplant recipients is peaking, requiring novel systems of health care delivery that meet the needs of this special patient population. This article reviews updates and new development in pediatric liver transplantation. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Successful Transplantation of Reduced Sized Rat Alcoholic Fatty Livers Made Possible by Mobilization of Host Stem Cells

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    Hisada, Masayuki; Ota, Yoshihiro; Zhang, Xiuying; Cameron, Andrew M; Gao, Bin; Montgomery, Robert A; Williams, George Melville; Sun, Zhaoli

    2015-01-01

    Livers from Lewis rats fed with 7% alcohol for 5 weeks were used for transplantation. Reduced sized (50%) livers or whole livers were transplanted into normal DA recipients, which, in this strain combination, survive indefinitely when the donor has not been fed alcohol. However, none of the rats survived a whole fatty liver transplant while six of seven recipients of reduced sized alcoholic liver grafts survived long term. SDF-1 and HGF were significantly increased in reduced size liver grafts compared to whole liver grafts. Lineage-negative Thy-1+CXCR4+CD133+ stem cells were significantly increased in the peripheral blood and in allografts after reduced size fatty liver transplantation. In contrast, there were meager increases in cells reactive with anti Thy-1, CXCR4 and CD133 in peripheral blood and allografts in whole alcoholic liver recipients. The provision of plerixafor, a stem cell mobilizer, salvaged 5 of 10 whole fatty liver grafts. Conversely, blocking SDF-1 activity with neutralizing antibodies diminished stem cell recruitment and four of five reduced sized fatty liver recipients died. Thus chemokine insuficiency was associated with transplant failure of whole grafts which was overcome by the increased regenerative requirements promoted by the small grafts and mediated by SDF-1 resulting in stem cell influx. PMID:22994609

  20. [Ultrasound after liver transplantation].

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    Welker, M- W; Friedrich-Rust, M

    2015-01-01

    Graft specific complications after liver transplantation may be classified as vascular, biliar, and miscellaneous. This review provides an overview on sonography after liver transplantation. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Liver Transplant

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    ... The person will go through extensive medical and psychological testing to evaluate their appropriateness for donation. Blood type ... medical follow-up with the transplant team are essential during the first year. To achieve the best ...

  2. Combined treatment with MSC transplantation and neutrophil depletion ameliorates D-GalN/LPS-induced acute liver failure in rats.

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    Zhao, Xin; Shi, Xiaolei; Zhang, Zhiheng; Ma, Hucheng; Yuan, Xianwen; Ding, Yitao

    2016-12-01

    The imbalance of immunity is an important pathogenesis of acute liver failure (ALF). Neutrophils are the hallmark of acute inflammation, which have an essential role in immune regulation. Mesenchymal stem cell (MSC) transplantation is a promising therapy in ALF treatment. Recent studies indicated a considerable connection between MSCs and neutrophils in immune regulation. To investigate changes in neutrophils in ALF rats after MSC transplantation, and to explore the therapeutic effect and mechanism of the combined treatment with MSC transplantation and neutrophil depletion in ALF. We employed monotherapy and the combination therapy with MSCs and anti-PMN serum in D-galactosamine (D-GalN)/lipopolysaccharides (LPS)-induced ALF rats. Rats were sacrificed at 6, 12 and 24h, respectively. Blood samples and liver tissues were collected. Hepatic injury, inflammatory cytokines (TNF-α, IL-1β and IL-10), chemokines (CXCL1 and CXCL2), the number and activity of neutrophils and animal survival were assessed at fixed times. MSC transplantation can effectively improve the liver function of ALF rats and reduce the number and activity of neutrophils in both peripheral blood and liver. Compared with MSC transplantation alone, anti-PMN treatment and co-treatment had a better result in diminishing neutrophils. The co-treatment also exhibited a better therapeutical effect in ALF rats compared with monotherapy. In this process, the expressions of inflammatory cytokines in the liver were consistent with liver function. The regulation of the neutrophil-related microenvironment is affected in D-GalN/LPS-induced ALF rats after MSC transplantation. The combined treatment with MSC transplantation and neutrophil depletion may have a better therapeutic effect in ALF rats. Copyright © 2016. Published by Elsevier Masson SAS.

  3. Liver transplant - slideshow

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    ... this page: //medlineplus.gov/ency/presentations/100090.htm Liver transplant - series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The liver is in the right upper abdomen. The liver ...

  4. Repopulation of the fibrotic/cirrhotic rat liver by transplanted hepatic stem/progenitor cells and mature hepatocytes

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    Yovchev, Mladen I.; Xue, Yuhua; Shafritz, David A.; Locker, Joseph; Oertel, Michael

    2013-01-01

    Background & Aim Considerable progress has been made in developing anti-fibrotic agents and other strategies to treat liver fibrosis; however, significant long-term restoration of functional liver mass has not yet been achieved. Therefore, we investigated whether transplanted hepatic stem/progenitor cells can effectively repopulate the liver with advanced fibrosis/cirrhosis. Methods Stem/progenitor cells derived from fetal livers or mature hepatocytes from DPPIV+ F344 rats were transplanted into DPPIV− rats with thioacetamide (TAA)-induced fibrosis/cirrhosis; rats were sacrificed 1, 2, or 4 months later. Liver tissues were analyzed by histochemistry, hydroxyproline determination, RT-PCR, and immunohistochemistry. Results After chronic TAA administration, DPPIV− F344 rats exhibited progressive fibrosis, cirrhosis and severe hepatocyte damage. Besides stellate cell activation, increased numbers of stem/progenitor cells (Dlk-1+, AFP+, CD133+, Sox-9+, FoxJ1+) were observed. In conjunction with partial hepatectomy (PH), transplanted stem/progenitor cells engrafted, proliferated competitively compared to host hepatocytes, differentiated into hepatocytic and biliary epithelial cells, and generated new liver mass with extensive long-term liver repopulation (40.8 ± 10.3%). Remarkably, more than 20% liver repopulation was achieved in the absence of PH, associated with reduced fibrogenic activity (e.g., expression of α-SMA, PDGFRβ, desmin, vimentin, TIMP1) and fibrosis (reduced collagen). Furthermore, hepatocytes can also replace liver mass with advanced fibrosis/cirrhosis, but to a lesser extent than FLSPCs. Conclusions This study is a Proof of Principle demonstration that transplanted epithelial stem/progenitor cells can restore injured parenchyma in a liver environment with advanced fibrosis/cirrhosis and exhibit anti-fibrotic effects. PMID:23840008

  5. Transplantation of Porcine Hepatocytes Cultured with Polylactic Acid-O-Carboxymethylated Chitosan Nanoparticles Promotes Liver Regeneration in Acute Liver Failure Rats

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    Zhong Chen

    2011-01-01

    Full Text Available In this study, free porcine hepatocytes suspension (Group A, porcine hepatocytes embedded in collagen gel (Group B, porcine hepatocytes cultured with PLA-O-CMC nanoparticles and embedded in collagen gel (Group C, and PLA-O-CMC nanoparticles alone (Group D were transplanted into peritoneal cavity of ALF rats, respectively. The result showed that plasma HGF levels were elevated post-transplantation with a peak at 12 hr. The rats in Group C showed highest plasma HGF levels at 2, 6, 12, 24 and 36 hr post-transplantation and lowest HGF level at 48 hr. Plasma VEGF levels were elevated at 48 hr post-transplantation with a peak at 72 hr. The rats in Group C showed highest plasma HGF levels at 48, 72, and 96 hr post-transplantation. The liver functions in Group C were recovered most rapidly. Compared with Group B, Group C had significant high liver Kiel 67 antigen labeling index (Ki-67 LI at day 1 post-HTx (P<.05. Ki-67 LI in groups B and C was higher than that in groups A and D at days 5 and 7 post-HTx. In conclusion, intraperitoneal transplantation of porcine hepatocytes cultured with PLA-O-CMC nanoparticles and embedded in collagen gel can promote significantly liver regeneration in ALF rats.

  6. CD47 blockade reduces ischemia/reperfusion injury and improves survival in a rat liver transplantation model.

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    Xiao, Zhen-Yu; Banan, Babak; Jia, Jianluo; Manning, Pamela T; Hiebsch, Ronald R; Gunasekaran, Muthukumar; Upadhya, Gundumi A; Frazier, William A; Mohanakumar, Thalachallour; Lin, Yiing; Chapman, William C

    2015-04-01

    Orthotopic liver transplantation (OLT) remains the standard treatment option for nonresponsive liver failure. Because ischemia/reperfusion injury (IRI) is an important impediment to the success of OLT, new therapeutic strategies are needed to reduce IRI. We investigated whether blocking the CD47/thrombospondin-1 inhibitory action on nitric oxide signaling with a monoclonal antibody specific to CD47 (CD47mAb400) would reduce IRI in liver grafts. Syngeneic OLT was performed with Lewis rats. Control immunoglobulin G or CD47mAb400 was administered to the donor organ at procurement or to both the organ and the recipient at the time of transplant. Serum transaminases, histological changes of the liver, and animal survival were assessed. Oxidative stress, inflammatory responses, and hepatocellular damage were also quantified. A significant survival benefit was not achieved when CD47mAb400 was administered to the donor alone. However, CD47mAb400 administration to both the donor and the recipient increased animal survival afterward. The CD47mAb400-treated group showed lower serum transaminases, bilirubin, oxidative stress, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling staining, caspase-3 activity, and proinflammatory cytokine expression of tumor necrosis factor α, interleukin-1β, and interleukin-6. Thus, CD47 blockade with CD47mAb400 administered both to the donor and the recipient reduced liver graft IRI in a rat liver transplantation model. This may translate to decreased liver dysfunction and increased survival of liver transplant recipients. © 2015 American Association for the Study of Liver Diseases.

  7. [CD4(+) CD25(+) Tr cells and transcription factor Foxp3 in the naturally tolerance of rat liver transplantation].

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    Zhang, Feng; Lv, Ling; Pu, Li-Yong; Li, Xiang-Cheng; Yao, Ai-Hua; Zhang, Wei; Yu, Yue; Wang, Xue-Hao

    2006-11-01

    To investigate the role of intrahepatic CD4(+)CD25(+) T regulatory cells and Foxp3 gene in the natural tolerance in rat liver transplantation. The orthotopic liver transplantation models of inbred rats (LEW and DA rats) were established with double-sleeve technique and the models were divided into two groups: tolerance group (TOL group, LEW-to-DA) and rejection group (REJ group, DA-to-LEW). The intrahepatic lymphocytes from each group were isolated by using density gradient centrifugation. CD4(+)CD25(+) T cells were isolated by magic cell sorting system (MACS) and identified by flow cytometry (FCM). CD4(+)CD25(+) Tr cells suppression on the proliferation of CD4(+)CD25(-) T effector cells were analyzed by cell proliferation assay in vitro. Western blot was used to detect Scurfin protein expression of CD4(+)CD25(+) Tr cells. CD4(+)CD25(+) Tr cells developed significantly greater in the TOL group than in the REJ group. In vitro, the spleen cells from LEW rats can irritate the proliferation of CD4(+)CD25(+) T cells more obviously than the syngeneic spleen cells. CD4(+)CD25(+) T cells could suppress the proliferation of CD4(+)CD25(-) T cells, but the inhibition was reversed by exogenous IL-2 (200 U/ml). The immune suppression function of CD4(+)CD25(+) Tr cell, mediated by Foxp3 gene, is one of the mechanisms in liver transplantation tolerance.

  8. Auxiliary Liver Transplantation for Acute Liver Failure.

    Science.gov (United States)

    Shanmugam, Naresh P; Al-Lawati, Tawfiq; Kelgeri, Chaya; Rela, Mohamed

    2016-01-01

    Auxiliary partial orthotopic liver transplantation is a technique where part of diseased native liver is removed and replaced with healthy donor liver so that, the left behind native liver could later regenerate. 2 year 6 month old girl with acute liver failure due to Hepatitis A. She underwent a successful auxiliary partial orthotopic liver transplantation. Successful native liver regeneration and immunosuppression withdrawal after two and half years of surgery. In selective cases of acute liver failure, auxiliary partial orthotopic liver transplantation could provide a chance for native liver regeneration and immunosuppression-free life.

  9. Losartan activates sirtuin 1 in rat reduced-size orthotopic liver transplantation.

    Science.gov (United States)

    Pantazi, Eirini; Bejaoui, Mohamed; Zaouali, Mohamed Amine; Folch-Puy, Emma; Pinto Rolo, Anabela; Panisello, Arnau; Palmeira, Carlos Marques; Roselló-Catafau, Joan

    2015-07-14

    To investigate a possible association between losartan and sirtuin 1 (SIRT1) in reduced-size orthotopic liver transplantation (ROLT) in rats. Livers of male Sprague-Dawley rats (200-250 g) were preserved in University of Wisconsin preservation solution for 1 h at 4 °C prior to ROLT. In an additional group, an antagonist of angiotensin II type 1 receptor (AT1R), losartan, was orally administered (5 mg/kg) 24 h and 1 h before the surgical procedure to both the donors and the recipients. Transaminase (as an indicator of liver injury), SIRT1 activity, and nicotinamide adenine dinucleotide (NAD(+), a co-factor necessary for SIRT1 activity) levels were determined by biochemical methods. Protein expression of SIRT1, acetylated FoxO1 (ac-FoxO1), NAMPT (the precursor of NAD+), heat shock proteins (HSP70, HO-1) expression, endoplasmic reticulum stress (GRP78, IRE1α, p-eIF2) and apoptosis (caspase 12 and caspase 3) parameters were determined by Western blot. Possible alterations in protein expression of mitogen activated protein kinases (MAPK), such as p-p38 and p-ERK, were also evaluated. Furthermore, the SIRT3 protein expression and mRNA levels were examined. The present study demonstrated that losartan administration led to diminished liver injury when compared to ROLT group, as evidenced by the significant decreases in alanine aminotransferase (358.3 ± 133.44 vs 206 ± 33.61, P losartan was associated with enhanced SIRT1 protein expression and activity (5.27 ± 0.32 vs 6.08 ± 0.30, P Losartan treatment also provoked significant attenuation of endoplasmic reticulum stress parameters (GRP78, IRE1α, p-eIF2) which was consistent with reduced levels of both caspase 12 and caspase 3. Furthermore, losartan administration stimulated HSP70 protein expression and attenuated HO-1 expression. However, no changes were observed in protein or mRNA expression of SIRT3. Finally, the protein expression pattern of p-ERK and p-p38 were not altered upon losartan administration. The

  10. Impairment of Host Liver Repopulation by Transplanted Hepatocytes in Aged Rats and the Release by Short-Term Growth Hormone Treatment.

    Science.gov (United States)

    Stock, Peggy; Bielohuby, Maximilian; Staege, Martin S; Hsu, Mei-Ju; Bidlingmaier, Martin; Christ, Bruno

    2017-03-01

    Hepatocyte transplantation is an alternative to whole liver transplantation. Yet, efficient liver repopulation by transplanted hepatocytes is low in livers of old animals. This restraint might be because of the poor proliferative capacity of aged donor hepatocytes or the regenerative impairment of the recipient livers. The age-dependent liver repopulation by transplanted wild-type hepatocytes was investigated in juvenile and senescent rats deficient in dipeptidyl-peptidase IV. Repopulation was quantified by flow cytometry and histochemical estimation of dipeptidyl-peptidase IV enzyme activity of donor cells in the negative host liver. As a potential pathway involved, expression of cell cycle proteins was assessed. Irrespective of the age of the donor hepatocytes, large cell clusters appeared in juvenile, but only small clusters in senescent host livers. Because juvenile and senescent donor hepatocytes were likewise functional, host-derived factor(s) impaired senescent host liver repopulation. Growth hormone levels were significantly higher in juvenile than in senescent rats, suggesting that growth hormone might promote host liver repopulation. Indeed, short-term treatment with growth hormone augmented senescent host liver repopulation involving the growth hormone-mediated release of the transcriptional blockade of genes associated with cell cycle progression. Short-term growth hormone substitution might improve liver repopulation by transplanted hepatocytes, thus augmenting the therapeutic benefit of clinical hepatocyte transplantation in older patients. Copyright © 2017 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

  11. Effect of bone marrow mesenchymal stem cells transplantation on the serum and liver HMGB1 expression in rats with acute liver failure.

    Science.gov (United States)

    Zheng, Sheng; Yang, Juan; Tang, Yingmei; Yang, Jinhui; Shao, Qinghua; Guo, Ling; Liu, Qinghua

    2015-01-01

    This study aimed to investigate the effect of bone marrow mesenchymal stem cells (BMSCs) transplantation on the expression of high mobility group box 1 protein (HMGB1) in the serum and liver of rats with acute liver failure (ALF). Healthy male SD rats were randomly divided into control group, ALF group and BMSCs group. ALF was induced by intraperitoneal injection of 900 mg/kg D-GalN and 10 μg/kg LPS. In BMSCs group, rats received BMSCs (1.0×10(7)) transplantation via the tail vein at 2 h after ALF induction. Intraperitoneal injection of 900 mg/kg D-GalN and 10 μg/kg LPS was able to induce ALF in rats. In ALF group, serum ALT and AST increased gradually over time. At 72 h, the serum ALT and AST in BMSCs group were significantly different from those in ALF group. HMGB1 expression in the serum and liver remained at a low level at any time point in control group, but increased significantly in ALF group and BMSCs group. The serum and liver HMGB1 expression increased progressively in ALF group, but reduced gradually in BMSCs group. Significant difference in serum and liver HMGB1 expression was observed between ALF group and BMSCs group at 24 h and 72 h. In addition, there was marked difference in the survival rate among three groups at 24 h (χ (2) =21.098, Pliver function and liver pathology in ALF rats and decrease the serum and liver HMGB1.

  12. Evaluation of lipid peroxidation activity at intravenous administration of gold nanorods in rats with simulated diabetes and transplanted liver cancer

    Science.gov (United States)

    Bucharskaya, Alla B.; Dikht, Natalia I.; Afanasyeva, Galina A.; Terentyuk, Georgy S.; Maslyakova, Galina N.; Zaraeva, Nadezhda V.; Khlebtsov, Nikolai G.; Khlebtsov, Boris N.

    2014-01-01

    In the experiment the white outbred rats with transplanted liver cancer (cholangiocarcinoma line PC-1) and simulated alloxan diabetes were treated by single intravenous injection of gold nanorods. State of lipid peroxidation was evaluated by the following parameters: the malondialdehyde, lipid hydroperoxide, the average weght molecules in the serum of animals by conventional spectrophotometric methods study using a spectrofluorometer RF-5301 PC (Shimadzu, Japan). In both experimental groups of animals the significant increasing of levels of lipid peroxidation products was noted compared with control group. After intravenous administration of nanoparticles in the group of animals with alloxan diabetes the activation of a free radical oxidation was not observed, in group with transplanted liver cancer the increasing of levels of lipid hydroperoxide, malondialdehyde was established.

  13. Mast cell stabilization alleviates acute lung injury after orthotopic autologous liver transplantation in rats by downregulating inflammation.

    Directory of Open Access Journals (Sweden)

    Ailan Zhang

    Full Text Available BACKGROUND: Acute lung injury (ALI is one of the most severe complications after orthotopic liver transplantation. Amplified inflammatory response after transplantation contributes to the process of ALI, but the mechanism underlying inflammation activation is not completely understood. We have demonstrated that mast cell stabilization attenuated inflammation and ALI in a rodent intestine ischemia/reperfusion model. We hypothesized that upregulation of inflammation triggered by mast cell activation may be involve in ALI after liver transplantation. METHODS: Adult male Sprague-Dawley rats received orthotopic autologous liver transplantation (OALT and were executed 4, 8, 16, and 24 h after OALT. The rats were pretreated with the mast cell stabilizers cromolyn sodium or ketotifen 15 min before OALT and executed 8 h after OALT. Lung tissues and arterial blood were collected to evaluate lung injury. β-hexosaminidase and mast cell tryptase levels were assessed to determine the activation of mast cells. Tumor necrosis factor α (TNF-α, interleukin (IL-1β and IL-6 in serum and lung tissue were analyzed by enzyme-linked immunosorbent assay. Nuclear factor-kappa B (NF-κB p65 translocation was assessed by Western blot. RESULTS: The rats that underwent OALT exhibited severe pulmonary damage with a high wet-to-dry ratio, low partial pressure of oxygen, and low precursor surfactant protein C levels, which corresponded to the significant elevation of pro-inflammatory cytokines, β-hexosaminidase, and tryptase levels in serum and lung tissues. The severity of ALI progressed and maximized 8 h after OALT. Mast cell stabilization significantly inhibited the activation of mast cells, downregulated pro-inflammatory cytokine levels and translocation of NF-κB, and attenuated OALT-induced ALI. CONCLUSIONS: Mast cell activation amplified inflammation and played an important role in the process of post-OALT related ALI.

  14. Liver transplant using octogenarian donors

    National Research Council Canada - National Science Library

    Ferla, Fabio; De Carlis, Riccardo; Mariani, Anna; De Carlis, Luciano

    2016-01-01

    ... that liver transplantations (LTs) from octogenarian donors increased constantly between 2001 (3.5%) and 2010 (16.1%); this result is consistent with data from Spain and from the European Liver Transplant Registry. In our series (1571 liver transplants performed between December 1985 and December 2015), the first LT with an octogenarian do...

  15. TRANSPLANTATION OF CRYOPRESERVED FETAL LIVER CELLS SEEDED INTO MACROPOROUS ALGINATE-GELATIN SCAFFOLDS IN RATS WITH LIVER FAILURE

    Directory of Open Access Journals (Sweden)

    D. V. Grizay

    2015-01-01

    Full Text Available Aim. To study the therapeutic potential of cryopreserved fetal liver cells seeded into macroporous alginategelatin scaffolds after implantation to omentum of rats with hepatic failure.Materials and methods.Hepatic failure was simulated by administration of 2-acetyl aminofl uorene followed partial hepatectomy. Macroporous alginate-gelatin scaffolds, seeded with allogenic cryopreserved fetal liver cells (FLCs were implanted into rat omentum. To prevent from colonization of host cells scaffolds were coated with alginate gel shell. Serum transaminase activity, levels of albumin and bilirubin as markers of hepatic function were determined during 4 weeks after failure model formation and scaffold implantation. Morphology of liver and scaffolds after implantation were examined histologically. Results. Macroporous alginate-gelatin scaffolds after implantation to healthy rats were colonized by host cells. Additional formation of alginate gel shell around scaffolds prevented the colonization. Implantation of macroporous scaffolds seeded with cryopreserved rat FLCs and additionally coated with alginate gel shell into omentum of rats with hepatic failure resulted in signifi cant improvement of hepatospecifi c parameters of the blood serum and positive changes of liver morphology. The presence of cells with their extracellular matrix within the scaffolds was confi rmed after 4 weeks post implantation.Conclusion. The data above indicate that macroporous alginate-gelatin scaffolds coated with alginate gel shell are promising cell carriers for the development of bioengineered liver equivalents.

  16. Subnormothermic machine perfusion at both 20°C and 30°C recovers ischemic rat livers for successful transplantation.

    Science.gov (United States)

    Tolboom, Herman; Izamis, Maria-Louisa; Sharma, Nripen; Milwid, Jack M; Uygun, Basak; Berthiaume, François; Uygun, Korkut; Yarmush, Martin L

    2012-06-01

    Utilizing livers from donors after cardiac death could significantly expand the donor pool. We have previously shown that normothermic (37°C) extracorporeal liver perfusion significantly improves transplantation outcomes of ischemic rat livers. Here we investigate whether recovery of ischemic livers is possible using sub-normothermic machine perfusion at 20°C and 30°C. Livers from male Lewis rats were divided into five groups after 1 h of warm ischemia (WI): (1) WI only, (2) 5 h of static cold storage (SCS), or 5 h of MP at (3) 20°C, (4) 30°C, and (5) 37°C. Long-term graft performance was evaluated for 28 d post-transplantation. Acute graft performance was evaluated during a 2 h normothermic sanguineous reperfusion ex vivo. Fresh livers with 5 h of SCS were positive transplant controls while fresh livers were positive reperfusion controls. Following machine perfusion (MP) (Groups 3, 4, and 5), ischemically damaged livers could be orthotopically transplanted into syngeneic recipients with 100% survival (N ≥ 4) after 4 wk. On the other hand, animals from WI only, or WI + SCS groups all died within 24 h of transplantation. Fresh livers preserved using SCS had the highest alanine aminotransferase (ALT), aspartate aminotransferase (AST), and the lowest bile production during reperfusion, while at 28 d post-transplantation, livers preserved at 20°C and 30°C had the highest total bilirubin values. MP at both 20°C and 30°C eliminated temperature control in perfusion systems and recovered ischemically damaged rat livers. Postoperatively, low transaminases suggest a beneficial effect of sub-normothermic perfusion, while rising total bilirubin levels suggest inadequate prevention of ischemia- or hypothermia-induced biliary damage. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. Adipose derived mesenchymal stem cells transplantation via portal vein improves microcirculation and ameliorates liver fibrosis induced by CCl4 in rats

    Directory of Open Access Journals (Sweden)

    Wang Yu

    2012-06-01

    Full Text Available Abstract Introduction Adipose derived mesenchymal stem cells (ADMSCs, carrying the similar characteristics to bone marrow mesenchymal stem cells, only much more abundant and easier to obtain, may be a promising treatment for liver fibrosis. We aim to investigate the therapeutic potential of ADMSCs transplantation in liver fibrosis caused by carbon tetrachloride (CCl4 in rats as well as its underlying mechanism, and to further explore the appropriate infusion pathway. Methods ADMSCs were isolated, cultured and identified. Placebo and ADMSCs were transplanted via portal vein and tail vein respectively into carbon tetrachloride (CCl4-induced liver fibrosis rats. Computed tomography (CT perfusion scan and microvessel counts were performed to measure the alteration of liver microcirculation after therapy. Liver function tests and histological findings were estimated. Results CT perfusion scan shown significant decrease of hepatic arterial perfusion index, significant increased portal vein perfusion, total liver perfusion in rats receiving ADMSCs from portal vein, and Factor VIII (FVIII immunohistochemical staining shown significant decrease of microvessels in rats receiving ADMSCs from portal vein, indicating microcirculation improvement in portal vein group. Vascular endothelial growth Factor (VEGF was significantly up-regulated in fibrosis models, and decreased after ADMSCs intraportal transplantation. A significant improvement of liver functional test and histological findings in portal vein group were observed. No significance was found in rats receiving ADMSCs from tail vein. Conclusions ADMSCs have a therapeutic effect against CCl4-mediated liver fibrosis. ADMSCs may benefit the fibrotic liver through alteration of microcirculation, evidenced by CT perfusion scan and down-regulation of VEGF. Intraportal transplantation is a better pathway than tail vein transplantation.

  18. Bile salt-induced pro-oxidant liver damage promotes transplanted cell proliferation for correcting Wilson disease in the Long-Evans Cinnamon rat model.

    Science.gov (United States)

    Joseph, Brigid; Kapoor, Sorabh; Schilsky, Michael L; Gupta, Sanjeev

    2009-05-01

    Insights into disease-specific mechanisms for liver repopulation are needed for cell therapy. To understand the efficacy of pro-oxidant hepatic perturbations in Wilson disease, we studied Long-Evans Cinnamon (LEC) rats with copper toxicosis under several conditions. Hepatocytes from healthy Long-Evans Agouti (LEA) rats were transplanted intrasplenically into the liver. A cure was defined as lowering of copper to below 250 microg/g liver, presence of ATPase, Cu++ transporting, beta polypeptide (atp7b) messenger RNA (mRNA) in the liver and improvement in liver histology. Treatment of animals with the hydrophobic bile salt, cholic acid, or liver radiation before cell transplantation produced cure rates of 14% and 33%, respectively; whereas liver radiation plus partial hepatectomy followed by cell transplantation proved more effective, with cure in 55%, P < 0.01; and liver radiation plus cholic acid followed by cell transplantation was most effective, with cure in 75%, P < 0.001. As a group, cell therapy cures in rats preconditioned with liver radiation plus cholic acid resulted in less hepatic copper, indicating greater extent of liver repopulation. We observed increased hepatic catalase and superoxide dismutase activities in LEC rats, suggesting chronic oxidative stress. After liver radiation or cholic acid, hepatic lipid peroxidation levels increased, indicating further oxidative injury, although we did not observe overt additional cytotoxicity. This contrasted with healthy animals in which liver radiation and cholic acid produced hepatic steatosis and loss of injured hepatocytes. We concluded that pro-oxidant perturbations were uniquely effective for cell therapy in Wilson disease because of the nature of preexisting hepatic damage.

  19. Takotsubo cardiomyopathy post liver transplantation.

    Science.gov (United States)

    Vachiat, Ahmed; McCutcheon, Keir; Mahomed, Adam; Schleicher, Gunter; Brand, Liezl; Botha, Jean; Sussman, Martin; Manga, Pravin

    2016-10-23

    A patient with end-stage liver disease developed stress-induced Takotsubo cardiomyopathy post liver transplantation, with haemodynamic instability requiring a left ventricular assist device. We discuss the diagnosis and management of this condition.

  20. Split-liver transplantation : An underused resource in liver transplantation

    NARCIS (Netherlands)

    Rogiers, Xavier; Sieders, Egbert

    2008-01-01

    Split-liver transplantation is an efficient tool to increase the number of liver grafts available for transplantation. More than 15 years after its introduction only the classical splitting technique has reached broad application. Consequently children are benefiting most from this possibility.

  1. Infections After Orthotopic Liver Transplantation

    Science.gov (United States)

    Pedersen, Mark; Seetharam, Anil

    2014-01-01

    Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. PMID:25755581

  2. Lipids in liver transplant recipients

    National Research Council Canada - National Science Library

    Anna Hüsing Iyad Kabar Hartmut H Schmidt

    2016-01-01

    ... factors, such as obesity, diabetes mellitus and nutrition. Due to recent improvements in survival of liver transplant recipients, the prevention of cardiovascular events has become more important, especially as approximately 64...

  3. Current development of liver transplantation in China

    Directory of Open Access Journals (Sweden)

    ZHENG Shusen

    2014-01-01

    Full Text Available As the only effective way for the treatment of end-stage liver disease, liver transplantation has been developed rapidly in China over recent years. The latest developments of liver transplantation in China are reviewed, including establishment of selection criteria for the liver cancer recipients of liver transplantation——Hangzhou Criteria; latest application of salvage liver transplantation and downstaging therapy in liver transplantation for liver cancer; progress in liver transplantation combined with artificial liver support system for treatment of severe acute liver failure; breakthrough in technology innovation of living donor liver transplantation and organ donation and transplantation after cardiac death in China. Facing the problem of organ shortage, a scientific and standardized organ donation system should be established in line with the national conditions of China, so as to benefit the people and further improve the reputation of China in the international organ transplant community.

  4. Lipids in liver transplant recipients

    Science.gov (United States)

    Hüsing, Anna; Kabar, Iyad; Schmidt, Hartmut H

    2016-01-01

    Hyperlipidemia is very common after liver transplantation and can be observed in up to 71% of patients. The etiology of lipid disorders in these patients is multifactorial, with different lipid profiles observed depending on the immunosuppressive agents administered and the presence of additional risk factors, such as obesity, diabetes mellitus and nutrition. Due to recent improvements in survival of liver transplant recipients, the prevention of cardiovascular events has become more important, especially as approximately 64% of liver transplant recipients present with an increased risk of cardiovascular events. Management of dyslipidemia and of other modifiable cardiovascular risk factors, such as hypertension, diabetes and smoking, has therefore become essential in these patients. Treatment of hyperlipidemia after liver transplantation consists of life style modification, modifying the dose or type of immunosuppressive agents and use of lipid lowering agents. At the start of administration of lipid lowering medications, it is important to monitor drug-drug interactions, especially between lipid lowering agents and immunosuppressive drugs. Furthermore, as combinations of various lipid lowering drugs can lead to severe side effects, such as myopathies and rhabdomyolysis, these combinations should therefore be avoided. To our knowledge, there are no current guidelines targeting the management of lipid metabolism disorders in liver transplant recipients. This paper therefore recommends an approach of managing lipid abnormalities occurring after liver transplantation. PMID:27022213

  5. Hepatitis C and liver transplantation

    Science.gov (United States)

    Brown, Robert S.

    2005-08-01

    Liver transplantation is a life-saving therapy to correct liver failure, portal hypertension and hepatocellular carcinoma arising from hepatitis C infection. But despite the successful use of living donors and improvements in immunosuppression and antiviral therapy, organ demand continues to outstrip supply and recurrent hepatitis C with accelerated progression to cirrhosis of the graft is a frequent cause of graft loss and the need for retransplantation. Appropriate selection of candidates and timing of transplantation, coupled with better pre- and post-transplant antiviral therapy, are needed to improve outcomes.

  6. Ventilatory strategy during liver transplantation

    DEFF Research Database (Denmark)

    Sørensen, Henrik; Grocott, Hilary P; Niemann, Mads

    2014-01-01

    BACKGROUND: As measured by near infrared spectroscopy (NIRS), cerebral oxygenation (ScO2) may be reduced by hyperventilation in the anhepatic phase of liver transplantation surgery (LTx). Conversely, the brain may be subjected to hyperperfusion during reperfusion of the grafted liver. We investig...

  7. Liver transplantation for nontransplant physicians

    Directory of Open Access Journals (Sweden)

    Amany AbdelMaqsod Sholkamy

    2014-01-01

    Full Text Available Many of the nontransplant physicians who manage hepatic patients (internists and hepatologists keep asking about liver transplantation. The purpose of this article is to highlight important topics a nontransplant colleague may require in his practice. There are many topics in this respect; however, three most important topics need to be highlighted; those are; the time of referral to transplantation, the indications and contraindications and the metabolic issues regarding a transplanted patient. Still, there are no clear guidelines for the management of many of the metabolic issues regarding liver transplanted patients. And this why, collaborative efforts of transplant and nontransplant physicians are needed to conduct multicenter, long term randomized controlled trials and proper follow up programs.

  8. Nutritional Therapy in Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Ahmed Hammad

    2017-10-01

    Full Text Available Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation.

  9. Propofol postconditioning attenuates hippocampus ischemia-reperfusion injury via modulating JAK2/STAT3 pathway in rats after autogenous orthotropic liver transplantation.

    Science.gov (United States)

    Jia, Lili; Wang, Fei; Gu, Xiangqian; Weng, Yiqi; Sheng, Mingwei; Wang, Gang; Li, Shipeng; Du, Hongyin; Yu, Wenli

    2017-02-15

    Liver transplantation has been a routine treatment for the end stage liver diseases. Severe changes in circulation system and internal environment may occur during transplant surgery and cause injury to many organs including brain. Specific mechanisms of brain injury associated with liver transplantation are not yet elucidated. Previous studies have shown that the JAK/STAT signal transduction pathways are involved in the development of the central nervous system, such as nerve cell proliferation, survival, differentiation, and it also have a role in the disease processes, including brain tumor, brain ischemia and other diseases of the central nervous system. In this study we investigate whether propofol plays an important role in protecting the hippocampus through JAK2/STAT3 pathway. Thirty-two healthy male Sprague-Dawley rats, were randomly divided into four groups (n=8). Sham operation group (group S), autogenous orthotropic liver transplantation group (group I), autogenous orthotropic liver transplantation+propofol treatment group (group P) and autogenous orthotropic liver transplantation+propofol+AG490 treatment group (group A). We evaluated histological damage, inflammation, oxidative stress and apoptosis in hippocampus using HE staining, light microscope, real-time PCR and western blot. The results showed that there was a significant damage of hippocampus in group I compared to the sham group as demonstrated by increased serum levels of S100β, NSE and the histological changes. However, an induction of propofol reduced the levels of MDA, TNFα, S100β, NSE and increased activity of SOD, IL-10, and attenuated the expression of JAK2 and STAT3, meanwhile. Consistently, pretreatment with JAK2/STAT3 pathway inhibitor AG490, decreased the levels of MDA, TNFα, S100β, NSE and increased activity of SOD, IL-10, and attenuated the expression of JAK2 and STAT3. These results reveal that autogenous orthotropic liver transplantation induces the activation of JAK2/STAT3

  10. Excellent survival after liver transplantation for isolated polycystic liver disease : an European Liver Transplant Registry study

    NARCIS (Netherlands)

    van Keimpema, Loes; Nevens, Frederik; Adam, Rene; Porte, Robert J.; Fikatas, Panagiotis; Becker, Thomas; Kirkegaard, Preben; Metselaar, Herold J.; Drenth, Joost P. H.

    2011-01-01

    Patients with end-stage isolated polycystic liver disease (PCLD) suffer from incapacitating symptoms because of very large liver volumes. Liver transplantation (LT) is the only curative option. This study assesses the feasibility of LT in PCLD. We used the European Liver Transplant Registry (ELTR)

  11. Liver transplantation in polycystic liver disease

    DEFF Research Database (Denmark)

    Krohn, Paul S; Hillingsø, Jens; Kirkegaard, Preben

    2008-01-01

    OBJECTIVE: Polycystic liver disease (PLD) is a rare, hereditary, benign disorder. Hepatic failure is uncommon and symptoms are caused by mass effects leading to abdominal distension and pain. Liver transplantation (LTX) offers fully curative treatment, but there is still some controversy about...... whether it is a relevant modality considering the absence of liver failure, relative organ shortage, perioperative risks and lifelong immunosuppression. The purpose of this study was to review our experience of LTX for PLD and to compare the survival with the overall survival of patients who underwent LTX...... from 1992 to 2005. MATERIAL AND METHODS: A retrospective study of the journals of 440 patients, who underwent 506 LTXs between 1992 and 2005, showed that 14 patients underwent LTX for PLD. All patients had normal liver function. Three were receiving haemodialysis and thus underwent combined liver...

  12. Autologous subcutaneous adipose tissue transplants improve adipose tissue metabolism and reduce insulin resistance and fatty liver in diet-induced obesity rats.

    Science.gov (United States)

    Torres-Villalobos, Gonzalo; Hamdan-Pérez, Nashla; Díaz-Villaseñor, Andrea; Tovar, Armando R; Torre-Villalvazo, Ivan; Ordaz-Nava, Guillermo; Morán-Ramos, Sofía; Noriega, Lilia G; Martínez-Benítez, Braulio; López-Garibay, Alejandro; Torres-Landa, Samuel; Ceballos-Cantú, Juan C; Tovar-Palacio, Claudia; Figueroa-Juárez, Elizabeth; Hiriart, Marcia; Medina-Santillán, Roberto; Castillo-Hernández, Carmen; Torres, Nimbe

    2016-09-01

    Long-term dietary and pharmacological treatments for obesity have been questioned, particularly in individuals with severe obesity, so a new approach may involve adipose tissue transplants, particularly autologous transplants. Thus, the aim of this study was to evaluate the metabolic effects of autologous subcutaneous adipose tissue (SAT) transplants into two specific intraabdominal cavity sites (omental and retroperitoneal) after 90 days. The study was performed using two different diet-induced obesity (DIO) rat models: one using a high-fat diet (HFD) and the other using a high-carbohydrate diet (HCHD). Autologous SAT transplant reduced hypertrophic adipocytes, improved insulin sensitivity, reduced hepatic lipid content, and fasting serum-free fatty acids (FFAs) concentrations in the two DIO models. In addition, the reductions in FFAs and glycerol were accompanied by a greater reduction in lipolysis, assessed via the phosphorylation status of HSL, in the transplanted adipose tissue localized in the omentum compared with that localized in the retroperitoneal compartment. Therefore, the improvement in hepatic lipid content after autologous SAT transplant may be partially attributed to a reduction in lipolysis in the transplanted adipose tissue in the omentum due to the direct drainage of FFAs into the liver. The HCHD resulted in elevated fasting and postprandial serum insulin levels, which were dramatically reduced by the autologous SAT transplant. In conclusion, the specific intraabdominal localization of the autologous SAT transplant improved the carbohydrate and lipid metabolism of adipose tissue in obese rats and selectively corrected the metabolic parameters that are dependent on the type of diet used to generate the DIO model. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

  13. The history of liver transplantation in Turkey.

    Science.gov (United States)

    Moray, Gökhan; Arslan, Gülnaz; Haberal, Mehmet

    2014-03-01

    Liver transplantation is the definitive treatment for end-stage liver diseases. The first successful liver transplant was performed in the United States by Thomas Starzl in 1967. The first successful solid organ transplant in Turkey was a living-related kidney transplant performed by Dr. Haberal in 1975. After much effort by Dr. Haberal, the Turkish parliament enacted a law about organ transplantation in 1979. After clinical and experimental studies, the first liver transplant in Turkey was performed by Dr. Haberal in 1988. The first successful partial living-donor liver transplant in children in Turkey was performed by the same team on March 15, 1990. On April 24, 1990, the first living-donor liver transplant was performed on a child in Turkey using a left lateral segment by Dr. Haberal and coworkers. On May 16, 1992, Dr. Haberal performed a simultaneous living-donor liver and kidney transplantation to an adult from the same donor. There currently are 30 liver transplantation centers in Turkey. According to data from the Ministry of Health, there presently are 2065 patients in Turkey who are waiting for a liver transplantation. From January 2002 to June 2013, there were 6091 liver transplants performed in Turkey (4020 living-donor [66% ] and 2071 deceased donor liver transplants [34% ]). From January 2011 to June 2013, there were 2514 patients who had liver transplants in Turkey, and 437 patients (17%) died. The number of liver transplants per year in Turkey reached 1000 transplants in 2012 and more than 1150 transplants in 2013 (15.1/million/y). Therefore, Turkey has one of the highest volumes of liver transplantation per population worldwide, with 90% survival within 1 year after transplantation.

  14. Liver Transplantation and Hepatitis C

    Science.gov (United States)

    Akamatsu, Nobuhisa; Sugawara, Yasuhiko

    2012-01-01

    Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompensation. The use of poor quality organs, particularly from older donors, has a highly negative impact on the severity of recurrence and patient/graft survival. Although immunosuppressive regimens have a considerable impact on the outcome, the optimal regimen after liver transplantation for HCV-infected patients remains unclear. Disease progression monitoring with protocol biopsy and new noninvasive methods is essential for predicting patient/graft outcome and starting antiviral treatment with the appropriate timing. Antiviral treatment with pegylated interferon and ribavirin is currently considered the most promising regimen with a sustained viral response rate of around 30% to 35%, although the survival benefit of this regimen remains to be investigated. Living-donor liver transplantation is now widely accepted as an established treatment for HCV cirrhosis and the results are equivalent to those of deceased donor liver transplantation. PMID:22900194

  15. Primary sclerosing cholangitis and liver transplantation

    NARCIS (Netherlands)

    Klompmaker, IJ; Haagsma, EB; Jansen, PLM; Slooff, MJH

    1996-01-01

    Primary sclerosing cholangitis is a chronic disease, strongly associated with ulcerative colitis and cholangiocarcinoma. Ulcerative colitis itself does not influence the liver transplant results. However; intensified screening after liver transplantation for carcinoma of the colon may be necessary.

  16. Pediatric liver transplantation for fibropolycystic liver disease.

    Science.gov (United States)

    Ko, Jae Sung; Yi, Nam-Joon; Suh, Kyung Suk; Seo, Jeong Kee

    2012-03-01

    Fibropolycystic liver disease includes CHF, Caroli's syndrome, and Caroli's disease. Patients with Caroli's disease and Caroli's syndrome have an increased risk of recurrent cholangitis, intrahepatic calculi, biliary cirrhosis, and cholangiocarcinoma. The aim of this study was to examine the post-transplantation outcomes of children with fibropolycystic liver disease. Of the 158 children transplanted at Seoul National University Hospital, there were four patients with Caroli's syndrome, two patients with CHF, and one patient with Caroli's disease. One patient underwent combined liver/kidney transplantation. Associated renal manifestations included ARPKD in three children and nephronophthisis in one child. The indications for LT were recurrent cholangitis, decompensated cirrhosis, and refractory complications of portal hypertension. Both graft and patient survival rates were 100% at a median follow-up period of two yr after LT. Three children with growth failure achieved catch-up growth after LT. In three patients with ARPKD, mean serum creatinine levels increased from 0.53 mg/dL at the time of LT to 0.91 mg/dL at the last follow-up (p = 0.01). LT is an excellent option for children with complications from fibropolycystic liver disease. Renal function should be monitored cautiously after LT in the patients with ARPKD. © 2012 John Wiley & Sons A/S.

  17. Pediatric Liver Transplant

    National Research Council Canada - National Science Library

    SM Dehghani

    2014-01-01

    The goals of post-transplant management are to manage and treat postoperative complications, and develop a balanced long-term immunotherapy regimen that minimizes infection and side effects but controls rejection...

  18. The effect of cortisol in rat steatotic and non-steatotic liver transplantation from brain-dead donors.

    Science.gov (United States)

    Jiménez-Castro, Mónica B; Negrete-Sánchez, Elsa; Casillas-Ramírez, Araní; Gulfo, Jose; Álvarez-Mercado, Ana I; Cornide-Petronio, María Eugenia; Gracia-Sancho, Jordi; Rodés, Juan; Peralta, Carmen

    2017-04-25

    In the present study, we examined the effects of cortisol on steatotic and non-steatotic liver grafts from brain-dead donors and characterized the underlying mechanisms involved. Non-steatotic liver grafts showed reduced cortisol and increased cortisone levels in association with up-regulation of enzymes that inactivate cortisol. Conversely, steatotic liver grafts exhibited increased cortisol and reduced cortisone levels. The enzymes involved in cortisol generation were overexpressed, and those involved in cortisol inactivation or clearance were down-regulated in steatotic liver grafts. Exogenous administration of cortisol negatively affected hepatic damage and survival rate in non-steatotic liver transplantation (LT); however, cortisol treatment up-regulated the phosphoinositide 3-kinase (PI3K)-protein kinase C (PKC) pathway, resulting in protection against the deleterious effects of brain-dead donors on damage and inflammatory response in steatotic LT as well as in increased survival of recipients. The present study highlights the differences in the role of cortisol and hepatic mechanisms that regulate cortisol levels based on the type of liver. Our findings suggest that cortisol treatment is a feasible and highly protective strategy to reduce the adverse effects of brain-dead donor livers in order to ultimately improve liver graft quality in the presence of steatosis, whereas cortisol treatment would not be recommended for non-steatotic liver grafts. © 2017 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.

  19. In Utero Hepatocellular Transplantation in Rats

    Directory of Open Access Journals (Sweden)

    Emma Muñoz-Sáez

    2013-01-01

    Full Text Available This work represents a step forward in the experimental design of an in utero hepatocellular transplantation model in rats. We focused on the enrichment optimization of isolated fetal hepatocytes suspension, arranging the surgery methodology of in utero transplantation, monitoring the biodistribution of the transplanted hepatocytes, and assessing the success of the transplants. Rat fetuses have been transplanted at the 17th embryonic day (ED17 with fetal hepatocytes isolated from rats at the end of pregnancy (ED21. We assessed possible differences between lymphocyte population, CD4 positive, CD8 positive, double-positive T-cells, and anti-inflammatory cytokines interleukins 4 and 10 (IL4 and IL10 as well. Cellular viability reached the rates of 90–95%. Transplanted groups had a limited success. Transplanted hepatocytes were not able to pass through the hematoplacental barrier. The hepatocytes injected were primarily located in the liver. There was an upward trend in the whole amount of T CD4 and T CD8 cells. There was an increased IL4 in the transplanted groups observed in the pregnant rats. The possibility to induce tolerance in fetuses with a hepatocyte transplant in utero could be a key point to avoid the immunosuppression treatments which must be undergone by transplanted patients.

  20. Protective effect of gadolinium chloride on early warm ischemia/reperfusion injury in rat bile duct during liver transplantation.

    Directory of Open Access Journals (Sweden)

    Biao Wang

    Full Text Available BACKGROUND: Activation of Kupffer cell (KC is acknowledged as a key event in the initiation and perpetuation of bile duct warm ischemia/reperfusion injury. The inhibitory effect of gadolinium chloride (GdCl(3 on KC activation shows potential as a protective intervention in liver injury, but there is less research with regard to bile duct injury. METHODS: Sixty-five male Sprague-Dawley rats (200-250 g were randomly divided into three experimental groups: a sham group (n = 15, a control group (n = 25, and a GdCl(3 group (n = 25. Specimen was collected at 0.5, 2, 6, 12 and 24 h after operation. Alanine aminotransferase (ALT, alkaline phosphatase (ALP and total bilirubin (TBIL of serum were measured. Tumor necrosis factor-α (TNF-α, Capase-3 activity and soluble Fas (sFas were detected. The pathologic changes of bile duct were observed. Immunochemistry for bile duct Fas was performed. Apoptosis of bile duct cells was evaluated by the terminal UDP nick end labeling assay. RESULTS: GdCl(3 significantly decreased the levels of ALT, ALP and TBIL at 2, 6, 12, and 24 h, and increased serum sFas at 2, 6 and 12 h (P<0.05. TNF-α was lower in the GdCl(3 group than in the control group at 2, 6, 12 and 24 h (P<0.05. Preadministration of GdCl(3 significantly reduced the Caspase-3 activity and bile duct cell apoptosis at 2, 6, 12 and 24 h. After operation for 2, 6 and 12 h, the expression of Fas protein was lower in the GdCl(3 group than in the control group (P<0.05. CONCLUSIONS: GdCl(3 plays an important role in suppressing bile duct cell apoptosis, including decreasing ALT, ALP, TBIL and TNF-α; suppressing Fas-FasL-Caspase signal transduction during transplantation.

  1. Protective effect of gadolinium chloride on early warm ischemia/reperfusion injury in rat bile duct during liver transplantation.

    Science.gov (United States)

    Wang, Biao; Zhang, Qi; Zhu, Bili; Cui, Zhonglin; Zhou, Jie

    2013-01-01

    Activation of Kupffer cell (KC) is acknowledged as a key event in the initiation and perpetuation of bile duct warm ischemia/reperfusion injury. The inhibitory effect of gadolinium chloride (GdCl(3)) on KC activation shows potential as a protective intervention in liver injury, but there is less research with regard to bile duct injury. Sixty-five male Sprague-Dawley rats (200-250 g) were randomly divided into three experimental groups: a sham group (n = 15), a control group (n = 25), and a GdCl(3) group (n = 25). Specimen was collected at 0.5, 2, 6, 12 and 24 h after operation. Alanine aminotransferase (ALT), alkaline phosphatase (ALP) and total bilirubin (TBIL) of serum were measured. Tumor necrosis factor-α (TNF-α), Capase-3 activity and soluble Fas (sFas) were detected. The pathologic changes of bile duct were observed. Immunochemistry for bile duct Fas was performed. Apoptosis of bile duct cells was evaluated by the terminal UDP nick end labeling assay. GdCl(3) significantly decreased the levels of ALT, ALP and TBIL at 2, 6, 12, and 24 h, and increased serum sFas at 2, 6 and 12 h (Pbile duct cell apoptosis at 2, 6, 12 and 24 h. After operation for 2, 6 and 12 h, the expression of Fas protein was lower in the GdCl(3) group than in the control group (Pbile duct cell apoptosis, including decreasing ALT, ALP, TBIL and TNF-α; suppressing Fas-FasL-Caspase signal transduction during transplantation.

  2. Liver transplantation: history, outcomes and perspectives.

    Science.gov (United States)

    Meirelles Júnior, Roberto Ferreira; Salvalaggio, Paolo; Rezende, Marcelo Bruno de; Evangelista, Andréia Silva; Guardia, Bianca Della; Matielo, Celso Eduardo Lourenço; Neves, Douglas Bastos; Pandullo, Fernando Luis; Felga, Guilherme Eduardo Gonçalves; Alves, Jefferson André da Silva; Curvelo, Lilian Amorim; Diaz, Luiz Gustavo Guedes; Rusi, Marcela Balbo; Viveiros, Marcelo de Melo; Almeida, Marcio Dias de; Pedroso, Pamella Tung; Rocco, Rodrigo Andrey; Meira Filho, Sérgio Paiva

    2015-01-01

    In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first five liver transplantations no patient survived more than 23 days. In 1967, stimulated by Calne who used antilymphocytic serum, Starzl began a successful series of liver transplantation. Until 1977, 200 liver transplantations were performed in the world. In that period, technical problems were overcome. Roy Calne, in 1979, used the first time cyclosporine in two patients who had undergone liver transplantation. In 1989, Starzl et al. reported a series of 1,179 consecutives patients who underwent liver transplantation and reported a survival rate between one and five years of 73% and 64%, respectively. Finally, in 1990, Starzl et al. reported successful use of tacrolimus in patents undergoing liver transplantation and who had rejection despite receiving conventional immunosuppressive treatment. Liver Transplantation Program was initiated at Hospital Israelita Albert Einstein in 1990 and so far over 1,400 transplants have been done. In 2013, 102 deceased donors liver transplantations were performed. The main indications for transplantation were hepatocellular carcinoma (38%), hepatitis C virus (33.3%) and alcohol liver cirrhosis (19.6%). Of these, 36% of patients who underwent transplantation showed biological MELD score > 30. Patient and graft survival in the first year was, 82.4% and 74.8%, respectively. A major challenge in liver transplantation field is the insufficient number of donors compared with the growing demand of transplant candidates. Thus, we emphasize that appropriated donor/receptor selection, allocation and organ preservation topics should contribute to improve the number and outcomes in liver transplantation.

  3. Liver transplantation: history, outcomes and perspectives

    Science.gov (United States)

    Meirelles, Roberto Ferreira; Salvalaggio, Paolo; de Rezende, Marcelo Bruno; Evangelista, Andréia Silva; Guardia, Bianca Della; Matielo, Celso Eduardo Lourenço; Neves, Douglas Bastos; Pandullo, Fernando Luis; Felga, Guilherme Eduardo Gonçalves; Alves, Jefferson André da Silva; Curvelo, Lilian Amorim; Diaz, Luiz Gustavo Guedes; Rusi, Marcela Balbo; Viveiros, Marcelo de Melo; de Almeida, Marcio Dias; Pedroso, Pamella Tung; Rocco, Rodrigo Andrey; Meira, Sérgio Paiva

    2015-01-01

    In 1958 Francis Moore described the orthotopic liver transplantation technique in dogs. In 1963, Starzl et al. performed the first liver transplantation. In the first five liver transplantations no patient survived more than 23 days. In 1967, stimulated by Calne who used antilymphocytic serum, Starzl began a successful series of liver transplantation. Until 1977, 200 liver transplantations were performed in the world. In that period, technical problems were overcome. Roy Calne, in 1979, used the first time cyclosporine in two patients who had undergone liver transplantation. In 1989, Starzl et al. reported a series of 1,179 consecutives patients who underwent liver transplantation and reported a survival rate between one and five years of 73% and 64%, respectively. Finally, in 1990, Starzl et al. reported successful use of tacrolimus in patents undergoing liver transplantation and who had rejection despite receiving conventional immunosuppressive treatment. Liver Transplantation Program was initiated at Hospital Israelita Albert Einstein in 1990 and so far over 1,400 transplants have been done. In 2013, 102 deceased donors liver transplantations were performed. The main indications for transplantation were hepatocellular carcinoma (38%), hepatitis C virus (33.3%) and alcohol liver cirrhosis (19.6%). Of these, 36% of patients who underwent transplantation showed biological MELD score > 30. Patient and graft survival in the first year was, 82.4% and 74.8%, respectively. A major challenge in liver transplantation field is the insufficient number of donors compared with the growing demand of transplant candidates. Thus, we emphasize that appropriated donor/receptor selection, allocation and organ preservation topics should contribute to improve the number and outcomes in liver transplantation. PMID:25993082

  4. Autoimmune liver disease, autoimmunity and liver transplantation.

    Science.gov (United States)

    Carbone, Marco; Neuberger, James M

    2014-01-01

    Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) represent the three major autoimmune liver diseases (AILD). PBC, PSC, and AIH are all complex disorders in that they result from the effects of multiple genes in combination with as yet unidentified environmental factors. Recent genome-wide association studies have identified numerous risk loci for PBC and PSC that host genes involved in innate or acquired immune responses. These loci may provide a clue as to the immune-based pathogenesis of AILD. Moreover, many significant risk loci for PBC and PSC are also risk loci for other autoimmune disorders, such type I diabetes, multiple sclerosis and rheumatoid arthritis, suggesting a shared genetic basis and possibly similar molecular pathways for diverse autoimmune conditions. There is no curative treatment for all three disorders, and a significant number of patients eventually progress to end-stage liver disease requiring liver transplantation (LT). LT in this context has a favourable overall outcome with current patient and graft survival exceeding 80% at 5years. Indications are as for other chronic liver disease although recent data suggest that while lethargy improves after transplantation, the effect is modest and variable so lethargy alone is not an indication. In contrast, pruritus rapidly responds. Cholangiocarcinoma, except under rigorous selection criteria, excludes LT because of the high risk of recurrence. All three conditions may recur after transplantation and are associated with a greater risk of both acute cellular and chronic ductopenic rejection. It is possible that a crosstalk between alloimmune and autoimmune response perpetuate each other. An immunological response toward self- or allo-antigens is well recognised after LT in patients transplanted for non-autoimmune indications and sometimes termed "de novo autoimmune hepatitis". Whether this is part of the spectrum of rejection or an autoimmune

  5. Pediatric Liver Transplant

    Directory of Open Access Journals (Sweden)

    SM Dehghani

    2014-04-01

    Full Text Available The goals of post-transplant management are to manage and treat postoperative complications, and develop a balanced long-term immunotherapy regimen that minimizes infection and side effects but controls rejection. While modern immunosuppressant regimes have reduced rates of graft loss due to rejection, they impart major risks for infection, growth failure, metabolic complications, and malignancy. There is significantly more post-transplant morbidity and mortality from infection than from rejection, particularly in infants. This has led to a trend toward minimization of immunosuppression, which is supported by evidence that some rejection facilitates graft tolerance and thus is not necessarily always harmful. Post-transplant complications are divided into those that occur in the first 3–12 months (“early”, and these are relatively common, and those occurring after 12 months (“late”, which are generally uncommon. Most “early” complications relate to surgical issues, and/or immunosuppression, most notably infection, vascular complications of the graft, and biliary leaks. Infection is the most common cause of post-transplant mortality. Rejection does occur but usually responds to treatment with steroid pulse dosing, and appears not to contribute to either graft or patient mortality. “Late” complications include biliary strictures, which are uncommon and generally respond to percutaneous biliary dilatation and stent procedures. Most late complications are primarily related to the effects of long-term immunosuppression, notably infections such as EBV and associated PTLD, and side effects of immunosuppression such as renal dysfunction, hypertension, and immune dysregulation.  

  6. Arterioportal Fistulas in Liver Transplant Recipients

    OpenAIRE

    Saad, Wael E. A.

    2012-01-01

    Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically s...

  7. Liver transplantation for Wilson disease

    Science.gov (United States)

    Catana, Andreea M; Medici, Valentina

    2012-01-01

    The aim of this paper is to review the current status of liver transplantation (LT) for Wilson disease (WD), focusing on indications and controversies, especially in patients with neuropsychiatric disease, and on identification of acute liver failure (ALF) cases related to WD. LT remains the treatment of choice for patients with ALF, as initial presentation of WD or when anti-copper agents are stopped, and for patients with chronic liver disease progressed to cirrhosis, unresponsive to chelating medications or not timely treated with copper chelating agents. The indication for LT in WD remains highly debated in patients with progressive neurological deterioration and failure to improve with appropriate medical treatment. In case of Wilsonian ALF, early identification is key as mortality is 100% without emergency LT. As many of the copper metabolism parameters are believed to be less reliable in ALF, simple biochemical tests have been proposed for diagnosis of acute WD with good sensitivity and specificity. LT corrects copper metabolism and complications resulting from WD with excellent 1 and 5 year survival. Living related liver transplantation represents an alternative to deceased donor LT with excellent long-term survival, without disease recurrence. Future options may include hepatocyte transplantation and gene therapy. Although both of these have shown promising results in animal models of WD, prospective human studies are much needed to demonstrate their long-term beneficial effects and their potential to replace the need for medical therapy and LT in patients with WD. PMID:22312450

  8. Liver ischemic preconditioning (IPC) improves intestinal microbiota following liver transplantation in rats through 16s rDNA-based analysis of microbial structure shift.

    Science.gov (United States)

    Ren, Zhigang; Cui, Guangying; Lu, Haifeng; Chen, Xinhua; Jiang, Jianwen; Liu, Hui; He, Yong; Ding, Songming; Hu, Zhenhua; Wang, Weilin; Zheng, Shusen

    2013-01-01

    Ischemia-reperfusion (I/R) injury is associated with intestinal microbial dysbiosis. The "gut-liver axis" closely links gut function and liver function in health and disease. Ischemic preconditioning (IPC) has been proven to reduce I/R injury in the surgery. This study aims to explore the effect of IPC on intestinal microbiota and to analyze characteristics of microbial structure shift following liver transplantation (LT). The LT animal models of liver and gut IPC were established. Hepatic graft function was assessed by histology and serum ALT/AST. Intestinal barrier function was evaluated by mucosal ultrastructure, serum endotoxin, bacterial translocation, fecal sIgA content and serum TNF-α. Intestinal bacterial populations were determined by quantitative PCR. Microbial composition was characterized by DGGE and specific bacterial species were determined by sequence analysis. Liver IPC improved hepatic graft function expressed as ameliorated graft structure and reduced ALT/AST levels. After administration of liver IPC, intestinal mucosal ultrastructure improved, serum endotoxin and bacterial translocation mildly decreased, fecal sIgA content increased, and serum TNF-α decreased. Moreover, liver IPC promoted microbial restorations mainly through restoring Bifidobacterium spp., Clostridium clusters XI and Clostridium cluster XIVab on bacterial genus level. DGGE profiles indicated that liver IPC increased microbial diversity and species richness, and cluster analysis demonstrated that microbial structures were similar and clustered together between the NC group and Liver-IPC group. Furthermore, the phylogenetic tree of band sequences showed key bacteria corresponding to 10 key band classes of microbial structure shift induced by liver IPC, most of which were assigned to Bacteroidetes phylum. Liver IPC cannot only improve hepatic graft function and intestinal barrier function, but also promote restorations of intestinal microbiota following LT, which may further

  9. Liver ischemic preconditioning (IPC improves intestinal microbiota following liver transplantation in rats through 16s rDNA-based analysis of microbial structure shift.

    Directory of Open Access Journals (Sweden)

    Zhigang Ren

    Full Text Available BACKGROUND: Ischemia-reperfusion (I/R injury is associated with intestinal microbial dysbiosis. The "gut-liver axis" closely links gut function and liver function in health and disease. Ischemic preconditioning (IPC has been proven to reduce I/R injury in the surgery. This study aims to explore the effect of IPC on intestinal microbiota and to analyze characteristics of microbial structure shift following liver transplantation (LT. METHODS: The LT animal models of liver and gut IPC were established. Hepatic graft function was assessed by histology and serum ALT/AST. Intestinal barrier function was evaluated by mucosal ultrastructure, serum endotoxin, bacterial translocation, fecal sIgA content and serum TNF-α. Intestinal bacterial populations were determined by quantitative PCR. Microbial composition was characterized by DGGE and specific bacterial species were determined by sequence analysis. PRINCIPAL FINDINGS: Liver IPC improved hepatic graft function expressed as ameliorated graft structure and reduced ALT/AST levels. After administration of liver IPC, intestinal mucosal ultrastructure improved, serum endotoxin and bacterial translocation mildly decreased, fecal sIgA content increased, and serum TNF-α decreased. Moreover, liver IPC promoted microbial restorations mainly through restoring Bifidobacterium spp., Clostridium clusters XI and Clostridium cluster XIVab on bacterial genus level. DGGE profiles indicated that liver IPC increased microbial diversity and species richness, and cluster analysis demonstrated that microbial structures were similar and clustered together between the NC group and Liver-IPC group. Furthermore, the phylogenetic tree of band sequences showed key bacteria corresponding to 10 key band classes of microbial structure shift induced by liver IPC, most of which were assigned to Bacteroidetes phylum. CONCLUSION: Liver IPC cannot only improve hepatic graft function and intestinal barrier function, but also promote

  10. Liver Transplantation in the Mouse: Insights Into Liver Immunobiology, Tissue Injury and Allograft Tolerance

    Science.gov (United States)

    Yokota, Shinichiro; Yoshida, Osamu; Ono, Yoshihiro; Geller, David A.; Thomson, Angus W.

    2016-01-01

    The surgically-demanding mouse orthotopic liver transplant model was first described in 1991. It has proved a powerful research tool for investigation of liver biology, tissue injury, the regulation of alloimmunity and tolerance induction and the pathogenesis of specific liver diseases. Liver transplantation in mice has unique advantages over transplantation of the liver in larger species, such as the rat or pig, since the mouse genome is well-characterized and there is much greater availability of both genetically-modified animals and research reagents. Liver transplant experiments using various transgenic or gene knockout mice has provided valuable mechanistic insights into the immuno- and pathobiology of the liver and the regulation of graft rejection and tolerance over the past 25 years. The molecular pathways identified in regulation of tissue injury and promotion of liver transplant tolerance provide new potential targets for therapeutic intervention to control adverse inflammatory responses/ immune-mediated events in the hepatic environment and systemically. Conclusion: Orthotopic liver transplantation in the mouse is a valuable model for gaining improved insights into liver biology, immunopathology and allograft tolerance that may result in therapeutic innovation in liver and other diseases. PMID:26709949

  11. Anesthesia care for liver transplantation.

    Science.gov (United States)

    Hannaman, Michael J; Hevesi, Zoltan G

    2011-01-01

    Intraoperative transfusion practices for liver transplantation have evolved dramatically since the first transplants of the 1960s. It is important for today's clinicians to be current in their understanding of how transplant patients should be managed with regard to their coagulation profile, volume status, and general hemodynamic state. The anesthesia team is presented with the unique task of manipulating this tenuous balance in a rapid and precise manner when managing patients undergoing liver transplantation. Although significant progress has been made in reducing blood product administration, it is still common to encounter large volume blood loss in these cases. Increasingly, clinicians are challenged to justify transfusion practices with a stronger evidentiary base. The current state of the literature for transfusion guidelines and blood product management in this particular patient subset will be discussed, as well as a variety of means (both pharmacologic and otherwise) used to reduce the need for transfusion. The aim was to review the latest evidence on these topics, as well as to highlight areas that need further clarification regarding their role in the optimal care of these patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. FORUM Paediatric living donor liver transplantation

    African Journals Online (AJOL)

    Liver transplantation (LT) is the definitive treatment for children with end-stage liver disease (ESLD). The greatest limitation for LT is scarcity of deceased donor organs. This is particularly critical for smaller children (weighing <10 kg). Living donor liver transplantation. (LDLT) has emerged over the last 2 decades as a viable ...

  13. Bile acids for liver-transplanted patients

    DEFF Research Database (Denmark)

    Poropat, Goran; Giljaca, Vanja; Stimac, Davor

    2010-01-01

    Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease allograft rejection after liver transplantation by changing the expression of major histocompatibility complex class molecules in bile duct epithelium and central vein...

  14. Report on Liver Cell Transplantation Using Human Fetal Liver Cells.

    Science.gov (United States)

    Pietrosi, Giada; Chinnici, Cinzia

    2017-01-01

    In an era of organ shortage, human fetuses donated after medically indicated abortion could be considered a potential liver donor for hepatic cell isolation. We investigated transplantation of fetal liver cells as a strategy to support liver functionality in end-stage liver disease. Here, we report our protocol of human fetal liver cells (hFLC) isolation in fetuses from 17 to 22 gestational weeks, and our clinical procedure of hFLC transplantation through the splenic artery.

  15. Getting a New Liver: Facts about Liver Transplants

    Science.gov (United States)

    ... will refer you to a transplant specialist. Your primary care provider or a gastroenterologist will refer you for liver transplantation when and if your liver disease begins to get worse and you show signs of liver failure or portal hypertension. This is a specialized operation, so you will ...

  16. Liver transplantation for non-resectable colorectal liver metastases ...

    African Journals Online (AJOL)

    Non-resectable colorectal liver metastases (CLMs) are generally considered an absolute contraindication for liver transplantation. However, a 2013 Norwegian study transplanted livers in 21 patients with CLMs and reported excellent outcomes. The current article reports on the deliberations of the Wits Human Research ...

  17. Hepatic Hemangiosarcoma : An Absolute Contraindication to Liver Transplantation-The European Liver Transplant Registry Experience

    NARCIS (Netherlands)

    Orlando, Giuseppe; Adam, Rene; Mirza, Darius; Soderdahl, Goran; Porte, Robert J.; Paul, Andreas; Burroughs, Andrew K.; Seiler, Christian A.; Colledan, Michele; Graziadei, Ivo; Garcia Valdecasas, Juan-Carlos; Pruvot, Francois-Rene; Karam, Vincent; Lerut, Jan

    2013-01-01

    Background. Liver transplantation (LT) is performed for hemangiosarcoma (HAS) despite disappointing results. Methods. Retrospective study of 14 males and 8 females reported to the European Liver Transplant Registry. In view of the difficult differential diagnosis between HAS and hemangioendothelioma

  18. Excellent survival after liver transplantation for isolated polycystic liver disease: an European Liver Transplant Registry study

    DEFF Research Database (Denmark)

    van Keimpema, Loes; Nevens, Frederik; Adam, René

    2011-01-01

    Patients with end-stage isolated polycystic liver disease (PCLD) suffer from incapacitating symptoms because of very large liver volumes. Liver transplantation (LT) is the only curative option. This study assesses the feasibility of LT in PCLD. We used the European Liver Transplant Registry (ELTR......) database to extract demographics and outcomes of 58 PCLD patients. We used Kaplan-Meier survival analysis for survival rates. Severe abdominal pain (75%) was the most prominent symptom, while portal hypertension (35%) was the most common complication in PCLD. The explantation of the polycystic liver...

  19. Liver Transplantation for Cirrhosis in Cystic Fibrosis

    Directory of Open Access Journals (Sweden)

    T Lamireau

    2006-01-01

    Full Text Available BACKGROUND: Liver disease is the third most common cause of death in children with cystic fibrosis (CF. Liver transplantation is an effective treatment in children with hepatic failure.

  20. Transoesophageal echocardiography during liver transplantation.

    Science.gov (United States)

    De Pietri, Lesley; Mocchegiani, Federico; Leuzzi, Chiara; Montalti, Roberto; Vivarelli, Marco; Agnoletti, Vanni

    2015-10-18

    Liver transplantation (LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver transplant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the procedures as a result of both the disease process and the surgery. Transoesophageal echocardiography (TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. Moreover, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure.

  1. Arterioportal fistulas in liver transplant recipients.

    Science.gov (United States)

    Saad, Wael E A

    2012-06-01

    Arterioportal fistulas (APFs) are classified into intrahepatic (>75% of all reported) and extrahepatic (APFs), so the actual prevalence of intrahepatic APFs is probably much higher (likely >90% of APFs). All reported APFs in liver transplant recipients have been intrahepatic. Hemodynamically significant APFs in liver transplant recipients are rare, occurring in 0.2%; however, APFs (hemodynamically significant or not) are not uncommonly seen in hepatic angiograms of liver transplant recipients (up to 5.4% of hepatic arteriograms in transplants). Interestingly, hemodynamically significant APFs warranting endovascular treatment are reported more commonly in the literature in native compared with transplanted livers (n >280-300 versus n = 13, respectively). This article discusses APFs that are specific to liver transplant recipients; their incidence, etiology, pathogenesis, natural history, clinical presentation, and endovascular management are discussed in detail.

  2. Fetal liver cell-containing hybrid organoids improve cell viability and albumin production upon transplantation.

    Science.gov (United States)

    Ye, Jingjia; Shirakigawa, Nana; Ijima, Hiroyuki

    2016-06-01

    Cell transplantation is a potential alternative for orthotopic liver transplantation because of the chronic donor shortage. Functional liver tissue is needed for cell transplantations. However, large functional liver tissue is difficult to construct because of the high oxygen consumption of hepatocytes. In our previous study, we developed a novel method to generate hybrid organoids. In this study, we used fetal liver cells (FLCs) to construct a hybrid organoid. Nucleus numbers, angiogenesis, and albumin production were measured in transplanted samples. Higher cell viability and larger liver tissue was found in FLC-containing samples than in hepatocyte-containing samples. Furthermore, the therapeutic efficiency of FLC-containing samples was evaluated by transplantation into Nagase analbuminemia rats. As a result, an increase in albumin concentration was found in rat blood. In summary, transplantation of a FLC-containing hybrid organoid is a potential approach for cell transplantation. Copyright © 2015 The Society for Biotechnology, Japan. Published by Elsevier B.V. All rights reserved.

  3. Cyclosporin versus tacrolimus for liver transplanted patients

    DEFF Research Database (Denmark)

    Haddad, E M; McAlister, V C; Renouf, E

    2006-01-01

    Most liver transplant recipients receive either cyclosporin or tacrolimus to prevent rejection. Both drugs inhibit calcineurin phosphatase which is thought to be the mechanism of their anti-rejection effect and principle toxicities. The drugs have different pharmacokinetic profiles and potencies....... Several randomised clinical trials have compared cyclosporin and tacrolimus in liver transplant recipients, but it remains unclear which is superior....

  4. Urgent liver transplantation for Amanita phalloides poisoning.

    Science.gov (United States)

    Yildiz, Baris Dogu; Abbasoglu, Osman; Saglam, Arzu; Sökmensüer, Cenk

    2008-02-01

    Amanita phalloides is a deadly wild mushroom causing severe damage in man ranging from diarrhea to organ dysfunction. If not treated, mortality is as high as 80%. Treatment includes supportive measures, inactivation of the toxin and if liver failure occurs liver transplantation. The indications for transplantation are debatable.

  5. [Biliary complications after liver transplant].

    Science.gov (United States)

    Lladó, Laura; Fabregat, Joan; Ramos, Emilio; Baliellas, Carme; Torras, Jaume; Rafecas, Antoni

    2012-01-01

    There have been biliary complications since the beginning of liver transplants, and is a topic of great interest due to its high incidence, as well as their influence on morbidity and mortality. The biliary fistula is currently uncommon and its management is straightforward. Anastomotic stenosis continues to have an incidence of 10-15%. Although the current treatment of choice is endoscopic retrograde cholangiopancreatography (ERCP), surgical treatment (hepatico-jejunostomy) continues to have an important role. Non-anastomotic stenosis has an incidence of 5-10%, and is associated with ischaemic or immunological factors, and usually involves a re-transplant. Choledocholithiasis has an incidence of 5-10%, with the treatment of choice being ERCP. However the treatment of biliary complications should be individualised. We must take into account, liver function, the general health status of the patient, and the availability and experience of the team in the different therapeutic options. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

  6. The study of indicators of bone marrow and peripheral blood of rats with diabetes and transplanted liver tumor after intravenous injection of gold nanorods

    Science.gov (United States)

    Dikht, Nataliya I.; Bucharskaya, Alla B.; Maslyakova, Galina N.; Terentyuk, Georgy S.; Matveeva, Olga V.; Navolokin, Nikita A.; Khlebtsov, Boris N.; Khlebtsov, Nikolai G.

    2015-03-01

    In study the evaluation of the influence of gold nanorods on morphological indicators of red bone marrow and peripheral blood of rats with diabetes and transplanted liver tumor after intravenous administration of gold nanorods was conducted. We used gold nanorods with length 41 ± 8 nm and diameter of 10.2±2 nm, synthesized in the laboratory of nanobiotechnology IBPPM RAS (Saratov). After intravenous administration of gold nanorods the decrease of leukocytes, platelets and lymphocytes was observed in animals of control group in blood. It was marked the decrease of the number of mature cellular elements of the leukocyte germ in bone marrow - stab neutrophils and segmented leukocytes, and the increase of immature elements- metamyelocytes, indicating the activation of leukocyte germ after nanoparticle administration. The decrease of leukocyte amount was noted in blood and the increase of cellular elements of the leukocyte germ was revealed in bone marrow, indicating the activation of leukocyte germ in rats with alloxan diabetes and transplanted tumors. The changes of morphological indicators of blood and bone marrow testify about stimulation of myelocytic sprouts of hemopoiesis in bone marrow as a result of reduction of mature cells in peripheral blood after gold nanoparticle administration.

  7. Galectin-1 in stable liver transplant recipients.

    Science.gov (United States)

    García, M J; Jurado, F; San Segundo, D; López-Hoyos, M; Iruzubieta, P; Llerena, S; Casafont, F; Arias, M; Puente, Á; Crespo, J; Fábrega, E

    2015-01-01

    The achievement of a state of tolerance and minimization of the immunosuppressive load form part of the "Holy Grail" in solid organ transplantation. Galectin-1 recently has been described to be involved in the maintenance of a tolerant environment, but there is no evidence of its role in human liver transplantation. The aim of our study was to measure the serum levels of galectin-1 in stable liver transplant recipients. Serum levels of galectin-1 were determined in 30 stable liver transplant recipients who had been free of rejection episodes for at least 8 years. Fifteen patients with an acute rejection episode and 34 healthy subjects were used as the control group. The concentrations of galectin-1 were significantly higher in stable liver transplant recipients compared with healthy subjects and with the acute rejection group. These preliminary results indicate that galectin-1 is upregulated in stable liver transplant recipients. Thus, our results extend the recent findings that galectin-1 may play an immune-suppressive role in liver transplantation. It remains to be established whether it might help to induce tolerance in liver transplantation. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Liver transplantation for erythropoietic protoporphyria in Europe

    DEFF Research Database (Denmark)

    Wahlin, Staffan; Stal, Per; Adam, Rene

    2011-01-01

    Liver transplantation is an established lifesaving treatment for patients with severe protoporphyric liver disease, but disease recurrence in the graft occurs for the majority of recipients. Severe burn injuries may occur when protective light filters are not used with surgical luminaires. Motor...... neuropathy with an unclear pathogenesis is a frequent complication. We retrospectively studied 35 transplants performed for protoporphyric liver disease in 31 European patients between 1983 and 2008. Most of the patients were male (61.3%), and the mean age at the time of primary transplantation was 39 years...... the postoperative course for 5 of the 31 patients (16.1%). Hematopoietic stem cell transplantation was performed for 3 patients to prevent graft loss due to disease recurrence. Prognostic markers are needed to identify patients prone to severe protoporphyric liver disease so that curative stem cell transplantation...

  9. Liver transplantation in mitochondrial respiratory chain disorders

    NARCIS (Netherlands)

    Sokal, EM; Sokol, R; Cormier, [No Value; Lacaille, F; McKiernan, P; Van Spronsen, FJ; Bernard, O; Saudubray, JM

    1999-01-01

    Mitochondrial respiratory chain disease may lead to neonatal or late onset liver failure, requiring liver transplantation. In rare cases, the disease is restricted to the liver and the patient is cured after surgery. More frequently, other organs are simultaneously involved and neuromuscular or

  10. Acute liver failure : Spontaneous recovery or transplantation?

    NARCIS (Netherlands)

    Meerman, L; Zijlstra, JG; Schweizer, JJ; Verwer, R; Slooff, MJH; Haagsma, EB

    1997-01-01

    Background: Decision-making in acute liver failure. Acute liver failure is a disease with multiple organ involvement and a high mortality rate. Conservative management alone will only partly influence the outcome. The option of emergency liver transplantation has greatly improved survival rates, but

  11. Ochrobactrum intermedium infection after liver transplantation

    NARCIS (Netherlands)

    Moller, LVM; Arends, JP; Harmsen, HJM; Talens, A; Terpstra, P; Slooff, MJH

    A case of bacteremia due to Ochrobactrum intermedium, with concomitant liver abscesses, in an orthotopic liver transplant recipient is presented. Identical microorganisms were isolated from fecal specimens and from an aspirate of a liver abscess that was indicative of invasion of the graft by

  12. When Your Child Needs a Liver Transplant

    Science.gov (United States)

    ... enough liver tissue to have a normal-sized liver within a few weeks of transplantation. Determining When Surgery Is Needed If your doctor ... tests and imaging tests (such as an abdominal ultrasound or CT scan ). To check the liver more closely, the doctors also might perform a ...

  13. De Novo Gastric Cancer After Liver Transplantation.

    Science.gov (United States)

    Gong, Chung-Sik; Yoo, Moon-Won; Kim, Beom-Su; Hwang, Shin; Kim, Ki-Hun; Yook, Jeong-Hwan; Kim, Byung-Sik; Lee, Sung-Gyu

    2016-06-23

    BACKGROUND In South Korea, which has a high incidence of gastric cancer, the most common de novo malignancy associated with liver transplantation is gastric cancer. This study sought to identify clinicopathologic characteristics in gastric cancer patients after liver transplantation, and to help manage these cases. MATERIAL AND METHODS We investigated gastric cancer patients after liver transplantation at Asan Medical Center. We analyzed sex, age, cause of liver transplantation, initiating immunosuppressant, pre-transplantation gastric fibroscopy findings, time interval between transplantation and gastric cancer occurrence, follow-up period, existence of gastric cancer screening, Helicobacter pylori infection, family cancer history, gastric cancer treatment, cancer location, size of tumor, macroscopic gross type, WHO histologic type, Lauren's classification, TNM stage, and survival. RESULTS Of 2968 adult liver transplantation patients at our hospital, 19 were diagnosed with gastric cancer. The mean age at the time of gastric cancer diagnosis was 60.2±6.8 (46-71) years and mean time interval between liver transplantation and diagnosis of gastric cancer was 56.0±30.7 (3.20-113) months. Endoscopic submucosal dissection was done for 10 patients, 4 of whom underwent surgical resection. Surgical resection as an initial treatment was done in 8 patients. One patient received chemotherapy first. The standard incidence ratio of gastric cancer in these patients was 1036 per 100 000 persons (95% CI, 623.7-1,619) in men and 318.9 per 100 000 (95% CI, 4.170-1,774) in women. CONCLUSIONS For long-term survival of liver transplant patients, early detection of de novo cancer is necessary. Therefore, annual screening for gastric cancer after liver transplantation is needed, especially in areas where the incidence of gastric cancer is high, such as South Korea.

  14. Liver transplantation for portal cavernoma cholangiopathy.

    Science.gov (United States)

    Gupta, Subash; Taneja, Sunil

    2014-02-01

    Portal cavernoma cholangiopathy (PCC) is a difficult clinical problem, where the portal cavernoma is both the cause of biliary obstruction and the obstacle to its safe surgical treatment. The available endoscopic and surgical treatment is successful in majority and further intervention is seldom required since the native liver is normal. PCC is not an accepted indication for liver transplantation as only a small proportion of patients will fail both endoscopic and surgical treatment and progressive liver failure is rarely seen. Secondary biliary cirrhosis as a result of long standing biliary obstruction is an accepted indication however establishing a portal inflow in these patients is often difficult and challenging. The deceased donor liver transplantation would always be preferable over living donor liver transplantation as PCC is usually a non-emergency transplant and the graft can have portal blood inflow through a conduit to even a small segment of patent portal venous system or even to a cavernoma vessel.

  15. Experimental liver transplantation on pigs -- technical considerations.

    Science.gov (United States)

    Copca, N; Hanna, A; Pivniceru, C; Constantinica, V; Radilescu, G; Gardean, G; Campeanu, I

    2013-01-01

    The purpose was to improve and refine our technique for orthotopic liver transplantation. Experimental interventions were performed on pigs, 26 pairs. Orthotopic transplantation was performed after lavage of the donor pig liver by pressure gradient and transplantation was performed using portocavo- jugular shunt and veno-venous, arterio-arterial and choledocho-choledochal sutures in end-to-end manner. Immediate survival was 88.46%. Experimental transplant activity on pigs is of real value, contributing to a faster learning curve and at the same time improving handling, increasing the efficiency of sutures, as well as anesthetic and surgical team building. Celsius.

  16. [Orthotopic liver transplantation in therapy of advanced polycystic liver disease].

    Science.gov (United States)

    Klupp, J; Bechstein, W O; Lobeck, H; Neuhaus, P

    1996-05-01

    Polycystic liver disease (PLD) is an autosomal-dominant hereditary disease which usually presents together with polycystic kidney degeneration (ADPKD). The renal problems determine the course of this disease. Due to the development of dialysis an increasing number of patients present with symptoms from their liver cysts: These range from compression caused by hepatomegaly, which can severely limit the quality of life, to chronic liver failure. Ten patients with advanced symptoms of PLD underwent orthotopic liver transplantation, five of them with combined renal transplantation. Postoperative complications occurred in three patients. One patient died postoperatively from multiorgan failure after experiencing coagulopathy of unknown origin. After follow-up of 6-60 months, all patients had better quality of life after transplantation. There was a complete relief of symptoms; liver or renal failure did not occur. Liver transplantation should be considered in patients with highly symptomatic PLD. In the case of severe hepatomegaly or liver and renal failure the combined liver and renal transplantation are able to cure the PLD and ADPKD without rising the disadvantage of immunosuppression incurred with single organ transplantation.

  17. Caroli's disease and outcomes after liver transplantation.

    Science.gov (United States)

    Millwala, Farida; Segev, Dorry L; Thuluvath, Paul J

    2008-01-01

    Caroli's disease is a rare autosomal recessive disorder characterized by intrahepatic cystic dilatation of the bile ducts that, when progressive, leads to intrahepatic stones, recurrent cholangitis, portal hypertension, cholangiocarcinoma, and liver failure. Liver transplantation is a promising curative option for advanced Caroli's disease. The aim of this study was to determine the outcomes of liver transplantation in unselected patients with Caroli's disease and recommend an evidence-based therapeutic algorithm for the management of Caroli's disease. Of the 78,124 patients transplanted in the United States between 1987 and 2006, 104 had Caroli's disease; 96 of these underwent liver alone, and 8 underwent combined liver/kidney transplantation. The patient survival and graft survival were analyzed by Kaplan-Meier survival analysis, and risk of death and risk of graft loss were analyzed by Cox proportional hazards regression. The overall 1-, 3-, and 5-year graft (79.9%, 72.4%, and 72.4%) and patient (86.3%, 78.4%, and 77%) survival rates were excellent for patients after liver transplantation. For combined liver/kidney transplantation (n = 8), the 1-year patient survival and graft survival were 100%. Proportional hazards analysis identified Asian ethnicity, elevated bilirubin, requirement of life support or hospitalization prior to transplantation, and a cold ischemia time greater than 12 hours as associated with increased risk of both graft loss and death. A history of prior transplant or prior abdominal surgery was also associated with increased risk of graft loss. In conclusion, liver transplantation is an excellent treatment option for patients with advanced Caroli's disease and should be considered in a timely fashion to prevent worsening complications including refractory cholangitis and cholangiocarcinoma. (c) 2007 AASLD.

  18. Recurrent hepatitis C after liver transplant

    Science.gov (United States)

    deLemos, Andrew S; Schmeltzer, Paul A; Russo, Mark W

    2014-01-01

    End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5B polymerase inhibitors and NS5A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients. PMID:25152571

  19. Liver transplantation and risk of bleeding

    NARCIS (Netherlands)

    Groenland, Theo H. N.; Porte, Robert J.; Metselaar, Herold J.

    Purpose of review Blood loss in orthotopic liver transplantation has declined during the past decade. Recent papers addressed this issue and emphasized its importance, because there is a significant correlation between intraoperative blood transfusion requirements and postoperative morbidity. This

  20. [Schizophrenia and Liver Transplantation: Case Report].

    Science.gov (United States)

    Diana, Restrepo B; Marle, Duque G; Carlos, Cardeño C

    2012-09-01

    Liver transplantation is a treatment available for many patients with liver cirrhosis who find in this treatment a way to improve life expectancy and quality of life. Paranoid schizophrenia affects 1% of the general population, produces psychotic symptoms, and runs a chronic course in some cases with significant deterioration in all areas of life. To discuss the case of a patient with liver cirrhosis diagnosed with paranoid schizophrenia during the evaluation protocol for liver transplantation. Case report. We report the case of a 47-year-old woman with liver cirrhosis whose only alternative to improve life expectancy and quality of life was access to liver transplantation. During routine evaluations the liaison psychiatrist observed first-order psychotic symptoms and documented a life story that confirmed the presence of paranoid schizophrenia. Paranoid schizophrenia is a psychiatric disorder common in the general population that can be a part of the medical comorbidities of patients requiring liver transplantation and is not an absolute contraindication to its completion. We are unaware of similar cases of liver transplantation in patients with schizophrenia in our country. We believe this is a big step on the road to overcome the stigma that mental illness imposes on patients. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  1. Alemtuzumab and liver transplantation: a review.

    Science.gov (United States)

    Dhesi, Shawn; Boland, Brendon; Colquhoun, Steven

    2009-06-01

    Liver transplantation has always been fraught with conflict. The ongoing shortage of organs for transplantation has led to sicker recipients and the pressure to utilize more marginal grafts. At the same time, increasing public scrutiny and regulatory oversight have emphasized lower costs and better outcomes. This environment exaggerates the importance of the most fundamental conflict: that between preventing allograft rejection and avoiding the toxicities of immunosuppressive agents and the risks of infection. Resolving this struggle requires skillful balancing and a need to keep abreast of the latest developments. Alemtuzumab is a still-new agent with relatively little clinical experience that, therefore, deserves a review and an update of current knowledge in the setting of liver transplantation. The use of alemtuzumab in liver transplant recipients has shown promise with little information to support concerns over significantly increased risks of infectious complications. However, there have been very few studies overall and fewer still in the last 2-3 years. Much of what is known must still be extrapolated from experience in kidney transplant recipients. Alemtuzumab appears to be a drug with significant potential advantages for liver transplant recipients. Improved renal function may be the largest potential advantage. However, the advantages may be offset in some groups. Defining subgroups will be critical to the definition of the optimal role of alemtuzumab in liver transplant recipients.

  2. Postoperative doppler evaluation of liver transplants

    Directory of Open Access Journals (Sweden)

    Rupan Sanyal

    2014-01-01

    Full Text Available Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications. This article describes the normal Doppler findings following liver transplantation and reviews the imaging appearances of various vascular complications associated with it. The article also discusses transient waveform abnormalities, often seen on a post-transplant Doppler examination, and the importance of differentiating them from findings suggestive of ominous vascular complications.

  3. Postoperative doppler evaluation of liver transplants

    Science.gov (United States)

    Sanyal, Rupan; Zarzour, Jessica G; Ganeshan, Dakshina M; Bhargava, Puneet; Lall, Chandana G; Little, Mark D

    2014-01-01

    Doppler ultrasound plays an important role in the postoperative management of hepatic transplantation, by enabling early detection and treatment of various vascular complications. This article describes the normal Doppler findings following liver transplantation and reviews the imaging appearances of various vascular complications associated with it. The article also discusses transient waveform abnormalities, often seen on a post-transplant Doppler examination, and the importance of differentiating them from findings suggestive of ominous vascular complications. PMID:25489129

  4. Graft loss after pediatric liver transplantation

    NARCIS (Netherlands)

    Sieders, E; Peeters, PMJG; TenVergert, EM; de Jong, KP; Porte, RJ; Zwaveling, JH; Bijleveld, CMA; Gouw, ASH; Slooff, MJH

    Objective To describe the epidemiology and causes of graft loss after pediatric liver transplantation and to identify risk factors. Summary Background Data Graft failure after transplantation remains an important problem. It results in patient death or retransplantation, resulting in lower survival

  5. Liver Transplantation: Past Accomplishments and Future Challenges

    Directory of Open Access Journals (Sweden)

    William J Wall

    1999-01-01

    Full Text Available Liver transplantation has evolved from a rare and risky operation of questionable therapeutic value to the preferred treatment for an extensive list of end-stage liver diseases. Superior immunosuppression (cyclosporine, and improvements in surgery and anesthesia brought liver grafting to its current level of success. Nearly 60,000 liver transplants have been performed, and survival rates are very good; however liver grafting faces serious immediate and long term challenges, mainly due to the widening gap between donor supply and recipient demand. Increasing numbers of sick candidates, recurrent disease (especially hepatitis C and recidivism rates after transplantation for alcoholic cirrhosis will force increasingly difficult decisions on candidate selection and priority listing of potential recipients. Although xenotransplantation may be the ultimate solution, it has its own specific set of biological and societal challenges - the full extent of which should be revealed in the next several years.

  6. Liver transplantation for symptomatic centrohepatic biliary cystadenoma.

    Science.gov (United States)

    Romagnoli, Renato; Patrono, Damiano; Paraluppi, Gianluca; David, Ezio; Tandoi, Francesco; Strignano, Paolo; Lupo, Francesco; Salizzoni, Mauro

    2011-05-01

    Biliary cystadenoma is a rare benign cystic tumor of the liver. The mainstay of treatment is complete resection, either by enucleation or by formal hepatectomy, since incomplete removal entails not only constant recurrence but also the risk of malignant transformation to cystadenocarcinoma. A case of symptomatic centrohepatic biliary cystadenoma involving the main vasculobiliary structures of the liver is reported. After an unsuccessful attempt at resection resulting in an intrahepatic biliary injury, relief of jaundice and radical excision were achieved by total hepatectomy and liver transplantation. The patient is now alive and well 4 years after transplant, disease-free, with normal liver and renal function while receiving everolimus monotherapy. This is the first report of liver transplantation performed for the treatment of this tumor. With the case on the background, diagnostic aspects and available therapeutic strategies for biliary cystadenoma are reviewed and discussed. Copyright © 2011. Published by Elsevier Masson SAS.

  7. Outcomes of liver transplantation alone after listing for simultaneous kidney: comparison to simultaneous liver kidney transplantation.

    Science.gov (United States)

    Hmoud, Bashar; Kuo, Yong-Fang; Wiesner, Russell H; Singal, Ashwani K

    2015-04-01

    Data on patient and liver graft survival comparing liver transplantation alone after listing for kidney with simultaneous liver kidney (SLK) transplantation are scanty. United Network Organ Sharing network database (1994-2011) queried for liver transplantation alone after being listed for kidney and SLK transplants. Of 65,206 first liver transplants, 3549 were listed for simultaneous kidney. Of these, 422 (12%) received only liver (LIST) and differed from SLK recipients for the white race (64% vs. 57%; 0.005), diabetes (27% vs. 37%; P = 0.02), model for end-stage liver disease era (68% vs. 82%; P = 0.0001), serum creatinine (2.9±1.9 vs. 4.3±2.5; P transplantation in LIST group (11% vs. 0.5%; P transplantation in the LIST group with 16 (4%) receiving kidney within first year after transplantation. After excluding patients receiving kidney within first year, about 33% recovered renal function to above estimated GFR of greater than 60 mL per min. Guidelines are needed for patient selection to list for and receipt of simultaneous liver kidney transplantation.

  8. Liver transplantation at Hospital Israelita Albert Einstein

    Directory of Open Access Journals (Sweden)

    Sergio Mies

    2005-09-01

    Full Text Available Objective: To present patients and results of liver transplantationperformed by the Liver Unit team at the Hospital Israelita AlbertEinstein. Methods: The medical records of all patients transplantedby the team at the Liver Unit of the Hospital Israelita Albert Einstein,from January 2002 to June 2005, were analyzed. Results: Duringthis period, 328 transplants were performed and 64.3% were malerecipients; 64.9% were performed with cadaveric donor; 31.1%with living donors; and 4.3% were domino liver transplants. Thethree-year survival rate was 78% with cadaveric donors, 71.1%with living donor and 46.2% with domino liver transplant. The meanseverity index according to the Child-Pugh score was 8.7 (ChildB–9 and the median was 9 (Child B-9; the mean MELD score was17.6 and the median 18. Conclusion: The Liver Unit team has thelargest number of liver transplantation cases in Latin Americawith over 850 transplants performed and outcomes similar to theworld’s best centers.

  9. Bioartificial liver and liver transplantation: new modalities for the treatment of liver failure

    Directory of Open Access Journals (Sweden)

    DING Yitao

    2017-09-01

    Full Text Available The main features of liver failure are extensive necrosis of hepatocytes, rapid disease progression, and poor prognosis, and at present, there are no effective drugs and methods for the treatment of liver failure. This article summarizes four treatment methods for liver failure, i.e., medical treatment, cell transplantation, liver transplantation, and artificial liver support therapy, and elaborates on the existing treatment methods. The current medical treatment regimen should be optimized; cell transplantation has not been used in clinical practice; liver transplantation is the most effective method, but it is limited by donor liver shortage and high costs; artificial liver can effectively remove toxic substances in human body. Therefore, this article puts forward artificial liver as a transition for liver transplantation; artificial liver can buy time for liver regeneration or liver transplantation and prolong patients′ survival time and thus has a promising future. The new treatment modality of bioartificial liver combined with liver transplantation may bring good news to patients with liver failure.

  10. Liver transplantation for Hepatocellular carcinoma: Predictors of ...

    African Journals Online (AJOL)

    DOWNLOAD FULL TEXT Open Access DOWNLOAD FULL TEXT Subscription or Fee Access. Liver transplantation for Hepatocellular carcinoma: Predictors of recurrence in our study. HD Smith. Abstract. Hepatocellular carcinoma (HCC) is an aggressive malignancy mostly complicating some underlying liver pathology that ...

  11. Liver Transplantation for Erythropoietic Protoporphyria in Europe

    NARCIS (Netherlands)

    Wahlin, Staffan; Stal, Per; Adam, Rene; Karam, Vincent; Porte, Robert; Seehofer, Daniel; Gunson, Bridget K.; Hillingso, Jens; Klempnauer, Juergen L.; Schmidt, Jan; Alexander, Graeme; O'Grady, John; Clavien, Pierre-Alain; Salizzoni, Mauro; Paul, Andreas; Rolles, Keith; Ericzon, Bo-Goran; Harper, Pauline

    Liver transplantation is an established lifesaving treatment for patients with severe protoporphyric liver disease, but disease recurrence in the graft occurs for the majority of recipients. Severe burn injuries may occur when protective light filters are not used with surgical luminaires. Motor

  12. Liver transplantation in patients with hepatocellular carcinoma

    NARCIS (Netherlands)

    Polak, Wojciech G.; Soyama, Akihiko; Slooff, Maarten J. H.

    2008-01-01

    Liver transplantation has a definitive place in the treatment of patients with hepatocellular carcinoma (HCC) in a cirrhotic liver. Patients with a tumor load within the Milan criteria have excellent survival comparable to survival in patients with benign indications. When tumor load exceeds the

  13. Determinants of complications in liver transplant patients

    NARCIS (Netherlands)

    E.L.D. de Mare-Bredemeijer (Emmeloes)

    2015-01-01

    markdownabstractAbstract The aims of this thesis were to identify risk factors for the occurrence of complications in patients with end-stage liver disease (ESLD), both before and after liver transplantation (LTx), and to develop strategies to optimize immunosuppression after LTx in order to

  14. Liver transplantation : chimerism, complications and matrix metalloproteinases

    NARCIS (Netherlands)

    Hove, Willem Rogier ten

    2011-01-01

    Chimerism after orthotopic liver transplantation (OLT) is the main focus of the studies described in this thesis. The first study showed that chimerism of different cell lineages within the liver graft does occur after OLT. Subsequently, in allogeneic blood stem cell recipients, chimerism was

  15. Liver transplantation for overlap syndromes of autoimmune liver diseases.

    Science.gov (United States)

    Bhanji, Rahima A; Mason, Andrew L; Girgis, Safwat; Montano-Loza, Aldo J

    2013-02-01

    The term overlap syndrome describes variant forms of autoimmune hepatitis (AIH) that present in combination with either characteristics of primary biliary cirrhosis (PBC), or primary sclerosing cholangitis (PSC). This study analysed the outcomes and evidence of recurrent liver disease after liver transplantation in patients with overlap syndromes compared with patients transplanted for single autoimmune liver disease. We evaluated 231 adult patients who received a liver transplant as a result of autoimmune liver diseases; including 103 with PBC, 84 with PSC, 32 with AIH and 12 with overlap syndrome (7 AIH-PBC and 5 AIH-PSC). Patients with overlap syndromes had a higher probability of recurrence than patients with a single autoimmune liver disease (5 years: 53% vs. 17%; 10 years 69% vs. 29%, P = 0.001). Furthermore, median time for recurrence in overlap syndrome was shorter when compared with patients with single autoimmune liver disease (67 ± 20 vs. 172 ± 9 months, P = 0.001). The diagnosis of overlap syndrome was independently associated with a higher risk to develop recurrent disease than patients transplanted with a single disease (HR 3.39, P = 0.007). Median graft survival for overlap syndrome was 123 ± 16 months and 180 ± 8 months in patients with single autoimmune liver diseases (P = 0.9), and median patient survival for overlap syndrome was 135 ± 13 months and 193 ± 8 months in patients with single autoimmune liver disease (P = 0.6). Patients that received an allograft for end-stage liver disease secondary to overlap syndrome had a higher rate of disease recurrence when compared with transplant recipients with single autoimmune liver disorders, but the overall survival was comparable. © 2012 John Wiley & Sons A/S.

  16. Nocardia liver abscess post liver transplantation-A rare presentation.

    Science.gov (United States)

    Hanchanale, Pavan; Jain, Mayank; Varghese, Joy; V, Jayanthi; Rela, Mohamed

    2017-04-01

    Nocardiosis is usually a disseminated disease seen in immunocompromised individuals. We herein present a rare case of isolated Nocardia liver abscess post liver transplantation. The patient responded well to treatment and is on long-term antibiotics for Nocardia infection. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Non-alcoholic fatty liver disease and liver transplantation.

    Science.gov (United States)

    Khan, Reenam S; Newsome, Philip N

    2016-08-01

    Cirrhosis secondary to non-alcoholic steatohepatitis (NASH) is a common indication for liver transplant. In comparison to other cirrhotic patients, patients with NASH cirrhosis are more likely to be older and have the metabolic syndrome. Pre-transplant, patients require careful evaluation of cardiovascular risk. As the incidence of non-alcoholic fatty liver disease (NAFLD) is rising, a greater proportion of donor grafts have steatosis greater than 30%, which is associated with poor outcomes. Grafts with steatosis greater than 60% are unsuitable for transplant. Overall, post-transplant survival outcomes for patients with NASH cirrhosis are similar to those with cirrhosis without NASH. However, NASH cirrhosis is associated with a higher 30-day mortality, predominantly from an increase in cardiovascular events and infections. Following liver transplant, there is a significant risk of NASH recurrence, although this seldom results in allograft loss. Furthermore, a significant number of patients who had a liver transplant for other reasons develop NASH de novo. When patients with NASH cirrhosis are considered for transplant, one of the major challenges lies in identifying which patients are too high risk for surgery. This review aims to provide information to aid this decision making process, and to provide guidance on the peri-operative care strategies that can modify risk. Copyright © 2016. Published by Elsevier Inc.

  18. Primary Liver Transplantation for Autoimmune Hepatitis : A Comparative Analysis of the European Liver Transplant Registry

    NARCIS (Netherlands)

    Schramm, Christoph; Bubenheim, Michael; Adam, Rene; Karam, Vincent; Buckels, John; O'Grady, John G.; Jamieson, Neville; Pollard, Stephen; Neuhaus, Peter; Manns, Michael M.; Porte, Robert; Castaing, Denis; Paul, Andreas; Traynor, Oscar; Garden, James; Friman, Styrbjorn; Ericzon, Bo-Goran; Fischer, Lutz; Vitko, Stefan; Krawczyk, Marek; Metselaar, Herold J.; Foss, Aksel; Kilic, Murat; Rolles, Keith; Burra, Patrizia; Rogiers, Xavier; Lohse, Ansgar W.

    The principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing transplantation for

  19. ACUTE APENDICITIS IN LIVER TRANSPLANT RECIPIENTS.

    Science.gov (United States)

    Fonseca-Neto, Olival Cirilo Lucena da; Lima, Heloise Caroline de Souza; Melo, Paulo Sérgio Vieira de; Lemos, Roberto; Leitão, Laércio; Amorim, Américo Gusmão; Lacerda, Cláudio Moura

    2016-03-01

    Appendicitis is a common cause of emergency surgery that in the population undergoing organ transplantation presents a rare incidence due to late diagnosis and treatment. To report the occurrence of acute appendicitis in a cohort of liver transplant recipients. Retrospective analysis in a period of 12 years among 925 liver transplants, in witch five cases of acute appendicitis were encountered. Appendicitis occurred between three and 46 months after liver transplantation. The age ranged between 15 and 58 years. There were three men and two women. The clinical presentations varied, but not discordant from those found in non-transplanted patients. Pain was a symptom found in all patients, in two cases well located in the right iliac fossa (40%). Two patients had symptoms characteristic of peritoneal irritation (40%) and one patient had abdominal distention (20%). All patients were submitted to laparotomies. In 20% there were no complications. In 80% was performed appendectomy complicated by suppuration (40%) or perforation (40%). Superficial infection of the surgical site occurred in two patients, requiring clinical management. The hospital stay ranged from 48 h to 45 days. Acute appendicitis after liver transplantation is a rare event being associated with a high rate of drilling, due to delays in diagnosis and therapy, and an increase in hospital stay.

  20. Transplante isogênico de ilhotas de Langerhans no fígado de ratos: metodologia para separação e purificação das ilhotas de Langerhans Isogenic islet transplantation on the rat liver: Method for isolation and purification of the rat islets

    Directory of Open Access Journals (Sweden)

    Eleazar CHAIB

    2000-01-01

    Full Text Available A maior indicação do transplante de pâncreas ou de ilhotas de Langerhans é o diabetes mellitus do tipo I. O processo deve suprir as necessidades de insulina mantendo os níveis glicêmicos dentro da normalidade. Estudou-se o transplante isogênico de ilhotas de Langerhans no fígado de ratos WAG-RT1u. Com o método de separação e purificação das ilhotas de Langerhans obteve-se 2.834 ± 551,64 ilhotas com pureza de 83 ± 2,45%. O transplante de 2.834 ± 551,64 ilhotas de Langerhans no fígado destes animais, normalizou a glicemia que chegou a 35 mmol/L após indução do diabetes pela estreptozotocina, ficando em 9,62 ± 2,65 mmol/L nos primeiros 10 dias após o enxerto e 7,43 ± 0,27 mmol/L nos dias subseqüentes (P The major indication for pancreas or islet transplantation is diabetes mellitus type I. This process has to supply the insulin necessity keeping glucose under control. We have studied isogenic islet transplantation on the rat (WAG-RT1u liver. The method of isolation and purification of the islets obtained 2.834 ± 551,64 islets with purity of 83 ± 2,45%. Diabetes was induced by streptozotocin and seric glucose prior transplantation was 35 mmol/L. The islet transplantation of 2.834 ± 551,64 islets in the rat liver has normalized glucose test from 9,62 ± 2,65 mmol/L 10 days after transplantation to 7,43 ± 0,27 mmol/L later in the follow-up (P <0,05. The median survival time of the islets was 73 days. In conclusion both the method of isolation and purification of the islets and islet transplantation was effective in the control of the diabetes induced by streptozotocin with median survival time of both islet and rat more than 73 days when rats were sacrificied.

  1. Proteinuria can predict prognosis after liver transplantation.

    Science.gov (United States)

    Pan, Heng-Chih; Chen, Ying-Jen; Lin, Jhe-Ping; Tsai, Ming-Jung; Jenq, Chang-Chyi; Lee, Wei-Chen; Tsai, Ming-Hung; Fan, Pei-Chun; Chang, Chih-Hsiang; Chang, Ming-Yang; Tian, Ya-Chung; Hung, Cheng-Chieh; Fang, Ji-Tseng; Yang, Chih-Wei; Chen, Yung-Chang

    2016-09-15

    Proteinuria is a manifestation of renal dysfunction and it has been demonstrated to be a significant prognostic factor in various clinical situations. The study was designed to analyze prognosis of patients receiving liver transplantation as well as to determine predictive performance of perioperative proteinuria. We retrospectively reviewed data of patients who had received a liver transplant in a medical center between 2002 and 2010. Demographic information and clinical characteristic parameters were recorded on the day of intensive care unit admission before operation and on postoperative days 1, 7, and 14. Among a total of 323 patients, in-hospital mortality and 90-day mortality rates were 13.0 % (42/323) and 14.2 % (46/323), respectively. Patients with proteinuria on admission had higher rates of acute kidney injury (26.8 % vs. 8.8 %, p proteinuria on admission and Sequential Organ Failure Assessment (SOFA) score were independent predictors of in-hospital mortality. The discriminatory ability of proteinuria plus SOFA was even better than that of SOFA alone, especially on postoperative day 1. The presence of proteinuria before liver transplantation is supposed to be recognized as a negative predictor for in-hospital survival. Moreover, the presence of proteinuria after liver transplantation can assist in the early prediction of poor short-term prognosis for patients receiving liver transplantation.

  2. Interleukin-9 in stable liver transplant recipients.

    Science.gov (United States)

    Fábrega, E; López-Hoyos, M; San Segundo, D; Casafont, F; Moraleja, I; Sampedro, B; Pons-Romero, F

    2012-01-01

    Interleukin-9 (IL-9) has recently been described to be involved in the maintenance of a tolerant environment, but there is no evidence of its role in human liver transplantation. The aim of our study was to measure the serum levels of IL-9 in stable liver transplant recipients and examine their influence on immunosuppressant load. Serum IL-9 levels were determined in 34 healthy subjects and 30 stable liver transplant recipients who were free of rejection episodes for at least 8 years. The results were analyzed according to the blood levels of calcineurin inhibitors (CNIs) at the time of the study: 13 patients showed high concentrations of either cyclosporine or tacrolimus (high CNI: cyclosporine > 80 ng/mL or tacrolimus > 5 ng/mL) and another 17 patients showed low CNI levels. The concentrations of IL-9 were significantly higher among liver transplant recipients compared with healthy subjects. In addition, patients with low CNI blood levels showed higher serum levels of IL-9, an effect that was greater with tacrolimus, albeit not significantly. These preliminary results indicated that increased serum IL-9 concentrations accompanied a lower immunosuppressive load. It remains to be established whether this relates to induction of tolerance in liver transplantation. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Pregnancy outcomes after liver transplantation in Finland.

    Science.gov (United States)

    Mattila, Mirjami; Kemppainen, Helena; Isoniemi, Helena; Polo-Kantola, Päivi

    2017-09-01

    Pregnancy after liver transplantation is possible but associated with increased risk of obstetrical complications. We report here for the first time the pregnancy outcomes after liver transplantation in Finland. All of the 25 pregnancies ending in deliveries after liver transplantation in Finland in 1998-2015 were analyzed. The data were collected from the mothers' medical records. The main outcome measures included pregnancy complications and the mode of delivery. Neonatal outcome measures were birthweight, 5-min Apgar score and umbilical artery pH. Twenty-six infants were born. Of all deliveries, 76% occurred at the ≥37 weeks of gestation and the average birthweight was 3040 g. Apgar scores were ≥7 in 25/26 (96%) of the infants and cases of birth asphyxia (umbilical artery pH ≤ 7.05) were not detected. Cesarean section rate was 32%. Preeclampsia occurred in 12% of the women and the preterm delivery rate was 24%. Co-morbidities (hypertension, intrahepatic cholestasis of pregnancy, Hodgkin's disease, colitis ulcerosa, epileptic attacks, cholangitis, splenic artery rupture, renal insufficiency and graft rejection) complicated 52% of pregnancies. Pregnancies after liver transplantation in Finland result in good perinatal outcome with healthy, mostly full-term, normally grown offspring; however, serious maternal complications related to underlying liver pathology, transplant surgery and immunosuppressive medication occur frequently. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  4. Liver Transplantation for Hepatitis C and Alcoholic Liver Disease

    Directory of Open Access Journals (Sweden)

    Marco Carbone

    2010-01-01

    Full Text Available End-stage liver disease due to hepatitis C (HCV and cirrhosis from alcohol (ALD are the commonest indications for liver transplantation in the western countries. Up to one third of HCV-infected transplant candidates have a history of significant alcohol intake prior to transplantation. However, there are few data available about the possible interaction between alcohol and HCV in the post-transplant setting. Patients with both HCV and alcohol are more likely to die on the waiting list than those with ALD and HCV alone. However, after transplantation, non-risk adjusted graft and patient survival of patients with HCV + ALD are comparable to those of patients with HCV cirrhosis or ALD cirrhosis alone. In the short and medium term HCV recurrence after transplant in patients with HCV + ALD cirrhosis does not seem more aggressive than that in patients with HCV cirrhosis alone. A relapse in alcohol consumption in patients with HCV + ALD cirrhosis does not have a major impact on graft survival. The evidence shows that, as is currently practiced, HCV + ALD as an appropriate indication for liver transplantation. However, these data are based on retrospective analyses with relatively short follow-up so the conclusions must be treated with caution.

  5. Incidence and prevention of liver transplantation-related cardiovascular complications

    Directory of Open Access Journals (Sweden)

    LI Jiangbin

    2014-01-01

    Full Text Available Liver transplantation is an effective treatment for acute liver failure, decompensated cirrhosis, hepatocellular carcinoma, and other end-stage liver diseases. In recent years, with the improvements in patients′ understanding of medical technology and their requirement for postoperative quality of life, liver transplantation has become a common surgery in clinical practice. The causes and preventive methods for liver transplantation-related cardiovascular complications are reviewed from the aspects before, during, and after liver transplantation, aiming at a better understanding and guidance for clinical liver transplantation.

  6. The role of everolimus in liver transplantation

    Directory of Open Access Journals (Sweden)

    Ganschow R

    2014-09-01

    Full Text Available Rainer Ganschow,1 Jörg-Matthias Pollok,2 Martin Jankofsky,3 Guido Junge4 1Department of Pediatrics, 2Department of General, Visceral, Thoracic, and Vascular Surgery, 3Department of Pediatrics, University of Bonn, Bonn, Germany; 4Integrated Hospital Care, Novartis Pharma AG, Basel, SwitzerlandAbstract: During the last 5 decades, liver transplantation has witnessed rapid development in terms of both technical and pharmacologic advances. Since their discovery, calcineurin inhibitors (CNIs have remained the standard of care for immunosuppression therapy in liver transplantation, improving both patient and graft survival. However, adverse events, particularly posttransplant nephrotoxicity, associated with long-term CNI use have necessitated the development of alternate treatment approaches. These include combination therapy with a CNI and the inosine monophosphate dehydrogenase inhibitor mycophenolic acid and use of mammalian target of rapamycin (mTOR inhibitors. Everolimus, a 40-O-(2-hydroxyethyl derivative of mTOR inhibitor sirolimus, has a distinct pharmacokinetic profile. Several studies have assessed the role of everolimus in liver transplant recipients in combination with CNI reduction or as a CNI withdrawal strategy. The efficacy of everolimus-based immunosuppressive therapy has been demonstrated in both de novo and maintenance liver transplant recipients. A pivotal study in 719 de novo liver transplant recipients formed the basis of the recent approval of everolimus in combination with steroids and reduced-dose tacrolimus in liver transplantation. In this study, everolimus introduced at 30 days posttransplantation in combination with reduced-dose tacrolimus (exposure reduced by 39% showed comparable efficacy (composite efficacy failure rate of treated biopsy-proven acute rejection, graft loss, or death and achieved superior renal function as early as month 1 and maintained it over 2 years versus standard exposure tacrolimus. This review

  7. Imaging follow-up after liver transplantation

    Science.gov (United States)

    Rossi, Massimo; Mennini, Gianluca; Melandro, Fabio; Anzidei, Michele; De Vizio, Silvia; Koryukova, Kameliya; Catalano, Carlo

    2016-01-01

    Liver transplantation (LT) represents the best treatment for end-stage chronic liver disease, acute liver failure and early stages of hepatocellular carcinoma. Radiologists should be aware of surgical techniques to distinguish a normal appearance from pathological findings. Imaging modalities, such as ultrasound, CT and MR, provide for rapid and reliable detection of vascular and biliary complications after LT. The role of imaging in the evaluation of rejection and primary graft dysfunction is less defined. This article illustrates the main surgical anastomoses during LT, the normal appearance and complications of the liver parenchyma and vascular and biliary structures. PMID:27188846

  8. Celecoxib-induced cholestatic liver failure requiring orthotopic liver transplantation

    Science.gov (United States)

    El Hajj, Ihab I; Malik, Shahid M; Alwakeel, Hany R; Shaikh, Obaid S; Sasatomi, Eizaburo; Kandil, Hossam M

    2009-01-01

    Selective cyclooxygenase-2 (COX-2) inhibitors are widely used due to their efficacy and good safety profile. However, recent case reports have described varying degrees of liver injuries associated with the use of COX-2 inhibitors. We report the case of a patient who developed acute cholestatic hepatitis progressing to hepatic failure requiring liver transplantation, following a 3-d course of celecoxib for treatment of generalized muscle aches and pains. The clinical presentation, the laboratory data, as well as the liver histopathology were supportive of the putative diagnosis of drug induced liver injury. PMID:19701976

  9. Control of blood pressure in liver transplant recipients.

    NARCIS (Netherlands)

    Martinez-Saldivar, B.; Prieto, J.; Berenguer, M.; Mata, M. de la; Pons, J.A.; Serrano, T.; Rafael-Valdivia, L.; Aguilera, V.; Barrera, P.; Parrilla, P.; Lorente, S.; Rubin, A.; Fraga, E.; Rimola, A.

    2012-01-01

    BACKGROUND: Increased blood pressure (BP) is common after liver transplantation. However, there is scarce information on its control. METHODS: In this prospective, cross-sectional, multicenter study, we determined BP according to the recommended international standards in 921 liver transplant

  10. [Anaesthesia in connection with liver transplantation

    DEFF Research Database (Denmark)

    Secher, N.H.; Nissen, P.; Swiatek, F.A.

    2008-01-01

    The anaesthetic plan for liver transplantation focuses on maintaining central blood volume and thereby cerebral oxygenation. Normovolaemia represents a central blood volume that establishes a maximal venous oxygen saturation, and a value of 85% (78-90%) is maintained during the operation by admin......The anaesthetic plan for liver transplantation focuses on maintaining central blood volume and thereby cerebral oxygenation. Normovolaemia represents a central blood volume that establishes a maximal venous oxygen saturation, and a value of 85% (78-90%) is maintained during the operation...

  11. Donor graft interferon regulatory factor-1 gene transfer worsens liver transplant ischemia/reperfusion injury.

    Science.gov (United States)

    Kim, Kee-Hwan; Dhupar, Rajeev; Ueki, Shinya; Cardinal, Jon; Pan, Pinhua; Cao, Zongxian; Cho, Sung W; Murase, Noriko; Tsung, Allan; Geller, David A

    2009-08-01

    Liver ischemia and reperfusion (IR) injury is a phenomenon that leads to graft dysfunction after liver transplantation. Understanding the molecular mechanisms behind this process is crucial to developing strategies to prevent short- and long-term graft dysfunction. The purpose of this study was to explore the role of the transcription factor interferon regulatory factor-1 (IRF-1) in a model of orthotopic rat liver transplantation. Orthotopic syngeneic LEW rat liver transplantation (OLT) was performed after 18 or 3 hours preservation in cold University of Wisconsin solution. Adenovirus-expressing IRF-1 (AdIRF-1) or control gene vector (Adnull) was delivered to the liver by donor intravenous pretreatment 4 days before graft harvesting. Uninfected grafts also served as controls. Recipients were humanely killed 1-24 hours post-transplantation. Rats that underwent OLT with long-term preserved grafts (18 hours) displayed increased hepatic nuclear expression of IRF-1 protein at 1 and 3 hours. Rats pretreated with AdIRF-1 before transplantation had elevated alanine aminotransferase levels and increased expression of interferon (IFN)-beta, IFN-gamma, interleukin-12, and inducible nitric oxide synthase in the short-term period (3 hours) when compared with donor livers pretreated with Adnull. AdIRF-1 pretreated donor livers also exhibited increased susceptibility to early apoptosis in the transplanted grafts as shown by increased terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) staining and expression of cleaved caspase-3. Additionally, AdIRF-1 pretreated donor livers had increased activation of the MAP kinase Jun N-terminal kinase as compared with Adnull pretreated donor livers. IRF-1 is an important regulator of IR injury after OLT in rats. Targeting of IRF-1 may be a potential strategy to ameliorate ischemic liver injury after transplantation to minimize organ dysfunction.

  12. Transfusion support in liver transplantation

    Directory of Open Access Journals (Sweden)

    TVSP Murthy

    2007-01-01

    Full Text Available Solid-organ transplantation continues to grow as a treatment modality. Transfusion support remains an integral part of solid-organ transplantation, imparting demands on the transfusion service not only quantitatively in terms of blood product support, but also due to the unique requirements for specialized blood components, the complex serologic problems, and the immunologic effects of transfusion on both the allograft and the recipient.

  13. Transfusion support in liver transplantation

    OpenAIRE

    TVSP Murthy

    2007-01-01

    Solid-organ transplantation continues to grow as a treatment modality. Transfusion support remains an integral part of solid-organ transplantation, imparting demands on the transfusion service not only quantitatively in terms of blood product support, but also due to the unique requirements for specialized blood components, the complex serologic problems, and the immunologic effects of transfusion on both the allograft and the recipient.

  14. Procalcitonin in liver transplant patients--yet another stone turned

    DEFF Research Database (Denmark)

    Jensen, Jens-Ulrik; Lundgren, Jens D

    2008-01-01

    Liver transplantation has been reported to initiate increases in procalcitonin levels, in the absence of bacterial infection. The results of a study investigating the course of procalcitonin levels over several days after liver transplantation in noninfected patients were recently reported...... undergoing liver transplantation with and without bacterial infection are needed....

  15. Outcomes after combined liver-kidney transplant vs. kidney transplant followed by liver transplant.

    Science.gov (United States)

    Chan, Edie Y; Bhattacharya, Renuka; Eswaran, Sheila; Hertl, Martin; Shah, Nikunj; Fayek, Sameh; Cohen, Eric B; Hollinger, Edward F; Olaitan, Oyedolamu; Jensik, Stephen C; Perkins, James D

    2015-01-01

    The decision for isolated kidney transplant (KT) vs. combined liver-kidney transplant (CLKT) in patients with end-stage renal disease (ESRD) with compensated cirrhosis remains controversial. We sought to determine outcomes of patients requiring listing for a liver transplant (LT) following either a cadaveric or living donor KT and compare these outcomes to similar patients receiving a CLKT. Our dataset included the United Network for Organ Sharing (UNOS)/Standard Transplant and Analysis and Research (STAR) kidney files from 1987 to 2012 after being joined with the liver files from 2002 to 2012. Outcomes of patients who received a CLKT with an international normalized ratio (INR) ≤1 and total bilirubin ≤1 were compared to patients who received a primary KT and subsequently required listing for LT between zero and five yr or after five yr. For the three groups, 244 patients had a CLKT, 216 were wait-listed for LT between zero and five yr after KT (0-5 WL), and 320 were wait-listed five yr after KT (+5 WL). From the time of KT, the 0-5 WL group had significantly worse survival than the CLKT group and the +5 WL group. The +5 WL had the best survival of all groups. For the 0-5 WL group, 45% underwent LT and 40% died while waiting compared to the +5 WL group with 53% having LT and 26% died while waiting. At the time of LT, the 0-5 WL group had a higher model for end-stage liver disease (MELD) score, higher incidence of being in the ICU at the time of transplant, and higher incidence of requiring life support. From the time of LT, the CLKT trended toward better survival (p = 0.0549) than both the 0-5 WL and +5 WL groups, which had equivalent survival. The 0-5 WL group is a higher risk group with poorer survival due to a higher incidence of dying on the waitlist. Better identification of patients with a high risk for hepatic decompensation following KT and agreement for regional exception for LT in the event of decompensation may improve utilization of organs and

  16. The International Liver Transplantation Society Living Donor Liver Transplant Recipient Guideline.

    Science.gov (United States)

    Miller, Charles M; Quintini, Cristiano; Dhawan, Anil; Durand, Francois; Heimbach, Julie K; Kim-Schluger, Hyung Leona; Kyrana, Eirini; Lee, Sung-Gyu; Lerut, Jan; Lo, Chung-Mau; Pomfret, Elizabeth Anne

    2017-05-01

    Living donor liver transplantation (LDLT) has been increasingly embraced around the world as an important strategy to address the shortage of deceased donor livers. The aim of this guideline, approved by the International Liver Transplantation Society (ILTS), is to provide a collection of expert opinions, consensus, and best practices surrounding LDLT. Recommendations were developed from an analysis of the National Library of Medicine living donor transplantation indexed literature using the Grading of Recommendations Assessment, Development and Evaluation methodology. Writing was guided by the ILTS Policy on the Development and Use of Practice Guidelines (www.ilts.org). Intended for use by physicians, these recommendations support specific approaches to the diagnostic, therapeutic, and preventive aspects of care of living donor liver transplant recipients.

  17. The International Liver Transplantation Society Living Donor Liver Transplant Recipient Guideline

    Science.gov (United States)

    Miller, Charles M.; Quintini, Cristiano; Dhawan, Anil; Durand, Francois; Heimbach, Julie K.; Kim-Schluger, Hyung Leona; Kyrana, Eirini; Lee, Sung-Gyu; Lerut, Jan; Lo, Chung-Mau; Pomfret, Elizabeth Anne

    2017-01-01

    Abstract Living donor liver transplantation (LDLT) has been increasingly embraced around the world as an important strategy to address the shortage of deceased donor livers. The aim of this guideline, approved by the International Liver Transplantation Society (ILTS), is to provide a collection of expert opinions, consensus, and best practices surrounding LDLT. Recommendations were developed from an analysis of the National Library of Medicine living donor transplantation indexed literature using the Grading of Recommendations Assessment, Development and Evaluation methodology. Writing was guided by the ILTS Policy on the Development and Use of Practice Guidelines (www.ilts.org). Intended for use by physicians, these recommendations support specific approaches to the diagnostic, therapeutic, and preventive aspects of care of living donor liver transplant recipients. PMID:28437386

  18. Experimental vascular graft for liver transplantation

    NARCIS (Netherlands)

    Kobori, L; Nemeth, T; Nemes, B; Dallos, G; Sotonyi, P; Fehervari, [No Value; Patonai, A; Slooff, MJH; Jaray, J; De Jong, KP

    2003-01-01

    Hepatic artery thrombosis is a major cause of graft failure in liver transplantation. Use of donor interponates are common, but results are controversial because of necrosis or thrombosis after rejection. Reperfusion injury, hypoxia and free radical production determinate the survival. The aim of

  19. Smoking Behavior in Liver Transplant Recipients

    NARCIS (Netherlands)

    van der Heide, Frans; Dijkstra, Gerard; Porte, Robert J.; Kleibeuker, Jan H.; Haagsma, Elizabeth B.

    Long-term morbidity and survival after orthotopic liver transplantation (OLT) are to a large degree determined by cardiovascular disease and cancer. Tobacco use is a well-known risk factor for both. The aim of this study was to examine smoking behavior before and after OLT and to define groups at

  20. Early vascular complications after pediatric liver transplantation

    NARCIS (Netherlands)

    Sieders, E; Peeters, PMJG; Ten Vergert, EM; de Jong, KP; Porte, RJ; Zwaveling, JH; Bijleveld, CMA; Slooff, MJH

    Vascular complications have a detrimental effect on the outcome after liver transplantation. Most studies focus exclusively on hepatic artery thrombosis (HAT), The current study analyzed the incidence, consequences, and risk factors for HAT, portal vein thrombosis (PVT), and venous outflow tract

  1. [Anaesthesia in connection with liver transplantation

    DEFF Research Database (Denmark)

    Secher, N.H.; Nissen, P.; Swiatek, F.A.

    2008-01-01

    The anaesthetic plan for liver transplantation focuses on maintaining central blood volume and thereby cerebral oxygenation. Normovolaemia represents a central blood volume that establishes a maximal venous oxygen saturation, and a value of 85% (78-90%) is maintained during the operation...

  2. Liver transplantation for non-resectable colorectal liver metastases ...

    African Journals Online (AJOL)

    2017-06-06

    Jun 6, 2017 ... articles/906519-world-bank-country-and-lending-groups (accessed 3 March 2017). 4. Caicedo L, Buitrago D. Thomas L, et al. Liver transplantation for unresectable metastases from colon adenocarcinoma. Case Rep Gastroenterol 2017;10(3):808-. 813. http://dx.doi.org/10.1159/000454984. 5. World ...

  3. CT before and after liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Schurawitzki, H.; Stiglbauer, R.; Karnel, F.; Gritzmann, N.; Barton, P.; Muehlbacher, F.

    1988-10-01

    In our retrospective study, we evaluated the role of CT in cases of liver transplantation. 118 examinations (37 pre- and 81 post-operative) were carried out in 46 transplant recipients. Pre-operatively CT was used to exclude retro-peritoneal secondary lesions, although ultrasound was superior in the region of the porta hepatis. Patency of the portal vein can be established by means of duplex sonography and CT, portography is indicated only in exceptional circumstances. Post-operative complications (abscesses, hematomas, infarcts) can be demonstrated by CT. CT-guided fine needle biopsies and percutaneous drainage can be carried out post-operatively, even under difficult conditions. Liver cell necrosis, if extensive, represents a serious risk to transplant survival. CT may clarify this, while other problems and differential diagnosis may be solved by angiography.

  4. Primary liver transplantation for autoimmune hepatitis: A comparative analysis of the European liver transplant registry

    NARCIS (Netherlands)

    C. Schramm (Christoph); M. Bubenheim (Michael); R. Adam (René); V. Karam (Vincent); J. Buckels (John); J.G. O'Grady (John); N. Jamieson (Neville); S. Pollard (Stephen); P. Neuhaus (Peter); M.M. Manns (Michael); R.J. Porte (Robert); D. Castaing (Denis); A. Paul (Anna); O. Traynor (Oscar); J. Garden (James); S. Friman (Styrbjörn); B.G. Ericzon; L. Fischer (Lutz); S. Vitko (Stefan); M. Krawczyk (Marek); H.J. Metselaar (Herold); A. Foss (Aksel); M. Kilic (Murat); K. Rolles (Keith); P. Burra (Patrizia); X. Rogiers (Xavier); A.W. Lohse (Ansgar)

    2010-01-01

    textabstractThe principal aim of this study was to compare the probability of and potential risk factors for death and graft loss after primary adult and pediatric liver transplantation in patients undergoing transplantation for autoimmune hepatitis (AIH) to those in patients undergoing

  5. Freshly isolated hepatocyte transplantation in acetaminophen-induced hepatotoxicity model in rats

    Directory of Open Access Journals (Sweden)

    Daniela Rodrigues

    2012-12-01

    Full Text Available CONTEXT: Hepatocyte transplantation is an attractive therapeutic modality for liver disease as an alternative for orthotopic liver transplantation. OBJECTIVE: The aim of the current study was to investigate the feasibility of freshly isolated rat hepatocyte transplantation in acetaminophen-induced hepatotoxicity model. METHODS: Hepatocytes were isolated from male Wistar rats and transplanted 24 hours after acetaminophen administration in female recipients. Female rats received either 1x10(7 hepatocytes or phosphate buffered saline through the portal vein or into the spleen and were sacrificed after 48 hours. RESULTS: Alanine aminotransferase levels measured within the experiment did not differ between groups at any time point. Molecular analysis and histology showed presence of hepatocytes in liver of transplanted animals injected either through portal vein or spleen. CONCLUSION: These data demonstrate the feasibility and efficacy of hepatocyte transplantation in the liver or spleen in a mild acetaminophen-induced hepatotoxicity model.

  6. Intrapulmonary ectopic liver after orthotopic heart transplantation.

    Science.gov (United States)

    Mehta, Rupal I; Lai, Chi K; Kee, Stephen; Fishbein, Michael C

    2010-07-01

    We report a case of a 54-year-old woman who was found to have multiple intrapulmonary nodules detected on imaging 33 months after orthotopic heart transplantation. Needle biopsy of 2 discrete nodules showed benign hepatic tissue, consistent with intrapulmonary foci of ectopic liver. In this report, the clinical, radiologic, microscopic, and fluorescent in situ hybridization results of 2 biopsied nodules are described. A brief review of the published information on ectopic liver is also presented. To our knowledge, multiple ectopic foci of the liver have never been reported at any site. Furthermore, this is the first reported case that involves a transplant recipient, thereby introducing additional, unique ramifications to this rare but intriguing entity.

  7. Hepatocyte transplantation in the Long Evans Cinnamon rat model of Wilson's disease.

    Science.gov (United States)

    Park, Seon Mee; Vo, Kim; Lallier, Michel; Cloutier, Alexis-Simon; Brochu, Pierre; Alvarez, Fernando; Martin, Steven R

    2006-01-01

    Wilson's disease (WD), caused by a mutation in the P-type copper transporting ATPase (Atp7b) gene, results in excessive accumulation of copper in the liver. Long Evans Cinnamon rats (LEC) bear a mutation in the atp7b gene and share clinical characteristics of human WD. To explore hepatocyte transplantation (HT) as therapy for metabolic liver diseases, 8-week-old LEC rats (n = 12) were transplanted by intrasplenic injection of hepatocytes from donor Long Evans (LE) rats. Immunosuppression was maintained with intraperitoneal tacrolimus. The success of HT was monitored at 24 weeks of life. Serum aminotransferases and bilirubin peaked at 14-21 weeks in both HT rats and nontransplanted controls, but at 24 weeks, survival was 97% in LEC-HT versus 63% in controls. All transplanted rats showed restored biliary copper excretion and reduced liver iron concentration associated with increased ceruloplasmin oxidase activity. Liver tissue expressed atp7b mRNA (11.9 +/- 13.6%) indicative of engraftment of normal cells in 7 of 12 HT rats, associated with a reduced liver copper concentration compared to untreated LEC rats. Periportal islets of normal appearing hepatocytes, recognized by atp7b antibody, were observed in transplanted livers while lobular host cells showed persistent pleomorphic changes and inflammatory infiltrates. In conclusion, transplantation of normal hepatocytes prevented fulminant hepatitis, reduces chronic inflammation, and improved 6-month survival in LEC rats. Engraftment of transplanted cells, which express atp7b mRNA, repopulated the recipient liver with normal functional capacity.

  8. Interventional treatment of acute hepatic artery occlusion after liver transplantation.

    Science.gov (United States)

    Li, Zhi-Wei; Wang, Mao-Qiang; Zhou, Ning-Xin; Liu, Zhe; Huang, Zhi-Qiang

    2007-10-01

    With the development of the associated technology, interventional treatment has become an important method for the treatment of hepatic artery occlusion in some countries. This study was undertaken to evaluate the role of interventional methods in the diagnosis and treatment of acute hepatic artery occlusion after liver transplantation. The diagnosis and treatment of 9 cases of acute hepatic artery occlusion after liver transplantation were retrospectively analyzed. In 109 cases of liver transplantation, 9 were diagnosed by angiography. Among them, 7 were diagnosed by Doppler ultrasound. After transcatheter thrombolysis, the hepatic arteries were partially or totally patent again in 6 cases of hepatic artery occlusion after liver transplantation, and stent placements in the hepatic artery were performed in 5 cases. All stents proved patent and no patient required another liver transplantation. Angiography plays an important role in diagnosing hepatic artery complications after liver transplantation. Interventional therapy is a valuable method in the treatment of acute hepatic artery occlusion after liver transplantation.

  9. Rescue Living-donor Liver Transplantation for Liver Failure Following Hepatectomy for Hepatocellular Carcinoma

    OpenAIRE

    Chan, See Ching; Sharr, William Wei; Chan, Albert Chi Yan; Chok, Kenneth Siu Ho; Lo, Chung Mau

    2013-01-01

    Liver failure following major hepatectomy for hepatocellular carcinoma is a known but uncommon mode of early treatment failure. When post-hepatectomy liver failure becomes progressive, the only effective treatment for rescuing the patient is liver transplantation. Deceased-donor liver transplantation in this situation is often not feasible because of the shortage of deceased-donor liver grafts. Proceeding with living-donor liver transplantation is an ethical challenge because of the possibili...

  10. BONE MINERAL DENSITY AFTER LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. P. Buzulina

    2010-01-01

    Full Text Available Bone mineral density (BMD was estimated twice in 18 recipents of ortotopic liver transplantation. There was decreased BMD in axial so as in peripheral skeleton in early time and in vertebral or hip Ward triangle in late time following transplantation being lower in primary biliary cirrosis then in cirrosis following chronic virus hepatitis despite tacrolimus immunosupression without prednisolon. Tacrolimus immunosupression with prednisolon in primary biliary cirrosis patients in late postoperative time was associated with hard BMD lowering which correlated with glucocorticoid therapy duration and prednisolon cumulative dosis. 

  11. Caroli's disease and orthotopic liver transplantation.

    Science.gov (United States)

    Habib, Shahid; Shakil, Obaid; Couto, Osvaldo F; Demetris, Anthony J; Fung, John J; Marcos, Amadeo; Chopra, Kapil

    2006-03-01

    Caroli's disease is a rare congenital hepatic disease, characterized by segmental dilatation of the biliary tree. Patients who have recurrent bouts of biliary infection, particularly those with complications related to portal hypertension, may require orthotopic liver transplantation (OLT). Few case reports have described the outcome of OLT in patients with Caroli's disease and to date there is no large series reported in the literature. We retrospectively analyzed the outcome of OLT in patients with Caroli's disease who underwent OLT between 1982 and 2002 at Starzl Transplantation Institute, University of Pittsburgh. Patients were identified and data was collected by computerized search of the electronic database system. All patients had confirmation of diagnosis by histopathology of explanted liver. A total of 33 patients with Caroli's disease were listed for liver transplantation, 3 of whom were excluded, as they were not transplanted. A total of 90% had signs of hepatic decompensation at the time of OLT. Median posttransplantation follow-up was 7.7 yr. Short-term graft and patient survival at 1 month was 83% and 86%, whereas overall long-term graft survival rates at 1, 5, and 10 yr were 73%, 62%, and 53%, respectively, and patient survival rates were 76%, 65%, and 56%, respectively. Long-term outcome in patients who survived the first year after transplantation was significantly better. Their survival rate at 5 and 10 yr was 90% and 78%. On univariable analysis, recipient age, donor male gender, coexistent congenital hepatic fibrosis, and re-OLT were associated with poor patient survival. Eight patients were retransplanted, 3 of whom had primary nonfunction. A total of 13 patients died; the most common cause of death being sepsis and cardiovascular complications. Patients who died of sepsis had cholangitis pre-OLT. In conclusion, OLT is a form of curative and life-saving therapy in patients with Caroli's disease, especially in those with decompensated liver

  12. investigation on the model of living-donor liver transplantation

    OpenAIRE

    Nolting, Sabine Edith

    2012-01-01

    Liver transplantation is a common therapy of end stage liver disease. The aim of this study was to investigate metabolic pathways on the model of living-donor liver transplantation. Donors and recipients of liver transplantation underwent an insulin modified intravenous glucose tolerance test (ivGTT) at four points in time.121 With the minimal model technique insulin sensitivity, glucose effectiveness and ß-cell secretion have been calculated.15 Fasting glucose, insulin, c-peptid, proinsul...

  13. Bridging a patient with acute liver failure to liver transplantation by the AMC-bioartificial liver

    NARCIS (Netherlands)

    van de Kerkhove, Maarten-Paul; di Florio, Ernesto; Scuderi, Vincenzo; Mancini, Antonio; Belli, Antonello; Bracco, Adele; Scala, Daniela; Scala, Simona; Zeuli, Laura; Di Nicuolo, Giuseppe; Amoroso, Pietro; Calise, Fulvio; Chamuleau, Robert A. F. M.

    2003-01-01

    Recently a phase I clinical trial has been started in Italy to bridge patients with acute liver failure (ALF) to orthotopic liver transplantation (OLT) by the AMC-bioartificial liver (AMC-BAL). The AMC-BAL is charged with 10 X 109 viable primary porcine hepatocytes isolated from a specified

  14. Quality of life after liver transplantation

    Directory of Open Access Journals (Sweden)

    Anita Smajlović

    2013-10-01

    Full Text Available The liver is the largest gland and, apart from the skin, also the biggest organ in the body. They are a central laboratory for processing proteins, carbohidrates and fat, and they also detoxify our body.Liver failure is a result of cronic or acute liver disease or hepatic impairment. Many diseases of the liver are accompained by icterus as a result of increased level of bilirubin in the system. Today we can live without other organs important for metabolism, such as eg. the kidney or pancreas, because their function can be replaced. But we cannot live without the liver because their functions are too varied and complex. Therefore, when we have incurable disease of the liver we need liver transplantation.Life with a child who needs liver transplantation is very hard for all family members. Especially at the begining of treatment, life for all family members, and in particular for the parents, is very stressfull.Nurses must have sufficinet knowledge, she should be able to talk to parents in plain language with a high degree of optimism. We make them feel that they are not alone and we encourage them. Nurses must believe in successful treatment, so that they can inspire courage in parents.Quality of life is not in perfection, but rather in the way how we manage to live with imperfection. A person who is in any way affected, can perceive his quality of life as very good. Here, his personal attitude and attitude to his surrondings is most important. This is a higher quality than that obtainable by knowledge alone and which can be measured or evaluated.

  15. A practical approach to anaesthesia for paediatric liver transplantation

    African Journals Online (AJOL)

    A practical approach to anaesthesia for paediatric liver transplantation. Jenny Thomas, M McCulloch, W Spearman, T Butt, A Numanoglu. Abstract. Anaesthesia for paediatric liver transplantation requires meticulous attention to detail, an understanding of the disease process leading up to the need for transplantation, and an ...

  16. Liver Transplantation for Unresectable Metastases from Colon Adenocarcinoma.

    Science.gov (United States)

    Caicedo, Luis Armando; Buitrago, Diego; Thomas, Laura S; Villegas, Jorge I; Duque, Mauricio; Serrano, Oscar; Arrunategui, Ana M; Restrepo, Juan Guillermo; Echeverri, Gabriel Jaime

    2016-01-01

    Liver transplantation is an option that improves quality of life and prolongs life expectancy in patients with different types of liver disease. Liver transplantation is controversial for colorectal metastases and is not recommended in clinical practice guidelines. In this case report, we present, to our knowledge, the first liver transplantation for colorectal metastases conducted in Colombia, with a successful follow-up of more than 2 years. Patients with these characteristics who underwent liver transplantation experience reduced mortality and exponentially improved quality of life.

  17. Review on immunosuppression in liver transplantation

    OpenAIRE

    Moini, Maryam; Schilsky, Michael L; Tichy, Eric M

    2015-01-01

    The optimal level of immunosuppression in solid organ transplantation, in particular for the liver, is a delicate balance between the benefit of preventing rejection and the adverse side effects of immunosuppression. There is uncertainty about when this level is achieved in any individual recipient. Immunosuppression regimens vary between individual centers and changes with time as new agents and data are available. Presently concerns about the adverse side effects of calcineurin inhibitor, t...

  18. Treatment of cerebral aspergillosis after liver transplantation.

    Science.gov (United States)

    Polo, J M; Fábrega, E; Casafont, F; Fariñas, M C; Salesa, R; Vázquez, A; Berciano, J

    1992-09-01

    We report the treatment of cerebral aspergillosis with amphotericin B, flucytosine, surgery, and liposomal amphotericin B (L-AmB) after a liver transplant. The patient died 2 months after cessation of antifungal therapy, as a consequence of multiple-system organ failure. The only relevant postmortem finding in the brain was a small, encapsulated abscess containing hyphae. This case indicates that L-AmB is an effective alternative drug for cerebral aspergillosis.

  19. Purification of fetal liver stem/progenitor cells containing all the repopulation potential for normal adult rat liver

    DEFF Research Database (Denmark)

    Oertel, Michael; Menthena, Anuradha; Chen, Yuan-Qing

    2008-01-01

    . Rat ED14 FLSPC are alpha-fetoprotein(+)/cytokeratin-19(+) or alpha-fetoprotein(+)/cytokeratin-19(-) and contain all of the normal liver repopulation capacity found in fetal liver. Hematopoietic stem cells, a major component in crude fetal liver cell preparations that engraft in other organs......BACKGROUND & AIMS: Previously, we showed high-level, long-term liver replacement after transplantation of unfractionated embryonic day (ED) 14 fetal liver stem/progenitor cells (FLSPC). However, for clinical applications, it will be essential to transplant highly enriched cells, while maintaining...... and characteristic properties in vitro and their proliferative and differentiation potential in vivo after transplantation into normal adult rat liver. RESULTS: Rat ED14 FLSPC were purified to 95% homogeneity and exhibited cell culture and gene expression characteristics expected for hepatic stem/progenitor cells...

  20. Chemoprophylaxis with isoniazid in liver transplant recipients.

    Science.gov (United States)

    Fábrega, Emilio; Sampedro, Blanca; Cabezas, Joaquín; Casafont, Fernando; Mieses, Miguel Ángel; Moraleja, Irene; Crespo, Javier; Pons-Romero, Fernando

    2012-09-01

    A patient receiving a liver graft needs to be treated with immunosuppressive drugs to avoid rejection. These kinds of drugs predispose the patient to the reactivation of latent infections such as tuberculosis (TB). Therefore, it is necessary to establish treatment regimens to prevent this. We retrospectively analyzed all consecutive patients undergoing liver transplantation (LT) at our center between January 1, 2000 and December 31, 2010. Latent tuberculosis infections (LTBIs) were diagnosed with positive tuberculin skin test results. After LT, infected patients were treated with isoniazid for 6 months; the treatment began soon after transplantation, and the patients were followed until the end of the study. During this period, 53 patients had LTBI data. All these patients were treated with isoniazid after LT. The median observation period after LT was 52 months (range = 12-129 months). No cases of TB reactivation were reported during follow-up. Only 4 patients presented alterations in liver enzymes related to this treatment, and they showed clear improvement after the treatment was stopped. None of these patients showed severe graft dysfunction. In conclusion, preventive isoniazid appears to be a safe drug for use in LTBI patients after LT. The treatment may be established just after LT without important graft dysfunction or severe consequences for the patient. Copyright © 2012 American Association for the Study of Liver Diseases.

  1. Liver transplantation in the management of porphyria.

    Science.gov (United States)

    Singal, Ashwani K; Parker, Charles; Bowden, Christine; Thapar, Manish; Liu, Lawrence; McGuire, Brendan M

    2014-09-01

    Porphyrias are a group of eight metabolic disorders, each resulting from a mutation that affects an enzyme of the heme biosynthetic pathway. Porphyrias are classified as hepatic or erythropoietic, depending upon the site where the gene defect is predominantly expressed. Clinical phenotypes are classified as follows: (1) acute porphyrias with neurovisceral symptoms: acute intermittent porphyria; delta amino-levulinic acid hydratase deficiency porphyria; hereditary coproporphyria; and variegate porphyria and (2) cutaneous porphyrias with skin blistering and photosensitivity: porphyria cutanea tarda; congenital erythropoietic porphyria; hepatoerythropoietic porphyria and both erythropoietic protoporphyrias: autosomal dominant and X-linked. Liver transplantation (LT) may be needed for recurrent and/or life-threatening acute attack in acute intermittent porphyria or acute liver failure or end-stage chronic liver disease in erythropoietic protoporphyria. LT in acute intermittent porphyria is curative. Erythropoietic protoporphyria patients needing LT should be considered for bone marrow transplantation to achieve cure. This article provides an overview of porphyria with diagnostic approaches and management strategies for specific porphyrias and recommendations for LT with indications, pretransplant evaluation, and posttransplant management. © 2014 by the American Association for the Study of Liver Diseases.

  2. Replacement of Diseased Mouse Liver by Hepatic Cell Transplantation

    Science.gov (United States)

    Rhim, Jonathan A.; Sandgren, Eric P.; Degen, Jay L.; Palmiter, Richard D.; Brinster, Ralph L.

    1994-02-01

    Adult liver has the unusual ability to fully regenerate after injury. Although regeneration is accomplished by the division of mature hepatocytes, the replicative potential of these cells is unknown. Here, the replicative capacity of adult liver cells and their medical usefulness as donor cells for transplantation were investigated by transfer of adult mouse liver cells into transgenic mice that display an endogenous defect in hepatic growth potential and function. The transplanted liver cell populations replaced up to 80 percent of the diseased recipient liver. These findings demonstrate the enormous growth potential of adult hepatocytes, indicating the feasibility of liver cell transplantation as a method to replace lost or diseased hepatic parenchyma.

  3. Liver transplantation in Asia: past, present and future.

    Science.gov (United States)

    Ng, Kelvin K; Lo, Chung Mau

    2009-04-01

    With the technical advances and improvements in perioperative management and immunosuppressants, liver transplantation is the standard treatment for patients with end-stage liver diseases. In Asia, a shortage of deceased donor liver grafts is the universal problem to be faced with in all transplant centres. Many surgical innovations are then driven to counteract this problem. This review focuses on 3 issues that denote the development of liver transplantation in Asian countries. These include living donor liver transplantation (LDLT), split liver transplantation (SLT) and liver transplantation for hepatocellular carcinoma (HCC). Minimal graft weight, types of liver graft to donate and the inclusion of the middle hepatic vein with the graft are the main issues to be established in LDLT. The rapid growth and wide dissemination of LDLT has certainly alleviated the supply-and-demand problem of liver grafts in Asia. SLT is another attractive approach. Technical expertise, donor selection and graft allocation are the main determinants for its success. Liver transplantation plays a key role in the management of HCC in Asia. LDLT would be the main strategy in this aspect. The issue of extending the selection criteria for HCC patients for LDLT is still controversial. On the whole, future developments to increase the donor pool for the expanding recipient need in Asia would involve transplantation from non-heart beating donor and ABO incompatible transplantation.

  4. Liver transplantation in Turkey: historical review and future perspectives.

    Science.gov (United States)

    Akbulut, Sami; Yilmaz, Sezai

    2015-07-01

    Since the first successful liver transplantation by Starzl et al. in 1967, liver transplantation has become the standard therapy for many liver diseases, mainly chronic liver disease. Most liver transplantations performed in Europe and North America utilize deceased donors while a considerable portion of organ requirements is supplied by living donors in Asian countries including Turkey. The actual history of solid organ transplantation in Turkey began with the pioneering work of Dr. Haberal in collaboration with Thomaz E. Starzl in 1974 in Colorado University at Denver. The first successful solid organ transplantation in Turkey was accomplished by Haberal in 1975 with a living donor renal transplantation. Subsequently, legislations no 2238 and 2594 dated 1979 and 1982, respectively, were passed, paving the way for cadaveric tissue/organ utilization and preservation in Turkey. The first deceased donor liver transplantation and the first living donor liver transplantation were performed in 1988 and 1990, respectively. There are currently 45 liver transplantation centers in Turkey. Of these, 25 are state universities, 8 are private (foundation) universities, 9 are private hospitals, and 3 are training and research hospitals belonging to the Ministry of Health. A total of 7152 liver transplantations were performed in Turkey between January 2002 and May 2014. Of these, 4848 (67.8%) used living donors and 2304 (32.2%) used deceased donors. These figures indicate that, despite widespread organ donation campaigns and media-sponsored propaganda, desired targets have not been met yet in providing deceased organ donation. Despite unsatisfactory levels attained in supplying deceased donors, both the number of annual liver transplantations and improvements in overall survival rates of organ transplanted patients continues to increase. Actually, the one-year patient survival rate after liver transplantation in 2013 was 80.5%. This rate is getting better with each passing year

  5. Liver Transplantation for Hepatic Trauma: A Study From the European Liver Transplant Registry.

    Science.gov (United States)

    Krawczyk, Marek; Grąt, Michał; Adam, Rene; Polak, Wojciech G; Klempnauer, Jurgen; Pinna, Antonio; Di Benedetto, Fabrizio; Filipponi, Franco; Senninger, Norbert; Foss, Aksel; Rufián-Peña, Sebastian; Bennet, William; Pratschke, Johann; Paul, Andreas; Settmacher, Utz; Rossi, Giorgio; Salizzoni, Mauro; Fernandez-Selles, Carlos; Martínez de Rituerto, Santiago T; Gómez-Bravo, Miguel A; Pirenne, Jacques; Detry, Olivier; Majno, Pietro E; Nemec, Petr; Bechstein, Wolf O; Bartels, Michael; Nadalin, Silvio; Pruvot, Francois R; Mirza, Darius F; Lupo, Luigi; Colledan, Michele; Tisone, Giuseppe; Ringers, Jan; Daniel, Jorge; Charco Torra, Ramón; Moreno González, Enrique; Bañares Cañizares, Rafael; Cuervas-Mons Martinez, Valentin; San Juan Rodríguez, Fernando; Yilmaz, Sezai; Remiszewski, Piotr

    2016-11-01

    Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cut-off for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.

  6. Outcome of 200 Pediatric Living Donor Liver Transplantations in India.

    Science.gov (United States)

    Mohan, Neelam; Karkra, Sakshi; Rastogi, Amit; Dhaliwal, Maninder S; Raghunathan, Veena; Goyal, Deepak; Goja, Sanjay; Bhangui, Prashant; Vohra, Vijay; Piplani, Tarun; Sharma, Vivek; Gautam, Dheeraj; Baijal, S S; Soin, A S

    2017-11-15

    To describe our experience of pediatric living donor liver transplantation from India over a period of 12 years. A retrospective analysis of 200 living donor liver transplantation in children (18 years or younger) was done for demographic features, indications, donor and graft profile and outcome. Between September 2004 and July 2016, 200 liver transplants were performed on 197 children. Fifty transplants were done in initial 6 years and 150 in next 6 years. All donors (51% mothers) were discharged with a mean stay of 7 days. The leading indications of liver transplants were cholestatic liver disease (46%) followed by metabolic liver disease (33%) and acute liver failure/acute on chronic liver failure (28.5%). Biliary leakage (8.5%), biliary stricture (9%), hepatic artery thrombosis (4.5%) and portal vein thrombosis (4%) were the most common surgical complications; all could be managed by surgical or interventional radiological measures, except in one child who died. Sepsis, acute rejection and CMV hepatitis in first 6 months were seen in 14.5%, 25% and 17% cases, respectively. Post-transplant lymphoproliferative disease was seen in only 1.5%. Re-transplant rate was 1.5%. The overall 1 year survival rate was 94% and 5 year actuarial survival was 87% with no statistically significant difference between children weight 10 kg. Outcome in acute liver failure did not differ significantly between those with acute on chronic liver failure vs. those with chronic liver disease. Advances in medical and surgical techniques associated with multidisciplinary teams including skilled pediatric liver transplant surgeons, anesthetists, dedicated pediatric hepatologists, pediatric intensivists, interventional radiologists and pathologists resulted in an excellent outcome of living related liver transplants in children. Low age and weight of the baby does not seem to be a contraindication for liver transplantation as outcome were comparable in our experience.

  7. [Sequential heart and liver transplantation for familial amyloid polyneuropathy].

    Science.gov (United States)

    Lladó, Laura; Fabregat, Joan; Ramos, Emilio; Baliellas, Carme; Roca, Josep; Casasnovas, Carlos

    2014-03-04

    Combined heart and liver transplantation for familial amyloid polyneuropathy (FAP) is currently the best treatment for patients with cardiomyopathy related to FAP. However, its optimal timing and the possibility of domino liver transplantation in this setting remain under discussion. Most such cases in the medical literature have been performed simultaneously, although many of them have required the use of veno-venous bypass and the majority have not used the liver as a graft for domino liver transplantation. We report 3 cases of non-Val30Met mutation that underwent sequential heart and domino liver transplantation at our institution. We describe the 3 cases and the medical literature, with special attention to the reason for sequential heart and liver transplantation, the role of transient elastography in this setting, and the feasibility of domino liver transplantation. In our experience, combined heart and liver transplantation is a feasible but challenging procedure for patients with FAP. Performing the procedure sequentially rather than simultaneously seems safer and easier, both technically and hemodynamically. More importantly, such an approach allows the use of livers from FAP patients as grafts for domino liver transplantation. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  8. Liver Transplantation in the Management of Porphyria

    Science.gov (United States)

    Singal, Ashwani K.; Parker, Charles; Bowden, Christine; Thapar, Manish; Liu, Lawrence; McGuire, Brendan M.

    2015-01-01

    Porphyrias are a group of eight metabolic disorders, each resulting from a mutation that affects an enzyme of the heme biosynthetic pathway. Porphyrias are classified as hepatic or erythropoietic, depending upon the site where the gene defect is predominantly expressed. Clinical phenotypes are classified as follows: (1) acute porphyrias with neurovisceral symptoms: acute intermittent porphyria; delta amino-levulinic acid hydratase deficiency porphyria; hereditary coproporphyria; and variegate porphyria and (2) cutaneous porphyrias with skin blistering and photosensitivity: porphyria cutanea tarda; congenital erythropoietic porphyria; hepatoerythropoietic porphyria and both erythropoietic protoporphyrias: autosomal dominant and X-linked. Liver transplantation (LT) may be needed for recurrent and/or life-threatening acute attack in acute intermittent porphyria or acute liver failure or end-stage chronic liver disease in erythropoietic protoporphyria. LT in acute intermittent porphyria is curative. Erythropoietic protoporphyria patients needing LT should be considered for bone marrow transplantation to achieve cure. Conclusion This article provides an overview of porphyria with diagnostic approaches and management strategies for specific porphyrias and recommendations for LT with indications, pretransplant evaluation, and posttransplant management. PMID:24700519

  9. Liver transplantation for hemochromatosis, Wilson's disease, and other metabolic disorders.

    Science.gov (United States)

    Tung, B Y; Kowdley, K V

    1997-08-01

    Liver transplantation provides an effective means for replacing a failing liver, in addition to correcting the underlying abnormality in many metabolic disorders. Results of liver transplantation for metabolic diseases have been generally encouraging, with the exception of hereditary hemochromatosis, in which infectious and cardiac complications appear to increase post-transplant mortality. Better pretransplant diagnosis of hemochromatosis, utilizing the recently identified putative gene, may help reduce post-transplant complications. In metabolic diseases, improved understanding of the underlying genetic and molecular defects will lead to advances in medical therapy and perhaps a decreased need for liver transplantation. NTBC therapy for hereditary tyrosinemia and purified glucocerebroside therapy for Gaucher disease are two such examples. The prospects of gene therapy are being actively pursued for many metabolic diseases, such as CF, hemophilia, and familial hypercholesterolemia. Until such investigation leads directly to clinical practice, however, liver transplantation remains an effective option for therapy for a wide range of metabolic diseases.

  10. Transplantation With Livers From Deceased Donors Older Than 75 Years

    DEFF Research Database (Denmark)

    Thorsen, Trygve; Aandahl, Einar Martin; Bennet, William

    2015-01-01

    BACKGROUND: The availability of donor organs limits the number of patients in need who are offered liver transplantation. Measures to expand the donor pool are crucial to prevent on-list mortality. The aim of this study was to evaluate the use of livers from deceased donors who were older than 75...... years. METHODS: Fifty-four patients who received a first liver transplant (D75 group) from 2001 to 2011 were included. Donor and recipient data were collected from the Nordic Liver Transplant Registry and medical records. The outcome was compared with a control group of 54 patients who received a liver...

  11. Impact of estimated liver volume and liver weight on gender disparity in liver transplantation.

    Science.gov (United States)

    Mindikoglu, Ayse L; Emre, Sukru H; Magder, Laurence S

    2013-01-01

    Although lower Model for End-Stage Liver Disease (MELD) scores due to lower levels of serum creatinine in women might account for some of the gender disparity in liver transplantation (LT) rates, even within MELD scores, women undergo transplantation at lower rates than men. It is unclear what causes this disparity, but transplant candidate/donor liver size mismatch may be a factor. We analyzed Organ Procurement and Transplantation Network data for patients with end-stage liver disease on the waiting list. A pooled conditional logistic regression analysis was used to assess the association between gender and LT and to determine the degree to which this association was explained by lower MELD scores or liver size. In all, 28,866 patients and 424,001 person-months were included in the analysis. The median estimated liver volume (eLV) and the median estimated liver weight (eLW) were significantly lower for women versus men on the LT waiting list (P factor for the lower LT rates in women versus men (OR = 0.87, P list can be explained in part by lower MELD scores, eLVs, and eLWs in comparison with men. However, at least half of the gender disparity still remains unexplained. Copyright © 2012 American Association for the Study of Liver Diseases.

  12. REDUCED-SIZE LIVER-TRANSPLANTATION, SPLIT LIVER-TRANSPLANTATION, AND LIVING-RELATED LIVER-TRANSPLANTATION IN RELATION TO THE DONOR ORGAN SHORTAGE

    NARCIS (Netherlands)

    SLOOFF, MJH

    Because of the shortage of cadaveric donors, three techniques of partial liver grafting have been developed. These techniques are placed in perspective in relation to the organ shortage. Reduced size liver transplantation (RSLTx) is widely used and has results comparable to those from whole liver

  13. Intracardiac Thrombosis during Adult Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Marina Moguilevitch

    2013-01-01

    Full Text Available Intracardiac thrombosis (ICT and pulmonary embolism (PE during adult liver transplantation are rare but potentially lethal complications. They are often overlooked because of significant diagnostic challenges. The combination of hemodynamic compromise and transesophageal echocardiography (TEE findings allows for correct diagnosis. A large variety of putative risk factors for ICT and PE have been suggested, but these events are considered to be multifactorial. There are different proposed treatment modalities for these devastating complications. Unfortunately, in spite of growing knowledge in this area, intraoperative and postoperative mortalities remain very high. The retrospective nature of the study of these events makes the case reports extremely valuable.

  14. Major Challenges Limiting Liver Transplantation in the United States

    Science.gov (United States)

    Wertheim, Jason A.; Petrowsky, Henrik; Saab, Sammy; Kupiec-Weglinski, Jerzy W.; Busuttil, Ronald W.

    2011-01-01

    Liver transplantation is the gold standard of care in patients with end-stage liver disease and those with tumors of hepatic origin in the setting of liver dysfunction. From 1988 to 2009, liver transplantation in the United States grew 3.7-fold from 1713 to 6320 transplants annually. The expansion of liver transplantation is chiefly driven by scientific breakthroughs that have extended patient and graft survival well beyond those expected 50 years ago. The success of liver transplantation is now its primary obstacle, as the pool of donor livers fails to keep pace with the growing number of patients added to the national liver transplant waiting list. This review focuses on three major challenges facing liver transplantation in the United States and discusses new areas of investigation that address each issue: 1) the need for an expanded number of useable donor organs, 2) the need for improved therapies to treat recurrent hepatitis C after transplantation and 3) the need for improved detection, risk stratification based upon tumor biology and molecular inhibitors to combat hepatocellular carcinoma. PMID:21672146

  15. Geographic Inequity in Access to Livers for Transplantation

    Science.gov (United States)

    Yeh, Heidi; Smoot, Elizabeth; Schoenfeld, David A.; Markmann, James F.

    2013-01-01

    Background Liver transplantation offers life-saving therapy for patients with decompensated liver disease or T2 hepatocellular carcinomas. In the United States, deceased donor livers are primarily allocated by Model for End-Stage Liver Disease (MELD) score within each of the country's more than 50 donation service areas (DSAs). Variation in DSA size, population, and organ availability have engendered concern that unequal access to deceased donor livers across DSAs contributes to geographic variability in outcome. Methods To determine the extent to which DSA variability in organ availability correlated with combined waitlist and posttransplant mortality, we analyzed retrospectively national waitlist and posttransplant data for a 7-year period after implementation of the current MELD-based allocation system. Results Marked variation among DSAs was evident in death rate (3.3-fold), transplant rate (20-fold), and mean transplant MELD (>10 points). Death rate correlated with organ availability was assessed by transplant rate and transplant MELD. DSAs with low organ availability included the country's largest cities, had more new listings per capita, larger waitlists, more transplant centers per DSA, and a higher proportion of black and Asian patients. DSAs of organ shortage were also characterized by more frequent dual listing at another transplant center, more living donor liver transplants, and increased average length of the transplant admission. Conclusions Geographic differences in deceased donor organ availability contribute to variation in overall death rate of liver transplant patients, shape the clinical practice of transplant, and influence the resources consumed per transplant. Geographic variation in organ access results primarily from rates of listing rather than donation. Our findings highlight the need to restructure organ distribution areas to achieve equal access to deceased donor livers for transplantation in the United States. PMID:21200366

  16. [Hepatic cell transplantation: a new therapy in liver diseases].

    Science.gov (United States)

    Pareja, Eugenia; Cortés, Miriam; Martínez, Amparo; Vila, Juan José; López, Rafael; Montalvá, Eva; Calzado, Angeles; Mir, José

    2010-07-01

    Liver transplantation has been remarkably effective in the treatment in patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the greatest limitation, resulting in longer waiting times and increase in mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation.Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients. The procedure consists of transplanting individual cells to a recipient organ in sufficient quantity to survive and restore the function. The capacity of hepatic regeneration is the biological basis of hepatocyte transplantation. This therapeutic option is an experimental procedure in some patients with inborn errors of metabolism, fulminant hepatic failure and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. In the Hospital La Fe of Valencia, we performed the first hepatocyte transplantation in Spain creating a new research work on transplant program. Copyright 2009 AEC. Published by Elsevier Espana. All rights reserved.

  17. Liver transplantation using donor organs with markedly elevated liver enzymes: how far can we go?

    Science.gov (United States)

    Radunz, Sonia; Paul, Andreas; Nowak, Knut; Treckmann, Jürgen W; Saner, Fuat H; Mathé, Zoltan

    2011-08-01

    The disparity between the demand for solid organs and the current supply is a growing problem for patients with end-stage liver disease. To overcome organ shortage, extended criteria donor organs are also accepted for liver transplantation. We here unprecedentedly report the clinical course of patients receiving livers with markedly elevated liver enzymes. Between November 2007 and December 2010, 15 donor livers with markedly elevated liver enzymes [median aspartate aminotransferase (AST) 1400 (500-7538) U/l, median alanine aminotransferase (ALT) 1026 (308-9179) U/l] were offered to our transplant centre. Based on elaborate judgment, seven of these donor livers were rejected and eight donor livers were transplanted. All eight transplanted patients showed a liver enzyme peak on the day of surgery (AST 2076 ± 1808 U/l, ALT 1087 ± 833 U/l) and a statistically significant decrease from day 0 to day 7 post-liver transplantation. INR decreased and platelet count increased statistically significantly within 1 week after liver transplantation. The patients were discharged from the hospital 28 ± 11 days after liver transplantation in good clinical condition. These data demonstrate that using donor livers with markedly elevated liver enzymes may be an acceptable option to expand the donor pool. Universal objective parameters for acceptance should be defined in future studies. © 2011 John Wiley & Sons A/S.

  18. [Liver transplant at the UMAE 25 IMSS Monterrey].

    Science.gov (United States)

    Cisneros-Garza, Laura E; López-Hernández, Pedro A; Muñoz-Ramírez, M del Rosario; Castilla-Valdéz, Martha Patricia; Sebastián-Ruiz, M José; Carmona-Martínez, Juan Gerardo; Alvarez-Treviño, Guillermo Alberto; Martínez-Flores, José Guillermo; Olavide-Aguilar, Ramón

    2011-09-01

    Liver transplantation is the best treatment for end stage liver diseases. In April 2003, our institution started a Liver Transplantation Program for both pediatric and adults population. Shown the results of the Liver Transplantation Program in the UMAE 25 Monterrey N.L. This is a retrospective cohort study of patients with liver transplantation. A total of 51 liver transplantations have been done in 49 patients with two retrasplantation, 15 in children and 36 in adults. The principal indication for liver transplantation in children was biliary atresia and hepatitis C cirrhosis in adults. The acute renal failure was the main early complication, the acute cellular rejection in the mediate period, and the cardiovascular diseases as late complication related to obesity, metabolic syndrome, diabetes mellitus and hypertension. Overall survival at 1 and 5 years was 57.1 and 54.2%, respectively. During the first three years post-transplantation, the quality of life was good or very good. Although still a young and perfectible program, the effort of a multidisciplinary team has made possible to perform liver transplantation in two patient populations, pediatric and adults.

  19. Studies on predictability of early graft function after liver transplantation

    NARCIS (Netherlands)

    Maring, Jan Kornelis

    2005-01-01

    Liver transplantation has changed the future of patients with end-stage liver disease. Nowadays one year patient survival reaches 90% in experienced centers. Most patients die in the early phase after transplantation. After this initial period patient survival approximates survival curves of the

  20. Simultaneous liver-pancreas transplantation for cystic fibrosis-related liver disease : A multicenter experience

    NARCIS (Netherlands)

    Bandsma, R. H. J.; Bozic, M. A.; Fridell, J. A.; Crull, M. H.; Molleston, J.; Avitzur, Y.; Mozer-Glassberg, Y.; Gonzalez-Peralta, R. P.; Hodik, M.; Fecteau, A.; de Angelis, M.; Durie, P.; Ng, V. L.

    Background: Diabetes is associated with increased morbidity and mortality in patients with cystic fibrosis (CF). While liver transplantation is well established for CF-related liver disease (CFLD), the role of simultaneous liver pancreas transplantation is less understood. Methods: We polled 81

  1. DONOR GRAFT INTERFERON REGULATORY FACTOR-1 (IRF-1) GENE TRANSFER WORSENS LIVER TRANSPLANT ISCHEMIA/REPERFUSION INJURY

    Science.gov (United States)

    Kim, Kee-Hwan; Dhupar, Rajeev; Ueki, Shinya; Cardinal, Jon; Pan, Pinhua; Cao, Zongxian; Cho, Sung W; Murase, Noriko; Tsung, Allan; Geller, David A

    2009-01-01

    Background Liver ischemia and reperfusion (IR) injury is a phenomenon that leads to graft dysfunction following liver transplantation. Understanding the molecular mechanisms behind this process is crucial to developing strategies to prevent short and long term graft dysfunction. The purpose of this study is to explore the role of the transcription factor, IRF-1, in a model of orthotopic rat liver transplantation. Methods Orthotopic syngeneic LEW rat liver transplantation (OLT) was performed after 18 or 3 hours preservation in cold UW solution. AdIRF-1 or control gene vector (Adnull) was delivered to the liver by donor intravenous pretreatment 4 days before graft harvesting. Uninfected grafts also served as controls. Recipients were sacrificed 1 to 24 hours post-transplantation. Results Rats that underwent OLT with long-term preserved graft (18 hours) displayed increased hepatic nuclear expression of IRF-1 protein at 1 and 3 hours. Rats pre-treated with AdIRF-1 prior to transplantation had increased ALT levels and increased expression of IFN-β, IFN-γ, IL-12, and iNOS in short-term period graft(3 hours) when compared with donor livers pre-treated with Adnull. AdIRF-1 pre-treated donor livers also exhibited increased susceptibility to early apoptosis in the transplanted grafts with increased TUNEL staining expression of cleaved caspase-3. Additionally, AdIRF-1 pre-treated donor livers had increased activation of the MAP kinase JNK as compared with Adnull pre-treated donor livers. Conclusions IRF-1 is an important regulator of IR injury after OLT in rats. Targeting of IRF-1 may be a potential strategy to ameliorate ischemic liver injury after transplantation in order to minimize organ dysfunction. PMID:19628072

  2. Comprehensive ultrasound assessment of complications post-liver transplantation.

    LENUS (Irish Health Repository)

    O'Brien, J

    2010-04-01

    Human liver transplantation for end-stage liver disease was first performed in 1963. Refinements in surgical technique and new immunosuppressive regimens have improved outcomes. Today, transplant patients have a 5-year survival rate of approximately 75%. Nevertheless, significant complications still occur. Ultrasonography (US), is the initial imaging modality of choice allowing bedside assessment for detection and follow-up of early and delayed graft complications, and facilitating interventional procedures. This review outlines the role of ultrasound in post-transplantation assessment.

  3. Comprehensive ultrasound assessment of complications post-liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    O' Brien, J. [Department of Radiology, Adelaide and Meath Incorporating the National Children' s Hospital, Tallaght, Dublin 24 (Ireland)], E-mail: juliemarobrien@yahoo.com; Buckley, A.R. [Division of Abdominal Imaging, Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia (Canada); Browne, R. [Department of Radiology, Adelaide and Meath Incorporating the National Children' s Hospital, Tallaght, Dublin 24 (Ireland)

    2010-04-15

    Human liver transplantation for end-stage liver disease was first performed in 1963. Refinements in surgical technique and new immunosuppressive regimens have improved outcomes. Today, transplant patients have a 5-year survival rate of approximately 75%. Nevertheless, significant complications still occur. Ultrasonography (US), is the initial imaging modality of choice allowing bedside assessment for detection and follow-up of early and delayed graft complications, and facilitating interventional procedures. This review outlines the role of ultrasound in post-transplantation assessment.

  4. Acute renal failure in liver transplant patients: Indian study.

    Science.gov (United States)

    Naik, Pradeep; Premsagar, B; Mallikarjuna, M

    2015-01-01

    The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.

  5. Anesthetic Management of Pediatric Liver and Kidney Transplantation.

    Science.gov (United States)

    Wasson, Nicholas R; Deer, Jeremy D; Suresh, Santhanam

    2017-09-01

    Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Anesthetic management of pediatric liver and renal transplantation has not been well described. There are key differences between adults and children undergoing these procedures, and acknowledgment of some key principles provide a solid foundation to optimize perioperative outcomes. This article provides an overview of the perioperative management and considerations in pediatric patients undergoing liver and renal transplantation. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Microbubble contrast-enhanced ultrasound in liver transplantation.

    Science.gov (United States)

    Berry, Jonathan D; Sidhu, Paul S

    2004-10-01

    The use of liver transplantation for treatment of end-stage liver disease is now commonplace. The accurate assessment of the pre-transplant candidate and long-term follow-up of the posttransplant patient is vital in ensuring that the limited resource of donor livers is appropriately used. Ultrasound is accepted as playing an important role in this process. The advent of microbubble contrast enhanced ultrasound provides new opportunities in terms of improving diagnostic accuracy and obviating more invasive investigations with their associated patient morbidity and mortality. We present the current and developing applications of microbubble contrast-enhanced ultrasound in the field of liver transplantation.

  7. Interventional radiology in the management of the liver transplant patient.

    Science.gov (United States)

    Thornburg, Bartley; Katariya, Nitin; Riaz, Ahsun; Desai, Kush; Hickey, Ryan; Lewandowski, Robert; Salem, Riad

    2017-10-01

    Liver transplantation (LT) is commonly used to treat patients with end-stage liver disease. The evolution of surgical techniques, endovascular methods, and medical care has led to a progressive decrease in posttransplant morbidity and mortality. Despite these improvements, a multidisciplinary approach to each patient remains essential as the early diagnosis and treatment of the complications of transplantation influence graft and patient survival. The critical role of interventional radiology in the collaborative approach to the care of the LT patient will be reviewed. Liver Transplantation 23 1328-1341 2017 AASLD. © 2017 by the American Association for the Study of Liver Diseases.

  8. Marginal grafts increase early mortality in liver transplantation

    Directory of Open Access Journals (Sweden)

    Telesforo Bacchella

    Full Text Available CONTEXT AND OBJECTIVE: Expanded donor criteria (marginal grafts are an important solution for organ shortage. Nevertheless, they raise an ethical dilemma because they may increase the risk of transplant failure. This study compares the outcomes from marginal and non-marginal graft transplantation in 103 cases of liver transplantation due to chronic hepatic failure. DESIGN AND SETTING: One hundred and three consecutive liver transplantations to treat chronic liver disease performed in the Liver Transplantation Service of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between January 2001 and March 2006 were retrospectively analyzed. METHODS: We estimated graft quality according to a validated scoring system. We assessed the pre-transplantation liver disease category using the Model for End-Stage Liver Disease (MELD, as low MELD ( 20. The parameters for marginal and non-marginal graft comparison were the one-week, one-month and one-year recipient survival rates, serum liver enzyme peak, post-transplantation hospital stay and incidence of surgical complications and retransplantation. The significance level was 0.05. RESULTS: There were no differences between the groups regarding post-transplantation hospital stay, serum liver enzyme levels and surgical complications. In contrast, marginal grafts decreased overall recipient survival one month after transplantation. Furthermore, low-MELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the first month, patient survival was comparable in all groups up to one year. CONCLUSION: The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.

  9. Liver transplantation for patients with alcoholic hepatitis.

    Science.gov (United States)

    Artru, Florent; Louvet, Alexandre; Mathurin, Philippe

    2017-03-01

    Alcoholic liver disease, considered as a self-inflected disease, is an example of how moral judgment may affect ethical exercise of medicine which requires equity and fair utilization of a scarce resource in a context of organ shortage. Some consider that selection process should prioritize access to liver transplantation (LT) for patients who develop liver failure "through no fault of their own" even if limiting care because of a patient's perceived responsibility has been considered unethical. The absence of improvement after alcohol withdrawal, the high short-term mortality risk and the poor predictability of the 6-month rule in post-LT relapse in alcohol consumption in AH patients not responding to medical therapy led to recommend an evaluation of LT. In the French-Belgian pilot study, 26 patients with severe AH not responding to medical therapy underwent early LT (eLT). Stringent selection criteria were applied. Six-month and 2-year survivals of eLT patients were better than that of non-transplanted matched controls: 77% vs 23% and 71% vs 23% respectively. Alcohol relapse occurred in 12% of patients after eLT. Three studies confirmed these results. The impact organ donation should be limited as showed by a recent survey and the efforts that should be made in public information campaigns based on scientific data and medical ethics. In conclusion, the ongoing accumulation of scientific evidence and requirement of ethical exercise of medicine lead to continue evaluating eLT as a therapeutic option in patients with severe AH not responding to medical therapy. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Rescue Living-donor Liver Transplantation for Liver Failure Following Hepatectomy for Hepatocellular Carcinoma.

    Science.gov (United States)

    Chan, See Ching; Sharr, William Wei; Chan, Albert Chi Yan; Chok, Kenneth Siu Ho; Lo, Chung Mau

    2013-08-01

    Liver failure following major hepatectomy for hepatocellular carcinoma is a known but uncommon mode of early treatment failure. When post-hepatectomy liver failure becomes progressive, the only effective treatment for rescuing the patient is liver transplantation. Deceased-donor liver transplantation in this situation is often not feasible because of the shortage of deceased-donor liver grafts. Proceeding with living-donor liver transplantation is an ethical challenge because of the possibility of donor coercion. In addition, tumor status, as confirmed by histopathological examination of the resected specimen, may indicate aggressive cancer that warns against rescue transplantation because of the increased chance of tumor recurrence. Here we describe four cases of rescue living-donor liver transplantation for liver failure after hepatectomy for hepatocellular carcinoma. The patients all survived the transplantation and were free from tumor recurrence after follow-up periods ranging from 6 months to 9 years. Our experience has shown that rescue living-donor liver transplantation for post-hepatectomy liver failure is feasible. Tumor status should be considered carefully because large tumors and tumors with macrovascular invasion are strong contraindications to rescue living-donor liver transplantation.

  11. Predictors of heavy drinking after liver transplantation for alcoholic liver disease in Denmark (1990-2013)

    DEFF Research Database (Denmark)

    Askgaard, Gro; Tolstrup, Janne S.; Gerds, Thomas A.

    2016-01-01

    OBJECTIVE: Heavy drinking following liver transplantation decreases survival. Little is known of predictors of heavy drinking, which should guide clinicians identifying patients at high risk of return to heavy drinking after transplantation. MATERIAL AND METHODS: We calculated the cumulative...... incidence of heavy drinking among patients transplanted for alcoholic liver disease in Denmark 1990-2013. We then analyzed pre-transplant demographic and psychiatric characteristics as predictors of post-transplant heavy drinking. Information was obtained from medical records, from nationwide registries...... and by interview. RESULTS: Among 156 liver-transplanted patients, the cumulative incidence of heavy drinking was 18%, 24% and 27% after 5, 10 and 15 years post-transplant. In univariate analyses of pre-transplant predictors of heavy drinking after transplantation, younger age (p

  12. Evaluation of safety and efficacy of liver biopsy following liver transplant.

    Science.gov (United States)

    Kırnap, Mahir; Akdur, Aydıncan; Haberal Reyhan, Nihan; Aytekin, Cüneyt; Harman, Ali; Yıldırım, Sedat; Moray, Gokhan; Haberal, Mehmet

    2015-04-01

    Liver biopsy is a diagnostic tool for liver pathology after liver transplant. However, biopsy can cause life-threating complications. There is limited knowledge about efficacy and complications of liver biopsy after liver transplant. Our aim was to evaluate the risk and benefit of liver biopsy after liver transplant and quality of biopsy specimens. We retrospectively analyzed all liver biopsies performed after liver transplant between January 2000 and October 2014. All patients were monitored for minimum 24 hours after biopsy. We performed 245 liver biopsies in 159 liver transplant patients. Fifteen biopsies (6%) were nondiagnostic. In the samples, there were 102 cases (41%) of acute rejection, 79 cases (35%) of cholangitis, and 49 cases (20%) of cholestasis observed. Complications after biopsy were seen in 23 patients (9%) and biopsies. There were 7 patients who had severe abdominal pain followed by fever. We diagnosed 4 patients who had intercostal/subcapsular bleeding and 12 patients who had vasovagal reaction. All patients were treated with analgesic agents and monitored for 24 hours. No blood transfusion or surgery was required. Liver biopsy after liver transplant is an invasive diagnostic tool for liver pathology. However, it can be used safely in experienced centers.

  13. Treatment Experience of Severe Abdominal Infection after Orthotopic Liver Transplantation

    OpenAIRE

    Wang, Y-g; Wu, J-S; Jiang, B.; Wang, J-H; Liu, C-P; Peng, C.; Tian, B-Z

    2015-01-01

    This study aims to investigate the causes and treatment experience of severe abdominal infection after orthotopic liver transplantation. Clinical data were retrospectively analysed in perioperative severe abdominal infection of 186 orthotopic liver transplantation cases from March 2004 to November 2011. Among the 186 patients, 16 cases had severe abdominal infection: five cases had bile duct anastomotic leakage-inducing massive hydrops and infection under liver interstice, 10 cases had extens...

  14. Medical Management of Metabolic Complications of Liver Transplant Recipients

    OpenAIRE

    Barnard, Abbey; Konyn, Peter; Saab, Sammy

    2016-01-01

    Improved short- and long-term survival of liver transplant recipients has led to increased focus on complications of both the early and late posttransplant periods. A variety of metabolic complications have been observed in the post–orthotopic liver transplant population, including hypertension, hyperlipidemia, obesity, diabetes mellitus, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis. Although only a small proportion of patients experience metabolic complications prior to...

  15. Liver transplantation in Greek children: 15 years experience

    Directory of Open Access Journals (Sweden)

    Dimitrios Takoudas

    2010-09-01

    Full Text Available Liver transplantation (LT is the only available live-saving procedure for children with irreversible liver failure. This paper reports our experience from the follow-up of 16 Greek children with end-stage liver failure who underwent a LT. Over a period of 15 years, 16 pediatric liver recipients received follow up after being subjected to OLT (orthotopic liver transplantation due to end-stage liver failure. Nine children initially presented with extrahepatic biliary atresia, 2 with acute liver failure after toxic mushroom ingestion, 2 with intrahepatic cholestasis, 2 with metabolic diseases and one with hepatoblastoma. Ten children received a liver transplant in the Organ Transplantation Unit of Aristotle University of Thessaloniki and the rest in other transplant centers. Three transplants came from a living-related donor and 13 from a deceased donor. Six children underwent immunosuppressive treatment with cyclo­sporine, mycophenolate mofetil and corticosteroids, and 7 with tacrolimus, mycophenolate mofetil and corticosteroids. Three out of 16 children died within the first month after the transplantation due to post-transplant complications. Three children presented with acute rejection and one with chronic organ rejection which was successfully managed. Five children presented with cytomegalovirus infection, 5 with Epstein-Barr virus, 2 with HSV1,2, 2 with ParvoB19 virus, 2 with varicella-zoster virus and one with C. Albicans infection. One child presented with upper gastrointestinal hemorrhage and one with small biliary paucity. A satisfying outcome was achieved in most cases, with good graft function, except for the patient with small biliary paucity who required re-transplantation. The long-term clinical course of liver transplanted children is good under the condition that they are attended in specialized centers.

  16. Cell transplantation after oxidative hepatic preconditioning with radiation and ischemia-reperfusion leads to extensive liver repopulation

    Science.gov (United States)

    Malhi, Harmeet; Gorla, Giridhar R.; Irani, Adil N.; Annamaneni, Pallavi; Gupta, Sanjeev

    2002-10-01

    The inability of transplanted cells to proliferate in the normal liver hampers cell therapy. We considered that oxidative hepatic DNA damage would impair the survival of native cells and promote proliferation in transplanted cells. Dipeptidyl peptidase-deficient F344 rats were preconditioned with whole liver radiation and warm ischemia-reperfusion followed by intrasplenic transplantation of syngeneic F344 rat hepatocytes. The preconditioning was well tolerated, although serum aminotransferase levels rose transiently and hepatic injury was observed histologically, along with decreased catalase activity and 8-hydroxy adducts of guanine, indicating oxidative DNA damage. Transplanted cells did not proliferate in the liver over 3 months in control animals and animals preconditioned with ischemia-reperfusion alone. Animals treated with radiation alone showed some transplanted cell proliferation. In contrast, the liver of animals preconditioned with radiation plus ischemia-reperfusion was replaced virtually completely over 3 months. Transplanted cells integrated in the liver parenchyma and liver architecture were preserved normally. These findings offer a paradigm for repopulating the liver with transplanted cells. Progressive loss of cells experiencing oxidative DNA damage after radiation and ischemia-reperfusion injury could be of significance for epithelial renewal in additional organs.

  17. Risk factors for biliary complications after liver transplantation from donation after cardiac death

    Directory of Open Access Journals (Sweden)

    LYU Guoyue

    2015-12-01

    Full Text Available Liver transplantation has become the effective therapeutic method for end-stage liver disease, but the incidence of biliary complications after liver transplantation remains high. With an increasing number of liver transplantation procedures from donation after cardiac death (DCD, it is necessary to investigate the risk factors for biliary complications after liver transplantation from DCD and enhance our understanding of such risk factors in order to reduce biliary complications after liver transplantation from DCD.

  18. Outcomes of Technical Variant Liver Transplantation versus Whole Liver Transplantation for Pediatric Patients: A Meta-Analysis.

    Science.gov (United States)

    Ye, Hui; Zhao, Qiang; Wang, Yufang; Wang, Dongping; Zheng, Zhouying; Schroder, Paul Michael; Lu, Yao; Kong, Yuan; Liang, Wenhua; Shang, Yushu; Guo, Zhiyong; He, Xiaoshun

    2015-01-01

    To overcome the shortage of appropriate-sized whole liver grafts for children, technical variant liver transplantation has been practiced for decades. We perform a meta-analysis to compare the survival rates and incidence of surgical complications between pediatric whole liver transplantation and technical variant liver transplantation. To identify relevant studies up to January 2014, we searched PubMed/Medline, Embase, and Cochrane library databases. The primary outcomes measured were patient and graft survival rates, and the secondary outcomes were the incidence of surgical complications. The outcomes were pooled using a fixed-effects model or random-effects model. The one-year, three-year, five-year patient survival rates and one-year, three-year graft survival rates were significantly higher in whole liver transplantation than technical variant liver transplantation (OR = 1.62, 1.90, 1.65, 1.78, and 1.62, respectively, ptechnical variant liver transplantation. Continuing efforts should be made to minimize surgical complications to improve the outcomes of technical variant liver transplantation.

  19. A practical approach to anaesthesia for paediatric liver transplantation

    African Journals Online (AJOL)

    Adele

    The cause of the liver failure: is this acute hepatic failure or end-stage liver disease? ... Anaesthesia for paediatric liver transplantation requires meticulous attention to detail, an understanding of the disease process leading up to the need for ... valvular lesions (Alagilles), and occasionally biventricular failure.3,4,5 They are ...

  20. Idiopathic extensive peliosis hepatis treated with liver transplantation

    DEFF Research Database (Denmark)

    Hyodo, Masanobu; Mogensen, Anne Mellon; Larsen, Peter Nørgaard

    2004-01-01

    complicating liver cirrhosis. Extensive peliosis with liver cirrhosis is a rare condition. Only two cases, caused by contraceptives and treated by liver transplantation, are reported in the English-language literature. We could find no cause other than alcohol abuse lasting several years in this patient...

  1. Ischaemic preconditioning of the liver before transplantation | van As ...

    African Journals Online (AJOL)

    liver transplantation. Before being removed from the donor animal, the livers were randomised into two groups: group 1 – pre-procurement ischaemia (15 minutes\\' temporary arrest of portal venous and hepatic arterial inflow to the liver, followed by reperfusion of these vessels for a period of 15 minutes); group 2 – no prior ...

  2. Liver Transplant in Paediatrics | Popoola | Journal of the Obafemi ...

    African Journals Online (AJOL)

    Paediatric liver transplantation is a very interesting and challenging field. In the past 2 decades, it has become widely accepted as an established therapeutic measure for managing children with end stage liver disease. Liver diseases are responsible for less than 1% of morbidity and mortality in the paediatric age group in ...

  3. Combined Heart and Liver Transplantation: The Cedars-Sinai Experience.

    Science.gov (United States)

    Reich, H J; Awad, M; Ruzza, A; De Robertis, M A; Ramzy, D; Nissen, N; Colquhoun, S; Esmailian, F; Trento, A; Kobashigawa, J; Czer, L S

    2015-11-01

    Combined heart-liver transplantation is an increasingly accepted treatment for select patients with heart and liver disease. Despite growing optimism, heart-liver transplantation remains an infrequent operation. We report our institutional experience with heart-liver transplantation. All combined heart-liver transplantations at Cedars-Sinai Medical Center from 1998-2014 were analyzed. Primary outcomes were patient and graft survival and secondary outcomes included rejection, infection, reoperation, length of stay, and readmission. There were 7 heart-liver transplants: 6 simultaneous (single donor) and 1 staged (2 donors). Median follow-up was 22.1 (IQR 13.2-48.4) months. Mean recipient age was 50.8 ± 19.5 years. Heart failure etiologies included familial amyloidosis, congenital heart disease, hypertrophic cardiomyopathy, systemic lupus erythematosus, and dilated cardiomyopathy. Preoperative left ventricular ejection fraction averaged 32.3 ± 12.9%. Five (71.4%) patients required preoperative inotropic support; 1 required mechanical circulatory support. The most common indications for liver transplant were amyloidosis and cardiac cirrhosis. Median Model for End-stage Liver Disease score was 10.0 (9.3-13.8). Six-month and 1-year actuarial survivals were 100% and 83.3%, with mean survival exceeding 4 years. No patient experienced cardiac allograft rejection, 1 experienced transient liver allograft rejection, and 1 developed progressive liver dysfunction resulting in death. Five developed postoperative infections and 3 (42.9%) required reoperation. Median ICU and hospital stays were 7.0 (7.0-11.5) and 17.0 (13.8-40.5) days. There were 4 (57.1%) readmissions. For carefully selected patients with coexisting heart and liver disease, combined heart and liver transplantation offers acceptable patient and graft survival. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. The increasing burden of potentially preventable liver disease among adult liver transplant recipients: A comparative analysis of liver transplant indication by era in Australia and New Zealand.

    Science.gov (United States)

    Howell, Jessica; Balderson, Glenda; Hellard, Margaret; Gow, Paul; Strasser, Simone; Stuart, Katherine; Wigg, Alan; Jeffrey, Gary; Gane, Ed; Angus, Peter W

    2016-02-01

    Hepatitis C (HCV), hepatitis B (HBV), alcohol-related liver disease (ALD), and non-alcohol-related fatty liver disease (NAFLD) are leading indications for adult liver transplantation in Australia and New Zealand. However, these diseases are potentially preventable through effective primary and/or secondary prevention strategies. This study evaluates the relative contribution of potentially preventable liver diseases to liver transplant numbers in Australia and New Zealand over time. Prospectively recorded clinical, demographic, and outcome data were collected from the Australian and New Zealand Liver Transplant Registry for all primary adult liver transplants performed in Australia and New Zealand from 1 January 1985 until 31 December 2012. Potentially preventable liver disease was defined as HBV, HCV, NAFLD, ALD, and HCC. The etiology of liver disease leading to liver transplantation and the proportion of preventable liver disease-related liver transplantation was compared between Era 1 (1985-1993), Era 2 (1994-2003), and Era 3 (2004-2012). Overall, 1252 of 3266 adult primary liver transplants (38.3%) were performed for potentially preventable liver disease. There was a significant increase in the proportion of liver transplants because of preventable liver disease from 21.2% (93 of 439) in Era 1, to 49.8% (623 of 1252) in Era 2 and 63.5% (1000 of 1575) in Era 3 (P New Zealand have been because of potentially preventable liver diseases and the prevalence of these diseases has increased over time. This finding represents an opportunity for clinicians to make a significant impact on the overall burden of advanced liver disease in Australia and New Zealand by improving primary and secondary prevention measures. © 2015 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  5. Living donor liver transplantation with hyperreduced left lateral segments.

    Science.gov (United States)

    Kasahara, Mureo; Fukuda, Akinari; Yokoyama, Satoshi; Sato, Shuichi; Tanaka, Hideaki; Kuroda, Tatsuo; Honna, Toshiro

    2008-08-01

    Liver transplantation is now an established technique to treat children with end-stage liver disease. Implantation of left lateral segment grafts (Couidaud's segments II and III) can be a problem in small infants because of a large-for-size graft. Reduced left lateral segmental liver transplantation has been recently introduced for small infants to mitigate the problem of large-for-size graft. Further reduction of the left lateral segment graft increases the possibility of supplying an adequate hyperreduced left lateral segment graft as an alternative surgical technique. We report 3 cases of our experience of transplantation using hyperreduced left lateral segment grafts from living donors.

  6. CRRT Regional Anticoagulation Using Citrate in the Liver Failure and Liver Transplant Population.

    Science.gov (United States)

    Wonnacott, Rob; Josephs, Brandi; Jamieson, Jill

    2016-01-01

    Regional citrate for continuous renal replacement therapy (CRRT) use in patients with liver failure or post-liver transplant has been considered a contraindication because of the risk of citrate toxicity development. Regional citrate has the benefit of decreased bleeding risks over systemic anticoagulation; therefore, it is of great benefit to the coagulopathic and surgical populations. This article analyzes current empiric data and compares with a case study specifically related to liver failure, liver transplant, and CRRT use. We found that the use of a total serum to ionized calcium ratio was much more reliable in measuring liver function than liver enzyme figures. This when paired with a citrate-reduction guideline based on serum to ionized calcium ratios provided effective, early management of citrate toxicity. Using new measurements to calculate liver metabolism of citrate and using a new citrate-reducing guideline allow the bedside practitioner to use regional citrate anticoagulation in patients with liver failure and liver transplant who require CRRT.

  7. Liver transplantation in the Nordic countries - An intention to treat and post-transplant analysis from The Nordic Liver Transplant Registry 1982-2013

    DEFF Research Database (Denmark)

    Fosby, Bjarte; Melum, Espen; Bjøro, Kristian

    2015-01-01

    AIM AND BACKGROUND: The Nordic Liver Transplant Registry (NLTR) accounts for all liver transplants performed in the Nordic countries since the start of the transplant program in 1982. Due to short waiting times, donor liver allocation has been made without considerations of the model of end...... at the end of 2013 for 6019 patients out of whom 5198 were transplanted. Data for recipient and donor characteristics and relevant end-points retransplantation and death are manually curated on an annual basis to allow for statistical analysis and the annual report. RESULTS: Primary sclerosing cholangitis......, acute hepatic failure, alcoholic liver disease, primary biliary cirrhosis and hepatocellular carcinoma are the five most frequent diagnoses (accounting for 15.3%, 10.8%, 10.6%, 9.3% and 9.0% of all transplants, respectively). Median waiting time for non-urgent liver transplantation during the last 10...

  8. Quality of life after liver transplantation with old donor graft

    Directory of Open Access Journals (Sweden)

    Maria José Nascimento Flor

    2016-06-01

    Full Text Available Objective: to compare the quality of life of liver transplant patients who received liver from donor aged ≤60 or >60 years old. Methods: a prospective study with a sample of 141 recipients from liver donors aged equal to or less than 60 years and recipients of elderly donor liver, in a reference center. Authors used a tool for identification and the Short Form-36. The Student-t and Mann-Whitney tests were applied for comparison between groups. Results: there were higher levels of quality of life with a statistically significant difference: Group A in social aspect (p=0.02 and Group B >50 months of transplantation (p=0.05 in physical component summary. Conclusion: the quality of life of liver receptors from older donor livers was similar to those who received a graft from younger donors in most dimensions. Transplanting time had a positive impact on the quality of life of elderly recipients.

  9. Addressing geographic disparities in liver transplantation through redistricting.

    Science.gov (United States)

    Gentry, S E; Massie, A B; Cheek, S W; Lentine, K L; Chow, E H; Wickliffe, C E; Dzebashvili, N; Salvalaggio, P R; Schnitzler, M A; Axelrod, D A; Segev, D L

    2013-08-01

    Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90-day transplant rates range from 18% to 86% and death rates range from 14% to 82% across donation service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimized maps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28 063 liver transplant candidates, and 242 727 Model of End-Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p = 0.021), although it would decrease waitlist deaths (from 1368 to 1329, p = 0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p = 0.002) while achieving a larger decrease in waitlist deaths (to 1307, p = 0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

  10. SINGLE-CENTER EXPERIENCE OF ABO-INCOMPATIBLE LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2011-01-01

    Full Text Available Since 2008 up to 2010 eight ABO-incompatible liver transplantations have been performed in our center: one of them was urgent liver transplantation to adult patient from deceased donor, other seven were transplantations of left lateral segment to children from living relative donors. Own experience, as well as world one, proves, that barrier of ABO-incompatibility can be overcome more successfully in liver transplantation, particularly in pediatric population, that in other solid organs transplantation. Good results can be achieved even with less ag- gressive immunosuppressive therapy. Recipient conditioning before operation can significantly improve results of ABO-incompatible liver transplantation, but as own experience has shown, often there’s no need to hold some special preparation of children, because their anti-ABO antibodies are very low or absent before transplantation and do not increase after it. Thereby ABO-incompatible liver transplantation is reasonable in urgent cases and in pediatric population because of the limited pull of living relative donors for children. 

  11. Repeated transplantation of hepatocytes prevents fulminant hepatitis in a rat model of Wilson's disease.

    Science.gov (United States)

    Sauer, Vanessa; Siaj, Ramsi; Stöppeler, Sandra; Bahde, Ralf; Spiegel, Hans-Ullrich; Köhler, Gabriele; Zibert, Andree; Schmidt, Hartmut H J

    2012-02-01

    The outcome of consecutive hepatocyte transplants was explored in a rat model of Wilson's disease before the onset of fulminant hepatitis without preconditioning regimens. Rats received a high-copper diet in order to induce a rapid induction of liver failure. Sham-operated rats (15/15) developed jaundice and fulminant hepatitis, and they died within 4 weeks of first transplantation. Despite the continuation of a high dietary copper challenge, long-term survival was observed for a notable proportion of the transplanted animals (7/18). All survivors displayed normalized levels of hepatitis-associated serum markers and ceruloplasmin oxidase activity by posttransplant days 50 and 98, respectively. The liver copper concentrations, the liver histology, and the expression of marker genes were significantly restored within 4 months of transplantation in comparison with the control group. The high expression of a copper transporter gene (ATPase Cu++ transporting beta polypeptide) in the livers of the survivors indicated a high rate of repopulation by donor hepatocytes. Our data suggest that repeated cell transplantation can overcome the limitations of a single therapy session in rats with severe hepatic disease by functionally restoring the host liver without preconditioning. Copyright © 2011 American Association for the Study of Liver Diseases.

  12. New Insights in Recurrent HCV Infection after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Shih-Hsien Hsu

    2013-01-01

    Full Text Available Hepatitis C virus (HCV is a small-enveloped RNA virus belonging to the Flaviviridae family. Since first identified in 1989, HCV has been estimated to infect 170 million people worldwide. Mostly chronic hepatitis C virus has a uniform natural history, from liver cirrhosis to the development of hepatocellular carcinoma. The current therapy for HCV infection consists of a combination of Pegylated interferon and ribavirin. On the other hand, HCV-related liver disease is also the leading indication for liver transplantation. However, posttransplant HCV re-infection of the graft has been reported to be universal. Furthermore, the graft after HCV re-infection often results in accelerated progression to liver failure. In addition, treatment of recurrent HCV infection after liver transplantation is often compromised by enhanced adverse effects and limited efficacy of interferon-based therapies. Taken together, poor outcome after HCV re-infection, regardless of grafts or recipients, poses a major issue for the hepatologists and transplant surgeons. The aim of this paper is to review several specific aspects regarding HCV re-infection after transplant: risk factors, current therapeutics for HCV in different stages of liver transplantation, cellular function of HCV proteins, and molecular mechanisms of HCV entry. Hopefully, this paper will inspire new strategies and novel inhibitors against recurrent HCV infection after liver transplantation and greatly improve its overall outcome.

  13. Pregnancy and delivery in a parturient with liver transplant

    Directory of Open Access Journals (Sweden)

    A V Pyregov

    2013-01-01

    Full Text Available The article presents a case of successful spontaneous vaginal delivery with the use of epidural analgesia in a patient with orthotopic liver transplant. The importance of the multidisciplinary approach is highlighted in management of such cases.

  14. Predictive factors for portal fibrosis in pediatric liver transplant recipients

    NARCIS (Netherlands)

    Peeters, PMJG; Sieders, E; van der Heuvel, M; Bijleveld, CMA; de Jong, KP; TenVergert, EM; Slooff, MJH; Gouw, ASH

    2000-01-01

    Background, Recent histopathological studies showed an unexpected high incidence of pathological changes in asymptomatic survivors after pediatric liver transplantation. The aim of this study was to analyze the occurrence of histological abnormalities, to assess the clinical significance, and to

  15. Cyclosporin versus tacrolimus as primary immunosuppressant after liver transplantation

    DEFF Research Database (Denmark)

    McAlister, V C; Haddad, E; Renouf, E

    2006-01-01

    A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were...

  16. [Portal perfusion with right gastroepiploic vein flow in liver transplant].

    Science.gov (United States)

    Mendoza-Sánchez, Federico; Javier-Haro, Francisco; Mendoza-Medina, Diego Federico; González-Ojeda, Alejandro; Cortés-Lares, José Antonio; Fuentes-Orozco, Clotilde

    Liver transplantation in patients with liver cirrhosis, portal vein thrombosis, and cavernous transformation of the portal vein, is a complex procedure with high possibility of liver graft dysfunction. It is performed in 2-19% of all liver transplants, and has a significantly high mortality rate in the post-operative period. Other procedures to maintain portal perfusion have been described, however there are no reports of liver graft perfusion using right gastroepiploic vein. A 20 year-old female diagnosed with cryptogenic cirrhosis, with a Child-Pugh score of 7 points (class "B"), and MELD score of 14 points, with thrombosis and cavernous transformation of the portal vein, severe portal hypertension, splenomegaly, a history of upper gastrointestinal bleeding due to oesophageal varices, and left renal agenesis. The preoperative evaluation for liver transplantation was completed, and the right gastroepiploic vein of 1-cm diameter was observed draining to the infrahepatic inferior vena cava and right suprarenal vein. An orthotopic liver transplantation was performed from a non-living donor (deceased on January 30, 2005) using the Piggy-Back technique. Portal vein perfusion was maintained using the right gastroepiploic vein, and the outcome was satisfactory. The patient was discharged 13 days after surgery. Liver transplantation was performed satisfactorily, obtaining an acceptable outcome. In this case, the portal perfusion had adequate blood flow through the right gastroepiploic vein. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  17. Primary amyloidosis with spontaneous splenic rupture, cholestasis, and liver failure treated with emergency liver transplantation.

    Science.gov (United States)

    Sandberg-Gertzén, H; Ericzon, B G; Blomberg, B

    1998-11-01

    A 61-yr-old man with cholestatic jaundice soon after presentation had an emergency operation because of spontaneous rupture of the spleen. This was found to be caused by primary systemic amyloidosis. After the splenectomy, the patient deteriorated with liver failure and was successfully treated with liver transplantation. Osteopenic fractures of the thoracic columna developed after transplantation. Except for this, the patient is well 18 months after transplantation.

  18. Liver transplantation in Jehovah's Witnesses: two cases report

    OpenAIRE

    Jeong, Ju-Young; Jee, Hyeon Sook; Koo, Bon-Sung; Cho, Sung-Hwan; Kim, Sang-Hyun; Kim, Gaabsoo

    2016-01-01

    Liver transplantation is especially challenging in patients who are Jehovah's Witnesses because their religious beliefs prohibit the receipt of blood products. We present two cases of living donor liver transplantation performed in adult Jehovah's Witnesses in South Korea without the use of blood products. In the first case, preoperative erythropoiesisstimulation therapy increased hemoglobin levels from 8.1 to 13.1 g/dl after 9 weeks. In the second case, hemoglobin levels increased from 7.4 t...

  19. Challenging hepatitis C-infected liver transplant patients

    Directory of Open Access Journals (Sweden)

    Oliver M

    2016-01-01

    Full Text Available Madeleine Oliver,1 Christopher Chiodo Ortiz,2 Jorge Ortiz31University of Toledo College of Medicine, Toledo, OH, 2Bucknell University, Lewisburg, PA, 3Department of Transplant Surgery, University of Toledo Medical Center, Toledo, OH, USA Abstract: Caring for liver transplant patients suffering from chronic hepatitis C virus (HCV infection is a challenging task for transplant surgeons and primary physicians alike. HCV is the leading cause of liver transplantation in the USA and comes with a myriad of complications that increase morbidity and mortality. This review focuses on patient follow-up, spanning from before the liver transplant occurs to the patient's long-term health. Pretransplant, both donor and recipient variables, must be carefully chosen to ensure optimal surgical success. Risk factors must be identified and HCV viral load must be reduced to a minimum. In addition to standard transplant complications, HCV patients suffer from additional problems, such as fibrosing cholestatic hepatitis and widespread viremia. Physicians must focus on the balance of immunosuppressive and antiviral medications, while considering possible side effects from these potent drugs. Over the years following surgery, physicians must identify any signs of failing liver health, as HCV-positive patients have an increased risk for cirrhosis and certain life-threatening malignancies. Keywords: liver transplant, hepatitis C virus, postoperative, cirrhosis, donor and recipient variables, viremia

  20. [Epidemiology of infections after liver transplantation in children].

    Science.gov (United States)

    Pawłowska, J

    2001-01-01

    One of the most important problems after solid organ transplantation including liver, remains infections. Multiple risk factors play a role among which the most important are: general patients health before transplantation, prolong operative time, graft function and type of immunosuppression. The most important problems with bacterial, fungal and viral infections was described as well as treatment and profilaxis.

  1. Alteration of Brain Oxygenation During "Piggy Back" Liver Transplantation

    Science.gov (United States)

    Panzera, Piercarmine; Greco, Luigi; Carravetta, Giuseppe; Gentile, Antonella; Catalano, Giorgio; Cicco, Giuseppe; Memeo, Vincenzo

    Relevant changes in cerebral circulation occur during "Piggy Back" liver transplantation. Particularly at the washout-reperfusion time the cerebral perfusion suddenly changes from its lowest to its highest values. Further investigation is required to evaluate whether patients with the greatest change in cerebral oxygenation at this time point will suffer neurological complications after transplantation.

  2. Hypoalbuminaemia in brain-dead donors for liver transplantation

    African Journals Online (AJOL)

    Nicky

    We retrospectively reviewed the charts of the 37 brain-dead patients referred to the organ transplant unit at Groote. Schuur Hospital in 2001 and 2002 as potential donors for liver transplantation. All potential donors were assessed, investigated and man- aged according to standard protocols. The assessment con- sisted of ...

  3. [Evaluation of quality of life in patients with liver transplant].

    Science.gov (United States)

    Mendoza-Sánchez, Federico; Ramírez-González, Luis Ricardo; Reyes-Cruz, Alan Alejandro; González-Ojeda, Alejandro; Hernández-Machuca, Joel Sealtiel; Fuentes-Orozco, Clotilde

    2016-01-01

    Complications in patients with liver transplant may occur in less than 10 % of cases. These appear in short and/or long term and are due to a vascular or biliary cause, rejection, recurrence of the disease or adverse effects of immunosuppression, among others, which may affect the quality of life. The aim of this article is to evaluate the quality of life in patients with deceased donor liver transplantation through the questionnaire SF-36. A descriptive cross-sectional study. The quality of life of patients with deceased donor liver transplantation was assessed during the period from January 1, 2005 to December 31, 2012. The variables evaluated were: age, sex, time and main reason for transplantation and quality of life using the short form SF-36 version 1.1 for Mexican population. 37 patients were included. The mean age was 48.7 years. The most frequent cause was cirrhosis (n = 35). The highest average score corresponded to the mental health component, and the lowest score to the physical component. The average time of liver transplantation was 6.73 ± 3.53 years. Liver transplantation is still the most effective treatment for end-stage liver disease. It can increase the patient's life expectancy and their quality of life, assessed with the SF-36 questionnaire. The results were similar to those in other studies in both the physical and mental component.

  4. Liver transplantation for propionic acidemia in children.

    Science.gov (United States)

    Vara, Roshni; Turner, Charles; Mundy, Helen; Heaton, Nigel D; Rela, Mohammed; Mieli-Vergani, Giorgina; Champion, Mike; Hadzic, Nedim

    2011-06-01

    Propionic acidemia (PA) is a rare inherited disorder of branched chain amino acid metabolism; despite improvements in conventional medical management, the long-term outcome remains disappointing. Liver transplantation (LT) has been proposed to minimize the risk of further metabolic decompensations and to improve the quality of life. We performed a retrospective review of all children with PA who underwent LT between 1987 and 2008. Five children were identified with a median age of 1.2 years (range = 0.7-4.1 years) at referral. Four of the children presented clinically at 3 weeks of age or less, and 1 child was diagnosed prenatally. All had metabolic acidosis and hyperammonemia. Two had seizures and required intensive care; this care included inotropic support and continuous venovenous hemofiltration in 1 child. The children were considered for elective LT for the following reasons: frequent metabolic decompensations (2), previous sibling death (2), and elective management (1). One child underwent auxiliary LT, and 4 children received orthotopic grafts (1 living related graft). The median age at LT was 1.5 years (range = 0.8-7.0 years). There was 1 retransplant 3 months after LT due to hepatic artery thrombosis. One year after LT, 1 patient suffered a metabolic stroke with minimal residual neurology. After a median follow-up of 7.3 years (range = 2.2-15.0 years), all the children had normal graft function and a good quality of life with a protein-unrestricted diet and no further metabolic decompensations. In conclusion, LT has a role in the management of PA: it reduces the risk of metabolic decompensation and improves the quality of life. The potential for the development of metabolic sequelae is not completely eliminated. Copyright © 2011 American Association for the Study of Liver Diseases.

  5. Combined liver and kidney transplantation in Guangzhou, China.

    Science.gov (United States)

    Zhu, Xiao-Feng; He, Xiao-Shun; Chen, Gui-Hua; Chen, Li-Zhong; Wang, Chang-Xi; Huang, Jie-Fu

    2007-12-01

    When liver or kidney transplant can respectively cure end-stage liver or kidney disease, neither hepatic graft nor renal transplant alone can be used as a radical therapy for diseases which involve both liver and kidney. Combined liver and kidney transplantation commenced late in China, and the number of transplants has been limited. This study was designed to assess the effects of simultaneous combined liver and kidney transplantation (SLKT) on end-stage liver and kidney diseases. Fifteen patients who had received SLKT from 1996 to 2006 in the First Affiliated Hospital of Sun Yat-Sen University were reviewed. They included 5 patients with polycystic liver and kidney, 5 patients with hepatic cirrhosis and renal failure, and 5 patients with fulminant hepatic failure and hepatorenal syndrome (11 men and 4 women; average age 43.5 years). All patients had combined liver and kidney transplantation. The 5 patients with polycystic liver and kidney have survived for more than one year after SLKT, and the longest survival has been 5 years. Three of the 5 patients with hepatic cirrhosis and renal failure have survived more than two years; one died perioperatively and the other died from recurrence of hepatitis B 18 months after the operation. Three of the 5 patients with fulminant hepatic failure and hepatorenal syndrome have survived for two years, and 2 died of multiple organ failure during the operation. SLKT is an effective therapy for end-stage liver and kidney disease but the indications of SLKT for hepatorenal syndrome should be strict. SLKT may immunologically protect the renal graft.

  6. Loss of speech after orthotopic liver transplantation.

    Science.gov (United States)

    Bronster, D J; Boccagni, P; O'Rourke, M; Emre, S; Schwartz, M; Miller, C

    1995-01-01

    Alteration of speech is a rare but distressing complication of orthotopic liver transplantation (OLT). We describe a characteristic speech disorder identified in a large series of consecutive patients undergoing OLT. Between 1988 and 1993, 525 adults underwent OLT. For all recipients with neurologic complications, we reviewed clinical findings, imaging and electrophysiologic test results, and perioperative laboratory data. Five patients (ages 23-52; UNOS status 3-4) exhibited a characteristic pattern of stuttering dysarthria, leading to complete loss of speech production, occasionally with elements of aphasia. In four of the five patients, right-sided focal seizures were subsequently noted. All cases presented within the first 10 postoperative days and improved with 1 month of cessation of cyclosporin (CyA), although halting, monotonous speech was evident to some degree in all five for up to 1 year. There was no correlation between onset of symptoms and CyA levels. None of the patients has clinical or radiologic findings suggestive of central pontine myelinolysis or akinetic mutism. EEGs and Spect scan results were consistent with dysfunction in the left frontotemporoparietal regions of the brain. A characteristic speech disorder, which may be described as cortical dysarthria or speech apraxia, occurs in approximately 1% of adults undergoing OLT. Prompt recognition of this syndrome and temporary cessation of CyA therapy may favorable affect the course.

  7. Societal reintegration following cadaveric orthotopic liver transplantation.

    Science.gov (United States)

    Kelly, Ryan; Hurton, Scott; Ayloo, Subhashini; Cwinn, Mathew; De Coutere-Bosse, Sarah; Molinari, Michele

    2016-06-01

    Studies on patients' societal reintegration following orthotopic liver transplantation (OLT) are scarce. Between September 2006 and January 2008, all adults who were alive after 3 years post OLT were included in this prospective cohort study. Validated questionnaires were administered to all candidates with the primary aim of investigating the rate of their social re-integration following OLT and potential barriers they might have encountered. Among 157 eligible patients 110 (70%) participated. Mean participants' age was 57 years (SD 11.4) and 43% were females. Prior to OLT, 75% of patients were married and 6% were divorced. Following OLT there was no significant difference in marital status. Employment rate fell from 72% to 30% post-OLT. Patients who had been employed in either low-skill or advanced-skill jobs were less likely to return to work. After OLT, personal income fell an average of 4,363 Canadian dollars (CAN$) (SD 20,733) (P=0.03) but the majority of recipients (80%) reported high levels of satisfaction for their role in society. Although patients' satisfaction post-OLT is high, employment status is likely to be negatively affected for individuals who are not self-employed. Strategies to assist recipients in returning to their pre-OLT jobs should be developed to improve patients' economical status and societal ability to recoup resources committed for OLT.

  8. Comprehensive ultrasound assessment of complications post-liver transplantation.

    Science.gov (United States)

    O'Brien, J; Buckley, A R; Browne, R

    2010-04-01

    Human liver transplantation for end-stage liver disease was first performed in 1963. Refinements in surgical technique and new immunosuppressive regimens have improved outcomes. Today, transplant patients have a 5-year survival rate of approximately 75%. Nevertheless, significant complications still occur. Ultrasonography (US), is the initial imaging modality of choice allowing bedside assessment for detection and follow-up of early and delayed graft complications, and facilitating interventional procedures. This review outlines the role of ultrasound in post-transplantation assessment. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  9. ONE HUNDRED DECEASED DONOR LIVER TRANSPLANTATIONS AT A SINGLE CENTER

    Directory of Open Access Journals (Sweden)

    S.V. Gautier

    2012-01-01

    Full Text Available There’s a report of 100 cadaveric liver transplantation performed from December 2004 to June 2011. Indication for liver transplantation, including retransplantation, technical features of surgery, postoperative complications have been described. Patient survival was significantly lower in HCV-positive and HCC recipient than in other indications. Cumulative recipient survival rate at 1, 3, 5 years is 89; 87; 87%. Cumulative graft survival rate at 1, 3, 5 years is 85; 82; 70%. Long term immunosupression and HCV-infection after transplantation are discussed. 

  10. Liver transplantation in an adolescent with acute liver failure from acute lymphoblastic leukemia.

    Science.gov (United States)

    Reddi, D M; Barbas, A S; Castleberry, A W; Rege, A S; Vikraman, D S; Brennan, T V; Ravindra, K V; Collins, B H; Sudan, D L; Lagoo, A S; Martin, A E

    2014-03-01

    The most common identifiable causes of acute liver failure in pediatric patients are infection, drug toxicity, metabolic disease, and autoimmune processes. In many cases, the etiology of acute liver failure cannot be determined. Acute leukemia is an extremely rare cause of acute liver failure, and liver transplantation has traditionally been contraindicated in this setting. We report a case of acute liver failure in a previously healthy 15-yr-old male from pre-B-cell acute lymphoblastic leukemia. He underwent liver transplantation before the diagnosis was established, and has subsequently received chemotherapy for pre-B-cell acute lymphoblastic leukemia. He is currently alive 31 months post-transplantation. The published literature describing acute lymphoblastic leukemia as a cause of acute liver failure is reviewed. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Epstein-Barr viral load before a liver transplant in children with chronic liver disease.

    Science.gov (United States)

    Shakibazad, Nader; Honar, Naser; Dehghani, Seyed Mohsen; Alborzi, Abdolvahab

    2014-12-01

    Many children with chronic liver disease require a liver transplant. These patients are prone to various infections, including Epstein-Barr virus infection. This study sought to measure the Epstein-Barr viral load by polymerase chain reaction before a liver transplant. This cross-sectional study was done at the Shiraz University of Medical Sciences, Shiraz, Iran, in 2011. All patients were aged younger than 18 years with chronic liver disease and were candidates for a liver transplant at the Shiraz Nemazee Hospital Organ Transplant Center. They had been investigated regarding their demographic characteristics, underlying disease, laboratory findings, and Epstein-Barr viral load by real-time TaqMan polymerase chain reaction. Ninety-eight patients were studied and the mean age was 6.5 ± 5.9 years. Cryptogenic cirrhosis was the most-prevalent reason for liver transplant, and the death rate before a transplant was 15%. Among the study subjects, 6 had measurable Epstein-Barr viral load by polymerase chain reaction before the transplant, and 4 of them had considerably higher Epstein-Barr viral loads (more than 1000 copies/mL). With respect to the close prevalence of posttransplant lymphoproliferative disease (6%) and the high Epstein-Barr viral load in the patients before a transplant (4%), high pretransplant Epstein-Barr viral load can be considered a risk factor for posttransplant lymphoproliferative disorder.

  12. Liver transplantation for viral hepatitis - which patients will benefit ...

    African Journals Online (AJOL)

    Liver transplantation constitutes a significant part of the hepatologist's armamentarium and has become the treatment of choice for most patients with chronic end-stage liver disease. The results continue to improve and many centres are now able to achieve 1-year survival figures in excess of 90% in selected patients.

  13. Endoscopic therapy for gastrointestinal bleeding after liver transplantation

    Directory of Open Access Journals (Sweden)

    LIU Bo

    2016-10-01

    Full Text Available Objective To investigate the clinical effect of endoscopic therapy for patients with esophagogastric variceal bleeding (EVB after liver transplantation. Methods A retrospective analysis was performed for the clinical data of 8 patients who experienced EVB after liver transplantation and underwent endoscopic therapy, especially endoscopic features. The clinical outcome was evaluated, including hemostasis rate, change in varicose veins after treatment, and short-term recurrence and bleeding rate. Results The eight patients had a mean age of 55.00(44.75-61.50 years, and the mean time from liver transplantation to bleeding was 71.50(18.75-107.25 months. As for primary diseases, 6 patients had hepatitis B cirrhosis (among whom one patient each was complicated by liver cancer, alcoholic cirrhosis, and acute liver necrosis, and three were complicated by subacute liver necrosis, one had hepatitis C cirrhosis, and one had unexplained liver cirrhosis. Of all patients, 2 underwent sclerotherapy, 6 underwent endoscopic variceal ligation, and 6 underwent tissue adhesive treatment. The endoscopic therapy achieved successful hemostasis in all patients. No patients experienced rebleeding at discharge or the 12-month follow-up visit. One patient underwent selective endoscopic therapy due to the recurrence of varices. Conclusion Gastrointestinal bleeding remains a serious complication after liver transplantation. Besides antiviral therapy, the presence of varices should be closely monitored.

  14. Sequential and simultaneous revascularization in adult orthotopic piggyback liver transplantation

    NARCIS (Netherlands)

    Polak, WG; Miyamoto, S; Nemes, BA; Peeters, PMJG; de Jong, KP; Porte, RJ; Slooff, MJH

    The aim of the study was to assess whether there is a difference in outcome after sequential or simultaneous revascularization during orthotopic liver transplantation (OLT) in terms of patient and graft survival, mortality, morbidity, and liver function. The study population consisted of 102 adult

  15. [Liver transplant in children: comments and legislative proposal].

    Science.gov (United States)

    Stagni, S; Palazzolo, C; Ferraroli, G; Capasso, G; Campagnano, G; Erenbourg, L

    1993-11-01

    Having examined the literature on this subject, the authors raise the problem of segmentary liver transplant from a liver donor to a pediatric patient. They evaluate the current Italian legislation regarding the donation of organs and on the basis of foreign experience they draft a possible amendment to the law currently in force.

  16. Acute liver failure and transplantation in children | Horslen | South ...

    African Journals Online (AJOL)

    Acute liver failure (ALF) was relatively easy to recognise in the days before liver transplantation became available as rescue therapy, because the diagnosis was based on end-stage disease manifestations such as profound coagulopathy, jaundice, encephalopathy and cerebral oedema (in a patient with no history of ...

  17. The two tales of coagulation in liver transplantation

    NARCIS (Netherlands)

    Warnaar, Nienke; Lisman, Ton; Porte, Robert J.

    Purpose of review Hemostatic alterations in cirrhosis involve molecular pathways that both promote and stabilize blood clotting and pathways that mediate clot dissolution. Orthotopic liver transplantation for end-stage liver disease historically was a long and risky procedure, accompanied by

  18. Cystic Liver Infection after Living Donor Liver Transplantation: A Case Report

    Directory of Open Access Journals (Sweden)

    Kensuke Kudou

    2014-05-01

    Full Text Available There are no reports of cystic liver infection after liver transplantation. Herein, we report a rare case of cystic liver graft infection after living donor liver transplantation (LDLT. The patient was a 24-year-old man with primary sclerosing cholangitis who underwent right lobe graft LDLT. Preoperative abdominal computed tomography (CT revealed a liver cyst at segment 8 of the donor liver. Biliary reconstruction was performed with hepaticojejunostomy. The postoperative course was uneventful until the patient developed a high fever and abdominal pain 15 months after LDLT. Abdominal contrast CT revealed abscess formation. Percutaneous drainage of the cyst was performed and purulent liquid was drained. The fever gradually subsided after treatment. On follow-up CT, the size of the infected liver cyst was decreased. Clinicians should be aware of the potential for cystic liver infection when using grafts with liver cysts, particularly when biliary reconstruction is performed with hepaticojejunostomy.

  19. Spontaneous Clearance of Hepatitis C after Liver and Renal Transplantation

    Directory of Open Access Journals (Sweden)

    CH Dale

    2009-01-01

    Full Text Available Spontaneous clearance of hepatitis C virus (HCV is rare in immunocompromised patients, such as those who have undergone organ transplantation. It has been recognized that patients receiving liver transplantation for HCV-related disease have decreased graft and patient survival compared with those transplanted for other etiologies. There is a growing trend toward treating HCV recurrence aggressively after liver transplantation. For other organ transplant recipients with concurrent HCV, treatment is not often an option, given the high rates of graft rejection and loss secondary to interferon and its immunomodulatory effects. Although spontaneous clearance of HCV has been reported in recipients of solitary liver and renal transplants, a common factor arising in these cases has been previous exposure to interferon. To date, no reports of spontaneous clearance of HCV RNA have been reported in a multiorgan transplant recipient. A case of spontaneous clearance of HCV RNA in an immunocompromised patient, within five months of simultaneous liver and kidney retransplantation is described. Importantly, this patient had no previous exposure to interferon.

  20. Present and Future of Regenerative Medicine: Liver Transplantation.

    Science.gov (United States)

    Caralt, M

    2015-10-01

    In recent years, the creation of new organs using bioengineering has been proposed as a possible solution to the shortage of organs for transplantation. After decellularization of livers, the remaining extracellular matrix can be used as scaffolds that can be reseeded with different kinds of cells. Mature hepatocytes and fetal liver cells have been used, showing viability, functionality, and differentiation into mature cells. After perfusion in a bioreactor, the seeded scaffold or liver organoid may be transplanted. However, viability of these transplanted scaffolds is poor owing to the formation of thrombosis. We analyzed the recent advances in decellularizing and recellularizing and the results after transplantation reported in the literature. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Autologous subcutaneous adipose tissue transplants improve adipose tissue metabolism and reduce insulin resistance and fatty liver in diet?induced obesity rats

    OpenAIRE

    Torres?Villalobos, Gonzalo; Hamdan?P?rez, Nashla; D?az?Villase?or, Andrea; Tovar, Armando R.; Torre?Villalvazo, Ivan; Ordaz?Nava, Guillermo; Mor?n?Ramos, Sof?a; Noriega, Lilia G.; Mart?nez?Ben?tez, Braulio; L?pez?Garibay, Alejandro; Torres?Landa, Samuel; Ceballos?Cant?, Juan C.; Tovar?Palacio, Claudia; Figueroa?Ju?rez, Elizabeth; Hiriart, Marcia

    2016-01-01

    Abstract Long?term dietary and pharmacological treatments for obesity have been questioned, particularly in individuals with severe obesity, so a new approach may involve adipose tissue transplants, particularly autologous transplants. Thus, the aim of this study was to evaluate the metabolic effects of autologous subcutaneous adipose tissue (SAT) transplants into two specific intraabdominal cavity sites (omental and retroperitoneal) after 90?days. The study was performed using two different ...

  2. Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

    Science.gov (United States)

    Kawaguchi, Yoshikuni; Sugawara, Yasuhiko; Akamatsu, Nobuhisa; Kaneko, Junichi; Tanaka, Tomohiro; Tamura, Sumihito; Aoki, Taku; Sakamoto, Yoshihiro; Hasegawa, Kiyoshi; Kokudo, Norihiro

    2014-01-01

    Although alcoholic liver disease (ALD) is regarded as a common indication for liver transplantation (LT), debatable issues exist on the requirement for preceding alcoholic abstinence, appropriate indication criteria, predictive factors for alcoholic recidivism, and outcomes following living-donor LT. In most institutions, an abstinence period of six months before LT has been adopted as a mandatory selection criterion. Data indicating that pre-transplant abstinence is an associated predictive factor for alcoholic recidivism supports the reasoning behind this. However, conclusive evidence about the benefit of adopting an abstinence period is yet to be established. On the other hand, a limited number of reports available on living-donor LT experiences for ALD patients suggest that organ donations from relatives have no suppressive effect on alcoholic recidivism. Prevention of alcoholic recidivism has proved to be the most important treatment after LT based on the resultant inferior long-term outcome of patients. Further evaluations are still needed to establish strategies before and after LT for ALD. PMID:25429319

  3. Pediatric liver transplantation: A report from a pediatric surgical unit

    Directory of Open Access Journals (Sweden)

    Sanjay Rao

    2011-01-01

    Full Text Available Background: Liver transplantation is well established worldwide as an effective treatment for end-stage liver disease in children. Acceptance in India has been slow because of considerations of cost, infections, inability to support long-term care, and non-availability of expertise. Aim: This study was designed to report our experience with pediatric liver transplantation. Materials and Methods: Twenty-eight children underwent liver transplantation. Results: Biliary atresia was the commonest indication (n = 15 followed by metabolic liver disease. Twenty-six children had living donor transplants, mothers being the donors in a majority of these. Common surgical complications included bile leaks (n = 3 and vascular problems (n = 6. Common medical complications included infections, acute rejection, and renal failure. Overall, patient survival was 71%, while that for the last 14 cases was 92%. All survivors are doing well, have caught up with physical and developmental milestones and are engaged in age appropriate activities. Conclusions: The study demonstrates the feasibility of a successful pediatric liver transplant program in our country.

  4. [Liver transplantation in Amanita phalloides poisoning--authors' experience].

    Science.gov (United States)

    Klimaszyk, Dorota; Wilczek, Leszek

    2004-01-01

    So far 5 cases of severe acute liver failure in the course of Amanita phalloides poisoning, treated in Department of Toxicology in Poznań were regarded for need of liver transplantation. In September 2001, 4 patients were directed to transplantology center: 3 adult persons were treated in Department of General Surgery and Liver Diseases, Medical University of Warsaw, and one 15-year-old boy in Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute in Warsaw. According to King's College Hospital criteria a family of three qualified for liver transplantation. 40-year-old mother died during transplantation, 41-year old father and his 15-year old son underwent operation successfully. Two years after liver transplantation these two men were admitted to Department of Toxicology in Poznań for their clinical status assessment. Based on observations made in Department of Toxicology we conclude the management of patients who meet the clinical indicators of poor prognosis should be discussed with a transplantology center in the early stage of severe acute liver failure.

  5. The importance of nutrition for pediatric liver transplant patients

    OpenAIRE

    Paw?owska, Joanna

    2016-01-01

    Pediatric liver transplantation has changed the poor prognosis for children with liver failure, some metabolic diseases and liver tumors. With the increase of survival, long-term maintenance has become a priority. Therefore, obtaining appropriate nutrition, physical growth, bone metabolism, endocrine function and psychosocial development has become one of the most important long-term objectives. This article presents an up-to-date review and recommendation of nutrition assessment, both before...

  6. The Most Frequently Cited 100 Articles in Liver Transplantation Literature.

    Science.gov (United States)

    Özbilgin, M; Ünek, T; Egeli, T; Ağalar, C; Özbilgin, Ş; Hancı, V; Ellidokuz, H; Astarcıoğlu, I

    2017-04-01

    We investigated the liver transplantation literature since 1975 and found the most frequently cited 100 articles and assessed the distribution of authors and journals of these articles. Using the advanced mode of the Institute for Scientific Information (ISI) Web of Science (WOS) search engine, the words "SU = transplantation AND TI = liver OR SU = transplantation AND TS = liver" were used to scan articles and determine the most-cited 100 articles on July 18, 2016. From 1975 to date, it appears a total of 43,369 articles were published in the field of liver transplantation in the WOS. Although the most cited article had 677 citations, the least cited article had 180 citations. The mean citation number for the 100 articles was 252.31 ± 96.75. The mean annual citation number for the articles varied from 61.55 to 5 and the mean was 15.31 ± 8.63. The most cited article was by Feng et al "Characteristics Associated With Liver Graft Failure: The Concept of a Donor Risk Index" published in the American Journal of Transplantation (677 citations). Bibliometric analysis highlights the key topics and publications that have shaped the understanding and management of liver transplantation. According to our research, this is the first study to investigate articles with most citations in the field of liver transplantation. In our study the article with the most citations was cited 677 times, whereas the 100th article was cited 180 times with a mean citation number for the 100 articles of 252.31 ± 96.75. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Antibody induction versus corticosteroid induction for liver transplant recipients

    DEFF Research Database (Denmark)

    Penninga, Luit; Wettergren, André; Wilson, Colin H

    2014-01-01

    BACKGROUND: Liver transplantation is an established treatment option for end-stage liver failure. To date, no consensus has been reached on the use of immunosuppressive T-cell specific antibody induction compared with corticosteroid induction of immunosuppression after liver transplantation....... OBJECTIVES: To assess the benefits and harms of T-cell specific antibody induction versus corticosteroid induction for prevention of acute rejection in liver transplant recipients. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register...... of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 30 September 2013 together with reference checking, citation searching, contact with trial authors and pharmaceutical companies...

  8. Ultrasonic integrated backscatter in assessing liver steatosis before and after liver transplantation.

    Science.gov (United States)

    Yang, Han-Teng; Chen, Ke-Fei; Lu, Qiang; Wei, Yong-Gang; Li, Bo; Qin, Yang; Huang, Wen-Qing

    2014-08-01

    Liver steatosis affects 20%-30% of adults. Because of the increasing gap between graft supplies and demands, livers with steatosis are frequently used in liver transplantation. But severely steatotic liver grafts are associated with a high risk of intraoperative and postoperative complications. Accurate assessment of fat content of donor livers and monitoring of the extent of steatosis in recipients are required for liver transplantation. The present study aimed to determine the correlation between liver echogenicity and fat content, and to evaluate the use of an ultrasonic integrated backscatter system (IBS) in the assessment of changes in fat content after liver transplantation. Seventy-nine consecutive patients receiving liver grafts from living donors were evaluated in our center. Of these recipients, 67 survived for more than two years and were included in this study. Each liver graft was evaluated with IBS and ultrasound before operation and the fat content was estimated. The fat content of the grafts in the recipients was again assessed with ultrasound at 18 months after surgery. A correlation was detected between each graft's IBS value and its fat content (P=0.001). The IBS value in fatty grafts with various degrees of steatosis was significantly decreased in 3 (P=0.02), 12, 15 and 18 (P=0.001) months after orthotopic liver transplantation. The IBS value returned to normal in all patients in 18 months after liver transplantation. Decreased fat content in steatotic grafts can be observed in all recipients. Ultrasonic IBS is useful in determining the steatotic degree of grafts in donors as well as in monitoring the grafts after liver transplantation.

  9. Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center

    OpenAIRE

    Echeverry Junga, Gabriel Jaime; Holguin Holguin, Alfonso José; Rodriguez-Takeuchi, Sara Yukie; Ospina, Laura; Acosta, Diana; Botero Osorio, Verónica; Thomas Pérez, Laura Sofia; Villegas Otálora, Jorge Iván; Caicedo Rusca, Luis Armando

    2017-01-01

    To describe the experience of percutaneous transhepatic cholangiography (PTC) with biliary dilatation and drainage after pediatric liver transplantation and to determine the long-term outcome of this procedure. Methods: Retrospective study from 2001 to 2013. Follow-up after treatment was also undertaken. A survival analysis was performed in patients in whom the procedure and eventual removal of the catheter were successful. Results: In all, 196 children received liver transplants; 40 of them ...

  10. Erectile dysfunction in liver transplant patients.

    Science.gov (United States)

    Huyghe, E; Kamar, N; Wagner, F; Yeung, S J; Capietto, A H; El-Kahwaji, L; Muscari, F; Plante, P; Rostaing, L

    2008-12-01

    The objectives of the study were to determine the frequency of erectile dysfunction (ED) after liver transplantation (LT) and discuss potential risk factors. Of 123 eligible LT men, 98 (79.7%) responded to a questionnaire about sexual function at a mean time posttransplant of 5.4 +/- 4.0 years (1.0-21). Erection was evaluated using the five-question international index for erectile function score, and sexual satisfaction by the patient-baseline treatment-satisfaction status (TSS) score. Questions also focused on patient perception of changes overtime. We found that after LT, the proportion of sexually inactive men decreased from 29% to 15% (p = 0.01), but the proportion of men with ED remained unchanged. The absence of sexual activity was associated with pretransplant sexual inactivity (p = 0.001), age (p = 0.008), cardiovascular disease (p = 0.03), use of diuretics (p = 0.04), anticoagulants (p = 0.001), statins (p = 0.01) and treatment for diabetes (p = 0.03). Cardiovascular disease (p = 0.05), posttransplantation diabetes (p = 0.04), alcohol abuse (p = 0.03), antidepressants (p = 0.05) and angiotensin II receptor blockers (p = 0.05) were associated with having ED after LT. Having a low TSS score was associated with a history of endocrine disease (p = 0.03), antidepressants (p = 0.04) and diuretics (p = 0.03). In conclusion, LT improves sexual activity, but ED is multifactorial and remains a long-term condition in the majority of patients.

  11. Immunosupression in liver transplant for hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Juan Carlos Restrepo Restrepo

    2007-02-01

    Full Text Available

    The hepatocellular carcinoma (HCC has turned into a frequent indication for liver transplant. The reports of different series indicate that it represents at least 12% of all liver transplants in Europe. But what kind of inmunosuppression is better in these patients is an unanswered question. Our intension with this review is to give basic information to define which would be the best immunosuppression alternative. There is enough information on the relationship between immunosuppression and cancer, as it is seen in states of primary immunodeficiency or infection with the Human Immunodeficiency virus (HIV. The immune system offers a state of permanent guard to avoid the arousal of neoplasic diseases in immunocompetent patients and from this point of view it has been seen that in immunosuppressed patients there is an association with this condition and the development of lymphoproliferative disorders, which can range from reversible diseases (polyclonal proliferation of B type lymphocytes to the development of a lymphoma and other types of tumors, like the ones observed in skin, genital region or oropharynx. Colon tumors and breast tumors have not been associated with immunosuppression. Immunosuppressive medication takes part in a different manner in the development of tumors, it has been said that steroids that are associated with some tumors, especially those regarding skin, paradoxically have a protective role in the development of lymph tissue tumors.

    It has been said about Azathioprine and Mycophenolate mofetil (MMF that its immunosuppressive effect is an antiproliferative type of immunosuppression, inhibiting the synthesis of purinic nucleotides, especially in lymphocytes. Azathioprine has been involved in the development of hepatic tumors, especially in the era previous

  12. Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome after Liver Transplant.

    Science.gov (United States)

    Gitto, Stefano; Villa, Erica

    2016-04-02

    Liver transplant is the unique curative therapy for patients with acute liver failure or end-stage liver disease, with or without hepatocellular carcinoma. Increase of body weight, onset of insulin resistance and drug-induced alterations of metabolism are reported in liver transplant recipients. In this context, post-transplant diabetes mellitus, hyperlipidemia, and arterial hypertension can be often diagnosed. Multifactorial illnesses occurring in the post-transplant period represent significant causes of morbidity and mortality. This is especially true for metabolic syndrome. Non-alcoholic steatosis and steatohepatitis are hepatic manifestations of metabolic syndrome and after liver transplant both recurrent and de novo steatosis can be found. Usually, post-transplant steatosis shows an indolent outcome with few cases of fibrosis progression. However, in the post-transplant setting, both metabolic syndrome and steatosis might play a key role in the stratification of morbidity and mortality risk, being commonly associated with cardiovascular disease. The single components of metabolic syndrome can be treated with targeted drugs while lifestyle intervention is the only reasonable therapeutic approach for transplant patients with non-alcoholic steatosis or steatohepatitis.

  13. Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome after Liver Transplant

    Directory of Open Access Journals (Sweden)

    Stefano Gitto

    2016-04-01

    Full Text Available Liver transplant is the unique curative therapy for patients with acute liver failure or end-stage liver disease, with or without hepatocellular carcinoma. Increase of body weight, onset of insulin resistance and drug-induced alterations of metabolism are reported in liver transplant recipients. In this context, post-transplant diabetes mellitus, hyperlipidemia, and arterial hypertension can be often diagnosed. Multifactorial illnesses occurring in the post-transplant period represent significant causes of morbidity and mortality. This is especially true for metabolic syndrome. Non-alcoholic steatosis and steatohepatitis are hepatic manifestations of metabolic syndrome and after liver transplant both recurrent and de novo steatosis can be found. Usually, post-transplant steatosis shows an indolent outcome with few cases of fibrosis progression. However, in the post-transplant setting, both metabolic syndrome and steatosis might play a key role in the stratification of morbidity and mortality risk, being commonly associated with cardiovascular disease. The single components of metabolic syndrome can be treated with targeted drugs while lifestyle intervention is the only reasonable therapeutic approach for transplant patients with non-alcoholic steatosis or steatohepatitis.

  14. Correlation Between Liver Volumetric Computed Tomography Results and Measured Liver Weight: A Tool for Preoperative Planning of Liver Transplant

    NARCIS (Netherlands)

    Sonnemans, L.J.; Hol, J.C.; Monshouwer, R.; Prokop, M.; Klein, W.M.

    2016-01-01

    OBJECTIVES: Before liver transplant, it is necessary to know the size of the organ in advance of the procedure. We studied the correlation between liver volumetric computed tomography results and liver weight. MATERIALS AND METHODS: Postmortem volumetric computed tomography was conducted on cadavers

  15. Treatment of liver transplant recipients who have chronic hepatitis C virus infection.

    Science.gov (United States)

    Korkmaz, Murat

    2014-03-01

    Chronic hepatitis C virus infection is the most common cause of chronic liver disease and indication for liver transplant in Western countries. Viral infection may recur after transplant in most patients. The diagnosis of histologic recurrence of hepatitis C virus infection after liver transplant may be difficult and may be confused with acute cellular graft rejection. Characteristics of the recipient, donor, virus, and transplant may be associated with disease progression. Treatment of hepatitis C virus infection has a positive effect on the outcome of liver transplant. There are 3 approaches used to minimize recurrent hepatitis C virus infection after liver transplant: antiviral therapy before transplant, antiviral preventive and preemptive treatment after transplant, and treatment of established reinfection. Protease inhibitors are being evaluated in patients who have severe hepatitis C virus recurrence after liver transplant. Liver graft survival is less frequent after revision transplant. Several new drugs currently are being evaluated in clinical trials for treatment of hepatitis C virus infection.

  16. Liver transplantation in the Nordic countries – An intention to treat and post-transplant analysis from The Nordic Liver Transplant Registry 1982–2013

    Science.gov (United States)

    Fosby, Bjarte; Melum, Espen; Bjøro, Kristian; Bennet, William; Rasmussen, Allan; Andersen, Ina Marie; Castedal, Maria; Olausson, Michael; Wibeck, Christina; Gotlieb, Mette; Gjertsen, Henrik; Toivonen, Leena; Foss, Stein; Makisalo, Heikki; Nordin, Arno; Sanengen, Truls; Bergquist, Annika; Larsson, Marie E.; Soderdahl, Gunnar; Nowak, Greg; Boberg, Kirsten Muri; Isoniemi, Helena; Keiding, Susanne; Foss, Aksel; Line, Pål-Dag; Friman, Styrbjörn; Schrumpf, Erik; Ericzon, Bo-Göran; Höckerstedt, Krister; Karlsen, Tom H.

    2015-01-01

    Abstract Aim and background. The Nordic Liver Transplant Registry (NLTR) accounts for all liver transplants performed in the Nordic countries since the start of the transplant program in 1982. Due to short waiting times, donor liver allocation has been made without considerations of the model of end-stage liver disease (MELD) score. We aimed to summarize key outcome measures and developments for the activity up to December 2013. Materials and methods. The registry is integrated with the operational waiting-list and liver allocation system of Scandiatransplant (www.scandiatransplant.org) and accounted at the end of 2013 for 6019 patients out of whom 5198 were transplanted. Data for recipient and donor characteristics and relevant end-points retransplantation and death are manually curated on an annual basis to allow for statistical analysis and the annual report. Results. Primary sclerosing cholangitis, acute hepatic failure, alcoholic liver disease, primary biliary cirrhosis and hepatocellular carcinoma are the five most frequent diagnoses (accounting for 15.3%, 10.8%, 10.6%, 9.3% and 9.0% of all transplants, respectively). Median waiting time for non-urgent liver transplantation during the last 10-year period was 39 days. Outcome has improved over time, and for patients transplanted during 2004–2013, overall one-, five- and 10-year survival rates were 91%, 80% and 71%, respectively. In an intention-to-treat analysis, corresponding numbers during the same time period were 87%, 75% and 66%, respectively. Conclusion. The liver transplant program in the Nordic countries provides comparable outcomes to programs with a MELD-based donor liver allocation system. Unique features comprise the diagnostic spectrum, waiting times and the availability of an integrated waiting list and transplant registry (NLTR). PMID:25959101

  17. Natural history of hepatitis C following liver transplantation.

    Science.gov (United States)

    Rodriguez-Luna, Hector; Douglas, David D

    2004-08-01

    Currently, chronic hepatitis C virus-infection-related cirrhosis is the most common indication for liver transplantation in the USA and most parts of the world. While the incidence of new hepatitis C virus cases has decreased, the prevalence of infection will not peak until the year 2040. In addition, as the duration of infection increases, the proportion of new patients with cirrhosis will double by 2020 in an untreated patient population. If this model is correct, the projected increase in the need for liver transplantation secondary to chronic hepatitis C virus infection will place an impossible burden on an already limited supply of organs. In this article we present a comprehensive review of post-transplant hepatitis C virus infection and address the major challenges that face the transplant community. Hepatitis C virus infection recurs virtually in every post-transplant patient. Typically, serum levels of hepatitis C virus RNA increase rapidly from week 2 post-liver transplant, achieving 1-year post-liver transplant levels that are 10-20-fold greater than the mean pre-liver transplant levels. Progression of chronic hepatitis C virus is more aggressive after liver transplantation with a cumulative probability of developing graft cirrhosis estimated to reach 30% at 5 years. Approximately 10% of the patients with recurrent disease will die or require re-transplantation within 5 years post-transplantation. Interventions to prevent, improve, or halt the recurrence of hepatitis C virus infection have been evaluated by multiple small studies worldwide with similar overall rates of virological clearance of approximately 9-30%. Current consensus recommends combination therapy with pegylated interferon and ribavirin for those patients with histological recurrence of hepatitis C virus infection and fibrosis of >/= 2/4. Therapy is adjusted to tolerance and rescued with granulocyte colony-stimulating factor and erythropoietin for bone marrow suppression. The major

  18. Management of portal hypertension before and after liver transplantation.

    Science.gov (United States)

    Unger, Lukas W; Berlakovich, Gabriela A; Trauner, Michael; Reiberger, Thomas

    2018-01-01

    Orthotopic liver transplantation (OLT) represents a curative treatment option for end-stage liver disease (ESLD). Although epidemiology of ESLD has recently changed due to the rising prevalence of nonalcoholic fatty liver disease and the decreased burden of hepatitis C virus infections due to highly effective antiviral regimens, the management of portal hypertension (PHT) remains a clinical challenge in the pre- and post-OLT setting. The measurement of the hepatic venous pressure gradient represents the most reliable but invasive tool for assessment of the severity of PHT. Although novel liver ultrasound and magnetic resonance-based elastography methods have been developed, their value to screen for liver fibrosis and PHT in transplanted patients remains to be established. Nonselective beta-blockers represent the cornerstone of medical treatment of PHT, but more studies on their effects on clinical endpoints after OLT are needed. Statins are widely used to treat hyperlipidemia, which is a common condition after OLT. Although a growing body of evidence suggests that statins decrease portal pressure and PHT-related complications in ESLD, studies on potential benefits of statins after OLT are lacking. Finally, transjugular intrahepatic portosystemic shunts (TIPS) are effective in decreasing PHT and seem to decrease mortality on the OLT waiting list. Moreover, TIPS does not have an impact on liver function nor complicate the transplant surgical procedures. TIPS may also be used after OLT, but the evidence is limited. In conclusion, whereas the management of PHT in patients with ESLD is based on strong evidence, further data on the value of noninvasive monitoring tools as well as on medical and invasive treatment options in the post-OLT setting are needed to improve management strategies in patients with recurrent PHT after liver transplantation. Liver Transplantation 24 112-121 2018 AASLD. © 2017 by the American Association for the Study of Liver Diseases.

  19. Adherence to immunosuppressive therapy following liver transplantation: an integrative review

    Directory of Open Access Journals (Sweden)

    Ramon Antônio Oliveira

    Full Text Available ABSTRACT Objective: to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. Method: integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched. The search period corresponded to the initial date of indexation of different bases, up to the deadline of February 10, 2015, using controlled and uncontrolled descriptors: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance and patient compliance. Results: were located 191 investigations, 10 of which met the objectives of the study and were grouped into four categories, namely: educational process and non-adherence; non-adherence related to the number of daily doses of immunosuppressive medications; detection methods for non-adherence and side effects of therapy. Conclusion: there were risk factors related to the health service, such as control and reduction of the number of doses; related to the individual, such as being male, divorced, alcohol or other substances user, exposed to low social support and being mentally ill.

  20. Management of Candida infections in liver transplant recipients: current perspectives

    Directory of Open Access Journals (Sweden)

    Lingegowda PB

    2014-07-01

    Full Text Available Pushpalatha B Lingegowda,1–3 Tan Ban Hock1,2,4,5 1Department of Infectious Diseases, Singapore General Hospital, 2DUKE-NUS Graduate Medical School, 3Yong Loo Lin School of Medicine, National University of Singapore, 4SingHealth Internal Medicine Residency Program, 5Faculty of Medicine, National University of Singapore, Singapore Abstract: Liver transplantation has emerged as a widely accepted lifesaving therapeutic option for many patients with a variety of liver diseases. Improved surgical and medical management has led to significant improvements in post-transplant survival rates with a 1 year and 5 year patient survival of 87% and 73%, respectively. A high mortality rate due to infections during the first post-transplant year persists. Invasive candidiasis is recognized as a significant problem associated with high morbidity and mortality. Recent surveillance data has helped to understand the changes in the epidemiology and the evolving trends in the use of antifungal agents for prophylaxis and treatment combined with the challenges of managing these invasive fungal infections, which has led the transplant community to explore the best management strategies. The emergence of resistant fungi and excess costs in managing these invasive fungal infections has added to the complexities of management. In this context, current perspectives in the management of Candida infections in liver transplant recipients will be reviewed. Keywords: Candida infections, management, liver transplant

  1. Antiviral Treatment for Hepatitis C Virus Infection after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Yasuhiko Sugawara

    2010-01-01

    Full Text Available A significant proportion of patients with chronic hepatitis C virus (HCV infection develop liver cirrhosis and complications of end-stage liver disease over two to three decades and require liver transplantation, however, reinfection is common and leads to further adverse events under immunosuppression. Pretransplant antiviral or preemptive therapy is limited to mildly decompensated patients due to poor tolerance. The mainstay of management represents directed antiviral therapy after evidence of recurrence of chronic hepatitis C. Combined pegylated interferon and ribavirin therapy is the current standard treatment with sustained viral response rates of 25% to 45%. The rate is lower than that in the immunocompetent population, partly due to the high prevalence of intolerability. To date, there is no general consensus regarding the antiviral treatment modality, timing, or dosing for HCV in patients with advanced liver disease and after liver transplantation. New anti-HCV drugs to delay disease progression or to enhance viral clearance are necessary.

  2. Chemotherapy or Liver Transplantation for Nonresectable Liver Metastases From Colorectal Cancer?

    DEFF Research Database (Denmark)

    Dueland, Svein; Guren, Tormod K; Hagness, Morten

    2015-01-01

    OBJECTIVE:: The primary objective was to compare overall survival (OS) in patients with colorectal cancer (CRC) with nonresectable liver-only metastases treated by liver transplantation or chemotherapy. BACKGROUND:: CRC is the third most common cancer worldwide. About 50% of patients will develop....... The reason for the large difference in OS despite similar DFS/PFS is likely different metastatic patterns at relapse/progression. Relapse in the liver transplantation group was often detected as small, slowly growing lung metastases, whereas progression of nonresectable liver metastases was observed...

  3. Aggressive Recurrence of Primary Hepatic Epithelioid Haemangioendothelioma after Liver Transplantation.

    Science.gov (United States)

    Abdoh, Qusay A; Alnajjar, Asma M; Abaalkhail, Faisal A; Al Sebayel, Mohammed; Al-Hussaini, Hussa F; Al-Hamoudi, Waleed K; Helmy, Hazem; Almansour, Mohamad; Elsiesy, Hussien A

    2016-01-01

    HEHE is a rare neoplasm of vascular origin that occurs in the liver; UNOS reported a favorable outcome after liver transplantation in 110 patients with 1-year and 5-year survival of 80% and 64%. Case Report. A 40-year-old lady presented with a three-month history of right upper abdominal pain with nausea, vomiting, and significant loss of weight associated with scleral icterus and progressive abdominal distension. Examination revealed jaundice, hepatomegaly, and ascites. Serum bilirubin was 26.5 mg/dL and ALP was 552 CT. Abdomen and pelvis showed diffuse infiltrative neoplastic process of the liver with a mass effect and stretching of the hepatic and portal veins, in addition to bile duct dilatation. Viral hepatitis markers were negative and serum alpha fetoprotein was within reference range. Liver biopsy was consistent with HEHE, with positive endothelial markers (CD31, CD34, and factor VIII-related antigen). She underwent living related liver transplantation on June 2013 and was discharged after 20 days with normal liver enzymes. Four months later, she presented with diffuse disease recurrence. Liver biopsy confirmed disease recurrence; she received supportive treatment and unfortunately she died 2 weeks later. Conclusion. HEHE can have rapid and aggressive recurrence after liver transplantation.

  4. Aggressive Recurrence of Primary Hepatic Epithelioid Haemangioendothelioma after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Qusay A. Abdoh

    2016-01-01

    Full Text Available HEHE is a rare neoplasm of vascular origin that occurs in the liver; UNOS reported a favorable outcome after liver transplantation in 110 patients with 1-year and 5-year survival of 80% and 64%. Case Report. A 40-year-old lady presented with a three-month history of right upper abdominal pain with nausea, vomiting, and significant loss of weight associated with scleral icterus and progressive abdominal distension. Examination revealed jaundice, hepatomegaly, and ascites. Serum bilirubin was 26.5 mg/dL and ALP was 552 CT. Abdomen and pelvis showed diffuse infiltrative neoplastic process of the liver with a mass effect and stretching of the hepatic and portal veins, in addition to bile duct dilatation. Viral hepatitis markers were negative and serum alpha fetoprotein was within reference range. Liver biopsy was consistent with HEHE, with positive endothelial markers (CD31, CD34, and factor VIII-related antigen. She underwent living related liver transplantation on June 2013 and was discharged after 20 days with normal liver enzymes. Four months later, she presented with diffuse disease recurrence. Liver biopsy confirmed disease recurrence; she received supportive treatment and unfortunately she died 2 weeks later. Conclusion. HEHE can have rapid and aggressive recurrence after liver transplantation.

  5. [Living related liver transplantation - analysis of the first 102 cases].

    Science.gov (United States)

    Pawłowska, Joanna; Kaliciński, Piotr; Jankowska, Irena; Teisseyre, Mikołaj; Teisseyre, Joanna; Kamińska, Diana; Nachulewicz, Paweł; Markiewicz-Kijewska, Małgorzata; Socha, Jerzy

    2007-01-01

    of the study was to analyse the first 102 living-related liver transplantations performed in Poland at the Children's Memorial Health Institute. between November 1999 and January 2007 102 living-related liver transplantations were carried out in 101 patients. In 63 the patients the indication for liver transplantation was biliary atresia, in 7 - intrahepatic cholestasis, in 11 - acute liver failure, in 9 - hepatic tumour, in two - graft insufficiency. The remaining indications included hepatic cirrosis in course of cystic fibrosis, Caroli disease and biliary cysts. There were 61 girls and 40 boys aged from 4 months to 11 years (mean 2.5 years). The body weight ranged from 4.5 to 31 kg (mean 12 kg). eighty seven children are alive (86%). Five died in the early posttranplant period (between 2 and 11 days after operation), 9 died in the later period (from 36 days to 5 years and 10 months after the operation). The most serious, life threatening early and late complications were bacterial infections. The most frequent scheme of immunosuppressive treatment was tacrolimus and corticosteroids (64%) and tacrolimus and mycophenolate mofetil (16%). living-related liver transplantation is an effective method of treatment of acute and end-stage liver diseases in children with low body mass.

  6. Contrast-enhanced ultrasound (CEUS) prediction of focal liver lesions in patients after liver transplantation in comparison to histopathology results.

    Science.gov (United States)

    Rübenthaler, J; Paprottka, K J; Hameister, E; Hoffmann, K; Joiko, N; Reiser, M; Rjosk-Dendorfer, R; Clevert, D A

    2017-01-01

    To investigate the value of contrast-enhanced ultrasound (CEUS) in histologic prediction of focal liver lesions after liver transplantation. 10 focal liver lesions in 10 patients after liver transplantation were scanned using CEUS and the CEUS results were compared with the histopathological results. Among 10 focal liver lesions, 7 proofed to be histopathological benign and 3 lesions proofed to be histopathological malignant. All lesions (100%) were correctly report as benign or malignant in the report of the CEUS examination. CEUS can be helpful in the differentiation of benign and malignant focal liver lesions in patients after liver transplantation and can be used in clinical management of focal liver lesions.

  7. Single liver lobe repopulation with wildtype hepatocytes using regional hepatic irradiation cures jaundice in Gunn rats.

    Directory of Open Access Journals (Sweden)

    Hongchao Zhou

    Full Text Available BACKGROUND AND AIMS: Preparative hepatic irradiation (HIR, together with mitotic stimulation of hepatocytes, permits extensive hepatic repopulation by transplanted hepatocytes in rats and mice. However, whole liver HIR is associated with radiation-induced liver disease (RILD, which limits its potential therapeutic application. In clinical experience, restricting HIR to a fraction of the liver reduces the susceptibility to RILD. Here we test the hypothesis that repopulation of selected liver lobes by regional HIR should be sufficient to correct some inherited metabolic disorders. METHODS: Hepatocytes (10(7 isolated from wildtype F344 rats or Wistar-RHA rats were engrafted into the livers of congeneic dipeptidylpeptidase IV deficient (DPPIV(- rats or uridinediphosphoglucuronateglucuronosyltransferase-1A1-deficient jaundiced Gunn rats respectively by intrasplenic injection 24 hr after HIR (50 Gy targeted to the median lobe, or median plus left liver lobes. An adenovector expressing hepatocyte growth factor (10(11 particles was injected intravenously 24 hr after transplantation. RESULTS: Three months after hepatocyte transplantation in DPPIV(- rats, 30-60% of the recipient hepatocytes were replaced by donor cells in the irradiated lobe, but not in the nonirradiated lobes. In Gunn rats receiving median lobe HIR, serum bilirubin declined from pretreatment levels of 5.17 ± 0.78 mg/dl to 0.96 ± 0.30 mg/dl in 8 weeks and remained at this level throughout the 16 week observation period. A similar effect was observed in the group, receiving median plus left lobe irradiation. CONCLUSIONS: As little as 20% repopulation of 30% of the liver volume was sufficient to correct hyperbilirubinemia in Gunn rats, highlighting the potential of regiospecific HIR in hepatocyte transplantation-based therapy of inherited metabolic liver diseases.

  8. A shorter duration of pre-transplant abstinence predicts problem drinking after liver transplantation.

    Science.gov (United States)

    Tandon, Puneeta; Goodman, Karen J; Ma, Mang M; Wong, Winnie W; Mason, Andrew L; Meeberg, Glenda; Bergsten, Donna; Carbonneau, Michelle; Bain, Vincent G

    2009-07-01

    Liver transplantation for alcoholic liver disease (ALD) can be complicated by abusive or "problem" drinking (PD) after transplant. There are limited data for evaluating the effect of pre-transplant abstinence on post-transplant PD. Few existing studies have included a substantial number of patients with co-existing causes of hepatic dysfunction, and the effect of PD on survival in recent European studies has been controversial. We hypothesized that a longer duration of pre-transplant abstinence would lead to less PD after transplantation. Accordingly, the objectives of this study are to analyze a North American cohort of patients with ALD with or without a secondary diagnosis of liver disease to estimate (i) the incidence of PD and its predictors, as well as (ii) the effect of PD on patient survival. We conducted a retrospective review of all patients transplanted for ALD surviving for more than 3 months after transplant. PD was defined as either any drinking (AD) to the point of intoxication or drinking above the toxic threshold (>20 g/day in women and >40 g/day in men) on at least two separate occasions. We used Cox's proportional hazards regression to estimate risk ratios and Kaplan-Meier curves with log-rank analysis to compare survival. Of 213 eligible transplant patients, 42 were excluded. Of the 171 remaining patients, 78% were male; mean age was 52 years. Overall 53% of patients had co-existing causes of liver dysfunction. The mean follow-up was 64.8 months. The median pre-transplant abstinence was 19 months. In all patients, the risk of AD was 24% and PD 13%. Pre-transplant abstinence duration was the only independent predictor of PD after transplant. For every 1-month increment in pre-transplant abstinence, there was a 5% decrease in the adjusted relapse rate. There was no survival difference noted between problem drinkers and non-drinkers. The risk of PD decreased with increasing pre-transplant abstinence. Our data support pre-transplant abstinence as an

  9. Bone metabolism dynamics in the early post-transplant period following kidney and liver transplantation.

    Directory of Open Access Journals (Sweden)

    Peter W Schreiber

    Full Text Available Bone disease contributes to relevant morbidity after solid organ transplantation. Vitamin D has a crucial role for bone metabolism. Activation of vitamin D depends on the endocrine function of both, liver and kidney. Our study assessed key markers of bone metabolism at time of transplantation and 6 months after transplantation among 70 kidney and 70 liver recipients. In 70 kidney recipients 25-OH vitamin D levels did not differ significantly between peri-transplant (median 32.5nmol/l and 6 months post-transplant (median 41.9nmol/l; P = 0.272. Six months post-transplant median 1, 25-(OH2 vitamin D levels increased by >300% (from 9.1 to 36.5ng/l; P<0.001 and median intact parathyroid hormone levels decreased by 68.4% (from 208.7 to 66.0 ng/l; P<0.001. Median β-Crosslaps (CTx and total procollagen type 1 amino-terminal propeptide (P1NP decreased by 65.1% (from 1.32 to 0.46ng/ml; P<0.001 and 60.6% (from 158.2 to 62.3ng/ml; P<0.001, respectively. Kidney recipients with incident fractures had significantly lower levels of 1, 25-(OH2 vitamin D at time of transplantation and of intact parathyroid hormone 6 months post-transplant. Among 70 liver recipients, 25-OH vitamin D, 1, 25-(OH2 vitamin D and intact parathyroid hormone levels were not significantly altered between peri-transplant and 6 months post-transplant. Contrary to kidney recipients, median CTx increased by 60.0% (from 0.45 to 0.72 ng/ml; P = 0.002 and P1NP by 49.3% (from 84.0 to 125.4ng/ml; P = 0.001 in the longitudinal course. Assessed biomarkers didn't differ between liver recipients with and without fractures. To conclude, the assessed panel of biomarkers proved highly dynamic after liver as well as kidney transplantation in the early post-transplant period. After kidney transplantation a significant gain in 1, 25-(OH2 vitamin D combined with a decline in iPTH, CTx and P1NP, whereas after liver transplantation an increase in CTx and P1NP were characteristic.

  10. Delayed immune recovery following sequential orthotopic liver transplantation and haploidentical stem cell transplantation in erythropoietic protoporphyria

    NARCIS (Netherlands)

    Smiers, Frans J.; Van de Vijver, Els; Delsing, Bas J. P.; Lankester, Arjan C.; Ball, Lynne M.; Rings, Edmund H. H. M.; van Rheenen, Patrick F.; Bredius, Robbert G. M.

    A nine-yr-old boy with EPP suffered from severe skin burns and liver failure caused by progressive cholestasis and fibrosis. OLT was performed without major complications. Four months following liver transplantation he underwent parental haploidentical HSCT. The myeloablative conditioning regimen

  11. Transplantation of Thy1+Cells Accelerates Liver Regeneration by Enhancing the Growth of Small Hepatocyte-Like Progenitor Cells via IL17RB Signaling.

    Science.gov (United States)

    Ichinohe, Norihisa; Ishii, Masayuki; Tanimizu, Naoki; Kon, Junko; Yoshioka, Yusuke; Ochiya, Takahiro; Mizuguchi, Toru; Hirata, Koichi; Mitaka, Toshihiro

    2017-04-01

    Small hepatocyte-like progenitor cells (SHPCs) transiently form clusters in rat livers treated with retrorsine (Ret)/70% partial hepatectomy (PH). When Thy1 + cells isolated from d-galactosamine-treated rat livers were transplanted into the livers of Ret/PH-treated rats, the mass of the recipient liver transiently increased during the first 30 days after transplantation, suggesting that liver regeneration was enhanced. Here we addressed how Thy1 + cell transplantation stimulates liver regeneration. We found that the number and size of SHPC clusters increased in the liver at 14 days after transplantation. GeneChip analysis revealed that interleukin 17 receptor b (IL17rb) expression significantly increased in SHPCs from livers transplanted with Thy1 + cells. We subsequently searched for ligand-expressing cells and found that sinusoidal endothelial cells (SECs) and Kupffer cells expressed Il17b and Il25, respectively. Moreover, extracellular vesicles (EVs) separated from the conditioned medium of Thy1 + cell culture induced IL17b and IL25 expression in SECs and Kupffer cells, respectively. Furthermore, EVs enhanced IL17rb expression in small hepatocytes (SHs), which are hepatocytic progenitor cells; in culture, IL17B stimulated the growth of SHs. These results suggest that Thy1-EVs coordinate IL17RB signaling to enhance liver regeneration by targeting SECs, Kupffer cells, and SHPCs. Indeed, the administration of Thy1-EVs increased the number and size of SHPC clusters in Ret/PH-treated rat livers. Sixty days post-transplantation, most expanded SHPCs entered cellular senescence, and the enlarged liver returned to its normal size. In conclusion, Thy1 + cell transplantation enhanced liver regeneration by promoting the proliferation of intrinsic hepatic progenitor cells via IL17RB signaling. Stem Cells 2017;35:920-931. © 2016 AlphaMed Press.

  12. Biliary Atresia: Indications and Timing of Liver Transplantation and Optimization of Pre-Transplant Care

    Science.gov (United States)

    Sundaram, Shikha S.; Mack, Cara L.; Feldman, Amy G.; Sokol, Ronald J.

    2016-01-01

    Biliary Atresia is a progressive, fibro-obliterative disorder of the intra and extrahepatic bile ducts in infancy. The majority of affected children will eventually develop end-stage liver disease and require liver transplantation. Indications for liver transplant in biliary atresia include failed Kasai portoenterostomy, significant and recalcitrant malnutrition, recurrent cholangitis, and the progressive manifestations of portal hypertension. Extra-hepatic complications of this disease, such as hepatopulmonary syndrome and portopulmonary hypertension, are also indications for liver transplantation. Optimal pre-transplant management of these potentially life threatening complications and maximizing nutrition and growth require the expertise of a multi-disciplinary team with experience caring for biliary atresia. The timing of transplant for biliary atresia requires careful consideration of the potential risk of transplant versus the survival benefit at any given stage of disease. Children with biliary atresia often experience long wait times for transplant unless exception points are granted to reflect severity of disease. Family preparedness for this arduous process is therefore critical. PMID:27650268

  13. Internal Hernia in a Liver Transplant Recipien: A Case Report

    Directory of Open Access Journals (Sweden)

    Hironori Hayashi

    2013-01-01

    Full Text Available Biliary complications have great importance for liver transplant recipients because of affecting long-term prognosis. In rare situations, an internal hernia of the Roux-en-Y loop cause graft injury. A 42-year-old woman with a history of living donor liver transplantation 6 years ago presented with prolonged graft injury during the past 6 months. She suddenly developed ileus of the small bowel with internal hernia through the defect of the mesentery around the Roux-en-Y limb of the hepaticojejunostomy. Emergent surgery was performed to reduce the hernia and volvulus; also the mesenteric rent was closed with interrupted suture of silk. Internal hernia of the small bowel after liver transplantation is rare but causes graft injury due to associated biliary complications and rapid deterioration of patient’s condition.

  14. Cystic duct remnant mucocele in a liver transplant recipient

    Energy Technology Data Exchange (ETDEWEB)

    Ahlawat, Sushil K. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ (United States); Fishbien, Thomas M. [Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Washington, DC (United States); Haddad, Nadim G. [Georgetown University Hospital, Department of Surgery, Division of Transplant Surgery, Washington, DC (United States)

    2008-08-15

    Cystic duct remnant mucocele is an extremely rare complication of liver transplantation in children. Surgical correction is usually required for cystic duct remnant mucocele when it causes biliary obstruction. We describe a 14-month-old liver transplant recipient who presented with biliary obstruction 1 month after orthotopic liver transplantation with an end-to-end choledochocholedocal biliary anastomosis for hepatoblastoma. US, CT and cholangiography findings were consistent with mucocele of the allograft cystic duct remnant. Surgery was not needed in our patient because the mucocele and biliary obstruction had resolved on repeat imaging most likely due to guidewire manipulation during cholangiography, resulting in opening of the cystic duct remnant orifice and drainage into the common duct. (orig.)

  15. Risk factors for metabolic syndrome after liver transplantation

    DEFF Research Database (Denmark)

    Thoefner, Line Buch; Rostved, Andreas Arendtsen; Pommergaard, Hans-Christian

    2018-01-01

    that survival was not affected by metabolic syndrome. CONCLUSIONS: The prevalences of metabolic syndrome and new-onset metabolic syndrome were high after liver transplantation. Metabolic syndrome was associated with cardiovascular events, but not poorer survival. Patients with pre-transplant diabetes...... and -obesity are at high risk of metabolic syndrome and should be under careful surveillance in order to prevent, earlier diagnose, and treat metabolic syndrome and thereby limit the risk of cardiovascular events....

  16. Progressive pulmonary calcification in a child after orthotopic liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Weaver, Olena O.; Stazzone, Madelyn M.; Bhalla, Sanjeev [Washington University School of Medicine, Department of Radiology, 660 S. Euclid Ave., Campus Box 8131, St. Louis, MO (United States)

    2006-06-15

    We present a case of progressive pulmonary calcification associated with prolonged respiratory insufficiency in a 2-year-old boy with a history of orthotopic liver transplantation. This case demonstrates the potentially progressive nature of pulmonary calcification and that it can present with respiratory insufficiency at a later period after transplantation than previously thought. We describe radiological findings and discuss established as well as plausible pathological mechanisms contributing to the development of calcifications in these patients. (orig.)

  17. Differential Simultaneous Liver and Kidney Transplant Benefit Based on Severity of Liver Damage at the Time of Transplantation

    Science.gov (United States)

    Habib, Shahid; Khan, Khalid; Hsu, Chiu-Hsieh; Meister, Edward; Rana, Abbas; Boyer, Thomas

    2017-01-01

    Background We evaluated the concept of whether liver failure patients with a superimposed kidney injury receiving a simultaneous liver and kidney transplant (SLKT) have similar outcomes compared to patients with liver failure without a kidney injury receiving a liver transplantation (LT) alone. Methods Using data from the United Network of Organ Sharing (UNOS) database, patients were divided into five groups based on pre-transplant model for end-stage liver disease (MELD) scores and categorized as not having (serum creatinine (sCr) ≤ 1.5 mg/dL) or having (sCr > 1.5 mg/dL) renal dysfunction. Of 30,958 patients undergoing LT, 14,679 (47.5%) had renal dysfunction, and of those, 5,084 (16.4%) had dialysis. Results Survival in those (liver failure with renal dysfunction) receiving SLKT was significantly worse (P liver failure only). The highest mortality rate observed was 21% in the 36+ MELD group with renal dysfunction with or without SLKT. In high MELD recipients (MELD > 30) with renal dysfunction, presence of renal dysfunction affects the outcome and SLKT does not improve survival. In low MELD recipients (16 - 20), presence of renal dysfunction at the time of transplantation does affect post-transplant survival, but survival is improved with SLKT. Conclusions SLKT improved 1-year survival only in low MELD (16 - 20) recipients but not in other groups. Performance of SLKT should be limited to patients where a benefit in survival and post-transplant outcomes can be demonstrated. PMID:28496531

  18. Liver transplantation in Latin America: the state-of-the-art and future trends.

    Science.gov (United States)

    Salvalaggio, Paolo R; Caicedo, Juan C; de Albuquerque, Luiz Carneiro; Contreras, Alan; Garcia, Valter D; Felga, Guilherme E; Maurette, Rafael J; Medina-Pestana, José O; Niño-Murcia, Alejandro; Pacheco-Moreira, Lucio F; Rocca, Juan; Rodriguez-Davalos, Manuel; Ruf, Andres; Rusca, Luis A Caicedo; Vilatoba, Mario

    2014-08-15

    We reviewed the current status of liver transplantation in Latin America. We used data from the Latin American and Caribbean Transplant Society and national organizations and societies, as well as information obtained from local transplant leaders. Latin America has a population of 589 million (8.5% of world population) and more than 2,500 liver transplantations are performed yearly (17% of world activity), resulting in 4.4 liver transplants per million people (pmp) per year. The number of liver transplantations grows at 6% per year in the region, particularly in Brazil. The top liver transplant rates were found in Argentina (10.4 pmp), Brazil (8.4 pmp), and Uruguay (5.5 pmp). The state of liver transplantation in some countries rivals those in developed countries. Model for End-Stage Liver Disease-based allocation, split, domino, and living-donor adult and pediatric transplantations are now routinely performed with outcomes comparable to those in advanced economies. In contrast, liver transplantation is not performed in 35% of Latin American countries and lags adequate resources in many others. The lack of adequate financial coverage, education, and organization is still the main limiting factor in the development of liver transplantation in Latin America. The liver transplant community in the region should push health care leaders and authorities to comply with the Madrid and Istambul resolutions on organ donation and transplantation. It must pursue fiercely the development of registries to advance the science and quality control of liver transplant activities in Latin America.

  19. MELD score measured day 10 after orthotopic liver transplantation predicts death and re-transplantation within the first year

    DEFF Research Database (Denmark)

    Rostved, Andreas A; Lundgren, Jens D; Hillingsø, Jens

    2016-01-01

    OBJECTIVE: The impact of early allograft dysfunction on the outcome after liver transplantation is yet to be established. We explored the independent predictive value of the Model for End-Stage Liver Disease (MELD) score measured in the post-transplant period on the risk of mortality or re-transplantation....... MATERIAL AND METHODS: Retrospective cohort study on adults undergoing orthotopic deceased donor liver transplantation from 2004 to 2014. The MELD score was determined prior to transplantation and daily until 21 days after. The risk of mortality or re-transplantation within the first year was assessed...... according to quartiles of MELD using unadjusted and adjusted stepwise Cox regression analysis. RESULTS: We included 374 consecutive liver transplant recipients of whom 60 patients died or were re-transplanted. The pre-transplant MELD score was comparable between patients with good and poor outcome, but from...

  20. Are liver transplant recipients protected against hepatitis A and B?

    Science.gov (United States)

    Andersson, D; Castedal, M; Friman, V

    2013-04-01

    Liver transplant recipients are at an increased risk for liver failure when infected with hepatitis A virus (HAV) and hepatitis B virus (HBV). Therefore, it is important to vaccinate these individuals. The aim of the study was to evaluate how well liver transplanted patients in our unit were protected against HAV and HBV infection. Furthermore we investigated the vaccination rate and the antibody response to vaccination in these liver transplanted patients. Patients liver transplanted from January 2007 until August 2010 with a posttransplant check-up during the period March-November 2010 were included (n = 51). Information considering diagnose, date of transplantation, Child-Pugh score, and vaccination were collected from the patient records. Anti-HAV IgG and anti-HBs titers in serum samples were analyzed and protective levels were registered. Of the patients 45% were protected against hepatitis A infection and 29% against hepatitis B infection after transplantation. Only 26% were vaccinated according to a complete vaccination schedule and these patients had a vaccine response for HAV and HBV of 50% and 31%, respectively. An additional 31% received ≥ 1 doses of vaccine, but not a complete vaccination and the vaccine response was much lower among these patients, stressing the importance of completing the vaccination schedule. Even when patients were fully vaccinated, they did not respond to the same degree as healthy individuals. Patients seemed to be more likely to respond to a vaccination if they had a lower Child-Pugh score, suggesting that patients should be vaccinated as early as possible in the course of their liver disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Effect of airplane transport of donor livers on post-liver transplantation survival.

    Science.gov (United States)

    Huang, Yi; MacQuillan, Gerry; Adams, Leon A; Garas, George; Collins, Megan; Nwaba, Albert; Mou, Linjun; Bulsara, Max K; Delriviere, Luc; Jeffrey, Gary P

    2016-11-07

    To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes. A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox regression. One hundred and ninety-three patients received a local donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase (mean: 45 U/L vs 84 U/L, P = 0.035), higher donor risk index (mean: 1.88 vs 1.42, P airplane transport retained significance for graft loss (HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver (P = 0.027). Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.

  2. The cost effectiveness of lung transplantation compared with that of heart and liver transplantation in the Netherlands

    NARCIS (Netherlands)

    Ouwens, JP; van Enckevort, PJ; TenVergert, EM; Bonsel, GJ; van der Bij, W; Haagsma, EB; Rutten, FFH; Slooff, MJH; Koeter, GH

    This study was performed to assess the main reasons for the unfavorable cost effectiveness of lung transplantation compared with that of heart and liver transplantation. Costs, effects, and cost-effectiveness ratios of Dutch lung, heart, and liver transplantation programs were compared. The data are

  3. [Risk factors of bacterial nosocomial infection after pediatric liver transplantation].

    Science.gov (United States)

    Zhu, H; Gao, W

    2017-08-02

    Objective: To analyze the risk factors of nosocomial infection after liver transplantation in children, so as to provide scientific evidence for the prevention and control of nosocomial infection. Method: Clinical data of 223 pediatric patients undergoing liver transplantation between January 2014 and December 2015 were analyzed retrospectively. Univariate and multivariate analyses were carried out to investigate the risk factors of infection after transplantation. Result: Totally 51 children were infected among the 223 patients, the infection rate was 22.86%(51/223). Among the 74 cases with infection, 38 were infected with the blood (included peripherally inserted central catheters) accounting for 51.35 %; and surgical site infection accounted for 21.62%, the respiratory tract infections accounted for 18.92% and the other infections accounted for 8.11%. Totally 74 strains of infectious pathogens were found in 51 cases of infected patients, including Gram-negative bacteria accounting for 48.65%, Gram-positive bacteria accounting for 44.59% and the fungus accounting for 6.76%. According to a variety of survey factors, univariate analysis showed factors of hospitalization time, hospitalization time before surgery, surgical duration, and reoperation had statistically significant association with nosocomial infection( P nosocomial infection after pediatric liver transplantation. Conclusion: There are a variety of risk factors for the postoperative infections after liver transplantation in children. It is necessary to take into account the surgery factor, medical staff factor and hospital management factor. Management strengthening of these factors is necessary to reduce the infection rate.

  4. Peritransplant energy changes and their correlation to outcome after human liver transplantation

    NARCIS (Netherlands)

    Bruinsma, Bote G; Avruch, James H; Sridharan, Gautham V; Weeder, Pepijn D; Jacobs, Marie Louise; Crisalli, Kerry; Amundsen, Beth; Porte, Robert J; Markmann, James F; Uygun, Korkut; Yeh, Heidi

    BACKGROUND: The ongoing shortage of donor livers for transplantation and the increased use of marginal livers necessitate the development of accurate pretransplant tests of viability. Considering the importance energy status during transplantation, we aimed to correlate peritransplant energy

  5. Long-term prognosis for transplant-free survivors of paracetamol-induced acute liver failure

    DEFF Research Database (Denmark)

    Jepsen, P; Schmidt, L E; Larsen, F S

    2010-01-01

    The prognosis for transplant-free survivors of paracetamol-induced acute liver failure remains unknown.......The prognosis for transplant-free survivors of paracetamol-induced acute liver failure remains unknown....

  6. Outcomes of living versus deceased donor liver transplantation for acute liver failure in the United States.

    Science.gov (United States)

    Urrunaga, N H; Rachakonda, V P; Magder, L S; Mindikoglu, A L

    2014-01-01

    Clinical outcomes for living donor liver transplantation (LDLT) for acute liver failure (ALF) in the United States remain to be determined. To address this gap in knowledge, we examined post-liver transplantation outcomes of adults with ALF undergoing LDLT and deceased donor liver transplantation (DDLT) in the United States. We analyzed Organ and Procurement and Transplantation Network data for adults with ALF who were listed for liver transplantation as status 1 or 1A and who underwent LDLT (N = 21) or DDLT (N = 2316) between October 1987 and April 2011. We found no strong evidence that the survival probabilities for adults with ALF who underwent LDLT were inferior to those who underwent DDLT (P = .764). In adults with ALF who underwent LDLT, 1- and 5-year survival probabilities were both 71%; for DDLT these probabilities were 79% and 71%, respectively. In adults with ALF, 1- and 5-year liver graft survival probabilities, respectively, were 62% and 57% for LDLT, and 74% and 66% for DDLT. In these series of adults with ALF who were listed as status 1 or 1A, patient and graft survival rates for LDLT were similar to those for DDLT. Our findings suggest that if deceased donor livers are unavailable, LDLT is an acceptable option in experienced centers for adults with ALF. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Pompili, Maurizio, E-mail: mpompili@rm.unicatt.i [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy); Pacella, Claudio Maurizio, E-mail: claudiomauriziopacella@gmail.co [Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Via S. Francesco D' Assisi, 50, 00041 Albano Laziale (RM) (Italy); Francica, Giampiero, E-mail: giampierofrancica@tin.i [Department of Interventional Ultrasound, Presidio Ospedaliero Camilliani, S. Maria della Pieta, Via S. Rocco, 9, 80026 Casoria (Namibia) (Italy); Angelico, Mario, E-mail: angelico@med.uniroma2.i [Hepatology Unit, Universita di Tor Vergata, Viale Oxford, 81, 00133 Rome (Italy); Tisone, Giuseppe, E-mail: tisone@med.uniroma2.i [Transplant and General Surgery Unit, Universita di Tor Vergata, Ospedale S. Eugenio, Piazzale dell' Umanesimo 10-00144 Rome (Italy); Craboledda, Paolo, E-mail: paolo.craboledda@virgilio.i [Department of Pathology, Ospedale S. Eugenio, Piazzale dell' Umanesimo, 10-00144 Rome (Italy); Nicolardi, Erica; Rapaccini, Gian Ludovico; Gasbarrini, Giovanni [Department of Internal Medicine, Universita Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Roma (Italy)

    2010-06-15

    Objective: The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation. Materials and methods: The data of 9 male cirrhotic patients (mean age 50 years, range 45-60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0-3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors. Results: No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule. Conclusion: In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.

  8. Succinct guide to liver transplantation for medical students

    OpenAIRE

    Ho, Cheng-Maw; Lee, Po-Huang; Cheng, Wing Tung; Hu, Rey-Heng; Wu, Yao-Ming; Ho, Ming-Chih

    2016-01-01

    Literature on liver transplantation for use in medical education is limited and as yet unsatisfactory. The aim of this article is to help medical students gain enough insight into the reality of being a liver transplant recipient. This is crucial so in the future they can feel confident in approaching these patients with adequate knowledge and confidence. The knowledge-tree based learning core topics are designed for a 2-h class including indication/contraindication in the real-world setting,...

  9. Doppler US findings of vascular complication after liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Dong Jin; Kim, Pyo Nyun; Ha, Hyun Kwon; Lee, Mun Gyu; Auh, Yong Ho [College of Medicine, University of Ulsan, Ulsan (Korea, Republic of)

    2000-02-01

    Vascular complications after liver transplantation may involve the hepatic artery, and hepatic and portal veins. Arterial complications are common and significant vascular complications include thrombosis or stenosis, as well as pseudoaneurysms. Venous complications include thrombosis or stenosis of the inferior vena cana, or hepatic or portal vein. Since recent evidence has shown that emergent revascularization leads to improved graft salvage and patient survival with a relatively low rate of late biliary complications, accurate and prompt diagnosis of hepatic arterial complications is important. Doppler US is a relatively inexpensive, accurate, and non invasive method of diagnosing the vascular complications which may arise from liver transplantation. (author)

  10. Residual amoebic liver abscess in a prospective renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Ashish V Choudhrie

    2012-01-01

    Full Text Available Amoebic liver abscess (ALA is by far the most common extraintestinal manifestation of invasive amoebiasis. The vast majority of these resolve with treatment; however, a small percentage of the treated ALAs are known to persist asymptomatically. Herein, we present a prospective renal allograft recipient with a residual liver abscess who had a successful renal transplant after treatment. In our opinion, persistence of a radiological finding of residual abscess in the absence of clinical disease does not appear to be a contraindication to renal transplantation.

  11. Clinical application of modern ultrasound techniques after liver transplantation.

    Science.gov (United States)

    Teegen, Eva Maria; Denecke, Timm; Eisele, Robert; Lojewski, Christian; Neuhaus, Peter; Chopra, Sascha Santosh

    2016-10-01

    Liver transplantation has been established as a first-line therapy for a number of indications. Conventional ultrasound and contrast-enhanced ultrasound (CEUS) are methods of choice during the postoperative period as a safe and fast tool to detect potential complications and to enable early intervention if necessary. CEUS increases diagnostic quality and is an appropriate procedure for the examination of vessels and possibly bile ducts. This article presents the state of the art of ultrasound application during the early period after liver transplantation. It addresses common vascular complications and describes the identification of postoperative abnormal findings using ultrasound and CEUS. © The Foundation Acta Radiologica 2016.

  12. Cryptococcal osteomyelitis of the skull in a liver transplant patient.

    Science.gov (United States)

    Pudipeddi, Aviv V; Liu, Ken; Watson, Geoffrey F; Davis, Rebecca J; Strasser, Simone I

    2016-12-01

    Cryptococcus neoformans is an opportunistic fungal pathogen and an important cause of morbidity and mortality in immunocompromised patients. We report a case of osteomyelitis caused by C. neoformans in a liver transplant recipient who presented with a headache and scalp lump after sustaining mild head trauma. There was no evidence of central nervous system involvement or dissemination. This is the first known case report of isolated cryptococcal osteomyelitis in a liver transplant recipient. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Intraoperative hemodynamic monitoring during liver transplantation: goals and devices

    DEFF Research Database (Denmark)

    Nissen, Peter; Frederiksen, H J; Secher, N H

    2010-01-01

    With the introduction of orthotopic liver transplantation (OLT) almost 40 years ago, changes in the cardiovascular system that manifest during the different phases of the operation combined, sometimes with massive hemorrhage in likely critically ill patients have been a challenge. Here hemodynamic...... for other categories of patients when a flow related parameter (cardiac stroke volume, cardiac output or (mixed) venous oxygen saturation) does not respond to a fluid challenge, i.e. the patient is "normovolaemic". Also the administration strategy for liver transplantation is considered with emphasis...... on haemostatic control resuscitation, i.e. balanced administration of red blood cells, plasma and platelets to massively bleeding patients....

  14. How to improve long-term outcome after liver transplantation?

    Science.gov (United States)

    Durand, François

    2018-02-01

    The outcome of liver transplantation has markedly improved in the last 3 decades. Although early post-transplantation outcomes have improved over time, this is not true of the long-term outcome. The majority of late deaths are not related to graft dysfunction, and with the advent of new antiviral agents, recurrence of hepatitis B and hepatitis C after transplantation may no longer represent a source of graft loss and patient's death in the long term. The complications of metabolic syndrome may represent an increasing source of morbidity and mortality after transplantation. This study discusses these modifiable factors associated with late mortality to improve the long-term results of transplantation. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Effects of heme oxygenase-1-modified bone marrow mesenchymal stem cells on microcirculation and energy metabolism following liver transplantation

    Science.gov (United States)

    Yang, Liu; Shen, Zhong-Yang; Wang, Rao-Rao; Yin, Ming-Li; Zheng, Wei-Ping; Wu, Bin; Liu, Tao; Song, Hong-Li

    2017-01-01

    AIM To investigate the effects of heme oxygenase-1 (HO-1)-modified bone marrow mesenchymal stem cells (BMMSCs) on the microcirculation and energy metabolism of hepatic sinusoids following reduced-size liver transplantation (RLT) in a rat model. METHODS BMMSCs were isolated and cultured in vitro using an adherent method, and then transduced with HO-1-bearing recombinant adenovirus to construct HO-1/BMMSCs. A rat acute rejection model following 50% RLT was established using a two-cuff technique. Recipients were divided into three groups based on the treatment received: normal saline (NS), BMMSCs and HO-1/BMMSCs. Liver function was examined at six time points. The levels of endothelin-1 (ET-1), endothelial nitric-oxide synthase (eNOS), inducible nitric-oxide synthase (iNOS), nitric oxide (NO), and hyaluronic acid (HA) were detected using an enzyme-linked immunosorbent assay. The portal vein pressure (PVP) was detected by Power Lab ML880. The expressions of ET-1, iNOS, eNOS, and von Willebrand factor (vWF) protein in the transplanted liver were detected using immunohistochemistry and Western blotting. ATPase in the transplanted liver was detected by chemical colorimetry, and the ultrastructural changes were observed under a transmission electron microscope. RESULTS HO-1/BMMSCs could alleviate the pathological changes and rejection activity index of the transplanted liver, and improve the liver function of rats following 50% RLT, with statistically significant differences compared with those of the NS group and BMMSCs group (P improved the activity of mitochondrial aspartate aminotransferase (ASTm) and ATPase, compared with the other two groups (P improve the microcirculation of hepatic sinusoids significantly, and recover the energy metabolism of damaged hepatocytes in rats following RLT, thus protecting the transplanted liver. PMID:28596681

  16. Adrenomedullin in liver transplantation and its relationship with vascular complications.

    Science.gov (United States)

    Fábrega, E; Crespo, J; Casafont, F; de La Peña, J; García-Unzueta, M T; Amado, J A; Pons-Romero, F

    1999-11-01

    Adrenomedullin (AM) is a potent vasodilating peptide that increases rat platelet cyclic adenosine monophosphate levels and acts on endothelial cells to stimulate nitric oxide release. Both mechanisms inhibit platelet function. Considering these effects, AM may have a role in cardiovascular regulation after orthotopic liver transplantation (OLT) and could have an antithrombotic effect. The aim of the present study is to investigate plasma AM levels in the early postoperative period after OLT and their relationship with vascular complications in OLT. We measured plasma AM levels in 35 patients with cirrhosis who underwent OLT at baseline and 1, 7, and 15 days postoperatively. We found that AM levels were significantly greater in patients with cirrhosis compared with healthy subjects. Of the 35 patients, 10 had vascular complications. In these 10 patients, AM concentrations were significantly greater than those observed in the nonthrombotic group in the early postoperative period. In addition, we also noticed in the nonthrombotic group a significant increase in AM levels from baseline to day 1, then a decrease to baseline levels in the early postoperative period. Our study shows that AM might act as a new humoral factor involved in the response to surgery in OLT and is significantly associated with vascular thrombosis in OLT.

  17. MARS therapy, the bridging to liver retransplantation - Three cases from the Hungarian liver transplant program.

    Science.gov (United States)

    Pőcze, Balázs; Fazakas, János; Zádori, Gergely; Görög, Dénes; Kóbori, László; Dabasi, Eszter; Mándli, Tamás; Piros, László; Smudla, Anikó; Szabó, Tamás; Toronyi, Eva; Tóth, Szabolcs; Tőzsér, Gellért; Végső, Gyula; Doros, Attila; Nemes, Balázs

    2013-06-01

    Besides orthotopic liver transplantation (OLT) there is no long-term and effective replacement therapy for severe liver failure. Artificial extracorporeal liver supply devices are able to reduce blood toxin levels, but do not replace any synthetic function of the liver. Molecular adsorbent recirculating system (MARS) is one of the methods that can be used to treat fulminant acute liver failure (ALF) or acute on chronic liver failure (AoCLF). The primary non-function (PNF) of the newly transplanted liver manifests in the clinical settings exactly like acute liver failure. MARS treatment can reduce the severity of complications by eliminating blood toxins, so that it can help hepatic encephalopathy (HE), hepatorenal syndrome (HRS), and the high rate mortality of cerebral herniation. This might serve as a bridging therapy before orthotopic liver retransplantation (reOLT). Three patients after a first liver transplantation became candidate for urgent MARS treatment as a bridging solution prior to reOLT in our center. Authors report these three cases, fo-cusing on indications, MARS sessions, clinical courses, and final outcomes.

  18. Bone histomorphometric changes after liver transplantation for chronic cholestatic liver disease

    NARCIS (Netherlands)

    Guichelaar, MMJ; Malinchoc, M; Sibonga, JD; Clarke, BL; Hay, JE

    2003-01-01

    Introduction: Patients with advanced liver disease, especially chronic cholestasis, often have osteopenia, which worsens early after orthotopic liver transplantation (OLT) before starting to recover. The changes in bone metabolism leading to this rapid loss of bone after OLT, and to its recovery,

  19. Right-lobe liver transplant from donors with Gilbert syndrome.

    Science.gov (United States)

    Demirbas, Tolga; Piskin, Turgut; Dayangac, Murat; Yaprak, Onur; Akyildiz, Murat; Tokat, Yaman; Yuzer, Yildiray

    2012-02-01

    Donor safety is one of the most important aspects of living-donor liver transplant. The preoperative evaluation of candidates for such transplants essentially starts with serologic and biochemical analyses. However, some potential liver donors with normal liver function test results may have isolated mild hyperbilirubinemia (serum indirect bilirubin level > 20.5 μmol/L [1.2 mg/dL]). Gilbert syndrome is an autosomal recessive condition that is a common cause of nonhemolytic unconjugated hyperbilirubinemia, and its prevalence is 3% to 10% in the healthy US population. Mild hyperbilirubinemia episodes are expected in people with Gilbert syndrome when they are exposed to physical stress, such as operative intervention or low energy intake. The liver morphologic findings of these individuals are normal; however, there is a debate on the use of people with Gilbert syndrome as living-liver donors. The purpose of this study was to assess the results of right-lobe living-donor hepatectomy of liver donors with Gilbert syndrome. Between 2004 and 2010, two hundred twenty-five living-donor liver transplants using right-lobe grafts were performed in our hospital. Donors with Gilbert syndrome were defined as those whose serum bilirubin level was greater than 20.5 μmol/L (1.2 mg/dL). Six of 225 right-lobe living-donor liver transplants were performed using donors with Gilbert syndrome. The median follow-up after transplant was 34 months (range, 18 to 51 mo). One week after the operation, the median bilirubin level for right-lobe liver donors was 34.5 μmol/L (2.02 mg/dL) (range, 17.1 to 51.3 μmol/L [1 to 3 mg/dL]), and the median prothrombin time (international normalized ratio) was 1.36 (range, 1.1 to 1.7). The median bilirubin level of the donors after 6 months was 29 μmol/L (1.7 mg/dL) (range, 20.5 to 41 μmol/L [1.2 to 2.4 mg/dL]). Living-donor liver transplant from Gilbert syndrome donors can be safely performed.

  20. Periodontal Management of a Patient Undergoing Liver Transplantation.

    Science.gov (United States)

    Clozza, Emanuele; Segelnick, Stuart L; Sigal, Samuel H; Rovner, Deborah N; Weinberg, Mea A

    2016-01-01

    This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients.

  1. Liberation From Renal Replacement Therapy After Cadaveric Liver Transplantation

    OpenAIRE

    Hilmi, Ibtesam A.; Al-Khafaji, Ali; Damian, Daniela; Rosario-Rivera, Bedda L.; Abdullah, Ali; Kellum, John A.

    2016-01-01

    Background Renal failure requiring renal replacement therapy (RRT) is common in patients with end-stage liver disease (ESLD) and is associated with worse outcomes following liver transplantation (LT). We investigated the factors associated with liberation from posttransplant RRT and studied the impact of RRT on patient and graft outcomes. Methods A 5-year retrospective study of ESLD patients who received pretransplant RRT was conducted. Variables associated with liberation from RRT at 30 days...

  2. Donor safety in living donor liver transplantation: The Korean organ transplantation registry study.

    Science.gov (United States)

    Lee, Jae Geun; Lee, Kwang-Woong; Kwon, Choon Hyuck David; Chu, Chong Woo; Kim, Bong-Wan; Choi, Dong Lak; You, Young Kyoung; Kim, Dong-Sik; Nah, Yang Won; Kang, Koo Jeong; Choi, In Soek; Yu, Hee Chul; Hong, Geun; Han, Ho-Seong; Hwang, Shin; Kim, Myoung Soo

    2017-08-01

    Major concerns about donor safety cause controversy and limit the use of living donor liver transplantation to overcome organ shortages. The Korean Organ Transplantation Registry established a nationwide organ transplantation registration system in 2014. We reviewed the prospectively collected data of all 832 living liver donors who underwent procedures between April 2014 and December 2015. We allocated the donors to a left lobe group (n = 59) and a right lobe group (n = 773) and analyzed the relations between graft types and remaining liver volumes and complications (graded using the Clavien 5-tier grading system). The median follow-up was 19 months (range, 10-31 months). During the study period, 553 men and 279 women donated livers, and there were no deaths after living liver donation. The overall, biliary, and major complication (grade ≥ III) rates were 9.3%, 1.7%, and 1.9%, respectively. The graft types and remaining liver volume were associated with significantly different overall, biliary, and major complication rates. Of the 16 patients with major complications, 9 (56.3%) involved biliary complications (2 biliary strictures [12.5%] and 7 bile leakages [43.8%]). Among the 832 donors, the mean aspartate transaminase, alanine aminotransferase, and total bilirubin levels were 23.9 ± 8.1 IU/L, 20.9 ± 11.3 IU/L, and 0.8 ± 0.4 mg/dL, respectively, 6 months after liver donation. In conclusion, biliary complications were the most common types of major morbidity in living liver donors. Donor hepatectomy can be performed successfully with minimal and easily controlled complications. Our study shows that prospective, nationwide cohort data provide an important means of investigating the safety in living liver donation. Liver Transplantation 23 999-1006 2017 AASLD. © 2017 by the American Association for the Study of Liver Diseases.

  3. Liver transplantation in polycystic liver disease: a relevant treatment modality for adults?

    DEFF Research Database (Denmark)

    Krohn, P.S.; Hillingso, J.G.; Kirkegaard, P.

    2008-01-01

    OBJECTIVE: Polycystic liver disease (PLD) is a rare, hereditary, benign disorder. Hepatic failure is uncommon and symptoms are caused by mass effects leading to abdominal distension and pain. Liver transplantation (LTX) offers fully curative treatment, but there is still some controversy about...... whether it is a relevant modality considering the absence of liver failure, relative organ shortage, perioperative risks and lifelong immunosuppression. The purpose of this study was to review our experience of LTX for PLD and to compare the survival with the overall survival of patients who underwent LTX....../kidney transplantation. One patient had undergone kidney transplantation 10 years earlier. RESULTS: Median follow-up was 55 months. One patient who underwent combined transplantation died after 5.4 months because of multiorgan failure after re-LTX, and one patient, with well-functioning grafts, died of lymphoma after 7...

  4. Proteomic analysis of tyrosine phosphorylation during human liver transplantation

    Directory of Open Access Journals (Sweden)

    Boutros Tarek

    2007-01-01

    Full Text Available Abstract Background Ischemia-reperfusion (I/R causes a dramatic reprogramming of cell metabolism during liver transplantation and can be linked to an alteration of the phosphorylation level of several cellular proteins. Over the past two decades, it became clear that tyrosine phosphorylation plays a pivotal role in a variety of important signalling pathways and was linked to a wide spectrum of diseases. Functional profiling of the tyrosine phosphoproteome during liver transplantation is therefore of great biological significance and is likely to lead to the identification of novel targets for drug discovery and provide a basis for novel therapeutic strategies. Results Using liver biopsies collected during the early phases of organ procurement and transplantation, we aimed at characterizing the global patterns of tyrosine phosphorylation during hepatic I/R. A proteomic approach, based on the purification of tyrosine phosphorylated proteins followed by their identification using mass spectrometry, allowed us to identify Nck-1, a SH2/SH3 adaptor, as a potential regulator of I/R injury. Using immunoblot, cell fractionation and immunohistochemistry, we demonstrate that Nck-1 phosphorylation, expression and localization were affected in liver tissue upon I/R. In addition, mass spectrometry identification of Nck-1 binding partners during the course of the transplantation also suggested a dynamic interaction between Nck-1 and actin during I/R. Conclusion Taken together, our data suggest that Nck-1 may play a role in I/R-induced actin reorganization, which was previously reported to be detrimental for the hepatocytes of the transplanted graft. Nck-1 could therefore represent a target of choice for the design of new organ preservation strategies, which could consequently help to reduce post-reperfusion liver damages and improve transplantation outcomes.

  5. Succinct guide to liver transplantation for medical students

    Directory of Open Access Journals (Sweden)

    Cheng-Maw Ho

    2016-12-01

    Full Text Available Literature on liver transplantation for use in medical education is limited and as yet unsatisfactory. The aim of this article is to help medical students gain enough insight into the reality of being a liver transplant recipient. This is crucial so in the future they can feel confident in approaching these patients with adequate knowledge and confidence. The knowledge-tree based learning core topics are designed for a 2-h class including indication/contraindication in the real-world setting, model for end stage liver disease scoring and organ allocation policy, liver transplantation for hepatic malignancy, transplantation surgery, immunosuppression strategy in practical consideration, and management of viral hepatitis. The rationales of each topic are discussed comprehensively for better understanding by medical students. Recipient candidates may have reversible contraindications that halt the surgery temporarily and therefore, it warrants re-evaluation before transplant. Organ allocation policy is primarily based on disease severity instead of waiting time. Transplant surgery usually involves resection of the whole liver, in situ implantation with reconstruction of the hepatic vein, the portal vein, the hepatic artery and the biliary duct in sequence. The primary goal of artificial immunosuppression is to prevent graft rejection, and the secondary one is to reduce its complication or side effects. Life-long oral nucleoside/nucleotide analogues against hepatitis virus B is needed while short course of direct acting agents against hepatitis viral C is enough to eradicate the virus. Basic understanding of the underlying rationales will help students prepare for advanced learning and cope with the recipients confidently in the future.

  6. The price of donation after cardiac death in liver transplantation : a prospective cost-effectiveness study

    NARCIS (Netherlands)

    van der Hilst, Christian S.; IJtsma, Alexander J. C.; Bottema, Jan T.; van Hoek, Bart; Dubbeld, Jeroen; Metselaar, Herold J.; Kazemier, Geert; van den Berg, Aad P.; Porte, Robert J.; Slooff, Maarten J. H.

    This study aims to perform a detailed prospective observational multicenter cost-effectiveness study by comparing liver transplantations with Donation after Brain Death (DBD) and Donation after Cardiac Death (DCD) grafts. All liver transplantations in the three Dutch liver transplant centers between

  7. Optimisation of graft function in liver transplantation: functional and metabolic aspects

    NARCIS (Netherlands)

    J. de Jonge (Jeroen)

    2002-01-01

    textabstractPart one of this thesis contains the general introduction to partial and whole liver transplantation. Chapter 2 addresses the concept of auxiliary partial liver transplantation. Auxiliary partial heterotopic liver transplantation was first introduced as a less invasive procedure for

  8. Obstructive jaundice as a long-term complication in a patient with liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Boll, D.; Thoeni, R.F.

    1981-07-15

    Obstructive jaundice related to stricture and stone in cystic duct was found in a patient 6 years after liver transplantation and cholecystojejunostomy. Complications with biliary drainage following liver transplantation are discussed. In the presence of dilated ducts seen by ultrasound, percutaneous transhepatic cholangiography performed immediately can lead to surgical correction, thus preventing failure of the liver transplant.

  9. Integrating palliative care for liver transplant candidates: "too well for transplant, too sick for life".

    Science.gov (United States)

    Larson, Anne M; Curtis, J Randall

    2006-05-10

    Chronic liver disease results in more than 1 million physician visits and more than 300,000 hospitalizations per year in the United States. More than 27,000 patients annually progress to end-stage liver disease (ESLD), liver failure, or death. Patients with ESLD experience such complications as encephalopathy, malnutrition, muscle wasting, ascites, esophagogastric variceal hemorrhage, spontaneous bacterial peritonitis, fatigue, and depression. Despite significant improvements in palliation, patients' quality of life diminishes and their disease will often inexorably progress. Liver transplantation, a valid treatment option, increases life and reduces many symptoms. With the current shortage of organs, up to 10% to 15% of these patients die without receiving an organ. Many patients also are not candidates for transplantation due to comorbid illness. In addition, some patients receive a transplant but succumb to complications of the transplant itself. Such patients and families face the conundrum of a potentially treatable yet often fatal illness. Through the case of a 55-year-old woman with a life-long history of hepatitis B virus infection who is awaiting transplant, we discuss the transplant eligibility process and the struggle with maintaining hope for a cure in the face a life-threatening illness. In all of these circumstances, the health care team must combine elements of palliative care with life-sustaining therapy to maximize the patient's quality and quantity of life.

  10. [Functional recovery in hemifacial transplants in rats].

    Science.gov (United States)

    González-García, E; Landín-Jarillo, L; Piqueras-Del Rey, A

    There are a number of different options open to the surgeon for the reconstruction of the face and scalp, but when tissue loss is very extensive, good aesthetic and functional recovery is not possible. Not only must the damaged tissues be replaced, but motor and sensorial functioning also has to be restored. To evaluate the functional recovery of hemifacial allografts in rats. Twenty-one hemifacial flaps were transplanted from Long-Evans rats to Wistar-Lewis rats, under immunosuppression monotherapy with tacrolimus. Prior to the operation, anatomical and allograft viability studies were conducted. Two groups of transplanted rats were formed: with or without nerve repair. In the nerve repair group, end-to-end suture was employed to repair the infraorbital branch of the trigeminal nerve and the buccolabial, upper mandibular marginal and zygomatico-orbital branches of the facial nerve. Sensory recovery was evaluated by filming traction of the whiskers, whereas motor recovery was assessed by blind tests using electromyography studies of the mystacial muscles and electroneurography of the facial nerve. At eight weeks, the animals were sacrificed and biopsy samples were taken from the mystacial region. The facial flap was successfully lifted in 10 cases. In the nerve repair group both clinical and electrophysiological recovery were observed at six weeks, whereas biopsy samples taken in the eighth week showed recovery of the nerve fascicles. The hemifacial flap can be transplanted. By repairing the nerves of the allograft, it is possible to achieve its functional recovery, as can be confirmed clinically, electrophysiologically and histopathologically. To date, this is the first evidence of functional recovery following a hemifacial transplant in rats.

  11. Understanding the effect of corticosteroid pretreatment in brain-dead organ donors: new mechanistic insights for improvement of organ quality in liver transplantation.

    Science.gov (United States)

    Dahrenmöller, Carola; Reding, Raymond

    2017-09-15

    Transplant surgeons are currently faced with the challenge to accept marginal liver transplants due to steatosis or old age. Improving organ quality by implementing a selective organ protective donor management could be the first step towards a graft of enhanced quality. However, the molecular mechanisms of such treatments are still poorly understood. Glucocorticoid medication in donor medicine has been carried out and discussed for a long time. In a recent study published in Clinical Science , Jiménez-Castro et al. [Clin. Sci. (2017) 131, 733-746] demonstrate how liver histology and transplant liver function can be improved by administration of glucocorticoids to brain-dead donor rats with steatotic livers. This work illustrates the need for further trials in order to selectively improve the quality of steatotic livers with a potential for liver transplantation. © 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

  12. Factors influencing liver and spleen volume changes after donor hepatectomy for living donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Ji Hee; Ryeom, Hunku; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2013-11-15

    To define the changes in liver and spleen volumes in the early postoperative period after partial liver donation for living-donor liver transplantation (LDLT) and to determine factors that influence liver and spleen volume changes. 27 donors who underwent partial hepatectomy for LDLT were included in this study. The rates of liver and spleen volume change, measured with CT volumetry, were correlated with several factors. The analyzed factors included the indocyanine green (ICG) retention rate at 15 minutes after ICG administration, preoperative platelet count, preoperative liver and splenic volumes, resected liver volume, resected-to-whole liver volume ratio (LV{sub R}/LV{sub W}), resected liver volume to the sum of whole liver and spleen volume ratio [LV{sub R}/(LV{sub W} + SV{sub 0})], and pre and post hepatectomy portal venous pressures. In all hepatectomy donors, the volumes of the remnant liver and spleen were increased (increased rates, 59.5 ± 50.5%, 47.9 ± 22.6%). The increment rate of the remnant liver volume revealed a positive correlation with LV{sub R}/LV{sub W} (r = 0.759, p < 0.01). The other analyzed factors showed no correlation with changes in liver and spleen volumes. The spleen and remnant liver volumes were increased at CT volumetry performed 2 weeks after partial liver donation. Among the various analyzed factors, LV{sub R}/LV{sub W} influences the increment rate of the remnant liver volume.

  13. The Association Between Skin Findings and Transplantation Period in Liver Transplant Recipients

    Directory of Open Access Journals (Sweden)

    İlgen Ertam

    2013-06-01

    Full Text Available Objective: Different types of skin diseases can be seen in liver transplant recipients. Here, we aimed to investigate the frequency of skin diseases and it's correlation with the duration of liver disease and the transplantation period in liver transplant recipients. Methods: One-hundred ninety seven patients and 50 controls were included in the study. Detailed skin examination was performed to the all patients and dermatological findings were recorded. Chi-square and Pearson correlation tests were used for statistical analyses. Results: Of 197 patients, 142 were males and 55 females, of 50 controls, 36 were males and 14 females. The mean age of the patients was 43.96±13.16 and the controls was 42.12±14.43. The transplantation reason was cirrhosis due to Hepatitis B-virus in 65.8% of the patients. Hypertrichosis, cherry angioma, telangiectasia, seborrheic dermatitis, tinea pedis were observed to be statistically significantly higher in the patients as compared to the control group. There were statistically significant correlation between the duration of liver disease and tinea pedis, scabies, psoriazis, gynecomastia, alopecia areata. Conclusion: We found that hypertrichosis, cherry angioma, telangiectasia, seborrheic dermatitis and tinea pedis are the most frequently seen dermatological diseases in our liver transplant recipients study group.

  14. Pre-Liver Transplant: Tips Versus Distal Splenorenal Shunt

    Directory of Open Access Journals (Sweden)

    Thomas W. Faust

    1997-01-01

    Full Text Available Recurrent variceal bleeding in liver transplant candidates with end-stage liver disease can complicate or even prohibit a subsequent transplant procedure (OLT. Endoscopic sclero-therapy and medical therapy are considered as first-line management with surgical shunts reserved for refractory situations. Surgical shunts can be associated with a high mortality in this population and may complicate subsequent OLT. The transjugular intrahepatic portosystemic shunt (TIPS has been recommended in these patients as a bridge to OLT. This is a new modality that has not been compared with previously established therapies such as the distal splenorenal shunt (DSRS. In this study we report our experience with 35 liver transplant recipients who had a previous TIPS (18 patients or DSRS (17 patients for variceal bleeding. The TIPS group had a significantly larger proportion of critically ill and Child-Pugh C patients. Mean operating time was more prolonged in the DSRS group (P=0.014 but transfusion requirements were similar. Intraoperative portal vein blood flow measurements averaged 2132±725 ml/min in the TIPS group compared with 1120±351ml/min in the DSRS group (P<0.001. Arterial flows were similar. Mean ICU and hospital stays were similar. There were 3 hospital mortalities in the DSRS group and none in the TIPS group (P=0.1. We conclude that TIPS is a valuable tool in the management of recurrent variceal bleeding prior to liver transplantation. Intra0Perative hemodynamic measurements suggest a theoretical advantage with TIPS. In a group of patients with advanced liver disease we report an outcome that is similar to patients treated with DSRS prior to liver transplantation. The role of TIPS in the treatment of nontransplant candidates remains to be clarified.

  15. Acute liver failure due to zinc phosphide containing rodenticide poisoning: Clinical features and prognostic indicators of need for liver transplantation.

    Science.gov (United States)

    Saraf, Vivek; Pande, Supriya; Gopalakrishnan, Unnikrishnan; Balakrishnan, Dinesh; Menon, Ramachandran N; Sudheer, O V; Dhar, Puneet; Sudhindran, S

    2015-07-01

    Zinc phosphide (ZnP) containing rodenticide poisoning is a recognized cause of acute liver failure (ALF) in India. When standard conservative measures fail, the sole option is liver transplantation. Records of 41 patients admitted to a single centre with ZnP-induced ALF were reviewed to identify prognostic indicators for requirement of liver transplantation. Patients were analyzed in two groups: group I (n = 22) consisted of patients who either underwent a liver transplant (n = 14) or died without a transplant (n = 8); group II (n = 19) comprised those who survived without liver transplantation. International normalized ratio (INR) in group I was 9 compared to 3 in group II (p Liver Disease (MELD) score in group I was 41 compared to 24 in group II (p liver transplantation.

  16. OSMOTICALLY LYSED RAT LIVER MITOCONDRIA

    Science.gov (United States)

    Vasington, Frank D.; Greenawalt, John W.

    1968-01-01

    Osmotically lysed rat liver mitochondria have been utilized for a study of the biochemical and ultrastructural properties in relation to divalent ion accumulation. Osmotic lysis of mitochondria by suspension and washing in cold, distilled water results in the extraction of about 50% of the mitochondrial protein, the loss of the outer mitochondrial membrane, an increase in respiration, and a marked decrease in the ability to catalyze oxidative phosphorylation. Nevertheless, except for a decrease in the ability to accumulate Sr2+ by an ATP-supported process, these lysed mitochondria retain full capacity to accumulate massive amounts of divalent cations by respiration-dependent and ATP-supported mechanisms. The decreased ability of osmotically lysed mitochondria to accumulate Sr2+ by an ATP-energized process does not appear to be due to a loss or inactivation of a specific Sr2+-activated ATPase. The energy-dependent accumulation processes in lysed mitochondria show an increased sensitivity to inhibition by monovalent cations. Extraction of cytochrome c from osmotically lysed mitochondria results in a complete loss of phosphorylation and the respiration-dependent accumulation of Ca2+; a lesser, but significant, decrease in the ATP-supported accumulation of Ca2+ also was observed. The addition of cytochrome c fully restores the respiration-dependent accumulation of Ca2+ to the level present in unextracted, osmotically lysed mitochondria. The ATP-supported process is not affected by the addition of cytochrome c to extracted mitochondria, indicating that cytochrome c is not involved in ion transport energized by ATP. The osmotically lysed mitochondria are devoid of outer membranes and contain relatively little matrix substance. The accumulation of Ca2+ and Pi by lysed mitochondria under massive loading conditions is accompanied by the formation of electron-opaque deposits within the lysed mitochondria associated with the inner membranes. This finding suggests that the

  17. Liver transplantation in children using organs from young paediatric donors.

    Science.gov (United States)

    Herden, Uta; Ganschow, Rainer; Briem-Richter, Andrea; Helmke, Knut; Nashan, Bjoern; Fischer, Lutz

    2011-06-01

    Nowadays, most paediatric liver transplant recipients receive a split or other technical variant graft from adult deceased or live donors, because of a lack of available age- and size matched paediatric donors. Few data are available, especially for liver grafts obtained from very young children (transplantations between 1989 and 2009. Recipients were divided into five groups (1-5) depending on donor age (transplantations from deceased donors were performed; 1- and 5-year graft survival rates were 75%, 80%, 78%, 81%, 74% and 75%, 64%, 70%, 67%, 46%, and 1- and 5-year patient survival rates were 88%, 91%, 90%, 89%, 78% and 88%, 84%, 84%, 83%, 63% for groups 1-5, respectively, without significant difference. Eight children received organs from donors younger than 1 year and 45 children received organs from donors between 1 and 6 years of age. Overall, vascular complications occurred in 13.2% of patients receiving organs from donors younger than 6 years. Analysis of our data revealed that the usage of liver grafts from donors younger than 6 years is a safe procedure. The outcome was comparable with grafts from older donors with excellent graft and patient survival, even for donors younger than 1 year. © 2011 The Authors. Transplant International © 2011 European Society for Organ Transplantation.

  18. [Is surgery for portal hypertension a contraindication for liver transplantation?].

    Science.gov (United States)

    Poves, I; Figueras, J; Lama, C; Fabregat, J; Rafecas, A; Torras, J; Ramos, E; Ruiz, D; Casanovas, T; Xiol, X; Baliellas, C; Jaurrieta, E

    1998-10-01

    Orthotopic liver transplantation (OLT) is the only curative treatment for hepatic cirrhosis and is the most effective in the control of portal hypertension. The aim of this study was to analyze whether greater morbi-mortality is observed in patients undergoing liver transplantation with previous surgery for portal hypertension with respect to patients not having undergone this surgery. Different variables were analyzed in 2 groups of transplanted patients: one of 18 patients who had previously undergone surgery for portal hypertension and another group of 54 patients without this previous surgery. The following factors were studied: mean operative time and length of anahepatic phase, intraoperative consumption of concentrates of erythrocytes, fresh frozen plasma, units of platelets and cryoprecipitates, days of mechanical ventilation, stay in the ICU and total postoperative stay. No significant differences were observed (p < 0.05) in any of these factors or in survival. On analysis of the difficulty of surgical technique, postoperative evolution and survival and based on the variables described it may be concluded that previous surgery for portal hypertension does not only not contraindicate posterior liver transplantation, but rather may be useful in patients with an adequate hepative reserve presenting variceal hemorrhage since posterior transplantation does not present a worsened prognosis.

  19. INFERIOR VENA-CAVA OBSTRUCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

    NARCIS (Netherlands)

    BROUWERS, MAM; DEJONG, KP; PEETERS, PMJG; BIJLEVELD, CMA; KLOMPMAKER, IJ; SLOOFF, MJH

    Post-operative inferior vena cava (IVC) obstruction is reported as an uncommon complication after orthotopic liver transplantation (OLT). We report 6 cases after 245 OLT's in the period between March '79 and December '92. Compression or torsion of the IVC or a technical problem were underlying

  20. Diagnosis and Management of Hepatic Artery Complications After Liver Transplantation.

    Science.gov (United States)

    Frongillo, F; Lirosi, M C; Nure, E; Inchingolo, R; Bianco, G; Silvestrini, N; Avolio, A W; De Gaetano, A M; Cina, A; Di Stasi, C; Sganga, G; Agnes, S

    2015-09-01

    We assessed the usefulness of color Doppler imaging in diagnosis and monitoring hepatic artery complications after liver transplantation. Subjects were 421 liver transplant recipients who underwent serial ultrasound (US) color Doppler evaluations of the hepatic arteries after surgery. We saw 4 hepatic arterial complications after liver transplantation (13 thrombosis, 29 stenosis, 2 kinking, 2 pseudo-aneurysm, and 2 pseudo-aneurysm rupture). All subjects underwent US color Doppler examination periodically after surgery. In 6 cases of early thrombosis, hepatic arterial obstruction was diagnosed with absence of Doppler signals; in the other 7 cases (late hepatic artery thrombosis), thrombosis was suspected for the presence of intra-parenchymal "tardus-parvus" waveforms. In all of the cases, computed tomography angiography showed obstruction of the main arterial trunk and the development of compensatory collateral circles (late hepatic artery thrombosis). In 10 of the 29 cases of stenosis, Doppler ultrasonography examination revealed stenotic tract and intra-hepatic tardus-parvus waveforms; in 17 stenosis cases, the site of stenosis could not be identified, but intra-parenchymal tardus-parvus waveforms were recorded. In 2 patients, hepatic artery stenosis occurred with ischemic complications. The use of US color Doppler examination allows the early diagnosis of hepatic arterial complications after liver transplantation. Tardus-parvus waveforms indicated severe impairment of hepatic arterial perfusion from either thrombosis or severe stenosis. The presence of these indirect signs enhanced the accuracy of color Doppler diagnosis, and detection should prompt therapy. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Trichoderma viride infection in a liver transplant recipient

    NARCIS (Netherlands)

    Jacobs, F.; Byl, B.; Bourgeois, N.; Coremans-Pelseneer, J.; Florquin, S.; Depré, G.; van de Stadt, J.; Adler, M.; Gelin, M.; Thys, J. P.

    1992-01-01

    A liver transplant recipient developed infection of a perihepatic haematoma due to Trichoderma viride. Before the infection was diagnosed, the patient received intense immuno-suppressive and prolonged antibacterial and anti-fungal therapies. Although the death of the patient was not directly related

  2. Two-factor logistic regression in pediatric liver transplantation

    Science.gov (United States)

    Uzunova, Yordanka; Prodanova, Krasimira; Spasov, Lyubomir

    2017-12-01

    Using a two-factor logistic regression analysis an estimate is derived for the probability of absence of infections in the early postoperative period after pediatric liver transplantation. The influence of both the bilirubin level and the international normalized ratio of prothrombin time of blood coagulation at the 5th postoperative day is studied.

  3. Optimal Technique for Abdominal Fascial Closure in Liver Transplant Patients

    Directory of Open Access Journals (Sweden)

    Unal Aydin

    2010-01-01

    Conclusion: Our results indicate that the novel technique used in this study contributed to overcoming early and late postoperative complications associated with closure of the abdominal fascia in liver transplant patients. In addition, this new technique has proven to be easily applicable, faster, safer and efficient in these patients; it is also potentially useful for conventional surgery.

  4. SPLENIC ARTERY STEAL SYNDROME AFTER ORTHOTOPIC LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. E. Zagainov

    2011-01-01

    Full Text Available Splenic artery steal syndrome is one of possible arterial complications after orthotopic liver transplantation. Material includes personal experience in diagnostics and treatment of this syndrome. In each case complication was opportunely suspected basing on laboratory and ultrasound data and proved by angiography. Successful treatment was performed using different variants of splenic artery embolization. 

  5. Orthotopic liver transplantation for patients with Caroli's disease.

    Science.gov (United States)

    Wang, Zhen-Xia; Yan, Lu-Nan; Li, Bo; Zeng, Yong; Wen, Tian-Fu; Wang, Wen-Tao

    2008-02-01

    Caroli's disease, a rare congenital hepatic disease, has a poor prognosis, especially in patients with diffuse dilatation of the bile ducts. But liver transplantation has been a curative option. The aim of this study was to investigate the feasibility and rationality of orthotopic liver transplantation as an indication for patients with diffuse Caroli's disease. The data from 3 patients with diffuse Caroli's disease who had undergone orthotopic liver transplantation in our unit were analyzed retrospectively. On postoperative day 7, patient 1 had acute rejection which was relieved after pulse treatment with methylprednisolone. He was discharged from hospital on postoperative day 27 and has been in good health for 82 months. Patient 2 had no acute rejection or severe complications, but died of chronic graft dysfunction 34 months postoperatively. Patient 3 had acute rejection on postoperative days 10 and 35, complicated with pulmonary infection, pleural effusion and opportunistic infection. After successful treatment, she resumed work and has been followed up for 47 months. Her condition is good. Liver transplantation can offer an effective therapy for patients with diffuse Caroli's disease, and can provide satisfactory long-term results.

  6. A practical approach to anaesthesia for paediatric liver transplantation

    African Journals Online (AJOL)

    Adele

    improved outcomes of both the graft and the patient. In more recent years, the use of reduced size and living related organs has increased the donor pool for infants and children. Paediatric liver transplantation in South Africa, up until the present time, has been centered at the Red Cross Children's Hospital in. Cape Town ...

  7. [The role of liver transplantation in the treatment of acute liver failure following Amanita phalloides poisoning].

    Science.gov (United States)

    Beckurts, K T; Hölscher, A H; Heidecke, C D; Zilker, T R; Natrath, W; Siewert, J R

    1997-03-21

    To formulate the indications for liver transplantation in the treatment of acute liver failure after Amanita phalloides poisoning and to determine the results of this treatment. In 1994 twelve patients with acute Amanita phalloides poisoning were treated in the intensive care unit of our hospital's toxicology department. Three of them developed irreversible signs of poisoning and were given orthotopic liver transplants. The findings and course of this group of patients were analysed retrospectively and prognostic criteria defined on the basis of this personal experience and published data. Amanita phalloides poisoning differs from other causes of acute liver failure in several respects. The following criteria make it possible reliably to distinguish a lethal from a non-lethal course: a Quick value 1.4 mg%, even after correcting water and electrolyte abnormalities, serum bilirubin > 4.6 mg%, and progressive encephalopathy indicate a lethal course. Two of three patients survived severe poisoning by being given a liver transplant. Renal failure, pancreatitis and bone marrow suppression, in addition to liver failure, were signs relevant to treatment decisions. Liver transplantation is the procedure of choice in the treatment of acute Amanita phalloides poisoning, if the criteria for a probably lethal course under conservative treatment have been met. This should be taken into account when poisoned patients are to be transferred to a centre for treatment.

  8. Liver transplant length of stay (LOS) index: A novel predictive score for hospital length of stay following liver transplantation.

    Science.gov (United States)

    Rana, Abbas; Witte, Ellen D; Halazun, Karim J; Sood, Gagan K; Mindikoglu, Ayse L; Sussman, Norman L; Vierling, John M; Kueht, Michael L; Galvan, Nhu Thao N; Cotton, Ronald T; O'Mahony, Christine A; Goss, John A

    2017-12-01

    An index to predict hospital length of stay after liver transplantation could address unmet clinical needs. Length of stay is an important surrogate for hospital costs and efforts to limit stays can preserve our healthcare resources. Here, we devised a scoring system that predicts hospital length of stay following liver transplantation. We used univariate and multivariate analyses on 73 635 adult liver transplant recipient data and identified independent recipient and donor risk factors for prolonged hospital stay (>30 days). Multiple imputation was used to account for missing variables. We identified 22 factors as significant predictors of prolonged hospital stay, including the most significant risk factors: intensive care unit (ICU) admission (OR 1.75, CI 1.58-1.95) and previous transplant (OR 1.60, CI 1.47-1.75). The length of stay (LOS) index assigns weighted risk points to each significant factor in a scoring system to predict prolonged hospital stay after liver transplantation with a c-statistic of 0.75. The LOS index demonstrated good discrimination across the entire population, dividing the cohort into tertiles, which had odds ratios of 2.25 (CI 2.06-2.46) and 7.90 (7.29-8.56) for prolonged hospital stay (>30 days). The LOS index utilizes 22 significant donor and recipient factors to accurately predict hospital length of stay following liver transplantation. The index further demonstrates the basis for a clear clinical recommendation to mitigate risk of long hospitalization by minimizing cold ischemia time. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Monogenic diseases that can be cured by liver transplantation.

    Science.gov (United States)

    Fagiuoli, Stefano; Daina, Erica; D'Antiga, Lorenzo; Colledan, Michele; Remuzzi, Giuseppe

    2013-09-01

    While the prevalence of most diseases caused by single-gene mutations is low and defines them as rare conditions, all together, monogenic diseases account for approximately 10 in every 1000 births according to the World Health Organisation. Orthotopic liver transplantation (LT) could offer a therapeutic option in monogenic diseases in two ways: by substituting for an injured liver or by supplying a tissue that can replace a mutant protein. In this respect, LT may be regarded as the correction of a disease at the level of the dysfunctional protein. Monogenic diseases that involve the liver represent a heterogeneous group of disorders. In conditions associated with predominant liver parenchymal damage (i.e., genetic cholestatic disorders, Wilson's disease, hereditary hemochromatosis, tyrosinemia, α1 antitrypsin deficiency), hepatic complications are the major source of morbidity and LT not only replaces a dysfunctional liver but also corrects the genetic defect and effectively cures the disease. A second group includes liver-based genetic disorders characterised by an architecturally near-normal liver (urea cycle disorders, Crigler-Najjar syndrome, familial amyloid polyneuropathy, primary hyperoxaluria type 1, atypical haemolytic uremic syndrome-1). In these defects, extrahepatic complications are the main source of morbidity and mortality while liver function is relatively preserved. Combined transplantation of other organs may be required, and other surgical techniques, such as domino and auxiliary liver transplantation, have been attempted. In a third group of monogenic diseases, the underlying genetic defect is expressed at a systemic level and liver involvement is just one of the clinical manifestations. In these conditions, LT might only be partially curative since the abnormal phenotype is maintained by extrahepatic synthesis of the toxic metabolites (i.e., methylmalonic acidemia, propionic acidemia). This review focuses on principles of diagnosis, management

  10. The role of narrative medicine in pregnancy after liver transplantation.

    Science.gov (United States)

    Donzelli, Gianpaolo; Paddeu, Erika Maria; D'Alessandro, Francesca; Nanni Costa, Alessandro

    2015-01-01

    Narrative medicine allows professionals from all fields of medical sciences to understand the patient's total experience of illness, and meet his/her needs in an empathetic environment. Narrative medicine helps spread holistic knowledge of a multitude of complex clinical conditions, including transplantation. To underline the role of narrative medicine in women who become pregnant after a liver transplant by using their narrations of this very special experience. We describe our study with narration and listening to the stories of three women expecting their first child after a liver transplant, by analysing the structure and role of narration in the context of relationships between patients and caregivers. The narrations were transcribed verbatim with the main plot analysed in order to address all the aspects of this rare clinical condition and the transition to parenthood. The women narrated this experience in three phases: transplantation, pregnancy and delivery, and post-partum. They described all phases of pregnancy as stressful but satisfying, whereas the fact of becoming a mother was perceived as a victory both as a woman and as a transplant patient. Our results suggest that narrative medicine represents a significant professional tool for caring for transplant patients during pregnancy.

  11. Biliary strictures complicating liver transplantation in pediatric patients: Experience in a South American transplant center.

    Science.gov (United States)

    Holguin, Alfonso J; Rodriguez-Takeuchi, Sara; Ospina, Laura; Acosta, Diana; Botero, Veronica; Thomas, Laura; Villegas, Jorge; Echeverry, Gabriel J; Caicedo, Luis

    2017-02-01

    To describe the experience of percutaneous transhepatic cholangiography (PTC) with biliary dilatation and drainage after pediatric liver transplantation and to determine the long-term outcome of this procedure. Retrospective study from 2001 to 2013. Follow-up after treatment was also undertaken. A survival analysis was performed in patients in whom the procedure and eventual removal of the catheter were successful. In all, 196 children received liver transplants; 40 of them (20 boys and 20 girls; median age of 4 years) were treated using PTC due to biliary complications. Sixty-one PTC procedures were performed in 40 liver transplant recipients. Technically successful PTC was achieved in 87.5% of the patients. The probability of a patient not developing unfavorable outcomes 1, 5, and 10 years after treatment was 88.9%, 83.0%, and 74.1%. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. [Complications associated with hyperglycemia in liver transplant patients].

    Science.gov (United States)

    Builes Montaño, Carlos Esteban; Montoya, Julián Felipe; Londoño, Carolina Aguilar; Palacios Bayona, Karen Lorena; Restrepo Gutiérrez, Juan Carlos; Restrepo, Johnayro Gutiérrez; Arango Toro, Clara María; Jaimes Barragan, Fabián Alberto

    2014-01-01

    Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated with negative outcomes. It is common in liver transplant patients as a result of stress and is related to immunosuppressant drugs. Although studies are few, a history of diabetes and the presentation of hyperglycemia during liver transplantation have been associated with a higher risk for rejection. To analyze whether hyperglycemia during the first 48hours after liver transplantation was associated with a higher risk for infection, rejection, or longer hospital stay. A retrospective cohort study was conducted on patients above the age of 15years that received a liver transplant. Hyperglycemia was defined as a value above 140mg/dl and it was measured in three different manners (as an isolated value, as a mean value, and as a weighted value over time). The relation of hyperglycemia to a risk for acute rejection, infection, or longer hospital stay was evaluated. Some form of hyperglycemia was present in 94% of the patients during the first 48 post-transplantation hours, regardless of its definition. There was no increased risk for rejection (OR: 1.49; 95%CI: 0.55-4.05), infection (OR: 0.62; 95%CI: 0.16-2.25), or longer hospital stay between the patients that presented with hyperglycemia and those that did not. Hyperglycemia during the first 48hours after transplantation appeared to be an expected phenomenon in the majority of patients and was not associated with a greater risk for rejection or infection and it had no impact on the duration of hospital stay. Copyright © 2014 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

  13. Splenectomy before adult liver transplantation: a retrospective study.

    Science.gov (United States)

    Kong, LingXiang; Li, Ming; Li, Lei; Jiang, Li; Yang, Jiayin; Yan, Lvnan

    2017-04-20

    A considerable number of patients with portal hypertension (PHT) have to undergo splenectomy because they do not meet the requirements for liver transplantation (LT) or cannot find a suitable liver donor. However, it is not known whether pre-transplantation splenectomy may create occult difficulties for patients who require LT in future. We analyzed 1059 consecutive patients who underwent adult liver transplantation (ADLT). Patients with pre-transplantation splenectomy Sp(+) and without splenectomy Sp(-) were compared using a propensity score analysis to create the best match between groups. There were no differences between patients in group Sp(+) and group Sp(-) with respect to the main post-operative infections (12.20% vs. 15.85%, P = 0.455), and the incidence of major complications (6.10% vs. 10.98%, P = 0.264). The post-operative platelet count was significantly higher in group Sp(+) (P = 0.041), while group Sp(-) had a higher rate of post-operative thrombocytopenia (91.46% vs. 74.39%, P = 0.006) and early allograft dysfunction (EAD) (23.20% vs. 10.98%, P = 0.038). The 5-year overall survival rates were similar in groups Sp(-) and Sp(+) (69.7% vs. 67.6%, P = 0.701). Compared with Sp(-), the risk of infection and post-operative complications in group Sp(+) was not increased, while group Sp(-) had a higher rate of post-operative EAD. Moreover, pre-transplantation splenectomy is very effective for the prevention of thrombocytopenia after LT. Pre-transplantation splenectomy is recommended in cases with risky PHT patients without appropriate source of liver for LT.

  14. Recidivism in Liver Transplant Recipients With Alcoholic Liver Disease: Analysis of Demographic, Psychosocial, and Histology Features.

    Science.gov (United States)

    Satapathy, Sanjaya K; Eason, James D; Nair, Satheesh; Dryn, Oleksandra; Sylvestre, Pamela B; Kocak, Mehmet; Vanatta, Jason M

    2015-10-01

    Liver transplant for alcoholic liver disease requires identifying potential recipients at risk for recidivism. We sought to identify risk factors for recidivism and survival in recipients of liver transplant with alcoholic liver disease. Demographic, psychosocial, and histology features were evaluated as risk factors toward harmful recidivism in 148 recipients of liver transplant with alcoholic liver disease. Based on the univariate analysis using Cox proportional hazards model, duration of alcohol abstinence 6 months (HR 3.74; P = .011, 95% CI: 1.36-10.3), non-alcohol related criminal history (HR 3.18; P = .032, 95% CI: 1.1-9.15), support from immediate family (HR 0.24; P = .0061, 95% CI: 0.09-0.67), and active smoking at the time of liver transplant (HR 2.74; P = .041, 95% CI: 1-7.53) were identified as significant predictors for recidivism. Older patients had less likelihood of alcohol relapse (HR 0.91; P = .0014, 95% CI: 0.87-0.97) on univariate model. In multivariate model older patients (HR 0.91; P = .004, 95% CI: 0.86-0.97) and patients who have immediate family support (HR 0.27; P = .012, 95% CI: 0.10-0.76) predicated against recidivism. Suggestive features of alcoholic hepatitis on liver explant did not predict recidivism or long-term survival. One-, three-, and five-year patient survival rates estimated by Kaplan-Meier survival model in the recipients that remained abstinent were 95%, 87%, and 80%, compared with 87%, 49%, and 49% for the recipients with recidivism (P = .001). Recidivism is associated with earlier death after liver transplant. Older recipients and patients with immediate family support are less likely to have alcohol relapse, and have better long-term survival.

  15. Neuropsychological assessment in kidney and liver transplantation candidates.

    Science.gov (United States)

    Lacerda, S S; Guimaro, M S; Prade, C V; Ferraz-Neto, B H; Karam, C H; Andreoli, P B A

    2008-04-01

    Chronic renal and liver diseases are associated with cognitive and intellectual impairment, which can be irreversible even after kidney or liver transplantation. We sought to investigate the presence of cognitive deficits in organ transplantation candidates. From May 2005 to March 2006, 35 organ transplantation candidates, of mean age 46.71 (+/- 13.01) years, 54.3% including females and 7.29 (+/- 4.22) years mean formal schooling. Of those, 27 (77%) were renal and 8 (23%), liver transplantation candidates. All subjects underwent a neuropsychological assessment battery designed to evaluate attention performance, executive functions, memory, language, visuaospatial, and intellectual skills. We found impairments in attention performance (attention span [34.3%], sustained attention [76.5%], and divided attention [77.8%]), executive functions (category formation [58.3%], errors [61.5%], and perseverative errors [30.4%]), memory (working memory [57.1%], verbal [37.1%] and visual short-term memory [31.4%], verbal [25.7%] and visual long-term memory [51.4], verbal learning [42.9%], interference susceptibility [42.9%], and verbal recognition memory [20.6%]), language (comprehension [38.1%], and vocabulary [30.8%]), visuaospatial (45.8%), and intellectual skills (50.0%). Neuropsychological (cognitive) deficits in transplant candidates are frequent, regardless of the kind of transplantation. The deficits involve several cognitive skills, such as attentional processes, executive functions, memory, language, visuaospatial, and intellectual skills. Therefore, we concluded that a pretransplant neuropsychological assessment is an important measure to detect impairments and to help understand how these difficulties can interfere with patient self-care before and after transplantation.

  16. Applicability of liver transplantation in Catalonia at the end of the millennium. A prospective study of adult patient selection for liver transplantation.

    Science.gov (United States)

    Vargas, Víctor; Rimola, Antoni; Casanovas, Teresa; Castells, Lluis; Navasa, Miquel; Baliellas, Carme; Bilbao, Itxarone; Visa, Josep; Jaurrieta, Eduardo; Margarit, Carlos

    2003-04-01

    We prospectively studied the global applicability of liver transplantation in Catalonia, a region with a high rate of organ donation. We followed 232 adult patients assessed as possible candidates for liver transplantation over 12 months in the three hospitals that perform the procedure in this region. The liver disease leading to patient assessment was cirrhosis in most cases, alone (159 patients) or associated with hepatocellular carcinoma (57 patients). After being assessed, 150 patients (65%) were accepted for transplantation and included on the waiting list, and 82 (32%) were excluded. Death during the period of assessment, advanced tumoral disease, early stage of liver disease, and extrahepatic co-morbidities were the most important reasons for exclusion. The median time of assessment of patients accepted for transplantation was 40 days. Of the 150 patients included on the waiting list, 131 (87%) received transplants, 17 (11%) were removed from the list, and two were still waiting for transplantation at the end of the follow-up period. Death and tumor progression were the most important reasons for patients' removal from the waiting list. The median time on the waiting list was 59 days. In conclusion, among liver-transplant candidates the overall applicability of this therapy in Catalonia was relatively low (131 out of 232 transplant candidates finally underwent transplantation, 56%), and inadequate liver-transplant indications and death or tumor progression during the period of assessment or while the patient was on the waiting list were the most frequent reasons why liver transplantations did not proceed.

  17. Living donor liver transplant (LDLT) is the way forward in Asia.

    Science.gov (United States)

    Rela, Mohamed; Reddy, Mettu Srinivas

    2017-03-01

    Living donor liver transplantation (LDLT) is currently the commonest form of liver transplantation in Asia. Efforts to improve the number of deceased donor liver transplantation have not been uniformly successful. We believe that THE unique combination of demographic, social, economic and political factors that exist in Asia will ensure that LDLT will continue to remain the predominant form of liver transplantation. While efforts to increase deceased donation rates should continue and intensify, progress in LDLT should also be supported and encouraged, as it will be the main workhorse of liver transplantation in Asia in the near and medium-term future.

  18. Severe Acute Hyperkalemia during Pre-Anhepatic Stage in Cadaveric Orthotopic Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sahmeddini

    2012-09-01

    Full Text Available A serious hazard to patients during orthotopic liver transplantation is hyperkalemia. Although the most frequent and hazardous hyperkalemia occurs immediately after reperfusion of the newly transplanted liver, morbid hyperkalemia could happen in the other phases during orthotopic liver transplantation. However, pre-anhepatic hyperkalemia during orthotopic liver transplantation is rare. This report describes one such patient, who without transfusion, developed severe hyperkalemia during pre-anhepatic phase. The variations in serum potassium concentration of the present case indicate that it is necessary to take care of the changes of serum potassium concentration not only during reperfusion but also during the other phases of the liver transplantation.

  19. Assessment of emergency liver transplantation criteria in acute liver failure due to Amanita phalloides.

    Science.gov (United States)

    Ferreira, Rosa; Romãozinho, José Manuel; Amaro, Pedro; Ferreira, Manuela; Sofia, Carlos

    2011-11-01

    The emergency liver transplantation criteria for acute liver failure (ALF) due to Amanita phalloides (A. phalloides) intoxication are not consensual. The aims of this study were to evaluate the clinical outcomes, and to assess the accuracy of the current and specific criteria for emergency liver transplantation in predicting fatal outcome in ALF induced by A. phalloides. Ten patients admitted with ALF induced by A. phalloides in a Gastroenterology Intensive Care Unit were studied. Indications for liver transplant were based on Clichy and/or King's College criteria. Specific criteria of Ganzert and Escudié were tested retrospectively. A. phalloides intoxication represented 11.6% of all admissions for ALF. Patients were admitted at a mean time of 60 ± 20.4 h after ingestion. Eight patients met the Clichy and/or King's College criteria for emergency liver transplantation, seven of these patients were listed for transplant and only six patients were transplanted. Four (40%) patients died in a mean time of 4.8 ± 0.74 days after ingestion. When applied retrospectively, Escudié's criteria showed 100% of accuracy for predicting fatal outcome, whereas, King's College, Clichy's and Ganzert's criteria had an accuracy of 90, 80 and 70%, respectively. A prothrombin index of less than 10% at day 3 after ingestion showed a positive predictive value of 100% and a negative predictive value of 60%. Escudié's criteria show the best accuracy for emergency liver transplant in ALF induced by A. phalloides. The assessment of these criteria at day 3 after ingestion shows a maximum positive predictive value, although with a decline in its negative predictive value.

  20. The Groningen hypothermic liver perfusion system for improved preservation in organ transplantation

    NARCIS (Netherlands)

    Plaats, Arjan van der

    2005-01-01

    End-stage liver diseases are nowadays effectively treated by transplantation of the affected liver. The transplantation procedure includes procurement of the liver from the donor and subsequently transport of the liver from donor to receiving patient (Chapter 1). To bridge the timespan of transport

  1. Cytomegalovirus infection in liver transplant recipients: updates on clinical management.

    Science.gov (United States)

    Marcelin, Jasmine Riviere; Beam, Elena; Razonable, Raymund R

    2014-08-21

    Cytomegalovirus (CMV) infection is a common complication after liver transplantation, and it is associated with multiple direct and indirect effects. Management of CMV infection and disease has evolved over the years, and clinical guidelines have been recently updated. Universal antiviral prophylaxis and a pre-emptive treatment strategy are options for prevention. A currently-recruiting randomized clinical trial is comparing the efficacy and safety of the two prevention strategies in the highest risk D+R- liver recipients. Drug-resistant CMV infection remains uncommon but is now increasing in incidence. This highlights the currently limited therapeutic options, and the need for novel drug discoveries. Immunotherapy and antiviral drugs with novel mechanisms of action are being investigated, including letermovir (AIC246) and brincidofovir (CMX001). This article reviews the current state of CMV management after liver transplantation, including the updated practice guidelines, and summarizes the data on investigational drugs and vaccines in clinical development.

  2. Neoplastic disease after liver transplantation: Focus on de novo neoplasms.

    Science.gov (United States)

    Burra, Patrizia; Rodriguez-Castro, Kryssia I

    2015-08-07

    De novo neoplasms account for almost 30% of deaths 10 years after liver transplantation and are the most common cause of mortality in patients surviving at least 1 year after transplant. The risk of malignancy is two to four times higher in transplant recipients than in an age- and sex-matched population, and cancer is expected to surpass cardiovascular complications as the primary cause of death in transplanted patients within the next 2 decades. Since exposure to immunosuppression is associated with an increased frequency of developing neoplasm, long-term immunosuppression should be therefore minimized. Promising results in the prevention of hepatocellular carcinoma (HCC) recurrence have been reported with the use of mTOR inhibitors including everolimus and sirolimus and the ongoing open-label prospective randomized controlled SILVER. Study will provide more information on whether sirolimus-containing vs mTOR-inhibitor-free immunosuppression is more efficacious in reducing HCC recurrence.

  3. Neoplastic disease after liver transplantation: Focus on de novo neoplasms

    Science.gov (United States)

    Burra, Patrizia; Rodriguez-Castro, Kryssia I

    2015-01-01

    De novo neoplasms account for almost 30% of deaths 10 years after liver transplantation and are the most common cause of mortality in patients surviving at least 1 year after transplant. The risk of malignancy is two to four times higher in transplant recipients than in an age- and sex-matched population, and cancer is expected to surpass cardiovascular complications as the primary cause of death in transplanted patients within the next 2 decades. Since exposure to immunosuppression is associated with an increased frequency of developing neoplasm, long-term immunosuppression should be therefore minimized. Promising results in the prevention of hepatocellular carcinoma (HCC) recurrence have been reported with the use of mTOR inhibitors including everolimus and sirolimus and the ongoing open-label prospective randomized controlled SILVER. Study will provide more information on whether sirolimus-containing vs mTOR-inhibitor-free immunosuppression is more efficacious in reducing HCC recurrence. PMID:26269665

  4. Recurrence and rejection in liver transplantation for primary sclerosing cholangitis

    Science.gov (United States)

    Fosby, Bjarte; Karlsen, Tom H; Melum, Espen

    2012-01-01

    Primary sclerosing cholangitis (PSC) is a chronic progressive inflammatory disease affecting the bile ducts, leading to fibrosis and eventually cirrhosis in most patients. Its etiology is unknown and so far no effective medical therapy is available. Liver transplantation (LTX) is the only curative treatment and at present PSC is the main indication for LTX in the Scandinavian countries. Close to half of the PSC patients experience one or more episodes of acute cellular rejection (ACR) following transplantation and approximately 1/5 of the transplanted patients develop recurrent disease in the graft. In addition, some reports indicate that ACR early after LTX for PSC can influence the risk for recurrent disease. For these important post-transplantation entities affecting PSC patients, we have reviewed the current literature on epidemiology, pathogenesis, treatment and the possible influence of rejection on the risk of recurrent disease in the allograft. PMID:22228965

  5. Market Competition and Density in Liver Transplantation: Relationship to Volume and Outcomes.

    Science.gov (United States)

    Adler, Joel T; Yeh, Heidi; Markmann, James F; Nguyen, Louis L

    2015-08-01

    Liver transplantation centers are unevenly distributed within the Donor Service Areas (DSAs) of the United States. This study assessed how market competition and liver transplantation center density are associated with liver transplantation volume within individual DSAs. We conducted a retrospective cohort study of 53,156 adult liver transplants in 45 DSAs with 110 transplantation centers identified from the Scientific Registry of Transplant Recipients between 2003 and 2012. The following measures were derived annually for each DSA: market competition using the Herfindahl Hirschman Index, transplantation center density by the Average Nearest Neighbor method, liver quality by the Liver Donor Risk Index, and patient risk by the Model for End-Stage Liver Disease. A hierarchical mixed effects negative binomial regression model of the relationship between liver transplants and market factors was created annually. Patient and graft survival were investigated with a Cox proportional hazards model. Transplantation center density was associated with market competition (p market competition (IRR = 1.36; p = 0.02), increased listings (IRR = 1.14; p market variables were associated with increased mortality after transplantation. After controlling for demographic and market factors, a greater concentration of centers was associated with more liver transplants without impacting overall survival. These results warrant additional investigation into the relationship between geospatial factors and liver transplantation volume with consideration for the optimization of scarce resources. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Increased liver regeneration rate and decreased liver function after synchronous liver and colon resection in rats

    OpenAIRE

    Okada Masaki; Funch-Jensen Peter; Knudsen Anders; Mortensen Frank; Sasanuma Hideki; Nagai Hideo; Yasuda Yoshikazu

    2009-01-01

    Abstract Background The surgical strategy for the treatment of colorectal cancer and synchronous liver metastases remains controversial. The aim of the present study was to investigate the effects of colonic resection on liver function and regeneration in a rat model. Methods Ninety-six Sprague-Dawley rats were block-randomized into six groups: Group I had a laparotomy performed. Group II had 1 cm colon resected and anastomosed. Group III and V had 40% or 70% of the liver resected, respective...

  7. Accuracy of Hepatobiliary Scintigraphy after Liver Transplantation and Liver Resection

    Directory of Open Access Journals (Sweden)

    Manuel Eckenschwiller

    2016-01-01

    Full Text Available Background and Aims. Biliary complications are the most frequent complications after common liver surgeries. In this study, accuracy of hepatobiliary scintigraphy (HBS and impact of hyperbilirubinemia were evaluated. Methods. Between November 2007 and February 2016, 131 patients underwent hepatobiliary scintigraphy after having liver surgery. 39 patients with 42 scans after LTX (n=13 or hepatic resection (n=26 were evaluated in the study; 27 were male, with mean age 60 years. The subjects underwent hepatobiliary scintigraphy with Tc-99m labeled Mebrofenin. The results were compared to ERCP as gold standard performed within one month after HBS. We calculated sensitivity, specificity, PPV, and NPV. We compared LTX patients to patients with other liver surgeries. Furthermore the influence of hyperbilirubinemia on HBS scans was evaluated. Results. HBS always provided the correct diagnosis in cases of bile leak in the liver-resected group (14/14. Overall diagnostic accuracy was 76% (19/25 in this group and 54% (7/13 in the LTX group. False negative (FN diagnoses occurred more often among LTX patients (p=0.011. Hyperbilirubinemia (>5 mg/dL significantly influenced the excretion function of the liver, prolonging HBS’s time-activity-curve (p=0.001. Conclusions. Hepatobiliary scintigraphy is a reliable tool to detect biliary complications, but reduced accuracy must be considered after LTX.

  8. Mental health and quality of life in liver transplant and cirrhotic patients with various etiologies

    OpenAIRE

    Pérez San Gregorio, María de los Ángeles; Martín Rodríguez, Agustín; Domínguez Cabello, Elisabeth; Fernández Jiménez, Eduardo; Borda Mas, María de las Mercedes; Bernardos Rodríguez, Ángel

    2012-01-01

    In this study we aimed to: 1) examine whether there were differences in mental health and quality of life of liver transplant recipients according to etiology that led to transplantation (alcoholic cirrhosis, Hepatitis B/C Virus, hepatocellular carcinoma and others); and 2) to compare mental health and quality of life between liver transplant and cirrhotic patients, according to etiologies that most often lead to liver transplantation (alcoholic and Hepatitis C Virus). Two pati...

  9. Medical Management of Metabolic Complications of Liver Transplant Recipients.

    Science.gov (United States)

    Barnard, Abbey; Konyn, Peter; Saab, Sammy

    2016-10-01

    Improved short- and long-term survival of liver transplant recipients has led to increased focus on complications of both the early and late posttransplant periods. A variety of metabolic complications have been observed in the post-orthotopic liver transplant population, including hypertension, hyperlipidemia, obesity, diabetes mellitus, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis. Although only a small proportion of patients experience metabolic complications prior to transplantation, the prevalence of these complications posttransplantation reaches or exceeds that of the general population. This is of particular concern, as cardiovascular disease is the second leading cause of death in the late transplant period. A number of mechanisms mediate these metabolic complications, including reversal of cirrhosis pathophysiology, patient lifestyle factors, and immunosuppressive medications. Titration and modification of immunosuppression have been demonstrated to improve and sometimes even eliminate these conditions. Therefore, given the multiple etiologies contributing to the metabolic derangements, an effective management approach must incorporate lifestyle modifications, immunosuppression titration, and medical management. Best practices and understanding of the mechanisms underlying these complications allow for discussion of initial therapies and strategies; however, further study is necessary to determine the optimal management of metabolic complications over time.

  10. Medical Management of Metabolic Complications of Liver Transplant Recipients

    Science.gov (United States)

    Barnard, Abbey; Konyn, Peter

    2016-01-01

    Improved short- and long-term survival of liver transplant recipients has led to increased focus on complications of both the early and late posttransplant periods. A variety of metabolic complications have been observed in the post–orthotopic liver transplant population, including hypertension, hyperlipidemia, obesity, diabetes mellitus, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis. Although only a small proportion of patients experience metabolic complications prior to transplantation, the prevalence of these complications posttransplantation reaches or exceeds that of the general population. This is of particular concern, as cardiovascular disease is the second leading cause of death in the late transplant period. A number of mechanisms mediate these metabolic complications, including reversal of cirrhosis pathophysiology, patient lifestyle factors, and immunosuppressive medications. Titration and modification of immunosuppression have been demonstrated to improve and sometimes even eliminate these conditions. Therefore, given the multiple etiologies contributing to the metabolic derangements, an effective management approach must incorporate lifestyle modifications, immunosuppression titration, and medical management. Best practices and understanding of the mechanisms underlying these complications allow for discussion of initial therapies and strategies; however, further study is necessary to determine the optimal management of metabolic complications over time. PMID:27917074

  11. Prevalence of Metabolic Syndrome in Liver Transplant Recipients in Iran

    Science.gov (United States)

    Masoumi, S. J.; Mazloom, Z.; Rezaianzadeh, A.; Nikeghbalian, S.; Malek-Hosseini, S. A.; Salahi, H.

    2016-01-01

    Background: Metabolic syndrome (MetSx) is common among liver transplant recipients. It contributes to morbidity and mortality. Objective: To determine the prevalence of MetSx in patients undergoing liver transplantation (LTx) in Iran. Methods: 202 liver transplant recipients of both sexes completed this study. Relevant information including age, sex, the underlying disease, systolic and diastolic blood pressure, waist circumference, fasting serum levels of blood sugar (FBS), triglyceride (TG), and HDL-cholesterol were measured. The prevalence of MetSx was evaluated at 1, 3, 6, 9, and 12 months after LTx. Results: The prevalence of MetSx was 36.6% after 1 month that decreased to 28.2% after 12 months of follow-up. The lowest prevalence of MetSx (27.7%) was observed 9 months after LTx. Our data showed a decrease in TG and an increase in HDL-C level and no significant changes in blood pressure, waist circumference and FBS during the study period. Conclusion: The prevalence of MetSx after LTx is high when compared to the normal population. It seems that a change in diet after transplantation may affect the prevalence of MetSx. PMID:28435640

  12. Liver transplantation and adolescence: The role of mental health.

    Science.gov (United States)

    Hames, Anna; Matcham, Faith; Joshi, Deepak; Heneghan, Michael A; Dhawan, Anil; Heaton, Nigel; Samyn, Marianne

    2016-11-01

    Young people (YP) with chronic illness have higher rates of mental health problems than the general population, with psychosocial complexity associated with nonadherence and poorer health outcomes. This study aimed to describe the prevalence of anxiety and depression in YP after liver transplantation, with autoimmune liver disease and other chronic liver diseases, identify the factors YP attribute their distress to and the relationship between anxiety/depression, and describe YP's beliefs about their illness and treatment. An electronically administered questionnaire battery was given routinely to YP attending an outpatient liver transition clinic; 187 YP participated, of which 17.7% screened positive for anxiety or depression. There were no significant differences between disease groups. This is significantly higher than the prevalence of common mental health problems in the general adolescent population. Patients most frequently attributed their distress to fatigue, sleep difficulties, financial concerns, problems at work/school, worry, and low self-esteem. Higher levels of depression and anxiety were significantly associated with specific illness and treatment beliefs but not with perceived understanding of illness or treatment control. In conclusion, the increased prevalence of mental health problems in YP and the intertwined nature of these with their physical health outcomes provide evidence that holistic care should be delivered as standard for this age group. Liver Transplantation 22 1544-1553 2016 AASLD. © 2016 by the American Association for the Study of Liver Diseases.

  13. Nasogastric tube induced refractory epistaxis during liver transplantation

    Directory of Open Access Journals (Sweden)

    Yun Hee Kim

    2016-10-01

    Full Text Available Cirrhosis has many possible manifestations. These signs and symptoms may be either the direct results of liver cell failure or secondary to the resultant portal hypertension. Portal hypertension can decrease the number of platelets, which increases the risk of bleeding.  Additionally, the liver plays a central role in hemostasis, because it is the site of clotting factors synthesis, coagulation inhibitors, and fibrinolytic proteins. Low platelet count and prolonged clotting times may increase the risk of epistaxis arising from minimal trauma, which can cause sometimes serious and occasionally fatal results. We experienced an intraoperative refractory epistaxis in a 60-year-old man with end-stage liver disease (ESLD due to hepatitis B virus-related hepatocellular carcinoma during liver transplantation. The patient started severe epistaxis after we attempted to place a nasogastric (NG tube. We describe successful management of massive epistaxis in an operating room under appropriate anesthesia and close hemodynamic monitoring.   Keywords: End-stage liver disease; Epistaxis; Liver transplantation; Nasogastric tube

  14. The place of liver transplantation in Caroli's disease and syndrome.

    Science.gov (United States)

    De Kerckhove, Laurent; De Meyer, Martine; Verbaandert, Catherine; Mourad, Michel; Sokal, Etienne; Goffette, Pierre; Geubel, Andre; Karam, Vincent; Adam, Rene; Lerut, Jan

    2006-05-01

    Caroli's disease (CD) or syndrome (CS) are rare inherited disorders which may cause severe, life-threatening, cholangitis or which may lead to hepatobiliary degeneration. The typical cystic biliary anomalies are often associated to congenital hepatic fibrosis (CHF) and, less frequently, to cystic renal disease especially autosomic recessive polycystic kidney disease (ARPKD). The place of liver transplantation (LT) in the treatment of CD or CS is evaluated based on our own experience of three successfully transplanted patients, the literature review of 19 patients and the European experience with 110 patients collected in the European Liver Transplant Registry. LT should be proposed as a definitive therapeutic option once severe cholangitis or (suspicion of) malignant transformation is present. The frequently used radiological, endoscopical or surgical biliary drainage procedures carry a high morbidity and mortality rate. In case of concomitant symptomatic CHF and renal failure, combined or sequential hepatorenal transplantation should be carried out, dependent on the evolution of the hepatic and renal disease. In case of associated ARPKD, renal transplantation is often indicated early on because of the more rapid progression of the renal component of the disease.

  15. Sleep Quality Assessment and Daytime Sleepiness of Liver Transplantation Candidates.

    Science.gov (United States)

    Marques, D M; Teixeira, H R S; Lopes, A R F; Martins-Pedersoli, T A; Ziviani, L C; Mente, Ê D; Castro-E-Silva, O; Galvão, C M; Mendes, K S

    2016-09-01

    The goal of this study was to evaluate the sleep quality and daytime sleepiness of patients eligible for liver transplants. A cross-sectional prospective study was conducted on liver transplant candidates from a transplant center in the interior of São Paulo State. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires were applied to obtain demographic and clinical characteristics and to assess sleep quality and daytime sleepiness. The mean (±SD) score on the Epworth Sleepiness Scale of the 45 liver transplantation candidates was 7.00 ± 2.83 points, with 28.89% having scores >10 points, indicating excessive daytime sleepiness. The mean score on the Pittsburgh Sleep Quality Index was 6.64 ± 4.95 points, with 60% of the subjects showing impaired sleep quality, with scores >5 points. The average sleep duration was 07:16 h. Regarding sleep quality self-classification, 31.11% reported poor or very poor quality. It is noteworthy that 73.33% of patients had to go to the bathroom, 53.33% woke up in the middle of the night, and 40.00% reported pain related to sleeping difficulties. Comparison of subjects with good and poor sleep quality revealed a significant difference in time to sleep (P = .0002), sleep hours (P = .0003), and sleep quality self-classification (P = .000072). Liver transplant candidates have a compromised quality of sleep and excessive daytime sleepiness. In clinical practice, we recommend the evaluation and implementation of interventions aimed at improving the sleep and wakefulness cycle, contributing to a better quality of life. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. [Analysis of 500 liver transplantations at Bellvitge Hospital, Spain].

    Science.gov (United States)

    Jaurrieta, E; Casais, L; Figueras, J; Ramos, E; Lama, C; Rafecas, A; Casanovas Taltavull, T; Fabregat, J; Xiol, X; Torras, J; Baliellas, C; Sabaté, A; Rufí, G; Benasco, C; Casanovas, T; Serrano, T; Gil-Vernet, S; Sabaté, I; Busquets, J

    2000-10-28

    We present the experience of the liver transplantation program at the Hospital of Bellvitge with 500 transplantations performed during 15 years, to describe changes in liver transplantation observed throughout the time and to analyze the long term results. Five groups each one including 100 consecutive transplantations are studied. The main indications were hepatocellular carcinoma (23%), alcoholic cirrhosis (22.8%), and post-hepatitis C cirrhosis (18.8%). Sixty-five retransplantations were performed in 59 patients (13%), being the more frequent indications arterial thrombosis (13 patients) and primary nonfunction of graft (10 patients). In 10 patients a hepatorenal transplantation was performed. In group I, the most frequent donor cause of death was cranial traumatism (80%), while in group V it was the vascular pathology (52%). There were other significative differences between these groups of patients (I vs V): patients with stage 2 or 3 from UNOS status (45 vs 19%), blood use (29.6 [26] vs 4.6 [5.3] PRBC), ICU stay (13 [13] vs 7.4 [11] days), hospital stay (40 [52] vs 23.7 [17] days), rejection rate (46 vs 20%) and primary graft nonfunction (9 vs 3%). However, the infection rates (48 vs 54.5%) and biliary tract complications (26 vs 20%) have not shown statistically significant differences. Actuarial one and 5-year survival are 83 and 70% respectively. An important and progressive improvement of liver transplantation results has been observed. However, de novo tumours, hepatitis C virus recurrence and chronic rejection can limit long term results.

  17. Menstrual function in female liver transplant recipients of reproductive age.

    Science.gov (United States)

    Jabiry-Zieniewicz, Z; Kaminski, P; Bobrowska, K; Pietrzak, B; Wielgos, M; Smoter, P; Zieniewicz, K; Krawczyk, M

    2009-06-01

    End-stage liver failure is associated with severe abnormalities in menstrual and reproductive function. These abnormalities may be reversed by successful orthotopic liver transplantation (OLT). The aim of the study was to investigate menstrual patterns and sex hormone profiles among female liver transplant recipients of reproductive age. The study group consisted of 24 women of reproductive age with end-stage liver failure who underwent successful OLT. Menstrual patterns and sex hormone profiles were analyzed before as well as 3 and 12 months after OLT. Twenty-seven healthy women of reproductive age served as controls. Biochemical parameters of liver function were assessed before and after OLT. Amenorrhea was the most commonly observed abnormality of menstrual cycle in women with end-stage liver failure (71% of patients). The recurrence of regular menstrual cycles was observed in 35% of patients 3 months after OLT. The percentage increased to 70% at 1 year after grafting and was clearly associated with stabilization of liver function. Similar levels of follicle stimulation hormone (FSH), luteinizing hormone (LH), prolactine (PRL), and testosterone (T) as well as lower levels of estradiol (E(2)), dehydroepiandrostendione sulphate (DHEA-S), and progesterone, (P) were observed in patients with liver failure compared with healthy women. We observed normalization of E(2) and DHEA-S levels after OLT. Amenorrhea, the most common menstrual disturbance in women with end-stage liver failure, may be reversed by OLT. One year after OLT menstrual bleedings were noted in 74% of patients of reproductive age. The recurrence of reproductive function indicated the need for effective and safe family planning methods in that group of patients.

  18. Pediatric acute liver failure in Brazil: Is living donor liver transplantation the best choice for treatment?

    Science.gov (United States)

    Tannuri, Ana Cristina Aoun; Porta, Gilda; Kazue Miura, Irene; Santos, Maria Merces; Moreira, Daniel de Albuquerque Rangel; de Rezende, Nathassia Mancebo Avila; Miyatani, Helena Thie; Tannuri, Uenis

    2016-07-01

    Acute liver failure (ALF) in children is a life-threatening condition that often leads to urgent liver transplantation (LT). The aim of the present investigation was to describe the experience in Brazil in treating pediatric ALF, with an emphasis on the role of living donor liver transplantation (LDLT) in treating this condition. All children with ALF who fulfilled the criteria for an urgent LT were admitted to the intensive care unit. Patients were divided into 2 groups based on the moment of admission: before and after June 2007, when the LDLT program for ALF was started. Statistical analyses were performed to identify prognostic factors of patients with ALF. For the study, 115 children with ALF were admitted. All patients had some degree of encephalopathy. Among the patients, 26% of them required intracranial pressure monitoring (IPM), 12.8% of the patients required hemodialysis, and 79 patients underwent transplantation (50 deceased donors and 29 living donors) corresponding to 12.4% of all pediatric LTs. Only 9 children recovered without LT. The need for IPM and nonperformance of LT were related to a higher mortality. The mortality rate of patients who underwent LT was significantly lower than that of children with ALF who did not undergo a LT (48.1% versus 75%; P = 0.02). The incidences of primary nonfunction and mortality were statistically higher among deceased donor liver transplantations than LDLTs. Finally, it was verified that the overall survival rate of transplanted patients was increased after the introduction of LDLT (P = 0.02). In conclusion, ALF in children continues to be a severe and devastating condition, and a LT should be performed promptly. The introduction of LDLT could increase the survival rate of patients in Brazil. Liver Transplantation 22 1006-1013 2016 AASLD. © 2016 American Association for the Study of Liver Diseases.

  19. Liver transplantation for Hepatocellular carcinoma: Predictors of ...

    African Journals Online (AJOL)

    Hepatocellular carcinoma (HCC) is an aggressive malignancy mostly complicating some underlying liver pathology that has lead to cirrhosis. Some of the epidemiological factors were summarized by the 54th AASLD meeting. South African Gastroenterology Journal Vol. 6 (3) 2008: pp. 6-12 ...

  20. Generation and characterization of rat liver stem cell lines and their engraftment in a rat model of liver failure

    NARCIS (Netherlands)

    Kuijk, Ewart W; Rasmussen, Shauna; Blokzijl, Francis; Huch, Meritxell; Gehart, Helmuth; Toonen, Pim; Begthel, Harry; Clevers, Hans; Geurts, Aron M; Cuppen, Edwin

    2016-01-01

    The rat is an important model for liver regeneration. However, there is no in vitro culture system that can capture the massive proliferation that can be observed after partial hepatectomy in rats. We here describe the generation of rat liver stem cell lines. Rat liver stem cells, which grow as

  1. Rhodotorula glutinis fungemia in a liver-kidney transplant patient.

    Science.gov (United States)

    Riedel, D J; Johnson, J K; Forrest, G N

    2008-06-01

    A 54-year-old man underwent simultaneous liver-kidney transplantation. During his prolonged hospitalization, he developed catheter-related fungemia with Rhodotorula glutinis and azole-resistant Candida glabrata. Management of the Rhodotorula fungemia was complicated by his renal insufficiency, hepatic insufficiency, and the concurrent fungemia with multi-azole resistant C. glabrata. He was treated with combination therapy with voriconazole and micafungin with subsequent clearance of the fungemia. Rhodotorula species are emerging as human pathogens with the increasing number of immunosuppressed patients in the last few decades. This is the first report of a R. glutinis fungemia in a solid organ transplant recipient.

  2. Pediatric liver transplantation - ethical dilemmas in a disabled patient.

    Science.gov (United States)

    Toker, A; Salzer, L

    2012-09-01

    Allocation of medical resources, especially resources with absolute scarcity such as organs for transplant, is a difficult task. Medical, surgical, and ethical considerations should be evaluated. In solid organ transplantation, ethics committees are the gate keepers that deal with moral philosophy when moral values are in conflict. Often, no good solution to a dilemma in these medical ethics exists. Our case presents split living liver donation for retransplantation in a mentally disabled girl, with few medical ethics principles at stake. © 2011 John Wiley & Sons A/S.

  3. Future Economics of Liver Transplantation: A 20-Year Cost Modeling Forecast and the Prospect of Bioengineering Autologous Liver Grafts.

    Directory of Open Access Journals (Sweden)

    Dany Habka

    Full Text Available During the past 20 years liver transplantation has become the definitive treatment for most severe types of liver failure and hepatocellular carcinoma, in both children and adults. In the U.S., roughly 16,000 individuals are on the liver transplant waiting list. Only 38% of them will receive a transplant due to the organ shortage. This paper explores another option: bioengineering an autologous liver graft. We developed a 20-year model projecting future demand for liver transplants, along with costs based on current technology. We compared these cost projections against projected costs to bioengineer autologous liver grafts. The model was divided into: 1 the epidemiology model forecasting the number of wait-listed patients, operated patients and postoperative patients; and 2 the treatment model forecasting costs (pre-transplant-related costs; transplant (admission-related costs; and 10-year post-transplant-related costs during the simulation period. The patient population was categorized using the Model for End-Stage Liver Disease score. The number of patients on the waiting list was projected to increase 23% over 20 years while the weighted average treatment costs in the pre-liver transplantation phase were forecast to increase 83% in Year 20. Projected demand for livers will increase 10% in 10 years and 23% in 20 years. Total costs of liver transplantation are forecast to increase 33% in 10 years and 81% in 20 years. By comparison, the projected cost to bioengineer autologous liver grafts is $9.7M based on current catalog prices for iPS-derived liver cells. The model projects a persistent increase in need and cost of donor livers over the next 20 years that's constrained by a limited supply of donor livers. The number of patients who die while on the waiting list will reflect this ever-growing disparity. Currently, bioengineering autologous liver grafts is cost prohibitive. However, costs will decline rapidly with the introduction of new

  4. [Adult-onset Still's disease with liver failure requiring liver transplantation].

    Science.gov (United States)

    Terán, Alvaro; Casafont, Fernando; Fábrega, Emilio; Martínez-Taboada, Víctor Manuel; Rodríguez-Valverde, Vicente; Pons-Romero, Fernando

    2009-12-01

    We present the case of a 23-year-old man with fever of unknown origin, who developed acute liver failure 2 months after symptom onset, requiring an urgent liver transplantation. The diagnosis of adult-onset Still's disease was established after the reappearance of symptoms after transplantation, and high doses of corticosteroids were used to control disease activity. Subsequently, given the impossibility of tapering the steroid dose, interleukin-1 receptor blocking treatment was started with satisfactory outcome. We also review the published literature.

  5. Rosiglitazone attenuates transplant arteriosclerosis after allogeneic aorta transplantation in rats

    NARCIS (Netherlands)

    Onuta, Geanina; Rienstra, Heleen; de Boer, Jan Freark; Boer, Mark Walther; Roks, Anton J. M.; Klatter, Flip A.; Uges, Donald R. A.; Navis, Gerjan; Rozing, Jan; Hillebrands, Jan-Luuk

    2007-01-01

    Background. Transplant arteriosclerosis is a leading cause of chronic transplant dysfunction and is characterized by occlusive neointima formation in intragraft arteries. Development of transplant arteriosclerosis is refractory to conventional immunosuppressive drugs and adequate therapy is not

  6. Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach

    Science.gov (United States)

    Biolato, Marco; Marrone, Giuseppe; Miele, Luca; Gasbarrini, Antonio; Grieco, Antonio

    2017-01-01

    Hepatocellular carcinoma is becoming an increasing indication for liver transplantation, but selection and allocation of patients are challenging because of organ shortages. Conventional Milan criteria are the reference for the selection of patients worldwide, but many expanded criteria, like University of California San Francisco criteria and up-to-7 criteria, have demonstrated that survival and recurrence results are lower than those for restricted indications. Correct staging is crucial and should include surrogate markers of biological aggressiveness (α-fetoprotein, response to loco-regional treatments). Successful down-staging can select between patients with tumor burden initially beyond transplantation criteria those with a more favorable biology, provided a 3-mo stability in meeting the transplantation criteria. Allocation rules are constantly adjusted to minimize the imbalance between the priorities of candidates with and without hepatocellular carcinoma, and take into account local donor rate and waitlist dynamics. Recently, Mazzaferro et al proposed a benefit-oriented “adaptive approach”, in which the selection and allocation of patients are based on their response to non-transplantation treatments: low priority for transplantation in case of complete response, high priority in case of partial response or recurrence, and no listing in case of progression beyond transplantation criteria. PMID:28566879

  7. Impact of Pre-Transplant Bacterial Infections on Post-Operative Outcomes in Patients after Liver Transplantation.

    Science.gov (United States)

    Kim, Im-Kyung; Park, Joon Seong; Ju, Man Ki

    In contrast to studies evaluating the negative effect of bacterial infections on clinical outcomes after liver transplantation, there is little evidence with regard to pre-transplant bacterial infections. We aimed to investigate the impact of pre-transplant bacterial infections on post-transplant outcomes in patients after liver transplantation. We retrospectively analyzed clinical data from 33 consecutive patients who underwent primary liver transplantations. Patients were divided into two groups based on the occurrence of a bacterial infection within the 30 days before transplantation. Of the 33 patients, 23 patients did not have pre-transplant bacterial infections, while 10 patients did have pre-transplant bacterial infections. Pre-transplant bacterial infections were urinary tract infections (n = 4), spontaneous bacterial peritonitis (n = 3), and one each of pneumonia, bacteremia, and cellulitis. There were no differences in clinical characteristics between the two groups. Post-operative clinical outcomes, including post-operative bacterial infection, intensive-care unit re-admission, 30-day re-hospitalization, and 90-day mortality rate were not significantly different between the two groups. The two-year overall survival rate was 76.7% in patients with pre-transplant infections and 80.0% in those without pre-transplant infections. Patients with pre-transplant bacterial infections did not have inferior clinical outcomes, compared with those without pre-transplant bacterial infections.

  8. Successful treatment of a child with fulminant liver failure and coma due to Amanita phalloides poisoning using urgent liver transplantation.

    Science.gov (United States)

    Araz, C; Karaaslan, P; Esen, A; Zeyneloglu, P; Candan, S; Torgay, A; Haberal, M

    2006-03-01

    Intoxication due to eating wild mushrooms presents with a variety of signs, ranging from mild diarrhea to severe organ failure. We present the case of an 11-year-old boy with fulminant liver failure and hepatic coma due to Amanita phalloides poisoning treated with an urgent pediatric orthotopic liver transplantation. Successful treatment of patients with fulminant liver failure and hepatic coma caused by Amanita phalloides poisoning is possible using urgent orthotopic liver transplantation when conservative medical treatment modalities are ineffective.

  9. The relevance of intestinal dysbiosis in liver transplant candidates.

    Science.gov (United States)

    Grąt, M; Hołówko, W; Wronka, K M; Grąt, K; Lewandowski, Z; Kosińska, I; Krasnodębski, M; Wasilewicz, M; Gałęcka, M; Szachta, P; Zborowska, H; Patkowski, W; Krawczyk, M

    2015-04-01

    The gut microbial ecosystem plays an important role in the pathogenesis of liver diseases. However, the association of microbial community structure with the severity of liver dysfunction is not completely understood. Fecal microflora was assessed in 40 patients with liver cirrhosis listed for primary liver transplantation (LT). Independent associations between fecal microbial counts and serum bilirubin, serum creatinine, international normalized ratio (INR), and the Model for End-stage Liver Disease (MELD) score were established in multiple linear regression models. Bifidobacterium (standardized regression coefficient [sβ] = -0.549; P dysbiosis, was significantly related to the MELD score following the adjustment for the absolute Bifidobacterium (sβ = -0.333; P = 0.029) and Enterococcus (sβ = -0.966; P = 0.003) numbers. This pre-transplant dysbiosis ratio (PTDR) was significantly correlated with Enterococcus (R = -0.897; P dysbiosis in cirrhotic patients. The H2 O2 -producing Lactobacillus strains potentially ameliorate this dysbiotic state. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. What’s on your mind? : Emotions and perceptions of liver transplant candidates and recipients

    NARCIS (Netherlands)

    Annema-de Jong, Coby

    2017-01-01

    Undergoing a liver transplant is a stressful and major life event. A significant part of the Dutch liver transplant patients experience, therefore, psychological problems such as symptoms of anxiety, depression, or posttraumatic stress (PTS), both before and after the transplant. A prospective study

  11. Survival without biliary complications after liver transplant for primary sclerosing cholangitis.

    Science.gov (United States)

    Mogl, Martina T; Albert, Kathrin; Pascher, Andreas; Sauer, Igor; Puhl, Gero; Gül, Safak; Schönemann, Constanze; Neuhaus, Peter; Guckelberger, Olaf

    2013-12-01

    Patients who have a liver transplant for primary sclerosing cholangitis may develop recurrent disease and biliary complications, organ loss necessitating revision liver transplant, or death. We evaluated long-term outcomes in patients who had liver transplant for primary sclerosing cholangitis. In 71 patients who had a liver transplant for end-stage liver disease because of primary sclerosing cholangitis, a retrospective review was done to evaluate biliary complication-free survival, transplanted organ survival, and death. Human leukocyte antigen typing and matching were reviewed. There were 39 patients (55%) who had biliary complications, loss of the liver transplant, or death at a mean 12.1 years after transplant. The 5- and 10-year event-free survival reached 74.6% and 45% (53 patients after 5 years, and 32 patients after 10 years). Male sex of transplant recipients was a significant risk factor for biliary complications, revision liver transplant, or death. Most patients had inflammatory bowel disease, primarily ulcerative colitis. The human leukocyte antigen profile or number of mismatches had no effect on complication-free survival. Biliary complications, revision liver transplant, and death are a useful combined primary endpoint for recurrent primary sclerosing cholangitis after liver transplant.

  12. Anaesthetic considerations for liver transplantation in propionic acidemia

    Directory of Open Access Journals (Sweden)

    Akila Rajakumar

    2016-01-01

    Full Text Available Propionic acidemia (PA is an autosomal recessive disorder of metabolism due to deficiency of the enzyme propionyl-CoA carboxylase (PCC that converts propionyl-CoA to methylmalonyl-CoA with the help of the cofactor biotin inside the mitochondria. The resultant accumulation of propionyl-CoA causes severe hyperammonaemia and life-threatening metabolic acidosis. Based on the positive outcomes, liver transplantation is now recommended for individuals with recurrent episodes of hyperammonaemia or acidosis that is not adequately controlled with appropriate medical therapies. We report anaesthetic management of two children with PA for liver transplantation at our institution. It is essential for the anaesthesiologist, caring for these individuals to be familiar with the manifestations of the disease, the triggers for decompensation and management of an acute episode.

  13. Anaesthetic considerations for liver transplantation in propionic acidemia.

    Science.gov (United States)

    Rajakumar, Akila; Kaliamoorthy, Ilankumaran; Reddy, Mettu Srinivas; Rela, Mohamed

    2016-01-01

    Propionic acidemia (PA) is an autosomal recessive disorder of metabolism due to deficiency of the enzyme propionyl-CoA carboxylase (PCC) that converts propionyl-CoA to methylmalonyl-CoA with the help of the cofactor biotin inside the mitochondria. The resultant accumulation of propionyl-CoA causes severe hyperammonaemia and life-threatening metabolic acidosis. Based on the positive outcomes, liver transplantation is now recommended for individuals with recurrent episodes of hyperammonaemia or acidosis that is not adequately controlled with appropriate medical therapies. We report anaesthetic management of two children with PA for liver transplantation at our institution. It is essential for the anaesthesiologist, caring for these individuals to be familiar with the manifestations of the disease, the triggers for decompensation and management of an acute episode.

  14. Ledipasvir and sofosbuvir for recurrent hepatitis C after liver transplantation.

    Science.gov (United States)

    Oya, Yuki; Sugawara, Yasuhiko; Watanabe, Takehisa; Yoshimaru, Yoko; Honda, Masaki; Hashimoto, Shintaro; Yoshii, Daiki; Isono, Kaori; Hayashida, Shintaro; Yamamoto, Hidekazu; Tanaka, Motohiko; Sasaki, Yutaka; Inomata, Yukihiro

    2017-01-16

    Management of recurrent hepatitis C following liver transplantation still remains a challenge. Here, we report five patients who achieved viral responses following combined treatment with ledipasvir and sofosbuvir. All the patients received tacrolimus for immunosuppression. No dose adjustment was made before the ledipasvir and sofosbuvir therapy. All completed the intended 12-week treatment course with the full dose of ledipasvir and sofosbuvir. There were no significant adverse events greater than grade 2. During the study period, no acute rejection episodes were detected. The trough levels of tacrolimus were maintained stably. Hepatitis C virus RNA was not detected at week 12 in any of the patients. Based on the findings from this pilot study, combined ledipasvir and sofosbuvir therapy for 12 weeks is effective and safe for living - donor liver transplantation recipients with recurrence of hepatitis C virus.

  15. An unusual cause of cancer mimicry following liver transplantation.

    Science.gov (United States)

    Qumosani, Karim; Chandok, Natasha

    2012-01-01

    Sirolimus is an approved anti-rejection agent following liver or kidney transplantation that works through inhibition of the mammalian target of rapamycin (mTOR). As sirolimus functions through a pathway independent of calcineurin inhibition, it may have less potential for nephrotoxicity and carcinogenesis. That being said, there are a myriad of potential adverse effects reported with sirolimus, many of which are severe and unknown or poorly understood. Herein we present a case of sirolimus causing a serious but uncommon adverse event in an adult liver transplant recipient; the adverse event in this instance unfortunately resulted in significant medical testing and morbidity. The adverse event profile of sirolimus is summarized through review of available evidence.

  16. A psychiatric study of 247 liver transplantation candidates.

    Science.gov (United States)

    Trzepacz, P T; Brenner, R; Van Thiel, D H

    1989-01-01

    This study prospectively evaluated 247 consecutive liver transplantation candidates for the presence of psychiatric disorders. While one-half did not meet DSM-III criteria for a psychiatric diagnosis, 18.6% had delirium, 19.8% had an adjustment disorder, 9% had alcohol abuse or dependence, 4.5% had major depression, and 2% had other drug abuse or dependence. Delirious subjects were significantly more likely to have a lower serum albumin, lower Mini-Mental State exam scores, higher Trailmaking Test scores (both A and B), and more dysrhythmia on electroencephalogram (EEG). In addition, while both delirious and nondelirious subjects were judged to have high levels of overall stress, those with delirium had significantly poorer adaptive functioning and lower occupational, family, and social scale ratings. Thus, while all liver transplant candidates are under substantial psychosocial stress and require psychosocial support, those identified as being delirious require particular attention because of their numerous cognitive, medical, and psychosocial problems.

  17. Value of ultrasound-guided percutaneous liver biopsy in children following liver transplantation.

    Science.gov (United States)

    Sornsakrin, Marijke; Helmke, Knut; Briem-Richter, Andrea; Ganschow, Rainer

    2010-11-01

    Pediatric liver transplant recipients often need to undergo liver biopsies for the detection and specification of complications such as acute or chronic graft rejection, infection, or drug toxicity. Complications resulting from liver biopsy are rare. The aim of our single-center retrospective study was to report on liver biopsy-related complications and, moreover, to assess the significance of histological findings in correlation with the suspected diagnosis. Overall, 120 liver biopsies from 67 children were performed and analyzed. All of the biopsies were performed with ultrasound guidance using midazolam and ketamine. The overall incidence of complications was 5.0%, but most of these complications were mild. In 2 cases, however, the complications were severe and required surgical intervention in addition to further medical treatment.In about 92% of the cases, liver histology confirmed the previously suspected diagnosis based on clinical and clinical laboratory indications. We concluded that postliver transplantation liver biopsy in children seldom provides unexpected results and, even using ultrasound guidance, has led, albeit rarely, to serious complications. We therefore now accept potential delay in treatment and reserve liver biopsy for patients who fail to respond to therapy based on clinical judgment.

  18. Application of contrast-enhanced ultrasound after liver transplantation: Current status and perspectives.

    Science.gov (United States)

    Ren, Jie; Wu, Tao; Zheng, Bo-Wen; Tan, Ying-Yi; Zheng, Rong-Qin; Chen, Gui-Hua

    2016-01-28

    Liver transplantation is an effective treatment for patients with end-stage liver disease. Accurate imaging evaluation of the transplanted patient is critical for ensuring that the limited donor liver is functioning appropriately. Ultrasound contrast agents (UCAs), in combination with contrast-specific imaging techniques, are increasingly accepted in clinical use for the assessment of the hepatic vasculature, bile ducts and liver parenchyma in pre-, intra- and post-transplant patients. We describe UCAs, their technical requirements, the recommended clinical indications, image interpretation and the limitations for contrast-enhanced ultrasound applications in liver transplantation.

  19. Echinocandin Resistance in Candida Species Isolates from Liver Transplant Recipients.

    Science.gov (United States)

    Prigent, Gwénolé; Aït-Ammar, Nawel; Levesque, Eric; Fekkar, Arnaud; Costa, Jean-Marc; El Anbassi, Sarra; Foulet, Françoise; Duvoux, Christophe; Merle, Jean-Claude; Dannaoui, Eric; Botterel, Françoise

    2017-02-01

    Liver transplant recipients are at risk of invasive fungal infections, especially candidiasis. Echinocandin is recommended as prophylactic treatment but is increasingly associated with resistance. Our aim was to assess echinocandin drug resistance in Candida spp. isolated from liver transplant recipients treated with this antifungal class. For this, all liver-transplanted patients in a University Hospital (Créteil, France) between January and June of 2013 and 2015 were included. Susceptibilities of Candida isolates to echinocandins were tested by Etest and the EUCAST reference method. Isolates were analyzed by FKS sequencing and genotyped based on microsatellites or multilocus sequence typing (MLST) profiles. Ninety-four patients were included, and 39 patients were colonized or infected and treated with echinocandin. Echinocandin resistance appeared in 3 (8%) of the treated patients within 1 month of treatment. One patient was colonized by resistant Candida glabrata, one by resistant Candida dubliniensis, and one by resistant Candida albicans Molecular analysis found three mutations in FKS2 HS1 (F659S, S663A, and D666E) for C. glabrata and one mutation in FKS1 HS1 (S645P) for C. dubliniensis and C. albicans Susceptible and resistant isolates belonged to the same genotype. To our knowledge, this is the first study on echinocandin resistance in Candida spp. in a liver transplant population. Most resistant isolates were found around/in digestive sites, perhaps due to lower diffusion of echinocandin in these sites. This work documents the risk of emergence of resistance to echinocandin, even after short-term treatment. Copyright © 2017 Prigent et al.

  20. Cytomegalovirus infection in liver transplant recipients: Updates on clinical management

    OpenAIRE

    Marcelin, Jasmine Riviere; Beam, Elena; Razonable, Raymund R

    2014-01-01

    Cytomegalovirus (CMV) infection is a common complication after liver transplantation, and it is associated with multiple direct and indirect effects. Management of CMV infection and disease has evolved over the years, and clinical guidelines have been recently updated. Universal antiviral prophylaxis and a pre-emptive treatment strategy are options for prevention. A currently-recruiting randomized clinical trial is comparing the efficacy and safety of the two prevention strategies in the high...

  1. Candida arteritis occurring in a liver transplant recipient.

    Science.gov (United States)

    Lladó, L; Solé, C; Bodro, M; Baliellas, C; Sabé, N; Petit, A; Ramos, E; Carratalà, J; Fabregat, J

    2014-06-01

    We report the first case, to our knowledge, of Candida arteritis in a liver transplant recipient. The patient presented with hemorrhagic shock requiring emergency arterial repair. As Candida albicans, Candida tropicalis, and Candida glabrata were growing in the arterial tissue, the patient received antifungal therapy for 5 months, but died because of chronic graft dysfunction. No evidence of fungal infection was found in the tissue on postmortem examination. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Metabolic syndrome and liver transplantation: a review and guide to management.

    Science.gov (United States)

    Watt, Kymberly D S; Charlton, Michael R

    2010-07-01

    Metabolic syndrome is common among liver transplant recipients before and after transplantation. The components of metabolic syndrome are often exacerbated in the post-transplant period by transplant specific factors, such as immunosuppression, and are strong predictors of patient morbidity and mortality. Many aspects of the metabolic syndrome are modifiable. Early recognition, prevention and treatment of post-transplant hypertension, obesity, dyslipidemia and diabetes may impact long-term post-transplant survival. Further study into the prevention and management of these issues in the transplant patient are needed. Copyright 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  3. Liver biopsy findings in patients with hematopoietic cell transplantation.

    Science.gov (United States)

    Eskandari, Farzan; Rowan, Daniel J; Hari, Parameswaran; Kapke, Jonathan; Schneidewend, Robert; E Hagen, Catherine; Oshima, Kiyoko

    2017-08-01

    Liver dysfunction is a frequent complication after hematopoietic cell transplantation. Liver biopsy has an important role for confirming the diagnosis of graft-versus-host disease (GVHD) or other liver diseases. The histological features of GVHD are not specific, and GVHD and other coexisting diseases may be present in the same biopsy, which makes the histologic interpretation of the liver biopsy more complex and challenging. The aim of the study is to improve the present diagnostic criteria. Fifty-two liver biopsies were studied. Most biopsies (47, 92%) showed some features of GVHD. Five (9.6%) had no GVHD, 20 (38.5%) had possible GVHD, and 27 (51.9%) had likely GVHD. Histologic features were analyzed semi-quantitatively and scored. Bile duct damage and intraepithelial lymphocytes were significantly more frequent in likely GVHD groups. Bile duct injury score calculated as the sum of bile duct damage and intraepithelial lymphocytes score was 2.3 in no GVHD and possible GVHD groups, and 4.2 in likely GVHD group (Pliver injury (8, 16%) and sinusoidal obstruction syndrome (6, 12%) are particularly important causes of liver dysfunction. Moderate degree of bile duct injury and intraepithelial lymphocytes were the most helpful histologic findings to confirm the diagnosis of GVHD. In addition, it is important for the pathologist to be aware of the etiologies of liver dysfunction other than GVHD. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Application of thromboelastography in patients after liver transplantation

    Directory of Open Access Journals (Sweden)

    YUAN Hongxiang

    2015-02-01

    Full Text Available ObjectiveTo evaluate the value of thromboelastography (TEG in guiding the proper use of blood components in patients after liver transplantation. MethodsThe blood samples from 35 patients after liver transplantation who visited our hospital from November 2013 to April 2014 were collected, in which TEG and conventional coagulation test were performed. The TEG parameters, such as reaction time of coagulation (R, clot formation time (K, Angle, and the maximum amplitude (MA, and coagulation parameters were subjected to bivariate linear regression analysis. The use of blood components and amount of blood transfusion following TEG′s instruction were compared with the clinical application. Comparison of continuous data was made by paired t test. ResultsActivated partial thromboplastin time and prothrombin time were positively correlated with R (r=0.69 and 0.41, P=0.001 and 0.030, respectively. Fibrinogen was negatively correlated with K (r=-0.03, P=0.008. Platelet was positively correlated with Angle and MA (r=0.46 and 0.68, P=0.029 and 0.000, respectively. Fibrinogen was positively correlated with MA (r=0.33, P=0.040. There was a significant difference in R value of TEG before and after the heparanase neutralization (P=0.027. ConclusionTEG has a clinical value in guiding the proper use of blood components in patients after liver transplantation.

  5. Bypass during Liver Transplantation: Anachronism or Revival? Liver Transplantation Using a Combined Venovenous/Portal Venous Bypass—Experiences with 163 Liver Transplants in a Newly Established Liver Transplantation Program

    Directory of Open Access Journals (Sweden)

    Anne Mossdorf

    2015-01-01

    Full Text Available Introduction. The venovenous/portal venous (VVP bypass technique has generally become obsolete in liver transplantation (LT today. We evaluated our experience with 163 consecutive LTs that used a VVP bypass. Patients and Methods. The liver transplant program was started in our center in 2010. LTs were performed using an extracorporal bypass device. Results. Mean operative time was 269 minutes and warm ischemic time 43 minutes. The median number of transfusion of packed cells and plasma was 7 and 14. There was no intraoperative death, and the 30-day mortality was 3%. Severe bypass-induced complications did not occur. Discussion. The introduction of a new LT program requires maximum safety measures for all of the parties involved. Both surgical and anaesthesiological management (reperfusion can be controlled very reliably using a VVP bypass device. Particularly when using marginal grafts, this approach helps to minimise both surgical and anaesthesiological complications in terms of less volume overload, less use of vasopressive drugs, less myocardial injury, and better peripheral blood circulation. Conclusion. Based on our experiences while establishing a new liver transplantation program, we advocate the reappraisal of the extracorporeal VVP bypass.

  6. Traumatic neuroma of extrahepatic bile ducts after orthotopic liver transplantation.

    Science.gov (United States)

    Herrera, L; Martino, E; Rodríguez-Sanjuán, J C; Castillo, J; Casafont, F; González, F; Figols, J; Casanueva, J; Cagigas, M; Gómez-Fleitas, M

    2009-04-01

    Traumatic neuromas (TN) of the biliary tree causing strictures have only occasionally been described after liver transplantation. Herein, we have reported 15 cases of TN that were detected between 1 and 17 months after transplantation (median: 4 months) during surgery for obstructive jaundice (12 cases), after alterations of liver function tests (two cases), or incidentally discovered after retransplantation (n = 1) we resected the lesion and the biliary anastomosis. Pathological examination and immunostaining for S-100 protein were performed to study the nerve fascicles. After a median follow-up time of 64 months (range = 0-127), 10 patients are alive without any complication related to the previous biliary TN. We propose the following classification: type I: TN originating from and located in the main biliary tract wall, and type II: TN arising from the surrounding tissues next to the main biliary tract. We conclude that TN are not uncommon after liver transplantation and that they are sometimes symptomatic, causing a biliary stricture that requires surgical treatment. We propose a classification to help patient selection for surgery. In our opinion, resection of the TN is the operation of choice, together with resection of the involved biliary tract in type I TN.

  7. Value of endothelin in cellular rejection after liver transplantation.

    Science.gov (United States)

    Fábrega, E; Figols, J; Dueñas, C; Crespo, J; Casafont, F; Sanchez-Antolín, G; de las Heras, G; Amado, J A; Pons-Romero, F

    1997-02-01

    Endothelin-1 is a vasoconstrictor peptide released by the vascular endothelium by various chemical and mechanical factors. Cellular rejection is one of the most common complications following orthotopic liver transplantation, endotheliitis being its most specific and consistent histological feature. To assess the role of endothelin in cellular hepatic rejection, we studied 21 cirrhotic patients undergoing elective liver transplantation. These patients were divided in two groups: Group I comprised 10 patients without cellular rejection, and Group II comprised 11 patients with cellular rejection. Endothelin was measured on day 7 after transplantation, on the day of liver biopsy, and after treatment for rejection. We found a significant increase in the plasma endothelin levels in the early postoperative period in the patients with moderate or severe cellular rejection compared with the non-rejection group. It remained significantly elevated until the clinical diagnosis of rejection was made. This value returned to baseline with successful treatment. So, the monitorization of this peptide may be of help in the diagnosis of rejection, its severity, and the evaluation of its resolution.

  8. Liver transplantation consequential to Caroli's syndrome: a case report.

    Science.gov (United States)

    Tallón Aguilar, L; Sánchez Moreno, L; Barrera Pulido, L; Pareja Ciuró, F; Suárez Artacho, G; Alamo Matinez, J M; Bernal Bellido, C; Garía González, I; Serrano Díaz-Canedo, J; Gómez Bravo, M A; Bernardos Rodríguez, A

    2008-11-01

    Caroli's disease is a rare condition that includes fibrocystic malformations of the bile duct. It consists of multifocal congenital dilatations of the intrahepatic bile ducts, which may be diffuse or limited, presenting in sack form that produces cystic structures which communicate with the biliary tree. Herein we have presented the case of a 44-year-old woman with recurrent cholangitis consequential to Caroli's syndrome. The distinctive feature of this case was that it was the first and only liver transplantation performed to date for this cause at our center among 700 procedures that had been performed over 19 years. The hepatectomy sample from the liver transplantation showed large cystic dilatations at the level of segments VII and VIII. The pathological study reported congenital dilatation of the intrahepatic bile ducts, associated with congenital hepatic fibrosis (Caroli's syndrome). Caroli's syndrome is a complex association of conditions which usually presents together with polycystic kidney lesions. Orthotopic liver transplantation is still the only therapeutic option for diffuse, uncontrollable cases or those with significant portal hypertension, as well as being the final option in the other cases in the event of a lack of response to other therapeutic options or as an alternative to them.

  9. Surgical treatment of biliary tract complications after liver transplantation.

    Science.gov (United States)

    Lladó, L; Fabregat, J; Baliellas, C; Gonzalez-Castillo, A; Ramos, E; Gonzalez-Vilatarsana, E; Torras, J; Rafecas, A

    2012-01-01

    Biliary strictures are the most common biliary tract complication after liver transplantation. There are scarce data on the results of hepaticojejunostomy (HJ) in the management of biliary complications after orthotopic liver transplantation (OLT). Thus, the role of surgery in this setting remains to be established. The aim of this study was to evaluate the results of surgical treatment of patients with biliary complications at our institution. We reviewed 1000 consecutive liver transplantations performed at our institution from 1984 to 2007. We used a prospectively recorded database to identify patients who underwent HJ to treat any biliary tract complication. Overall, 62 patients (6.2%) underwent HJ, 40 for an anastomotic and 7 for a non-anastomotic stricture as well as 15 for biliary leaks. Postoperative morbidity was 16%, and postoperative mortality 1.6%. There were 7 cases of anastomotic stenosis (11.3%). Four patients (5%) required retransplantation. HJ is a safe procedure to manage biliary complications after OLT. It may be the first treatment choice especially for cases with anastomotic strictures. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Liver transplantation for massive hepatomegaly due to polycystic liver disease: an extreme case.

    Science.gov (United States)

    Gringeri, E; D'Amico, F E; Bassi, D; Mescoli, C; Bonsignore, P; Boetto, R; Lodo, E; Noaro, G; Polacco, M; D'Amico, F; Boccagni, P; Zanus, G; Brolese, A; Cillo, U

    2012-09-01

    Polycystic liver disease (PLD) is due to a genetic disorder and frequently coexists with polycystic kidney disease (PKD). If the cysts produce symptomatology owing to their number and size, many palliative treatments are available. When none of the liver parenchyma is spared, or kidney insufficiency is marked, the only potentially curable treatment is liver transplantation (LT). A 49-year old woman, diagnosed with PLD and PKD, was listed in January 2008 for combined LT and kidney transplantation (KT). A compatible organ became available 8 months later. Despite preserved liver function, the patient's clinical condition was poor; she experienced dyspnea, advanced anorexia, abdominal pain, and severe ascites. At LT, which took 9 hours and was performed using the classic technique, the liver was hard, massive in size (15.5 kg), and not dissociable from the vena cava. The postoperative course was complicated by many septic episodes, the last one being fatal for the patient at 4 months after transplantation. LT for PLD in many series shows a high mortality rate. The Model for End-Stage Liver Disease (MELD) score does not stage patients properly, because liver function is usually preserved. The liver can achieve a massive size causing many symptoms, especially malnutrition and ascites; in this setting LT is the only possible treatment. Patients with a low MELD score undergo LT with severe malnutrition that predisposes them to greater susceptibility to sepsis. To identify predictor factors, beyond MELD criteria that relate to the increased liver volume before development of late symptoms is essential to expeditiously treat patients with the poorest prognosis to improve their outcomes. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Simultaneous Liver-Kidney Transplantation in Liver Transplant Candidates With Renal Dysfunction: Importance of Creatinine Levels, Dialysis, and Organ Quality in Survival

    OpenAIRE

    Tanriover, Bekir; MacConmara, Malcolm P.; Parekh, Justin; Arce, Cristina; Zhang, Song; Gao, Ang; Mufti, Arjmand; Levea, Swee-Ling; Sandikci, Burhaneddin; Ayvaci, Mehmet U.S.; Venketash K. Ariyamuthu; Hwang, Christine; Mohan, Sumit; Mete, Mutlu; Vazquez, Miguel A.

    2016-01-01

    The survival benefit from simultaneous liver-kidney transplantation (SLK) over liver transplant alone (LTA) in recipients with moderate renal dysfunction is not well understood. Moreover, the impact of deceased donor organ quality in SLK survival has not been well described in the literature. Methods: The Scientific Registry of Transplant Recipients was studied for adult recipients receiving LTA (N = 2700) or SLK (N = 1361) with moderate renal insufficiency between 2003 and 2013. The study...

  12. Fetal rat pancreas transplantation in BB rats: immunohistochemical and functional evaluation

    DEFF Research Database (Denmark)

    Yderstræde, Knud Bonnet; Starklint, Henrik; Steinbrüchel, Daniel Andreas

    1993-01-01

    Spontaneously diabetic BB/Wor rats received either a syngeneic fetal pancreas transplant or adult islets. In the former, 4-8 fetal pancreases were transplanted, and in the latter, 3-5000 islets. Transplantation was performed by transferring a blood clot containing the pancreases or islets...... to the renal subcapsular space. Insulin therapy was undertaken postoperatively, except in one experiment with adult islets. Of the fetal pancreas transplanted BB rats, 52% became normoglycaemic, and 21% remained so throughout an observation period of 10 months. Nephrectomy caused a prompt return of diabetes....... The histological appearance of the grafts transplanted to the diabetic animals closely resembled that of grafts transplanted to normal rats in a parallel series. For comparison a group of BB rats received a syngeneic transplant of isolated adult islets from WF rats or BBW rats. Following adult islet...

  13. Noninvasive characterization of graft steatosis after liver transplantation.

    Science.gov (United States)

    Karlas, Thomas; Kollmeier, Johanna; Böhm, Stephan; Müller, Jürgen; Kovacs, Peter; Tröltzsch, Michael; Weimann, Antje; Bartels, Michael; Rosendahl, Jonas; Mössner, Joachim; Berg, Thomas; Keim, Volker; Wiegand, Johannes

    2015-02-01

    Liver graft steatosis has not been noninvasively evaluated yet. We therefore characterized liver transplant recipients by transient elastography (TE) and controlled attenuation parameter (CAP) and correlated the results with clinical and genetic risk factors. A total of 204 patients (pretransplant disease: n = 102 nonalcoholic etiology, nonalcoholic liver cirrhosis (non-ALC); n = 102 alcoholic liver disease, ALC; 42% female; median age 57.8 years; median time since transplantation 66 months) underwent ultrasound, TE, CAP, and nonalcoholic fatty liver disease (NAFLD) fibrosis score. Recipient DNA samples were genotyped for patatin-like phospholipase domain-containing protein 3 (PNPLA3) (rs738409) and IL28B (rs8099917, rs12979860) polymorphisms. Increased hepatic echogenicity at ultrasound was observed in 36% of patients, CAP values >252 and >300 dB/m indicated steatosis and advanced steatosis in 44% and 24% of individuals. Advanced fibrosis (TE >7.9 kPa) was associated with increased CAP results (266 vs. 229 dB/m, p = 0.012). PNPLA3 G-allele carriers had increased CAP values (257 vs. 222 dB/m, p = 0.032), higher liver stiffness (TE 6.4 vs. 5.5 kPa, p = 0.005), and prevalence of diabetes mellitus (40% vs. 22%, p = 0.016). No such association was observed for IL28B polymorphisms. ALC compared to non-ALC patients had higher body mass index (28.1 vs. 25.5 kg/m², p CAP (266 vs. 221 dB/m, p = 0.001), and NAFLD fibrosis score (score -0.5 vs. -1.3, p < 0.001). Modern noninvasive liver graft assessment frequently detects hepatic steatosis, which is associated with graft fibrosis, components of the metabolic syndrome and recipient PNPLA3 rs738409 genotype, especially in ALC patients.

  14. Oral mucosal health in liver transplant recipients and controls.

    Science.gov (United States)

    Helenius-Hietala, Jaana; Ruokonen, Hellevi; Grönroos, Lisa; Rissanen, Harri; Vehkalahti, Miira M; Suominen, Liisa; Isoniemi, Helena; Meurman, Jukka H

    2014-01-01

    Immunosuppressive drugs and other medications may predispose patients to oral diseases. Data on oral mucosal health in recipients of liver transplantation (LT) are limited. We, therefore, recruited 84 LT recipients (64 with chronic liver disease and 20 with acute liver failure) for clinical oral examinations in a cross-sectional, case-control study. Their oral health had been clinically examined before transplantation. The prevalence of oral mucosal lesions (OMLs) was assessed in groups with different etiologies of liver disease and in groups with different immunosuppressive medications, and these groups were compared to controls selected from a nationwide survey in Finland (n = 252). Risk factors for OMLs were evaluated with logistic regression. OMLs were more frequent in LT recipients versus controls (43% versus 15%, P lesion, and its prevalence was significantly higher for patients using cyclosporine A (CSA; 29%) versus patients using tacrolimus (TAC; 5%, P = 0.007); the prevalence was even higher with the simultaneous use of calcium channel blockers and CSA (47%) or TAC (8%, P = 0.002). Lesions with malignant potential such as drug-induced lichenoid reactions, oral lichen planus-like lesions, leukoplakias, and ulcers occurred in 13% of the patients with chronic liver disease and in 6% of the controls. Every third patient with chronic liver disease had reduced salivary flow, and more than half of all patients were positive for Candida; this risk was higher with steroids. In conclusion, the high frequency of OMLs among LT recipients can be explained not only by immunosuppressive drugs but also by other medications. Because dry mouth affects oral health and OMLs may have the potential for malignant transformation, annual oral examinations are indicated. © 2013 American Association for the Study of Liver Diseases.

  15. Time spent in hospital after liver transplantation: Effects of primary liver disease and comorbidity

    Science.gov (United States)

    Tovikkai, Chutwichai; Charman, Susan C; Praseedom, Raaj K; Gimson, Alexander E; van der Meulen, Jan

    2016-01-01

    AIM To explore the effect of primary liver disease and comorbidities on transplant length of stay (TLOS) and LOS in later admissions in the first two years after liver transplantation (LLOS). METHODS A linked United Kingdom Liver Transplant Audit - Hospital Episode Statistics database of patients who received a first adult liver transplant between 1997 and 2010 in England was analysed. Patients who died within the first two years were excluded from the primary analysis, but a sensitivity analysis was also performed including all patients. Multivariable linear regression was used to evaluate the impact of primary liver disease and comorbidities on TLOS and LLOS. RESULTS In 3772 patients, the mean (95%CI) TLOS was 24.8 (24.2 to 25.5) d, and the mean LLOS was 24.2 (22.9 to 25.5) d. Compared to patients with cancer, we found that the largest difference in TLOS was seen for acute hepatic failure group (6.1 d; 2.8 to 9.4) and the largest increase in LLOS was seen for other liver disease group (14.8 d; 8.1 to 21.5). Patients with cardiovascular disease had 8.5 d (5.7 to 11.3) longer TLOS and 6.0 d (0.2 to 11.9) longer LLOS, compare to those without. Patients with congestive cardiac failure had 7.6 d longer TLOS than those without. Other comorbidities did not significantly increase TLOS nor LLOS. CONCLUSION The time patients spent in hospital varied according to their primary liver disease and some comorbidities. Time spent in hospital of patients with cancer was relatively short compared to most other indications. Cardiovascular disease and congestive cardiac failure were the comorbidities with a strong impact on increased LOS. PMID:28058226

  16. The Groningen hypothermic liver perfusion system for improved preservation in organ transplantation

    OpenAIRE

    Plaats, Arjan van der

    2005-01-01

    End-stage liver diseases are nowadays effectively treated by transplantation of the affected liver. The transplantation procedure includes procurement of the liver from the donor and subsequently transport of the liver from donor to receiving patient (Chapter 1). To bridge the timespan of transport between donor operation and actual implantation of the organ in the receiving patient, the liver has to be optimally stored and preserved in order to maintain viability of the organ. To date, the c...

  17. Liver cell proliferation after partial hepatectomy in rats with liver metastases

    NARCIS (Netherlands)

    de Jong, KP; Brouwers, MAM; Huls, GA; Bun, JCAM; Wubbena, AS; Nieuwenhuis, P; Slooff, MJH; Dam, A.

    OBJECTIVE: To validate proliferating cell nuclear antigen (PCNA) expression and flow cytometry as proliferation markers in regenerating rat liver containing metastases. STUDY DESIGN: Rats containing colorectal liver metastases were killed at various days after 70% partial hepatectomy or a sham

  18. Bile acids for liver-transplanted patients. Protocol for a Cochrane Review

    DEFF Research Database (Denmark)

    Chen, W; Gluud, C

    2003-01-01

    Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease the degree of allograft rejection after liver transplantation by changing the expression of major histocompatibility complex class molecules in bile duct epithelium...

  19. Adherence to immunosuppressive therapy following liver transplantation: an integrative review.

    Science.gov (United States)

    Oliveira, Ramon Antônio; Turrini, Ruth Natália Teresa; Poveda, Vanessa de Brito

    2016-08-29

    to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched. The search period corresponded to the initial date of indexation of different bases, up to the deadline of February 10, 2015, using controlled and uncontrolled descriptors: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance and patient compliance. were located 191 investigations, 10 of which met the objectives of the study and were grouped into four categories, namely: educational process and non-adherence; non-adherence related to the number of daily doses of immunosuppressive medications; detection methods for non-adherence and side effects of therapy. there were risk factors related to the health service, such as control and reduction of the number of doses; related to the individual, such as being male, divorced, alcohol or other substances user, exposed to low social support and being mentally ill. investigar as evidências disponíveis na literatura sobre a não adesão à terapêutica imunossupressora entre pacientes submetidos ao transplante de fígado. revisão integrativa da literatura, que incluiu investigações cuja amostra era composta por pacientes com idade igual ou superior a 18 anos, submetidos a transplante de fígado. Excluíram-se as que continham pacientes submetidos a transplantes de múltiplos órgãos. Para a seleção dos artigos foram consultadas as bases Medline/Pubmed, CINAHL, LILACS, Scopus e Embase. O período de busca determinado correspondeu à data inicial de indexação das

  20. Age dependence of rat liver function measurements

    DEFF Research Database (Denmark)

    Fischer-Nielsen, A; Poulsen, H E; Hansen, B A

    1989-01-01

    Changes in the galactose elimination capacity, the capacity of urea-N synthesis and antipyrine clearance were studied in male Wistar rats at the age of 8, 20 and 44 weeks. Further, liver tissue concentrations of microsomal cytochrome P-450, microsomal protein and glutathione were measured. All...... liver function measurements increased from the age of 8 to 44 weeks when expressed in absolute values. In relation to body weight, these function measurements were unchanged or reduced from week 8 to week 20. At week 44, galactose elimination capacity and capacity of urea-N synthesis related to body...... weight were increased by 10% and 36%, respectively, and antipyrine plasma clearance was reduced to 50%. Liver tissue concentrations of microsomal cytochrome P-450 and microsomal protein increased with age when expressed in absolute values, but were unchanged per g liver, i.e., closely related to liver...

  1. Hypophosphatemia after Right Hepatectomy for Living Donor Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Kelly W Burak

    2004-01-01

    Full Text Available Hypophosphatemia has been described in patients undergoing right hepatectomy for liver cancer and in living donors for liver transplantation who also received total parenteral nutrition. At the study centre, significant hypophosphatemia (0.36 mmol/L or less requiring intravenous replacement was seen in two of the first nine living donors for adult-to-adult liver transplantation. To determine the frequency of hypophosphatemia in living donors, the authors obtained phosphate levels on stored serum samples from postoperative days 0, 1, 3 and 7 in all nine patients, none of whom were on total parenteral nutrition. Within the first week, hypophosphatemia developed in 55.6% of patients and phosphate levels returned to normal by day 7 in all nine patients. One patient had normal phosphate levels during the first week, but had profound hypophosphatemia (0.32 mmol/L on day 14 when he presented with a Staphylococcus aureus infection of a bile collection and significant hypoxemia. The extent of hepatectomy and the rate of liver regeneration, estimated by baseline and postoperative day 7 volumetric computed tomography scans, did not correlate with the development of hypophosphatemia. In conclusion, hypophosphatemia is common in living donors undergoing right hepatectomy and may be associated with complications. All living donors should be monitored for the development of hypophosphatemia during the first two postoperative weeks.

  2. Glasgow coma scale and APACHE-II scores affect the liver transplantation outcomes in patients with acute liver failure.

    Science.gov (United States)

    Guler, Necdet; Unalp, Omer; Guler, Ayse; Yaprak, Onur; Dayangac, Murat; Sozbilen, Murat; Akyildiz, Murat; Tokat, Yaman

    2013-12-01

    The timing and selection of patients for liver transplantation in acute liver failure are great challenges. This study aimed to investigate the effect of Glasgow coma scale (GCS) and APACHE-II scores on liver transplantation outcomes in patients with acute liver failure. A total of 25 patients with acute liver failure were retrospectively analyzed according to age, etiology, time to transplantation, coma scores, complications and mortality. Eighteen patients received transplants from live donors and 7 had cadaveric whole liver transplants. The mean duration of follow-up after liver transplantation was 39.86+/-40.23 months. Seven patients died within the perioperative period and the 1-, 3-, 5-year survival rates of the patients were 72%, 72% and 60%, respectively. The parameters evaluated for the perioperative deaths versus alive were as follows: the mean age of the patients was 33.71 vs 28 years, MELD score was 40 vs 32.66, GCS was 5.57 vs 10.16, APACHE-II score was 23 vs 18.11, serum sodium level was 138.57 vs 138.44 mmol/L, mean waiting time before the operation was 12 vs 5.16 days. Low GCS, high APACHE-II score and longer waiting time before the operation (PAPACHE-II scores are related to poor outcomes in patients with acute liver failure after liver transplantation.

  3. Heterozygous α1-antitrypsin Z allele mutation in presumed healthy donor livers used for transplantation.

    Science.gov (United States)

    Roelandt, Philip; Dobbels, Pieter; Komuta, Mina; Corveleyn, Anniek; Emonds, Marie-Paule; Roskams, Tania; Aerts, Raymond; Monbaliu, Diethard; Libbrecht, Louis; Laleman, Wim; Verslype, Chris; Van Steenbergen, Werner; van der Merwe, Schalk; Pirenne, Jacques; Nevens, Frederik; Cassiman, David

    2013-11-01

    The Z allele (Glu342Lys) in α1-antitrypsin (AAT) deficiency is a combined deficiency and dysfunctional allele. Carrying one Z allele induces a risk of a more aggressive evolution in patients with a chronic liver disease. As most of the carriers of Z allele do not have overt liver disease, it is likely that Z allele-containing livers have been used previously for liver transplantation. We analyzed the incidence, epidemiology, and clinical features of AAT accumulation in the hepatocytes after liver transplantation. Follow-up biopsies of liver transplant recipients were analyzed with periodic acid Schiff staining until 2006 (n=486); from 2006 on (n=303), all biopsies were stained with a specific monoclonal antibody against mutated AATZ protein. Genotyping of both recipient and donor was performed in the case of positive staining. Of 789 liver transplantation patients, six patients (0.8%) showed mutated AATZ accumulation in the transplanted liver. Mutation analysis confirmed the presence of the Z allele in all donor organs including one transplanted organ with the SZ phenotype. There was a clear concordance between the isoelectrical focusing of the recipient AAT after transplantation and the genotype of the donor. Presumed healthy donor organs containing the Z allele were used for transplantation in 0.8% of cases in our series. As the presence of a Z allele is an independent risk factor of aggravation of chronic liver disease, AATZ accumulation in biopsies after liver transplantation should be actively looked for.

  4. Contrast-enhanced ultrasound of liver lesions related to arterial thrombosis in adult liver transplantation.

    Science.gov (United States)

    Fontanilla, Teresa; Noblejas, Ana; Cortes, Cristina; Minaya, Javier; Mendez, Santiago; Van den Brule, Enrique; Hernando, Concepcion Gonzalez; Alfageme, Marta; Baños, Isolina; Aguirre, Elisa

    2013-10-01

    To describe the contrast-enhanced ultrasound (CEUS) features of liver and biliary lesions related to hepatic artery thrombosis in adult patients with orthotopic liver transplantation. Gray-scale ultrasound (US), Doppler US, and CEUS using a hexafluoride-based US contrast media were performed on a series of eight patients with liver transplantation and hepatic artery thrombosis. Six of the cases presented infarctions, seen as parenchymal geographic areas of lack of enhancement. Biliary necrosis, seen as nonenhancing periportal cuff, was seen in one case. Infected biloma, seen as a nonenhancing hilar collection, was present in two cases. Infarction and biloma coexisted in one patient. Two abscesses were seen as a late complication in one case. One of them was seen as a typical necrotic abscess with a central nonenhancing area and peripheral rim enhancement higher than the surrounding liver. The other one was seen as a partially liquefied abscess. CEUS was useful to diagnose lesions related to hepatic artery thrombosis in liver transplantation. It enabled distinguishing between them and to define their size and extension better than conventional gray-scale US. Copyright © 2013 Wiley Periodicals, Inc.

  5. Recurrence of autoimmune liver disease and inflammatory bowel disease after pediatric liver transplantation.

    Science.gov (United States)

    Liberal, Rodrigo; Vergani, Diego; Mieli-Vergani, Giorgina

    2016-09-01

    Approximately 10% of children with autoimmune hepatitis (AIH) and 30% of those with sclerosing cholangitis (SC) require liver transplantation (LT). LT is indicated in patients who present with fulminant hepatic failure (ie, with encephalopathy) and in those who develop end-stage liver disease despite treatment. After LT, recurrent AIH is reported in approximately 30% of patients and recurrent SC in up to 50%. Diagnosis of recurrence is based on biochemical abnormalities, seropositivity for autoantibodies, interface hepatitis on histology, steroid dependence, and, for SC, presence of cholangiopathy. Recurrence of SC after LT is often associated with poorly controlled inflammatory bowel disease (IBD). Recurrence may even appear years after LT; therefore, steroid-based immunosuppression should be maintained at a higher dose than that used for patients transplanted for nonautoimmune liver diseases. Although the impact of recurrent disease on graft function is controversial, it seems that in pediatric LT recipients recurrence of AIH or SC is associated with compromised graft survival. Exacerbation of preexistent IBD may be observed after LT for SC or AIH, and IBD appears to have a more aggressive course than before LT. In addition, IBD can develop de novo following LT. Liver Transplantation 22 1275-1283 2016 AASLD. © 2016 by the American Association for the Study of Liver Diseases.

  6. Islet transplantation in diabetic rats normalizes basal and exercise-induced energy metabolism

    NARCIS (Netherlands)

    Houwing, Harmina; Benthem, L.; Suylichem, P.T.R. van; Leest, J. van der; Strubbe, J.H.; Steffens, A.B.

    Transplantation of islets of Langerhans in diabetic rats normalizes resting glucose and insulin levels, but it remains unclear whether islet transplantation restores resting and exercise-induced energy metabolism. Therefore, we compared energy metabolism in islet transplanted rats with energy

  7. Post–Endoscopic Retrograde Cholangiopancreaticography complications in liver transplanted patients, a single-center experience

    DEFF Research Database (Denmark)

    Ambrus, R B; Svendsen, Lars Bo; Hillingsø, J G

    2015-01-01

    BACKGROUND: Complications in the biliary tract occur in 5%-30% after liver transplantation and the main part of the complications is successfully managed with endoscopic retrograde cholangiopancreaticography (ERCP). The incidence and risk factors for post-ERCP complications in liver transplantation...... patients are not well described. Our objective was to define the frequency of post-ERCP complications in liver transplantation patients at the Abdominal Center, Rigshospitalet, the only Liver Transplantation Center in Denmark. METHODS: Retrospective study of all ERCPs performed in liver transplantation...... and cholangitis occurred after two procedures, respectively. Multivariate analysis concerning overall complications identified biliary sphincterotomy (p = 0.006) and time since liver transplantation within 90 days postoperatively (p = 0.044) as risk factors for post-ERCP complications. Specifically concerning...

  8. Amelioration of Hyperbilirubinemia in Gunn Rats after Transplantation of Human Induced Pluripotent Stem Cell-Derived Hepatocytes

    Directory of Open Access Journals (Sweden)

    Yong Chen

    2015-07-01

    Full Text Available Hepatocyte transplantation has the potential to cure inherited liver diseases, but its application is impeded by a scarcity of donor livers. Therefore, we explored whether transplantation of hepatocyte-like cells (iHeps differentiated from human induced pluripotent stem cells (iPSCs could ameliorate inherited liver diseases. iPSCs reprogrammed from human skin fibroblasts were differentiated to iHeps, which were transplanted into livers of uridinediphosphoglucuronate glucuronosyltransferase-1 (UGT1A1-deficient Gunn rats, a model of Crigler-Najjar syndrome 1 (CN1, where elevated unconjugated bilirubin causes brain injury and death. To promote iHep proliferation, 30% of the recipient liver was X-irradiated before transplantation, and hepatocyte growth factor was expressed. After transplantation, UGT1A1+ iHep clusters constituted 2.5%–7.5% of the preconditioned liver lobe. A decline of serum bilirubin by 30%–60% and biliary excretion of bilirubin glucuronides indicated that transplanted iHeps expressed UGT1A1 activity, a postnatal function of hepatocytes. Therefore, iHeps warrant further exploration as a renewable source of hepatocytes for treating inherited liver diseases.

  9. Cardiac evaluation in pediatric patients waiting for liver transplantation

    Directory of Open Access Journals (Sweden)

    Seyed Mohsen Dehghani, Naser Honar, Hamid Amoozegar, Ahad Eshraghian, Mohammad Borzooei, Mohammad Hadi Imanieh, Seyed Ali Malek-Hosseini

    2010-01-01

    Full Text Available Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT. The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7% heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5% had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1% patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18% patients. Eleven patients (12.4% had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6% patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

  10. Fetal rat pancreas transplantation in BB rats: immunohistochemical and functional evaluation.

    Science.gov (United States)

    Yderstraede, K B; Starklint, H; Steinbruchel, D; Jørgensen, T W; Gotfredsen, C F

    1993-01-01

    Spontaneously diabetic BB/Wor rats received either a syngeneic fetal pancreas transplant or adult islets. In the former, 4-8 fetal pancreases were transplanted, and in the latter, 3-5000 islets. Transplantation was performed by transferring a blood clot containing the pancreases or islets to the renal subcapsular space. Insulin therapy was undertaken postoperatively, except in one experiment with adult islets. Of the fetal pancreas transplanted BB rats, 52% became normoglycaemic, and 21% remained so throughout an observation period of 10 months. Nephrectomy caused a prompt return of diabetes. The histological appearance of the grafts transplanted to the diabetic animals closely resembled that of grafts transplanted to normal rats in a parallel series. For comparison a group of BB rats received a syngeneic transplant of isolated adult islets from WF rats or BBW rats. Following adult islet transplantation, 5 out of 6 animals became hyperglycaemic after a median of 20.5 days when no insulin was given post-transplantation. Four out of 5 animals became hyperglycaemic after a median of 23 days when supportive insulin therapy was administered after the transplantation. The results indicate that recurrent diabetes is not inevitable following syngeneic fetal pancreas transplantation to spontaneously diabetic BB rats. Recurrent diabetes was only occasionally associated with mononuclear cell infiltration. Transplanted tissue was well-preserved and vascularized; mega-islets were a constant finding.

  11. Study of factors affecting the incidence of skin cancer in patients after liver transplant*

    OpenAIRE

    Campos, Gabriela Rached; Boin,Ilka de Fátima Santana Ferreira; de Campos Junior, Ivan Dias; Cintra, Maria Letícia

    2017-01-01

    Abstract: Background: Many factors are currently being identified as potential inductors of skin cancer in patients after a liver transplant, among them, immunosuppressive regimen. Objective: To study the factors that influence the incidence of skin cancer in patients after liver transplant. Methods: We have carried out a retrospective and observational study with 170 transplanted patients who had undergone transplantation from 1997 to 2010. We have adjusted the multiple logistic regressio...

  12. Pre-and-post transplant considerations in patients with nonalcoholic fatty liver disease

    OpenAIRE

    Khullar, Vikas; Dolganiuc, Angela; Firpi, Roberto J

    2014-01-01

    Non-alcoholic fatty liver disease (NAFLD) is currently the third most common indication for liver transplantation in the United States. With the growing incidence of obesity, NAFLD is expected to become the most common indication for liver transplantation over the next few decades. As the number of patients who have undergone transplantation for NAFLD increases, unique challenges have emerged in the management and long-term outcomes in patients. Risk factors such as obesity, hypertension, dia...

  13. Oxidative DNA damage after transplantation of the liver and small intestine in pigs

    DEFF Research Database (Denmark)

    Loft, S; Larsen, P N; Rasmussen, A

    1995-01-01

    Oxidative damage is thought to play an important role in ischemia/reperfusion injury, including the outcome of transplantation of the liver and intestine. We have investigated oxidative DNA damage after combined transplantation of the liver and small intestine in 5 pigs. DNA damage was estimated...... to DNA results from reperfusion of transplanted small intestine and liver in pigs, as estimated from the readily excreted repair product 8-oxodG....

  14. LONG-TERM OUTCOMES OF DECEASED DONOR LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2014-01-01

    Full Text Available Aim of the study was to evaluate patient and graft survival after liver transplantation (LT and to determine if primary disease diagnosis, early graft dysfunction or other factors affect it. Furthermore, we analyzed the reasonsof short-term and long-term deaths or retransplantations.Materials and methods. 192 LTs from donors with brain death were performed from December 2004 until June 2014. Recipient age varied from 5 to 71 years. Most frequent diagnosis was liver cirrhosis (mainly due to hepatitis C, then hepatocellular carcinoma (HCC, liver graft dysfunction, etc.Results and discussion. 1-year patient survival is 89.5%, graft survival is 87.7%, 3-year –87% and 84.6%, respectively, and 5-year – 83.5% and 83.0%, respectively. Early mortality (in fi rst 30 days after transplantation was 8%, long-term mortality – 5.9%. Primary non-function graft (PNF was the reason of 66.7% early deaths. In the long term, infections and oncology were the reasons of death with the same frequency – 36.4%. Early graft dysfunction including primary non-function signifi cantly decreases short term survival (p = 0.0002. Nevertheless, in the majority of cases graft function improves and doesn’t affect survival. Donor factors play role in outcomes: early dysfunction is higher (40.6% in extended criteria donor group than in standard donor group (р = 0.0431. PNF has the same trend – 8.5% and 0.0%, respectively, but without signifi cance (р =0.0835. 5-year survival is remarkably lower in HCC group 40.8% (p = 0.003 than in other groups.Conclusion: survival after liver transplantation in our Center is comparable with the results of the world’s centers.

  15. Ozone inhalation modifies the rat liver proteome☆

    Science.gov (United States)

    Theis, Whitney S.; Andringa, Kelly K.; Millender-Swain, Telisha; Dickinson, Dale A.; Postlethwait, Edward M.; Bailey, Shannon M.

    2013-01-01

    Ozone (O3) is a serious public health concern. Recent findings indicate that the damaging health effects of O3 extend to multiple systemic organ systems. Herein, we hypothesize that O3 inhalation will cause downstream alterations to the liver. To test this, male Sprague-Dawley rats were exposed to 0.5 ppm O3 for 8 h/day for 5 days. Plasma liver enzyme measurements showed that 5 day O3 exposure did not cause liver cell death. Proteomic and mass spectrometry analysis identified 10 proteins in the liver that were significantly altered in abundance following short-term O3 exposure and these included several stress responsive proteins. Glucose-regulated protein 78 and protein disulfide isomerase increased, whereas glutathione S-transferase M1 was significantly decreased by O3 inhalation. In contrast, no significant changes were detected for the stress response protein heme oxygenase-1 or cytochrome P450 2E1 and 2B in liver of O3 exposed rats compared to controls. In summary, these results show that an environmentally-relevant exposure to inhaled O3 can alter the expression of select proteins in the liver. We propose that O3 inhalation may represent an important unrecognized factor that can modulate hepatic metabolic functions. PMID:25544660

  16. Ozone inhalation modifies the rat liver proteome.

    Science.gov (United States)

    Theis, Whitney S; Andringa, Kelly K; Millender-Swain, Telisha; Dickinson, Dale A; Postlethwait, Edward M; Bailey, Shannon M

    2014-01-01

    Ozone (O3) is a serious public health concern. Recent findings indicate that the damaging health effects of O3 extend to multiple systemic organ systems. Herein, we hypothesize that O3 inhalation will cause downstream alterations to the liver. To test this, male Sprague-Dawley rats were exposed to 0.5ppm O3 for 8h/day for 5 days. Plasma liver enzyme measurements showed that 5 day O3 exposure did not cause liver cell death. Proteomic and mass spectrometry analysis identified 10 proteins in the liver that were significantly altered in abundance following short-term O3 exposure and these included several stress responsive proteins. Glucose-regulated protein 78 and protein disulfide isomerase increased, whereas glutathione S-transferase M1 was significantly decreased by O3 inhalation. In contrast, no significant changes were detected for the stress response protein heme oxygenase-1 or cytochrome P450 2E1 and 2B in liver of O3 exposed rats compared to controls. In summary, these results show that an environmentally-relevant exposure to inhaled O3 can alter the expression of select proteins in the liver. We propose that O3 inhalation may represent an important unrecognized factor that can modulate hepatic metabolic functions. © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  17. Ozone inhalation modifies the rat liver proteome

    Directory of Open Access Journals (Sweden)

    Whitney S. Theis

    2014-01-01

    Full Text Available Ozone (O3 is a serious public health concern. Recent findings indicate that the damaging health effects of O3 extend to multiple systemic organ systems. Herein, we hypothesize that O3 inhalation will cause downstream alterations to the liver. To test this, male Sprague-Dawley rats were exposed to 0.5 ppm O3 for 8 h/day for 5 days. Plasma liver enzyme measurements showed that 5 day O3 exposure did not cause liver cell death. Proteomic and mass spectrometry analysis identified 10 proteins in the liver that were significantly altered in abundance following short-term O3 exposure and these included several stress responsive proteins. Glucose-regulated protein 78 and protein disulfide isomerase increased, whereas glutathione S-transferase M1 was significantly decreased by O3 inhalation. In contrast, no significant changes were detected for the stress response protein heme oxygenase-1 or cytochrome P450 2E1 and 2B in liver of O3 exposed rats compared to controls. In summary, these results show that an environmentally-relevant exposure to inhaled O3 can alter the expression of select proteins in the liver. We propose that O3 inhalation may represent an important unrecognized factor that can modulate hepatic metabolic functions.

  18. Review of Natural History, Benefits and Risk Factors Pediatric Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Manoochehr Karjoo

    2016-03-01

    Full Text Available Liver or hepatic transplantation (LT is the replacement of a diseased liver with part or whole healthy liver from another person (allograft. Human liver transplants were first performed by Thomas Starzl in the United States and Roy Calne in Cambridge, England in 1963 and 1967, respectively. Liver transplantation is a viable treatment option for end-stage liver disease and acute liver failure. Pediatric patients account for about 12.5% of liver transplant recipients. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Cirrhosis, or liver injury, is a common reason why adults need liver transplants and children with bile duct disease issues are often the candidates. Survival statistics depend greatly on the age of donor, age of recipient, skill of the transplant center, compliance of the recipient, whether the organ came from a living or cadaveric donor and overall health of the recipient. Survival rates improve almost yearly, due to improved techniques and medications.

  19. Maintenance of Minute Circulation Volume during Orthotopic Liver Transplantation

    Directory of Open Access Journals (Sweden)

    D. A. Levit

    2011-01-01

    Full Text Available Objective: to optimize procedures to maintain minute circulation volume at different stages of orthotopic liver transplantation. Subjects and methods. In the period 2005—2010, Sverdlovsk Regional Clinical Hospital One performed 32 orthotopic liver transplantations, including one retransplantation. The patients’ ASA class was (4—5. The operations were carried out under general anesthesia. The mean duration of surgery was 8.1 (range 5.8—10.5 hours. The investigators applied anesthesia based on iso-fluorane 0.6—0.9 MAC (by monitoring the anesthesia depth index with cerebral state index (CSI-40-60, as well as extended central hemodynamic monitoring (prepulmonary hemodilution. All the operations were made via portofemoroaxillary bypass, by using a centrifugal Biopump. Eight surgical stages were identified: 1 run-in (after tracheal intubation; 2 liver mobilization; 3 partial bypass; 4 complete bypass (hepatectomy, a liver-free period; 5 reperfusion; 6 a postreperfusion period (bypass end; 7 biliary repair; 8 the end of an operation. The concentrations of blood parameters, electrolytes, acid-base balance, and the levels of lactate and glucose were examined. The data were processed statistically. Central hemodynamics was monitored by prepulmonary thermodilution, by calculating cardiac index (CI, stroke index, and total peripheral vascular resistance index (TPVRI at the stages: liver mobilization, postreperfusion period (bypass end, and the end of surgery. Results. Even during partial bypass, there was a significant drop in mean blood pressure (MBP as compared to the baseline levels (p<0.05. Reperfusion was also accompanied by a significant decrease in MBP and an increase in heart rate. At the end of reperfusion and in the postreperfusion period, TPVRI was halved (689.2±68.0 as compared to the baseline levels. In the postreperfusion period, central venous and pulmonary artery pressures were significantly increased by 32 and 21%, respectively

  20. Recurrence of primary sclerosing cholangitis in pediatric liver transplant recipients.

    Science.gov (United States)

    Venkat, Veena L; Ranganathan, Sarangarajan; Mazariegos, George V; Sun, Qing; Sindhi, Rakesh

    2014-06-01

    There is little detailed clinical information on recurrent primary sclerosing cholangitis (rPSC) after liver transplantation in children. Our purpose was to describe the characteristics of children who had experienced rPSC after liver transplantation so that we could identify potential risk factors for recurrence. Clinical information for pediatric patients undergoing transplantation for primary sclerosing cholangitis (PSC) was retrospectively reviewed, and variables related to the pretransplant diagnosis of PSC and posttransplant variables were abstracted. The studied variables included the following: cytomegalovirus/Epstein-Barr virus status, early/late rejection, induction regimen, immunosuppression in the first year, steroid-resistant rejection, diagnosis of inflammatory bowel disease, and human leukocyte antigen markers commonly associated with PSC. A diagnosis of rPSC was made on the basis of radiographic features, histology, or both. Twelve patients underwent liver transplantation for PSC between 1993 and 2012. Patients received tacrolimus for maintenance immunosuppression after induction with steroids (n = 6) or thymoglobulin (n = 6). Three patients were diagnosed with rPSC 44, 60, and 62 months after transplantation. A fourth patient underwent retransplantation for graft failure with features of both hepatic artery stenosis and rPSC. This patient had distinct histological features of rPSC in the second graft. Three of the 4 patients were 7 years old or younger at the diagnosis of PSC. The patient and graft survival rates were similar for the steroid and thymoglobulin groups. All 4 children with rPSC received steroid-free thymoglobulin induction. In conclusion, our observation of an association between thymoglobulin, and age less than 10 years at the diagnosis of PSC, and rPSC adds to the existing suggestion of a link between the immune environment and the pathogenesis of rPSC. Defining the natural history of rPSC and searching for the etiology and

  1. Hepatitis C virus in body fluids after liver transplantation.

    Science.gov (United States)

    Caldwell, S H; Sue, M; Bowden, J H; Dickson, R C; Driscoll, C J; Yeaton, P; Stevenson, W C; Ishitani, M B; McCullough, C S; Pruett, T L; Lovell, M A

    1996-03-01

    Recurrence of hepatitis C virus (HCV) after liver transplantation is common and is associated with high blood levels of HCV RNA. Higher blood levels of HCV may promote body fluid expression of the virus. We tested 152 body fluid specimens from 33 patients with chronic hepatitis C, 21 of whom had undergone prior liver transplantation. All patients had hepatitis C viremia, as determined by a reverse-transcription polymerase chain reaction (PCR) to the 5' noncoding region. The virus was quantitated in serum by the branched chain DNA assay (bDNA). Body fluids (33 sputum, 33 saliva, 33 urine, 32 tear, 9 vaginal, and 12 semen samples) were analyzed using PCR for HCV RNA. Serum HCV RNA by bDNA in the posttransplantation group was 255 +/- 229 x 10(5) compared with 50 +/- 56 x 10(5) eq/mL in the patients who did not undergo transplantation (P = .01). All urine, tear, and semen specimens were negative for HCV RNA. Five of 21 (24%) posttransplantation patients had detectable HCV RNA using PCR in oral secretions compared with 0 of 12 patients who did not undergo transplantation (not statistically significant). However, 5 of 11 patients with serum HCV RNA by bDNA results greater than 150 x 10(5) eq/mL had positive RNA in oral secretions compared to 0 of 22 patients with bDNA less than 150 x 10(5) eq/mL (P = .01). Posttransplantation patients were more likely to have bDNA levels exceeding 150 x 10(5) eq/mL (11 of 21 v 1 of 12, P = .03). Patients within the first year of transplantation were particularly prone to viral RNA levels exceeding 150 x 10(5) eq/mL (8 of 9 v 3 of 12, P = .01). We conclude that HCV RNA can occasionally be detected using PCR in oral secretions after liver transplantation. This is more likely during the first year posttransplantation when blood levels of HCV RNA often exceed 150 x 10(5) eq/mL by the branched chain DNA assay. Whether or not these observations represent an increased risk of transmission of infection during the early posttransplantation period

  2. Gastroduodenal artery steal syndrome during liver transplantation: intraoperative diagnosis with Doppler ultrasound and management

    National Research Council Canada - National Science Library

    Nishida, Seigo; Kadono, Jun; DeFaria, Werviston; Levi, David M; Moon, Jang I; Tzakis, Andreas G; Madariaga, Juan R

    2005-01-01

    .... We present the recognized case of a gastroduodenal artery (GDA) steal syndrome that was diagnosed with intraoperative Doppler ultrasound and treated with GDA ligation during the liver transplantation...

  3. 3DCT angiography for detection of vascular complications in pediatric liver transplantation

    National Research Council Canada - National Science Library

    Cheng, Yu Fan; Chen, Chao Long; Huang, Tung Liang; Chen, Tai Yi; Chen, Yaw Sen; Wang, Chih Chi; Tsang, Leo Leung‐chit; Chiu, King Wah; Jawan, Bruno; Eng, Hock Liew

    2004-01-01

    Catheter angiography for early diagnosis of vascular complications in pediatric liver transplant yields excellent results but remains an extremely invasive examination for younger children, precluding its routine use...

  4. Pancreatic islet transplantation after upper abdominal exenteration and liver replacement

    Science.gov (United States)

    Tzakis, Andreas G.; Ricordi, Camillo; Alejandro, Rodolfo; Zeng, Yijun; Fung, John J.; Todo, Satoru; Demetris, Anthony J.; Mintz, Daniel H.; Starzl, Thomas E.

    2010-01-01

    Nine patients who became diabetic after upper-abdominal exenteration and liver transplantation were given pancreatic islet-cell grafts obtained from the liver donor (eight cases), a third-party donor (one), or both (four). Two patients were diabetic when they died of infections after 48 and 109 days, as was a third patient who died of tumour recurrence after 178 days. The other 6 are alive 101–186 days postoperatively, and five are insulin-free or on insulin only during night-time parenteral alimentation. C-peptide increased 1·7 to 3·3 fold in response to intravenous glucose in these five patients who have had glycosylated haemoglobin in the high normal range. However, the kinetics of the C-peptide responses to intravenous glucose in all eight patients tested revealed an absent first-phase release and a delayed peak response consistent with transplantation and/or engraftment of a suboptimal islet cell mass. The longest survivor, who requires neither parenteral alimentation nor insulin, is the first unequivocal example of successful clinical islet-cell transplantation. PMID:1974944

  5. Donation after cardiac death liver transplantation: Graft quality evaluation based on pretransplant liver biopsy.

    Science.gov (United States)

    Xia, Weiliang; Ke, Qinghong; Wang, Ye; Feng, Xiaowen; Guo, Haijun; Wang, Weilin; Zhang, Min; Shen, Yan; Wu, Jian; Xu, Xiao; Yan, Sheng; Zheng, Shusen

    2015-06-01

    Donation after cardiac death (DCD) liver grafts are associated with inferior clinical outcomes and high discard rates because of poor graft quality. We investigated the predictive value of DCD liver biopsy for the pretransplant graft quality evaluation. DCD liver transplants that took place between October 2010 and April 2014 were included (n = 127). Histological features of graft biopsy samples were analyzed to assess risk factors for graft survival. Macrovesicular steatosis ≥ 20% [hazard ratio (HR) = 2.973; P = 0.045] and sinusoidal neutrophilic infiltrate (HR = 6.969; P = 0.005) were confirmed as independent risk factors for graft survival; hepatocellular swelling, vacuolation, and necrosis failed to show prognostic value. Additionally, a donor serum total bilirubin level ≥ 34.2 μmol/L was also associated with a lower probability of graft survival. Our analysis indicates that macrovesicular steatosis ≥ 20% and sinusoidal neutrophilic infiltrate are novel and useful histological markers for DCD liver grafts with unacceptable quality. This finding can be used by transplant surgeons to improve DCD liver acceptance protocols. © 2015 American Association for the Study of Liver Diseases.

  6. Early steroid withdrawal after liver transplantation for hepatocellular carcinoma

    Science.gov (United States)

    Chen, Zhi-Shui; He, Fan; Zeng, Fan-Jun; Jiang, Ji-Pin; Du, Dun-Feng; Liu, Bin

    2007-01-01

    AIM: To evaluate the impact of early steroid withdrawal on the incidence of rejection, tumor recurrence and complications after liver transplantation for advanced-stage hepatocellular carcinoma. METHODS: Fifty-four patients underwent liver transplantation for advanced-stage hepatocellular carcinoma from April 2003 to June 2005. These cases were divided into a steroid-withdrawal group (group A, n = 28) and a steroid-maintenance group (group B, n = 26). In group A, steroid was withdrawn 3 mo after transplantation. In group B, steroid was continuously used postoperatively. The incidence of rejection, 6-mo and 1-year recurrence rate of carcinoma, 1-year survival rate, mean serum tacrolimus trough level, and liver and kidney function were compared between the two groups. RESULTS: In the two groups, no statistical difference was observed in the incidence of rejection (14.3 vs 11.5%, P > 0.05), mean serum tacrolimus trough levels (6.9 ± 1.4 vs 7.1 ± 1.1 μg/L, P > 0.05), liver and kidney function after 6 mo [alanine aminotransferase (ALT): 533 ± 183 vs 617 ± 217 nka/L, P > 0.05; creatinine: 66 ± 18 vs 71 ± 19 μmol/L, P > 0.05], 6-mo recurrence rate of carcinoma (25.0 vs 42.3%, P > 0.05), and 1-year survival rate (64.2 vs 46.1%, P > 0.05). The 1-year tumor recurrence rate (39.2 vs 69.2%, P < 0.05), serum cholesterol level (3.9 ± 1.8 vs 5.9 ± 2.6 mmol/L, P < 0.01) and fasting blood sugar (5.1 ± 2.1 vs 8.9 ± 3.6 mmol/L, P < 0.01) were significantly different. These were lower in the steroid-withdrawal group than in the steroid-maintenance group. CONCLUSION: Early steroid withdrawal was safe after liver transplantation in patients with advanced-stage hepatocellular carcinoma. When steroids were withdrawn 3 mo post-operation, the incidence of rejection did not increase, and there was no demand to maintain tacrolimus at a high level. In contrast, the tumor recurrence rate and the potential of adverse effects decreased significantly. This may have led to an increase

  7. Successful Fecal Microbiota Transplantation in a Patient with Severe Complicated Clostridium difficile Infection after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Kai Markus Schneider

    2018-02-01

    Full Text Available Clostridium difficile infection (CDI represents one of the most common healthcare-associated infections. Due to increasing numbers of recurrences and therapy failures, CDI has become a major disease burden. Studies have shown that fecal microbiota transplantation (FMT can both be a safe and highly efficacious therapy for patients with therapy-refractory CDI. However, patients undergoing solid organ transplantation are at high risk for CDI due to long-term immunosuppression, previous antibiotic therapy, and proton pump inhibitor use. Additionally, these patients may be especially prone to adverse events related to FMT. Here, we report a successful FMT in a patient with severe therapy-refractory CDI after liver transplantation.

  8. TESTOSTERONE CHANGES IN PATIENTS WITH LIVER CIRRHOSIS BEFORE AND AFTER ORTHOTOPIC LIVER TRANSPLANTATION AND ITS CORRELATION WITH MELD

    Directory of Open Access Journals (Sweden)

    Rodrigo NITSCHE

    2014-03-01

    Full Text Available Context Hypogonadism is a common clinical situation in male patients with liver cirrhosis. Objectives The aim of the present study was to evaluate the effects of orthotopic liver transplantation on testosterone, free testosterone and sex hormone-binding globulin in male with advanced liver disease and also to determine the relationship of these changes with Model for End-stage Liver Disease (MELD score. Methods In a prospective study, serum levels of testosterone, free testosterone and sex hormone-binding globulin of 30 male adult patients with end-stage liver disease were measured 2 to 4 hours before and 6 months after orthotopic liver transplantation. Results Total testosterone levels increased after orthotopic liver transplantation and the number of patients with normal testosterone levels increased from 18 to 24. Free testosterone mean level in the pre-transplant group was 7.8 pg/mL and increased to 11.5 pg/mL (P = 0.10 and sex hormone-binding globulin level decreased after orthotopic liver transplantation returning to normal levels in MELD ≤18 - group (A (P<0.05. Conclusions Serum level changes of testosterone, free testosterone and sex hormone-binding globulin are more pronounced in cirrhotic males with MELD ≤18. Serum levels of testosterone and free testosterone increase and serum levels of sex hormone-binding globulin decrease after orthotopic liver transplantation.

  9. Liver transplantation with donors older than 75 years.

    Science.gov (United States)

    Sampedro, B; Cabezas, J; Fábrega, E; Casafont, F; Pons-Romero, F

    2011-04-01

    Orthotopic liver transplantation has shown successful results over the last years. For this reason there are increased numbers of patients on waiting lists. To expand the pool of liver donors, elderly donors have been used as a strategy. We report our experience comparing donors of ≥ 75 years with younger ages for their characteristics, clinical outcomes, and survivals. From January 2001 to December 2009, we performed 174 consecutive liver transplantation from cadaveric donors in 166 patients. During this period, we used 24 liver grafts from donors ≥ 75 years. We analyzed their outcomes retrospectively, describing donors and recipient characteristics and their clinical evolution. The mean follow-up time among the entire study population was 42 ± 39 months. We observed an overall survival of 68.3% with similar incidences in both groups: 83% in the younger versus 78% in the older group at 1 year, and 69% versus 63%, at 5 years respectively. Both groups showed similar lengths of intensive care unit stay, cold and warm ischemia times, and intraoperative transfusion requirements. The older group had a total operative time than was longer and fewer hypotensive episodes than the younger group. There were no significant differences in the rates of rejection and retransplantation between the groups. The use of older donor livers was associated with a significantly higher rate of poor initial graft function (P = .027), an increased number of reinterventions (P = .013) in the older donor group, as well as more frequent vascular and biliar complications, without reaching significance. Our data suggested that donor age alone did not engendered a survival disadvantage for graft or recipient. However, careful donor selection is needed to avoid additional risk factors that can increase the morbidity or mortality of the procedure. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Effect of Bicyclol tablets on drug induced liver injuries after kidney transplantation

    National Research Council Canada - National Science Library

    Wenjun Shang; Yonghua Feng; Jinfeng Li; Xinzhou Wang; Hongchang Xie; Guiwen Feng

    2017-01-01

    .... Bicyclol tablets possess obvious anti-inflammatory and liver-protective functions. This study aimed to explore the clinical effect of preventive application of Bicyclol on drug induced liver injuries at an early stage after kidney transplantation...

  11. Trajectories of anxiety and depression in liver transplant candidates during the waiting-list period

    NARCIS (Netherlands)

    Annema, Coby; Roodbol, Petrie F; Van den Heuvel, Edwin R; Metselaar, Herold J; Van Hoek, Bart; Porte, Robert J; Ranchor, Adelita V

    OBJECTIVES: To explore whether distinct trajectories of anxiety and depression exist among liver transplant candidates, and to gain insight into demographic, clinical, and individual characteristics related with these trajectories. DESIGN: A multicentre, prospective cohort study among 216 liver

  12. Normal to increased thrombin generation in patients undergoing liver transplantation despite prolonged conventional coagulation tests

    NARCIS (Netherlands)

    Lisman, Ton; Bakhtiari, Kamran; Pereboom, Ilona T. A.; Hendriks, Herman G. D.; Meijers, Joost C. M.; Porte, Robert J.

    Background & Aims: Patients with liver disease often show substantial changes in their hemostatic system, which may aggravate further during liver transplantation. Recently, thrombin generation in patients with stable disease was shown to be indistinguishable from controls provided thrombomodulin,

  13. Matrix metalloproteinase 2 genotype is associated with nonanastomotic biliary strictures after orthotopic liver transplantation

    NARCIS (Netherlands)

    Ten Hove, W. Rogier; Korkmaz, Kerem S.; den Dries, Sanna Op; de Rooij, Bert-Jan F.; van Hoek, Bart; Porte, Robert J.; van der Reijden, Johan J.; Coenraad, Minneke J.; Dubbeld, Jeroen; Hommes, Daniel W.; Verspaget, Hein W.

    Background: Nonanastomotic biliary strictures (NAS) are a serious complication after orthotopic liver transplantation (OLT). Matrix metalloproteinases (MMPs) are involved in connective tissue remodelling in chronic liver disease and complications after OLT. Aim: To evaluate the relationship between

  14. Cardiotrophin-1 reduces ischemia/reperfusion injury during liver transplant.

    Science.gov (United States)

    Aguilar-Melero, Patricia; Luque, Antonio; Machuca, María M; Pérez de Obanos, María P; Navarrete, Rocío; Rodríguez-García, Inés C; Briceño, Javier; Iñiguez, María; Ruiz, Juan; Prieto, Jesús; de la Mata, Manuel; Gomez-Villamandos, Rafael J; Muntane, Jordi; López-Cillero, Pedro

    2013-05-01

    Orthotopic liver transplantation (OLT) is currently the elective treatment for advanced liver cirrhosis and acute liver failure. Ischemia/reperfusion damage may jeopardize graft function during the postoperative period. Cardiotrophin-1 (CT-1) has demonstrated cytoprotective properties in different experimental models of liver injury. There is no evidence to demonstrate its potential use in the prevention of the ischemia/reperfusion injury that occurs during OLT. The present study is the first report to show that the administration of CT-1 to donors would benefit the outcome of OLT. We tested the cytoprotective effect of CT-1 administered to the donor prior to OLT in an experimental pig model. Hemodynamic changes, hepatic histology, cell death parameters, activation of cell signaling pathways, oxidative and nitrosative stress, and animal survival were analyzed. Our data showed that CT-1 administration to donors increased animal survival, improved cardiac and respiratory functions, and reduced hepatocellular injury as well as oxidative and nitrosative stress. These beneficial effects, related to the activation of AKT, ERK, and STAT3, reduced caspase-3 activity and diminished IL-1β and TNF-α expression together with IL-6 upregulation in liver tissue. The administration of CT-1 to donors reduced ischemia/reperfusion injury and improved survival in an experimental pig model of OLT. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. [Activity and results of liver transplantation in Spain during 1984-2012. Analysis of the Spanish Liver Transplant Registry].

    Science.gov (United States)

    Cuervas-Mons, Valentín; de la Rosa, Gloria; Pardo, Fernando; San Juan, Fernando; Valdivieso, Andrés

    2015-04-20

    Liver transplantation (LT) is a proven effective treatment of severe liver disease. The aim of this paper is to analyze the results of LT in Spain during the period 1984-2012. We analyze the results of the database of Spanish Liver Transplant Registry. A total of 20,288 transplants were performed in 18,568 patients. The median age of the donor and recipient increased during the analysis period: 25 years (95% confidence interval [95% CI] 18-40) and 47 years (95% CI 34-55), respectively, in the period 1984-1994 compared to 59 years (95% CI 33-65; P<.05) and 55 years (95% CI 48-61; P<.01), respectively, in the period 2010-2012. The most frequent indications were liver cirrhosis (63.18%) and hepatocellular carcinoma (19.62%). The overall patient and graft survival was respectively 85.1 and 77.8% in the first year, 72.6 and 63.5% the fifth year and 62 and 52.6% in the tenth year. First year patients and graft survival increased respectively from 77.8 and 66.3% in the period 1984-1994 to 88.5 and 83% in 2010-2012 (P<.01). Donor and recipient age, etiology of underlying disease, and hepatitis C virus serological status, were factors associated with decreased survival in univariate and multivariate analysis. Results of LT improved significantly over the review period, despite a progressive increase in donor and recipient age. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  16. Significance and specificity of vascular anastomosis in liver transplantation: Our experience

    Directory of Open Access Journals (Sweden)

    Nenezić Dragoslav

    2007-01-01

    Full Text Available Introduction Transplantation is the method of choice in the treatment of terminal liver diseases with acute and structural damage of liver tissue and congenital liver diseases. Objective The aim of our study was to determine specificity and significance of vascular anastomosis in liver transplantation by postoperative evaluation of vascular anastomosis function. Method The study included 16 patients with 16 liver transplantations and one re-do liver transplantation. In all patients, preoperative angiography and postoperative duplex sonographic and angiographic evaluation of vascular anastomosis were performed. Results Preoperative angiographic evaluation did not reveal anomalies in liver blood vessels of transplant candidates. In one patient, we identified and angiographically confirmed stenosis on anastomosis of the hepatic artery on the 7th postoperative day. In another patient, we had artificial thrombosis of the hepatic artery branch due to the liver biopsy. Conclusion The successful performance of vascular anastomosis in liver transplantation is significant for adequate liver graft perfusion, good postoperative graft function and overall outcome of the liver transplantation.

  17. Increased liver regeneration rate and decreased liver function after synchronous liver and colon resection in rats.

    Science.gov (United States)

    Sasanuma, Hideki; Mortensen, Frank Viborg; Knudsen, Anders Riegels; Funch-Jensen, Peter; Okada, Masaki; Nagai, Hideo; Yasuda, Yoshikazu

    2009-12-24

    The surgical strategy for the treatment of colorectal cancer and synchronous liver metastases remains controversial. The aim of the present study was to investigate the effects of colonic resection on liver function and regeneration in a rat model. Ninety-six Sprague-Dawley rats were block-randomized into six groups: Group I had a laparotomy performed. Group II had 1 cm colon resected and anastomosed. Group III and V had 40% or 70% of the liver resected, respectively. Additionally Group IV and VI had 1 cm colon resected and anastomosed, respectively. Body weight was recorded on postoperative day 0, 3, 5 and 7. Rats were sacrificed on postoperative day 7 by rapid collection of blood from the inferior vena cava, and endotoxin levels were measured. Remnant liver function was evaluated by means of branched amino acids to tyrosine ratio. Liver regeneration was calculated by (liver weight per 100 g of the body weight at sacrifice/preoperative projected liver weight per 100 g of the body weight) x 100. The total number of complications was significantly higher in Group VI than Group I, III, IV, and V. Body weight and branched amino acids to tyrosine ratio were both significantly lower in rats that had simultaneous colonic and liver resection performed. Hepatic regeneration rate was significantly higher in the simultaneous colectomy group. Systemic endotoxin levels were unaffected by simultaneous colectomy on postoperative day 7. In our model morbidity seems to be related to the extent of hepatic resection. In rats undergoing liver resection, simultaneous colectomy induced a higher degree of hepatic regeneration rate. Body weight changes and branched amino acids to tyrosine ratio were negatively affected by simultaneous colectomy.

  18. [Cerebral aspergillosis and liver transplantation: about one case].

    Science.gov (United States)

    Delwarde, B; Schmitt, Z; Bienvenu, A L; Duperret, S; Aubrun, F

    2014-12-01

    Cerebral invasive aspergillosis is a rare but serious infection. Mortality is still high despite appropriate treatment. We report the case of a patient with liver transplantation in the context of alcoholic cirrhosis and transplanted back seven years later consequently to an ischemic cholangitis. Following an acquired active viral infection by HCV and treated by antiviral combination therapy the patient presented six months after this second operation a cerebral aspergillosis of tumour-like presentation. It rapidly evolved to an unfavourable outcome with intracranial hypertension state. If the therapeutic management is well established, the diagnosis is difficult. This observation allows us to discuss the various diagnostic criteria of cerebral aspergillosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Cancer Incidence among Heart, Kidney, and Liver Transplant Recipients in Taiwan.

    Science.gov (United States)

    Lee, Kwai-Fong; Tsai, Yi-Ting; Lin, Chih-Yuan; Hsieh, Chung-Bao; Wu, Sheng-Tang; Ke, Hung-Yen; Lin, Yi-Chang; Lin, Feng-Yen; Lee, Wei-Hwa; Tsai, Chien-Sung

    2016-01-01

    Population-based evidence of the relative risk of cancer among heart, kidney, and liver transplant recipients from Asia is lacking. The Taiwan National Health Insurance Research Database was used to conduct a population-based cohort study of transplant recipients (n = 5396), comprising 801 heart, 2847 kidney, and 1748 liver transplant recipients between 2001 and 2012. Standardized incidence ratios and Cox regression models were used. Compared with the general population, the risk of cancer increased 3.8-fold after heart transplantation, 4.1-fold after kidney transplantation and 4.6-fold after liver transplantation. Cancer occurrence showed considerable variation according to transplanted organs. The most common cancers in all transplant patients were cancers of the head and neck, liver, bladder, and kidney and non-Hodgkin lymphoma. Male recipients had an increased risk of cancers of the head and neck and liver, and female kidney recipients had a significant risk of bladder and kidney cancer. The adjusted hazard ratio for any cancer in all recipients was higher in liver transplant recipients compared with that in heart transplant recipients (hazard ratio = 1.5, P = .04). Cancer occurrence varied considerably and posttransplant cancer screening should be performed routinely according to transplanted organ and sex.

  20. Cancer Incidence among Heart, Kidney, and Liver Transplant Recipients in Taiwan.

    Directory of Open Access Journals (Sweden)

    Kwai-Fong Lee

    Full Text Available Population-based evidence of the relative risk of cancer among heart, kidney, and liver transplant recipients from Asia is lacking. The Taiwan National Health Insurance Research Database was used to conduct a population-based cohort study of transplant recipients (n = 5396, comprising 801 heart, 2847 kidney, and 1748 liver transplant recipients between 2001 and 2012. Standardized incidence ratios and Cox regression models were used. Compared with the general population, the risk of cancer increased 3.8-fold after heart transplantation, 4.1-fold after kidney transplantation and 4.6-fold after liver transplantation. Cancer occurrence showed considerable variation according to transplanted organs. The most common cancers in all transplant patients were cancers of the head and neck, liver, bladder, and kidney and non-Hodgkin lymphoma. Male recipients had an increased risk of cancers of the head and neck and liver, and female kidney recipients had a significant risk of bladder and kidney cancer. The adjusted hazard ratio for any cancer in all recipients was higher in liver transplant recipients compared with that in heart transplant recipients (hazard ratio = 1.5, P = .04. Cancer occurrence varied considerably and posttransplant cancer screening should be performed routinely according to transplanted organ and sex.

  1. Fecal microbiota transplantation prevents hepatic encephalopathy in rats with carbon tetrachloride-induced acute hepatic dysfunction.

    Science.gov (United States)

    Wang, Wei-Wei; Zhang, Yu; Huang, Xiao-Bing; You, Nan; Zheng, Lu; Li, Jing

    2017-10-14

    To investigate whether fecal microbiota transplantation (FMT) prevents hepatic encephalopathy (HE) in rats with carbon tetrachloride (CCl4)-induced acute hepatic dysfunction. A rat model of HE was established with CCl4. Rat behaviors and spatial learning capability were observed, and hepatic necrosis, intestinal mucosal barrier, serum ammonia levels and intestinal permeability were determined in HE rats receiving FMT treatment. Furthermore, the expression of tight junction proteins (Claudin-1, Claudin-6 and Occludin), Toll-like receptor (TLR) 4/TLR9, interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α was examined. FMT improved rat behaviors, HE grade and spatial learning capability. Moreover, FMT prevented hepatic necrosis and intestinal mucosal barrier damage, leading to hepatic clearance of serum ammonia levels and reduced intestinal permeability. The expression of TLR4 and TLR9, two potent mediators of inflammatory response, was significantly downregulated in the liver of rats treated with FMT. Consistently, circulating pro-inflammatory factors such as interleukin (IL)-1β, IL-6 and tumor necrosis factor-α were remarkably decreased, indicating that FMT is able to limit systemic inflammation by decreasing the expression of TLR4 and TLR9. Importantly, HE-induced loss of tight junction proteins (Claudin-1, Claudin-6 and Occludin) was restored in intestinal tissues of rats receiving FMT treatment. FMT enables protective effects in HE rats, and it improves the cognitive function and reduces the liver function indexes. FMT may cure HE by altering the intestinal permeability and improving the TLR response of the liver.

  2. In utero transplantation of fetal liver stem cells in humans.

    Science.gov (United States)

    Touraine, J L

    1991-01-01

    Following 15 years experience in postnatal fetal liver transplantation (FLT), we have developed a new therapeutical method, namely the in utero transplantation of stem cells from the human fetal liver. This early transplant takes advantage of the immunological tolerance that exists in young fetal recipients. The three fetuses that we treated were 28, 26, and 12 weeks of age (weeks after fecundation). The first two patients had immunodeficiencies, the third one had thalassemia major. Donor cells were obtained from 7- to 10-week-old fetuses, with conditions approved by the National Committee for Bioethics. Donors and recipients were not matched. The fetal cells were infused through the umbilical vein of the first two patients and injected intraperitoneally into the third one, under ultrasonic visualization. The first patient, born in 1988, has evidence of engraftment and reconstitution of cell-mediated immunity: initially 10% than 26% of lymphocytes of donor origin (with distinct phenotype), T cell responses to tetanus toxoid and candida antigens. This child, who had bare lymphocyte syndrome, has no clinical manifestation of the disease and lives normally at home. The second child was born in 1989 and it is too early for a thorough evaluation of the immunological effects of the transplant, although donor cell engraftment has been proven (Y chromosome in this female patient). The third patient has also evidence of donor cell take (Y chromosome in a female patient) but the effect on thalassemia has not yet been fully analyzed (donor hemoglobin present in small quantity). In all three cases, no side effect of any kind developed in the mother nor in the fetus.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Volatile Biomarkers in Breath Associated With Liver Cirrhosis — Comparisons of Pre- and Post-liver Transplant Breath Samples

    Directory of Open Access Journals (Sweden)

    R. Fernández del Río

    2015-09-01

    Conclusions: Limonene, methanol and 2-pentanone are breath markers for a cirrhotic liver. This study raises the potential to investigate these volatiles as markers for early-stage liver disease. By monitoring the wash-out of limonene following transplant, graft liver function can be non-invasively assessed.

  4. Survey of hemostasis management and transfusion in liver transplantation.

    Science.gov (United States)

    Mellado, P; Benítez, I; Sánchez-Carrillo, F; León, A; Álamo, J M; Gómez, M A

    2016-02-01

    To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain. A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011. Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient. There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Intraoperative hemodialysis during liver transplantation: a decade of experience.

    Science.gov (United States)

    Nadim, Mitra K; Annanthapanyasut, Wanwarat; Matsuoka, Lea; Appachu, Kari; Boyajian, Mark; Ji, Lingyun; Sedra, Ashraf; Genyk, Yuri S

    2014-07-01

    Liver transplantation (LT) for patients with renal dysfunction is frequently complicated by major fluid shifts, acidosis, and electrolyte and coagulation abnormalities. Continuous renal replacement therapy (CRRT) has been previously shown to ameliorate these problems. We describe the safety and clinical outcomes of intraoperative hemodialysis (IOHD) during LT for a group of patients with high Model for End-Stage Liver Disease (MELD) scores. We performed a retrospective study at our institution of patients who underwent IOHD from 2002 to 2012. Seven hundred thirty-seven patients underwent transplantation, and 32% received IOHD. The mean calculated MELD score was 37, with 38% having a MELD score ≥ 40. Preoperatively, 61% were in the intensive care unit, 19% were mechanically ventilated, 43% required vasopressor support, and 80% were on some form of renal replacement therapy at the time of transplantation, the majority being on CRRT. Patients on average received 35 U of blood products and 4.8 L of crystalloids without significant changes in hemodynamics or electrolytes. The average urine output was 450 ml, and the average amount of fluid removal with dialysis was 1.8 L. The 90-day patient and dialysis-free survival rates were 90% and 99%, respectively. One-year patient survival rates based on the pretransplant renal replacement status and the MELD status were not statistically different. This is the first large study to demonstrate the safety and feasibility of IOHD in a cohort of critically ill patients with high MELD scores undergoing LT with good patient and renal outcomes. © 2014 American Association for the Study of Liver Diseases.

  6. The morpho-functional assessment of plasmonic photothermal therapy effects on transplanted liver tumor

    Directory of Open Access Journals (Sweden)

    A. B. Bucharskaya

    2015-05-01

    Full Text Available The antitumor efficiency of gold nanorod plasmonic photothermal therapy (PPTT was evaluated experimentally. The rat cholangiocarcinoma line PC-1 was used as a tumor model. Exposure of tumors to 808-nm laser radiation was performed, and the noninvasive temperature monitoring of the tumor tissue was carried out using infrared imager. The growth rate kinetics and morphological alterations of transplanted liver tumors, as well as indicators of lipid peroxidation activity and autointoxication in rat serum, were studied. The activation of lipid peroxidation and the development of autointoxication were detected after PPTT. The results not only demonstrate the antitumor efficacy of the proposed therapeutic technology but also reveal the side effects in the presence of peroxidation products in systemic circulation.

  7. [Liver transplantation in Iceland: a retrospective study of indications and results].

    Science.gov (United States)

    Eggertsdóttir Claessen, Lára Ósk; Björnsson, Einar Stefán; Bergmann, Óttar Már; Ólafsson, Sigurður

    2016-01-01

    Liver transplantation is an important treatment option for end-stage liver disease. Since liver transplantation is not performed in Iceland, patients are sent abroad for this procedure. The aim of this study was to investigate indications and results of liver transplantations for Icelandic patients. The study was retrospective and included all patients in Iceland who had undergone liver transplantation from the first transplantation in 1984 to the end of 2012. Information was gathered from medical records. The study period was divided into three subperiods in order to evaluate changes in frequency of transplantation and survival. During the period, 45 liver transplantations, thereof five retransplantations, were performed. Of 40 patients 16 were males, 18 females, mean age 40 years. There were six children, 2 girls and 4 boys with an age range of 0.4-12 years. Number of transplantation per million inhabitants increased significantly (2.40 during 1984-1996; 5.18 during 1997-2006 and 8.90 during 2007-2013; p<0.01). The main indication for transplantation was cirrhosis with complications in 26 patients (65%), acute liver failure in 6 (15%), cirrhosis and hepatocellular carcinoma in three (8%), and hemangioendothelioma in two (5%). The most common underlying liver diseases were primary biliary cirrhosis in 8 (20%), autoimmune hepatitis in four (10%), alcoholic cirrhosis in three (7.5%) and primary sclerosing cholangitis in three (7.5%). The mean waiting time for transplantation was 5.9 months (median 3.2). Survial was 84% in one year and 63% in 5 years. Survival increased during the study period. The number of liver transplantations has increased significantly in recent years. Survival has improved and is comparable to survival in countries where liver transplantations are performed.

  8. Preventing infection from foodborne pathogens in liver transplant patients.

    Science.gov (United States)

    Cabelof, D C

    1994-10-01

    Patients who have had an orthotopic liver transplantation (OLT) experience impaired immune function resulting from the disease process and the therapeutic use of immunosuppressive and antibacterial drugs. Immunoimpairment increases the risk of foodborne illness from bacteria, viruses, fungi, and parasites. This article describes the organisms known to cause clinically important infections and their food sources, the distinctive clinical consequences of the infection in patients who have had an OLT, and methods of preventing foodborne illness in these patients and others. Dietitians are the health care providers typically responsible for teaching OLT patients and their caregivers about safe food handling and appropriate food choices.

  9. Modigraf administration through jejunostomy in liver transplant recipient: case report.

    Science.gov (United States)

    Marente, V Camacho; Gomez, L M Marin; Martinez, J Gracia; Bernal-Bellido, C; Suárez-Artacho, G; Alamo-Martínez, J M; Barrera-Pulido, L; Serrano-Díaz-Canedo, J; Padillo-Ruiz, F J; Gómez-Bravo, M A

    2013-01-01

    We report our experience with a 61-year-old patient with alcoholic and hepatitis C cirrhosis who underwent liver transplantation. On the 3rd postoperative day he presented a mediastinitis secondary to esophageal perforation produced by a Linton tube. An esophagectomy with jejunostomy was performed. Tacrolimus granules for oral suspension (Modigraf) were administered through the jejunostomy. This case report highlights the use of Modigraf and the absence of secondary effects. We observed biochemical parameters during the jejunostomy period. We discuss the administration strategy applied and whether tacrolimus granules for oral suspension by jejunostomy affect the bioavailability and its side effects. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Zygomycosis Associated with HIV Infection and Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Larry Nichols

    2011-01-01

    Full Text Available Zygomycosis is an increasing threat to patients with human immunodeficiency virus (HIV infection. Zygomycosis (formerly called mucormycosis is the fungal infection with Mucor, Rhizopus, or other species that share a common morphology of large empty pauciseptate hyphae with rare random-angle branching and a collapsed “twisted ribbon” appearance. Morphology allows a specific diagnosis on frozen section or smear prior to growth and identification of the fungi in culture which makes it improtant because treatment is different than that for more common mycoses such as candidiasis and aspergillosis. We present an informative and illustrative case of zygomycosis in a patient with HIV infection and liver transplantation.

  11. Importance of Liver Biopsy Findings on Prognosis of Kidney Transplant Patients.

    Science.gov (United States)

    Özgün, Gonca; Özdemir, Binnaz Handan; Tunca, Müzeyyen Zeyneb; Börcek, Pelin; Haberal, Mehmet

    2016-11-01

    Chronic hepatitis infection among kidney transplant recipients is not infrequent, with those with hepatitis C virus infection having worse survival. Here, we evaluated liver biopsy changes and its effects on prognosis in kidney transplant recipients. Patients with liver biopsies were selected from 1275 kidney transplant recipients who were treated at Başkent University from January 1990 to December 2012. Demographic and clinical findings were evaluated, including age, sex, liver biopsy findings, amyloid and hemosiderin accumulation, and patient survival. Among 1275 renal transplant patients, only 149 patients had liver biopsies. Of 149 patients, 68 patients (45.3%) had liver biopsy only before and 81 patients had liver biopsy after transplant, with 20 of the 81 patients also having biopsy before transplant. The 81 patients who had a liver biopsy after renal transplant were included in the study. In our patient group, mean follow-up was 166 ± 29 months, female-to-male ratio was 26/55, and mean age was 30.2 ± 9.87 years (range, 15-56 y). Only 2 of 81 liver biopsies (2.4%) were diagnosed as normal or nonspecific. Biopsy findings of the remaining 79 patients (97.6%) showed variable pathologies, including hepatocellular damage and minimal cholestatic changes in 29 patients (35.8%), chronic nonviral hepatitis in 9 (11.1%), and viral hepatitis in 41 (50.6%). The mean time between the first liver biopsy taken before transplant and second biopsy after transplant was 44.5 ± 38.0 months (range, 11-139 mo). Among 81 patients, 6 (7.4%) showed amyloid deposition and 13 (16.0%) showed hemosiderosis. Testing for viral infections is critical in transplant recipients. It is well known that these infections can affect the frequency of rejection episodes and also negatively affect survival in solidorgan transplant recipients. Livers should be evaluated by biopsy even if the variance in liver enzymes or serology is minimal.

  12. Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors.

    Directory of Open Access Journals (Sweden)

    Rianne van Rijn

    Full Text Available Liver grafts from donation after circulatory death (DCD donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess the outcome of liver transplantation with pediatric DCD grafts and to compare this with the outcome after transplantation of livers from pediatric donation after brain death (DBD donors.All transplantations performed with a liver from a pediatric donor (≤16 years in the Netherlands between 2002 and 2015 were included. Patient survival, graft survival, and complication rates were compared between DCD and DBD liver transplantation.In total, 74 liver transplantations with pediatric grafts were performed; twenty (27% DCD and 54 (73% DBD. The median donor warm ischemia time (DWIT was 24 min (range 15-43 min. Patient survival rate at 10 years was 78% for recipients of DCD grafts and 89% for DBD grafts (p = 0.32. Graft survival rate at 10 years was 65% in recipients of DCD versus 76% in DBD grafts (p = 0.20. If donor livers in this study would have been rejected for transplantation when the DWIT ≥30 min (n = 4, the 10-year graft survival rate would have been 81% after DCD transplantation. The rate of non-anastomotic biliary strictures was 5% in DCD and 4% in DBD grafts (p = 1.00. Other complication rates were also similar between both groups.Transplantation of livers from pediatric DCD donors results in good long-term outcome especially when the DWIT is kept ≤30 min. Patient and graft survival rates are not significantly different between recipients of a pediatric DCD or DBD liver. Moreover, the incidence of non-anastomotic biliary strictures after transplantation of pediatric DCD livers is remarkably low.

  13. Shipping impact on liver graft: results of liver transplantation program in Andalusia.

    Science.gov (United States)

    Oliver, C O; Marente, V C; Bellido, C B; Martínez, J M Á; Gómez, L M M; Artacho, G S; Canedo, J S D; Pulido, L B; Ruiz, F J P; Bravo, M A G

    2013-01-01

    Liver transplantation for the treatment of patients with advanced liver disease is organized according to a waiting list taking into account different criteria. The agreed distribution model in Andalusia assumes that sometimes an organ is extracted in a different province to that where the implantation is to be performed (shipping), which, therefore, increases the graft ischemic time. The aim of the present study was to determine whether transportation of the organ and being harvested by a team other than the implantation team have a negative effect on final patient survival. Copyright © 2013. Published by Elsevier Inc.

  14. Hepatic miR-301a as a Liver Transplant Rejection Biomarker? And Its Role for Interleukin-6 Production in Hepatocytes.

    Science.gov (United States)

    Nakano, Toshiaki; Chen, I-Hsuan; Goto, Shigeru; Lai, Chia-Yun; Tseng, Hui-Peng; Hsu, Li-Wen; Chiu, King-Wah; Lin, Chih-Che; Wang, Chih-Chi; Cheng, Yu-Fan; Chen, Chao-Long

    2017-01-01

    Acute rejection (AR) of liver transplantation remains a formidable challenge for diagnostic medicine and biomarker discovery. We characterized AR-related microRNAs (miRNAs) and the underlying AR mechanisms in liver transplantation. Using a rat model of orthotopic liver transplantation (OLT) as well as microarrays, we compared the miRNA expression profiles between naive and AR livers on day 7 after OLT with short- (liver into Lewis [LEW] recipient) and long-term (>60 days, donor DA liver into Piebald Virol Glaxo [PVG] recipient) survival fates. The microarray analysis revealed that the levels of miR-301a in the lethal AR livers were significantly higher than in naive and tolerogenic AR livers. The reduced expression of miR-301a in inflamed livers suggested a difference between AR and inflammation in terms of miR-301a-mediated molecular events. Overexpression of hepatic miR-301a induced IL-6 production in rat primary hepatocytes. Hepatocytes overexpressing miR-301a were capable of transferring miR-301a to cocultured splenocytes through exosomes. These splenocytes then showed overexpression of miR-301a and downregulation of protein inhibitor of activated STAT3 (PIAS3) expression, resulting in the induction of T helper 17 cell differentiation. In conclusion, this report raises the possibility that hepatic miR-301a might potentially prove value as a biomarker of liver transplant rejection. We call for future research on this molecular target and the attendant pathways as liver transplant rejection and its early diagnosis continue to be veritable healthcare challenges.

  15. Pediatric liver transplantation: predictors of survival and resource utilization.

    Science.gov (United States)

    Wagenaar, Amy E; Tashiro, Jun; Sola, Juan E; Ekwenna, Obi; Tekin, Akin; Perez, Eduardo A

    2016-05-01

    We sought to identify factors associated with increased resource utilization and in-hospital mortality for pediatric liver transplantation (LT). Kids' Inpatient Database (1997-2009) was used to identify cases of LT in patients liver disease was the most common (75 %). Logistic regression found higher mortality in children undergoing LT for malignant conditions (odds ratio: 4.8) and acute hepatic failure (OR 3.4). Cases complicated by renal failure (OR 7.7) and complications of LT (OR 2.7) had higher mortality rates. Resource utilization increased for children with renal failure and those with hemorrhage as a complication of LT, p failure and complications related to LT. Admission length was sensitive to payer status, hospital characteristics, and UNOS region, whereas total costs were unaffected by payer status or hospital type.

  16. Yersinia enterocolitica Infection Simulating Lymphoproliferative Disease, after Liver Transplant

    Directory of Open Access Journals (Sweden)

    E. Jakobovich

    2014-01-01

    Full Text Available We describe a 14-year-old girl, who was 13 y after liver transplantation for biliary atresia with an unremarkable postoperative course. She presented with fever of up to 40°C, extreme fatigue, malaise, anorexia, and occasional vomiting. On physical examination the only finding was splenomegaly. Lab results showed hyperglobulinemia and an elevated sedimentation rate. Liver function tests were normal except for mild elevation of γGTP. Abdominal U/S and CT demonstrated an enlarged spleen with retroperitoneal and mesenteric lymph nodes enlargement. An exhaustive evaluation for infectious causes, autoimmune conditions, and malignancy was negative. A full recovery after 5 months prompted testing for self-limited infectious etiologies. Yersinia enterocolitica infection was diagnosed.

  17. 31P-NMR SPECTROSCOPY OF RAT LIVER DURING SIMPLE STORAGE OR CONTINUOUS HYPOTHERMIC PERFUSION1

    Science.gov (United States)

    Rossaro, Lorenzo; Murase, Noriko; Caldwell, Cary; Farghali, Hassan; Casavilla, Adrian; Starzl, Thomas E.; Ho, Chien; Van Thiel, David H.

    2010-01-01

    SUMMARY The ATP content and intracellular pH (pHi)3 of isolated rat liver before, during, and after cold preservation in either UW-lactobionate (UW, n=10) or Euro-Collins (EC, n=8) solutions were monitored using phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy. The 31P-NMR spectra were obtained on a 4.7-Tesla system operating at 81 MHz. Fructose metabolism, liver enzyme release, O2 consumption, and rat survival after liver transplantation were also evaluated. During simple cold storage (SCS), the ATP level declined to undetectable levels with both preservation solutions while the pHi declined to approximately 7.0. In contrast, during continuous hypothermic perfusion (CHP), hepatic ATP levels remained measurable during the 24-hour EC preservation and actually increased significantly (p>0.01) during UW preservation. After reperfusion at 37°C with Krebs-lactate, the SCS livers treated with EC differed significantly from the UW livers in terms of their ATP and pHi as well as their response to a fructose challenge. In contrast, livers undergoing CHP demonstrated similar behaviors with both solutions. These results demonstrate an increase in the hepatic ATP content during CHP which occurs with UW but is not seen with EC. On the other hand, only livers that were simply stored with UW achieved significant survival after transplant, while CHP livers were affected by vascular damage as demonstrated by fatal thrombosis after transplant. These data suggest that ATP content is not the only determinant of good liver function although a system of hypothermic perfusion might further improve liver preservation efficacy should injury to vascular endothelium be avoided. PMID:1402332

  18. Diaphragm rupture in a liver transplant patient under chronic immunosuppressive therapy with sirolimus: rare complication after liver transplantation.

    Science.gov (United States)

    Rossetto, Anna; Baccarani, Umberto; Adani, Gian Luigi; Lorenzin, Dario; Bresadola, Vittorio; Terrosu, Giovanni

    2011-03-01

    A diaphragm rupture is a very rare event. A variety of conditions such as coughing, delivery, and vigorous exercise causing a sudden increase of the intra-abdominal pressure can result in diaphragm rupture [1]. The diagnosis can be difficult because of non-specific symptoms and no history of blunt or penetrating trauma. Due to anatomical reasons, diaphragmatic lesions in the left side are more common than those in the right side. Chronic immunosuppressive therapy in transplanted patients, especially with antiproliferative drugs such as mTOR inhibitor, has been considered as a risk factor for the development of incisional hernia [2, 3]. We present the case of diaphragm rupture in a liver transplant patient under chronic immunosuppressive therapy with sirolimus.

  19. Mental health affects the quality of life and recovery after liver transplantation.

    Science.gov (United States)

    Miller, Lisa Renee; Paulson, Daniel; Eshelman, Anne; Bugenski, Mary; Brown, Kimberly A; Moonka, Dilip; Abouljoud, Marwan

    2013-11-01

    There has been little research examining the effects of mental health before liver transplantation on quality of life (QOL) and recovery after transplantation. Therefore, the purpose of the current study was to examine how pretransplant depression and anxiety affect mental health, QOL, and recovery after transplantation. Eighty-two transplant recipients provided data when they were listed for transplantation and 6 months after transplantation. Pretransplant anxiety predicted posttransplant anxiety (P Mental Health, as well as the Mental Health Composite Score (P Health, Vitality, and Social Functioning, as well as the Physical Composite Score (P recovery 6 months after transplantation (P recovery (P = 0.09). These findings highlight the importance of evaluating transplant candidates both before and after transplantation for anxiety and depressive symptoms. Once patients with these symptoms are identified, they can be referred for treatment, which may lead to better posttransplant outcomes for mental health, QOL, and recovery. © 2013 American Association for the Study of Liver Diseases.

  20. Terapia nutricional no transplante hepático Nutritional therapy in liver transplantation

    Directory of Open Access Journals (Sweden)

    Mônica Beatriz PAROLIN

    2002-04-01

    Full Text Available Racional - Deficiências nutricionais, por vezes graves, são comuns em pacientes com insuficiência hepática, candidatos a transplante de fígado. A terapia nutricional pode corrigir total ou parcialmente tais deficiências, melhorando as condições clínicas e o prognóstico desses indivíduos, frente ao grande desafio do transplante hepático. Objetivos - Breve revisão do papel do fígado no metabolismo dos diversos nutrientes. Descrição dos métodos de avaliação do estado nutricional, traçando-se as bases da terapia nutricional segundo condições hepáticas diversas, no pré e pós-transplante, em relação às necessidades calóricas e dos diversos nutrientes. Apresentação de intervenções nutricionais, no controle das complicações metabólicas resultantes do uso de drogas imunossupressoras. Conclusão - A terapia nutricional é valiosa aliada no tratamento clínico de pacientes candidatos ou já submetidos ao transplante hepático, contribuindo para um prognóstico favorável e para a melhora da qualidade de vida desses indivíduos.Background - Malnutrition, sometimes severe is common in patients with chronic hepatic diseases who are candidates for liver transplantation. Nutritional therapy can induce partial or total correction of such deficiencies, improving clinical conditions and prognosis of patients who face the great defiance of liver transplantation. Aims - Brief revision of hepatic role in the metabolism of several nutrients. Description of available methods of dietary therapy and its application both under different abnormal hepatic conditions and pre and post-transplant periods. The role of nutritional intervention in metabolic side effects due to immunosuppressive drugs. Conclusion - Nutritional therapy is a valuable adjuvant resource to the clinical treatment of candidates and submitted patients to hepatic transplantation providing better prognosis and improved life quality.

  1. Measurement of bioimpedance and cell viability during ischemia-reperfusion in the rat liver.

    Science.gov (United States)

    Ahn, H; Shin, H; Yun, S; Kim, J; Choi, J

    2005-01-01

    During liver resection and liver transplant, liver is damaged by ischemia-reperfusion injury. Until now, there is no approved method to measure or predict the extent of liver injury during the operation. This is the preliminary study to make the real time monitoring system by quantification of bioimpedance and ischemiareperfusion reperfusion injury in liver. Sprague-Dawley rats were subjected to different periods of 70% partial hepatic ischemia (30, 60, 90 and 120minutes ischemia) and reperfusion. We measured changes of liver tissue bioimpedance (120Hz-100KHz) every five minutes. Cell viability was assessed by metabolic capacity of fatty acid (palmitic acid metabolic rate), ATP content and histological examination (H/E and TUNEL stain) at every 30 minutes interval during ischemia.

  2. Liver retinol and carotenoid concentration of rats experimentally ...

    African Journals Online (AJOL)

    This study investigated the liver retinol and carotenoid concentration of rats experimentally infected with Trypanosoma brucei. Results of the liver retinol determination showed that T. brucei infection led to a progressively significant (P < 0.01) depletion of liver retinol concentration (body vitamin A status) of infected rats from ...

  3. Should We Exclude Live Donor Liver Transplantation for Liver Transplant Recipients Requiring Mechanical Ventilation and Intensive Care Unit Care?

    Science.gov (United States)

    Goldaracena, Nicolas; Spetzler, Vinzent N; Sapisochin, Gonzalo; J, Echeverri; Moritz, Kaths; Cattral, Mark S; Greig, Paul D; Lilly, Les; McGilvray, Ian D; Levy, Gary A; Ghanekar, Anand; Renner, Eberhard L; Grant, David R; Selzner, Markus; Selzner, Nazia

    2015-09-01

    Patients with acute and chronic liver disease often require admission to intensive care unit (ICU) and mechanical ventilation support before liver transplantation (LT). Rapid disease progression and high mortality on LT waiting lists makes live donor LT (LDLT) an attractive option for this patient population. During 2000 to 2011, all ICU-bound and mechanically ventilated patients receiving an LDLT (n = 7) were compared to patients receiving a deceased donor LT (DDLT) (n = 38). Both groups were comparable regarding length of pretransplant ICU stay (DDLT: 2 [1-31] days vs LDLT: 2 [1-8] days; P = 0.2), days under mechanical ventilation (DDLT: 2 [1-31] days vs LDLT: 2 [1-5] days; P = 0.2), pretransplant dialysis (DDLT: 45% vs LDLT: 43%; P = 1) and model for end-stage liver disease score (DDLT: 33 ± 8 vs LDLT: 33 ± 10; P = 0.911). Live donors median evaluation time was 24 hours (18-561 hours). As expected, median time on waiting list was significantly lower in the LDLT group (DDLT: 13 [0-1704] days vs LDLT: 10 [1-33] days; P = 0.008). Incidence of postoperative complications was numerically, albeit not significantly higher in the DDLT versus LDLT (68% vs 29%; P = 0.08). No difference was detected between LDLT and DDLT patients regarding 1-year (DDLT: 76% vs LDLT: 85%), 3-year (DDLT: 68% vs LDLT: 85%), and 5-year (DDLT: 68% vs LDLT: 85%) graft and patient survivals (P = 0.41). No severe donor complication occurred after live donation. The LDLT may provide a faster access to transplantation and therefore, offers an alternative treatment option for critically ill patients requiring ICU care and mechanical ventilation support at the time of transplantation.

  4. Mesenchymal Stem Cells Transplantation following Partial Hepatectomy: A New Concept to Promote Liver Regeneration-Systematic Review of the Literature Focused on Experimental Studies in Rodent Models.

    Science.gov (United States)

    Papanikolaou, Ioannis G; Katselis, Charalambos; Apostolou, Konstantinos; Feretis, Themistoklis; Lymperi, Maria; Konstadoulakis, Manousos M; Papalois, Apostolos E; Zografos, George C

    2017-01-01

    Mesenchymal stem cells (MSCs) are an attractive source for regenerative medicine because they are easily accessible through minimally invasive methods and have the potential to enhance liver regeneration (LG) and improve liver function, following partial hepatectomy (PH) and acute or chronic liver injury. A systematic review of the literature was conducted for articles published up to September 1st, 2016, using the MEDLINE database. The keywords that were used in various combinations were as follows: "Mesenchymal stem cells", "transplantation", "stem cells", "adipose tissue derived stem cells", "bone marrow-derived stem cells", "partial hepatectomy", "acute liver failure", "chronic liver failure", "liver fibrosis", "liver cirrhosis", "rats", "mice", and "liver regeneration". All introduced keywords were searched for separately in MeSH Database to control relevance and terminological accuracy and validity. A total of 41 articles were identified for potential inclusion and reviewed in detail. After a strict selection process, a total of 28 articles were excluded, leaving 13 articles to form the basis of this systematic review. MSCs transplantation promoted LG and improved liver function. Furthermore, MSCs had the ability to differentiate in hepatocyte-like cells, increase survival, and protect hepatocytes by paracrine mechanisms. MSCs transplantation may provide beneficial effects in the process of LG after PH and acute or chronic liver injury. They may represent a new therapeutic option to treat posthepatectomy acute liver failure.

  5. Clinical utility of microbubble contrast-enhanced ultrasound in the diagnosis of hepatic artery occlusion after liver transplantation

    National Research Council Canada - National Science Library

    Berstad, Audun Elnaes; Brabrand, Knut; Foss, Aksel

    2009-01-01

    ...) in the diagnosis of hepatic artery occlusion after liver transplantation. One hundred and fifty-two liver transplantations in 142 adult subjects, comprising 80 male patients and 62 female patients, were studied...

  6. Liver Transplantation in Groningen, The Netherlands : A Single Center Status Report

    NARCIS (Netherlands)

    de Vries, Yvonne; de Jong, Iris E M; Berendsen, Tim A; Lisman, Ton; Verkade, Henkjan J; Scheenstra, René; Reyntjens, Koen M E M; de Boer, Marieke T; Blokzijl, Johannes; Peeters, Paul M G; van den Berg, Aad P; Porte, Robert J

    2015-01-01

    The liver transplantation program of the University Medical Center Groningen in the Netherlands was started in 1979, making it one of the first programs worldwide. During the past 36 years, a total of 1478 liver transplantations have been performed, 459 of which were in children. One of the first

  7. Immunosuppression after liver transplantation for primary sclerosing cholangitis influences activity of inflammatory bowel disease

    DEFF Research Database (Denmark)

    Jørgensen, Kristin Kaasen; Lindström, Lina; Cvancarova, Milada

    2013-01-01

    Previous studies have shown conflicting results regarding the course of inflammatory bowel disease (IBD) after liver transplantation in patients with primary sclerosing cholangitis (PSC). We studied the progression of IBD in patients with PSC who have undergone liver transplantation. We also...

  8. Recombinant factor Vlla in orthotopic liver transplantation : influence on parameters of coagulation and fibrinolysis

    NARCIS (Netherlands)

    Meijer, K; Hendriks, HGD; de Wolf, JTM; Klompmaker, IJ; Lisman, T; Hagenaars, AAM; Slooff, MJH; Porte, RJ; van der Meer, J

    The effect of recombinant factor Vila (rFVIIa) on blood loss was evaluated in cirrhotic patients undergoing orthotopic liver transplantation. In the present study, we explored the effect of rFVIIa on coagulation and fibrinolysis during orthotopic liver transplantation. Coagulation factors,

  9. No Evidence for Systemic Platelet Activation During or After Orthotopic Liver Transplantation

    NARCIS (Netherlands)

    Pereboom, Ilona T A; Adelmeijer, Jelle; van Leeuwen, Yvonne; Hendriks, Herman G D; Porte, Robert J; Lisman, Ton

    Platelet function is thought to deteriorate during liver transplantation as a result of platelet activation and proteolysis of platelet receptors by plasmin following reperfusion. However, this hypothesis has never been formally tested. Twenty patients undergoing a first or second liver transplant

  10. Prevalence of prednisolone (non)compliance in adult liver transplant recipients

    NARCIS (Netherlands)

    Drent, Gerda; Haagsma, EB; De Geest, S; van den Berg, AP; Ten Vergert, EM; van den Bosch, HJ; Slooff, MJH; Kleibeuker, JH

    Limited evidence is available concerning (non)compliance with the immunosuppressive regimen in adult liver transplant recipients. In our study we prospectively assessed prednisolone (non)compliance in 108 adult liver transplant recipients using electronic event monitoring (EEM) in an outpatient

  11. Vascular events after liver transplantation : a long-term follow-up study

    NARCIS (Netherlands)

    Borg, Maarten A. J. P.; van der Wouden, Egbert-Jan; Sluiter, Wim J.; Slooff, Maarten J. H.; Haagsma, Elizabeth B.; van den Berg, Arie P.

    Long-term follow-up studies on the impact of vascular events (VE) and risk factors of liver transplant recipients are scarce. In this study, 311 recipients of a first isolated liver transplant who survived at least 1 year were followed up from 1979 to 2002. The median follow-up duration was 6.2

  12. Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors

    NARCIS (Netherlands)

    van Rijn, Rianne; Hoogland, Pieter E. R.; Lehner, Frank; van Heurn, Ernest L. W.; Porte, Robert J.

    2017-01-01

    Background Liver grafts from donation after circulatory death (DCD) donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess

  13. Childhood Abuse, Nonadherence, and Medical Outcome in Pediatric Liver Transplant Recipients

    Science.gov (United States)

    Shemesh, Eyal; Annunziato, Rachel A.; Yehuda, Rachel; Shneider, Benjamin L.; Newcorn, Jeffrey H.; Hutson, Carolyn; Cohen, Judith A.; Briere, John; Gorman, Jack M.; Emre, Sukru

    2007-01-01

    Objective: The study assessed the relationship between a history of child abuse, nonadherence to medications, and medical outcome in children who had a liver transplant. Method: Abuse history for children and adolescents ages 8 to 21 who underwent a liver transplantation at Mount Sinai Medical Center in New York was obtained in interviews in 2002.…

  14. New criteria for liver transplantation in adults : the combined Groningen and Rotterdam protocol

    NARCIS (Netherlands)

    Jansen, PLM

    A combined protocol for liver transplantation has been written by the teams of Groningen and Rotterdam. This is to ensure that the criteria for selection and timing of liver transplantation, and the procedures for patient evaluation, are identical or at least very similar. Also, the waiting list

  15. Gangrene of the anterior abdominal wall after orthotopic liver transplantation: invasive cutaneous candidiasis.

    OpenAIRE

    Rela, M.; Heaton, N. D.; Vougas, V.; Rolando, N.; WADE, J.; Portmann, B; Williams, R.; Tan, K C

    1993-01-01

    Fungal infections following liver transplantation are not uncommon and may be life-threatening. Superficial candidal infections of the bronchus, oesophagus and urinary tract are the most common mode of presentation. Invasive cutaneous and subcutaneous candidiasis is, however, very rare. We report two patients with invasive cutaneous and subcutaneous candidiasis after orthotopic liver transplantation.

  16. Achievement of developmental milestones in young adults after liver transplantation in childhood

    NARCIS (Netherlands)

    Lind, Robert C.; Sze, Yuk-Kueng; de Vries, Willemien; Hulscher, Jan B. F.; Sieders, Egbert; Scheenstra, Rene; Peeters, Paul M. J. G.; Porte, Robert J.; Hoekstra-Weebers, Josephine

    Little is known about the achievement of developmental milestones (i.e., COL) after pediatric liver transplantation. The aim of this study was to examine the COL of young adults who underwent a liver transplantation during childhood and to compare it to healthy peers. Furthermore, we studied factors

  17. Liver transplantation for children with acute liver failure associated with secondary hemophagocytic lymphohistiocytosis.

    Science.gov (United States)

    Amir, Achiya Z; Ling, Simon C; Naqvi, Ahmed; Weitzman, Sheila; Fecteau, Annie; Grant, David; Ghanekar, Anand; Cattral, Mark; Nalli, Nadya; Cutz, Ernest; Kamath, Binita; Jones, Nicola; De Angelis, Maria; Ng, Vicky; Avitzur, Yaron

    2016-09-01

    Hemophagocytic lymphohistiocytosis (HLH) is a rare life-threatening systemic disease, characterized by overwhelming stimulation of the immune system and categorized as primary or secondary types. Occasionally, acute liver failure (ALF) may dominate the clinical presentation. Given the systemic nature of HLH and risk of recurrence, HLH is considered by many a contraindication to liver transplantation (LT). The aim of this study is to review our single-center experience with LT in children with secondary HLH and ALF (HLH-ALF). This is a cross-sectional, retrospective study of children with secondary HLH-ALF that underwent LT in 2005-2014. Of 246 LTs, 9 patients (3 males; median age, 5 years; range, 0.7-15.4 years) underwent LT for secondary HLH-ALF. Disease progression was rapid with median 14 days (range, 6-27 days) between first symptoms and LT. Low fibrinogen/high triglycerides, elevated ferritin, hemophagocytosis on liver biopsy, and soluble interleukin 2 receptor levels were the most commonly fulfilled diagnostic criteria; HLH genetic studies were negative in all patients. Immunosuppressive therapy after LT included corticosteroids adjusted to HLH treatment protocol and tacrolimus. Thymoglobulin (n = 5), etoposide (n = 4), and alemtuzumab (n = 2) were used in cases of recurrence. Five (56%) patients experienced HLH recurrence, 1 requiring repeat LT, and 3 died. Overall graft and patient survival were 60% and 67%, respectively. Six patients are alive and well at a median of 24 months (range, 15-72 months) after transplantation. In conclusion, LT can be beneficial in selected patients with secondary HLH-ALF and can restore good health in an otherwise lethal condition. Liver Transplantation 22 1245-1253 2016 AASLD. © 2016 by the American Association for the Study of Liver Diseases.

  18. [Amanita phalloides poisoning as an indication for liver transplantation in three family members].

    Science.gov (United States)

    Pawłowska, Joanna; Pawlak, Jacek; Kamiński, Andrzej; Hevelke, Piotr; Jankowska, Irena; Teisseyre, Mikołaj; Szymczak, Marek; Kalicińiski, Piotr; Krawczyk, Marek

    2006-01-01

    Amanita phalloides poisoning is one of the most dramatic medical invents. The course of the illness may vary from mild to the lethal, with signs of fulminant liver insufficiency with coma and multiorgan failure. When hepatic encephalopathy (III/IV degrees) occurs the prognosis is very poor. In definite cases the liver transplantation is necessary. The authors present severe Amanita phalloides poisoning in three family members, who due to fulminant hepatic failure underwent liver transplantation. The two of them (son and father) transplanted accordingly in fifth and seventh day after poisoning, survived. Mother, in whom transplantation started in ninth day after poisoning, died intraoperativel with signs of massive hemorrhage, and cardiac arrest.

  19. Liver Transplantation Utilizing Mixed Biologic and Synthetic Arterial Conduits

    Directory of Open Access Journals (Sweden)

    Marcio F. Chedid

    2016-01-01

    Full Text Available Arterial conduits are necessary in nearly 5% of all liver transplants and are usually constructed utilizing segments of donor iliac artery. However, available segments of donor iliac artery may not be lengthy enough or may not possess enough quality to enable its inclusion in the conduit. Although there are few reports of arterial conduits constructed solely utilizing prosthetic material, no previous reports of conduits composed of a segment of donor iliac artery and prosthetic material (mixed biologic and synthetic arterial conduits were found in the medial literature to date. Two cases reporting successful outcomes after creation of mixed biologic and prosthetic arterial conduits are outlined in this report. Reason for creation of conduits was complete intimal dissection of the recipient’s hepatic artery in both cases. In both cases, available segments of donor iliac artery were not lengthy enough to bridge infrarenal aorta to porta hepatis. Both patients have patent conduits and normally functioning liver allografts, respectively, at 4 and 31 months after transplant. Mixed biologic and synthetic arterial conduits constitute a viable technical option and may offer potential advantages over fully prosthetic arterial conduits.

  20. Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult

    Directory of Open Access Journals (Sweden)

    Adriá Rosat

    2015-01-01

    Full Text Available Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient’s condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms.

  1. Left Diaphragmatic Herniation following Orthotopic Liver Transplantation in an Adult

    Science.gov (United States)

    Rosat, Adriá; Alonso, Ayaya; Padilla, Javier; Sanz, Pablo; Varona, M. Aránzazu; Méndiz, Javier; Moneva, Enrique; Barrera, Manuel

    2015-01-01

    Diaphragmatic herniation is an uncommon complication in the postquirurgic follow of the liver transplant. The associated symptoms are unspecific and may not suggest the correct diagnosis. It may explain why in many patients the diagnosis remains unmade or it is made only after a long interval of time. We present the case of a fifty-seven-year-old male who required an orthotopic liver transplant in 2010 due to a trifocal hepatocarcinoma. In postoperatory follow-up the patient showed alimentary regurgitation, vomiting, and dyspepsia. The diagnosis was made by an oesophagogastroduodenal transit with barium and an abdominal CT scan that showed a left diaphragmatic herniation with the gastric fundus into the thorax. With these findings we decided to perform a programmed surgery. After takedown of adhesions and replacement of the stomach into the upper abdomen, the palm-sized diaphragmatic opening was closed with a synthetic material. The patient's condition remained stable throughout the entire operation. The postoperative course was uneventful and he was discharged at the fifth day after surgery with a normal digestive intake. In a 12-month follow-up the patient shows no symptoms. PMID:26064764

  2. [Strategies for avoiding hepatitis B infection recurrence following liver transplantation].

    Science.gov (United States)

    Prieto, Martín; García-Eliz, María

    2014-07-01

    Hepatitis B is currently an excellent indication for liver transplantation due to the highly effective strategies of prophylaxis and treatment for recurrent hepatitis B infection. The combined administration of low-dose hepatitis B hyperimmune gamma globulin and a nucleoside/nucleotide analogue with a high genetic barrier to resistance, such as entecavir (except for patients with lamivudine resistance) or tenofovir, represents the standard for the prophylaxis of recurrent hepatitis B infection and is used in most centers. The drawbacks of long-term administration of hyperimmune gamma globulin have led to research on regimens in which this agent is withdrawn after a certain amount of time in combination treatment, a strategy that appears to be safe in patients with undetectable viremia at the time of liver transplantation if the patients adhere to the treatment. In recent years, there has also been research into regimens of gamma-globulin-free prophylaxis, based only on the administration of oral antiviral drugs, which appear to be safe if antivirals with a high genetic barrier to resistance are used. Hepatitis B prophylaxis should be maintained indefinitely; therefore, the total withdrawal of prophylaxis is not an accepted strategy at present in daily clinical practice if not in the context of a clinical trial. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  3. LIVER TRANSPLANTATION. A SINGLE CENTER EXPERIENCE OF 100 CASES

    Directory of Open Access Journals (Sweden)

    A. M. Granov

    2012-01-01

    Full Text Available A single center experience of first 100 liver transplantations (LTs is summarized. Analysis of trends in cadaver donor population and waiting list status changes, and also of early and late postoperative complications are presented. 100 LTs were performed for 95 patients (pts, retransplantation – 4 pts; one patient received 3 liver transplants (female – 55 pts, male – 40 pts, mean age – 39.9 ± 12.1 years. Cumulative 1-year survival rate of pts by Kaplan–Meyer was 91%, 3-year – 83%. Biliary complications were revealed in 9% of pts during 2–9 months after LT. 77 pts have been regularly observed in outpatient clinic, mean age – 44 ± 9.2 years, male – 35, fema- le – 42, follow-up period – 1 months up to 13 years after LT. 3.9% remained invalid with limitation of ability to work, 61.8% have been working, 22.3% were capable to work, retirees were 10.5%. Development of preoperati- ve planning, adequate organ selection will allow to improve the results of LT. Study of hematopoietic stem cells role will expand tools of prognosis of posttransplant complications. 

  4. Future Economics of Liver Transplantation: A 20-Year Cost Modeling Forecast and the Prospect of Bioengineering Autologous Liver Grafts

    Science.gov (United States)

    Habka, Dany; Mann, David; Landes, Ronald; Soto-Gutierrez, Alejandro

    2015-01-01

    During the past 20 years liver transplantation has become the definitive treatment for most severe types of liver failure and hepatocellular carcinoma, in both children and adults. In the U.S., roughly 16,000 individuals are on the liver transplant waiting list. Only 38% of them will receive a transplant due to the organ shortage. This paper explores another option: bioengineering an autologous liver graft. We developed a 20-year model projecting future demand for liver transplants, along with costs based on current technology. We compared these cost projections against projected costs to bioengineer autologous liver grafts. The model was divided into: 1) the epidemiology model forecasting the number of wait-listed patients, operated patients and postoperative patients; and 2) the treatment model forecasting costs (pre-transplant-related costs; transplant (admission)-related costs; and 10-year post-transplant-related costs) during the simulation period. The patient population was categorized using the Model for End-Stage Liver Disease score. The number of patients on the waiting list was projected to increase 23% over 20 years while the weighted average treatment costs in the pre-liver transplantation phase were forecast to increase 83% in Year 20. Projected demand for livers will increase 10% in 10 years and 23% in 20 years. Total costs of liver transplantation are forecast to increase 33% in 10 years and 81% in 20 years. By comparison, the projected cost to bioengineer autologous liver grafts is $9.7M based on current catalog prices for iPS-derived liver cells. The model projects a persistent increase in need and cost of donor livers over the next 20 years that’s constrained by a limited supply of donor livers. The number of patients who die while on the waiting list will reflect this ever-growing disparity. Currently, bioengineering autologous liver grafts is cost prohibitive. However, costs will decline rapidly with the introduction of new manufacturing

  5. Imaging of Kaposi sarcoma in a transplanted liver: A rare case report

    Directory of Open Access Journals (Sweden)

    Saumya Gupta

    2015-06-01

    Full Text Available In post-transplant patients, de novo malignancies such as post-transplant lymphoproliferative disease (PTLD, lung carcinoma, renal cell carcinoma, cutaneous malignancies, and Kaposi sarcoma are now seen. The immunotherapy used to prevent graft failure indirectly increases their risk. We present a rare case of visceral Kaposi sarcoma in a patient with orthotopic liver transplant.

  6. Prevalence and factors associated with dyslipidemia after liver transplantation

    Directory of Open Access Journals (Sweden)

    Hélem de Sena Ribeiro

    2014-07-01

    Full Text Available Objective: to determine the prevalence of abnormal total cholesterol (TC, low density lipoprotein (LDL, high density lipoprotein (HDL and triglycerides in patients undergoing liver transplantation (LTx and to identify predictors of these disorders. Methods: cross-sectional study to assess the prevalence of dyslipidemia in patients undergoing LTx. Demographic, socioeconomic, clinical, anthropometric and dietetic data were collected to determine the association with dyslipidemia using univariate and multivariate statistical analysis. Results: 136 patients were evaluated, 68.1% of which had at least one type of dyslipidemia. The triglyceride level was high in 32.4% of cases, with low HDL in 49.3% of patients and high LDL levels in only 8.8%. High total cholesterol was observed in 16.2% of the study population and was associated with the recommendation for transplantation due to ethanolic cirrhosis (OR = 2.7 and a greater number of hours slept per night (OR = 1.5. Conclusion: many patients presented dyslipidemia after transplantation, demonstrating the need for interventions in relation to modifiable factors associated with dyslipidemias that can mitigate or prevent these disorders.

  7. Seronegative Herpes simplex Associated Esophagogastric Ulcer after Liver Transplantation

    Directory of Open Access Journals (Sweden)

    Edouard Matevossian

    2008-03-01

    Full Text Available Herpes simplex infection is characterized by acute or subacute infection, often followed by a chronic carrier state. Consecutive recurrences may flare up if immunocompromise occurs. Herpes simplex associated esophagitis or duodenal ulcer have been reported in immunocompromised patients due to neoplasm, HIV/AIDS or therapeutically induced immune deficiency. Here we report the case of an HSV-DNA seronegative patient who developed grade III dysphagia 13 days after allogeneic liver transplantation. Endoscopy revealed an esophageal-gastric ulcer, and biopsy histopathology showed a distinct fibroplastic and capillary ulcer pattern highly suspicious for viral infection. Immunohistochemistry staining revealed a distinct nuclear positive anti-HSV reaction. Antiviral therapy with acyclovir and high-dose PPI led to a complete revision of clinical symptoms within 48 h. Repeat control endoscopy after 7 days showed complete healing of the former ulcer site at the gastroesophageal junction. Although the incidence of post-transplantation Herpes simplex induced gastroesophageal disease is low, the viral HSV ulcer may be included into a differential diagnosis if dysphagia occurs after transplantation even if HSV-DNA PCR is negative.

  8. Clinical significance of surveillance culture in liver transplant recipients.

    Science.gov (United States)

    Kim, Y J; Kim, S I; Jun, Y H; Choi, J Y; Yoon, S K; You, Y-K; Kim, D-G

    2014-04-01

    Routine microbiologic surveillance is a method of infection control, but its clinical significance in transplant recipients is not known. We analyzed microbiologic data to evaluate the influence of cultured microorganisms between the point of surveillance and infectious episodes in liver transplant recipients. We performed surveillance culture for sputum and peritoneal fluid in liver transplant recipients from January 2009 to December 2011, at the time of transplantation (T1), 5 days (T2), and 10 days (T3) postoperatively. Of the 179 recipients, 32.9% had a positive sputum culture result and 37.4% had a positive peritoneal culture result during surveillance. In the culture surveillance of sputum, 37 organisms were isolated from 35 recipients at T1, and the most common organism was Staphylococcus aureus (n = 13). At T2, 45 organisms were isolated from 39 recipients, including Klebsiella pneumoniae (n = 10), S aureus (n = 8), and Acinetobacter baumannii (n = 6). At T3, 18 organisms were isolated from 15 patients, including Stenotrophomonas maltophilia (n = 5) and K pneumonia (n = 4). In the peritoneal fluid, 11 organisms were isolated from 10 recipients at T1, including Pseudomonas aeruginosa (n = 2) and Enterococcus species (n = 2). At T2, 39 organisms were isolated from 36 recipients, including coagulase-negative Staphylococcus species (CNS; n = 8) and Enterococcus species (n = 7). At T3, 54 organisms were isolated from 51 recipients, including CNS (n = 17) and Candida species (n = 8). Among the 59 patients with positive culture results for sputum surveillance, 16.9% dev