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Portal vein thrombosis in liver transplantation.

Sat, 02/16/2013 - 13:27

Portal vein thrombosis in liver transplantation.

Arq Bras Cir Dig. 2012 Dec;25(4):273-278

Authors: Pécora RA, Canedo BF, Andraus W, Martino RB, Santos VR, Arantes RM, Pugliese V, D Albuquerque LA

Abstract
BACKGROUND: Portal vein thrombosis was considered a contraindication for liver transplantation in the past because of the high morbidity and mortality rates. Many advances made the results better. AIM: Review the advances and surgical strategies for liver transplantation in presence of portal vein thrombosis. METHOD: Survey of publications in Medline, Scielo and Lilacs databases. Headings crossed: portal vein thrombosis, liver transplantation, vascular complications, jump graft, graft failure, multivisceral transplant. Data analyzed were epidemiology, risk factors, classification, diagnosis, surgical strategies and outcomes. CONCLUSION: Portal vein thrombosis is not a contraindication for liver transplantation anymore. There are many strategies to perform the liver transplantation in this condition, depending on portal vein thrombosis grade. Regardless higher morbidity and re-trhombosis rates, the outcomes of liver transplantation in portal vein thrombosis are similar to series without portal vein thrombosis.

PMID: 23411928 [PubMed - as supplied by publisher]

Endoscopic management of biliary complications after liver transplantation.

Sat, 02/16/2013 - 13:27

Endoscopic management of biliary complications after liver transplantation.

Arq Bras Cir Dig. 2012 Dec;25(4):269-272

Authors: Ribeiro JB, Martins FD, Garcia JH, Cunha AC, Pinto RA, Satacaso MV, Prado-Júnior FP, Pessoa RR

Abstract
BACKGROUND: Liver transplantation is the only effective treatment for chronic liver diseases and terminal survival rate has increased in recent decades. However, biliary complications have high incidence and remain as the "Achilles heel" for liver transplantation. AIM: To evaluate retrospectively endoscopic treatment outcomes of biliary complications in post-liver transplantations. METHODS: The sample consisted of post-liver transplantation patients for endoscopic retrograde cholangiopancreatography due to suspected biliary complications. RESULTS: Fifteen patients were included (10 male, mean age of 49.57 years) and 36 endoscopic retrograde cholangiopancreatographies were undertaken (2.4/patient). Biliary stricture was diagnosed in 13 patients and endoscopic treatment was successful in 56% (38,46% still in treatment). Biliary leaks were found in one patient and dysfunction of the hepatobilliary ampulla with choledocholithiasis was diagnosed in one patient, both cured by endoscopic treatment. CONCLUSIONS: Post-liver transplantation biliary complications are relatively common and endoscopic treatment may result in satisfactory outcome. Stenosis was the more frequent complication in this series.

PMID: 23411927 [PubMed - as supplied by publisher]

Low eosinophil count predicts in-hospital mortality in cirrhosis with systemic inflammatory response syndrome.

Sat, 02/16/2013 - 13:27

Low eosinophil count predicts in-hospital mortality in cirrhosis with systemic inflammatory response syndrome.

Eur J Gastroenterol Hepatol. 2013 Feb 13;

Authors: Kotecha HL, Arora A, Chawlani R, Toshniwal J, Bansal N, Tyagi P, Sharma P, Kumar M, Kumar A

Abstract
BACKGROUND: Absolute eosinophil count (AEC) and procalcitonin (PCT) level may have a prognostic value in critically ill patients. However, their role in cirrhotic patients has never been studied. We evaluated the role of AEC and PCT, obtained at admission, in predicting in-hospital mortality in cirrhotic patients with systemic inflammatory response syndrome (SIRS). PATIENTS AND METHODS: In consecutive cirrhotic patients with SIRS (with or without sepsis), the levels of AEC and PCT were estimated at admission. Their outcome was correlated with these baseline parameters. RESULTS: One hundred patients were enrolled [median age 52 (range 17-78) years, 84% men]. The etiology of cirrhosis was alcohol (47%), cryptogenic (35%), viral (13%), and others (5%). Their median model for end-stage liver disease (MELD) and Child-Turcotte-Pugh scores were 24 (range 6-40) and 11 (range 5-15), respectively. Infection was present in 59 patients and the rest of the 41 patients had SIRS without infection. There was a significant difference between the median levels of AEC and PCT between patients who had infection and those who did not have infection (P<0.01). Sixty-three patients recovered from SIRS and were discharged, 33 patients died, and four patients received orthotopic liver transplantation during the same admission. Baseline AEC and PCT levels were significantly different between patients who recovered and died. On multivariate analysis, baseline AEC values could independently predict in-hospital mortality, in addition to MELD and serum sodium. The area under receiver operating characteristic curve of AEC for predicting mortality was 0.785, and the best cutoff of AEC, obtained by Youden's index, was 104 cells/cumm, indicating that patients with baseline AEC values less than 104 cells/cumm had higher in-hospital mortality (sensitivity 78%, specificity 70%, positive predictive value 60%, negative predictive value 85%, and accuracy 73%). CONCLUSION: In critically ill cirrhotic patients with SIRS, a baseline AEC value of less than 104 cells/cumm accurately predicts in-hospital mortality. The prediction of mortality by AEC is independent of the MELD score and serum sodium.

PMID: 23411865 [PubMed - as supplied by publisher]

Accumulation of Xenotransplanted Canine Bone Marrow Cells in NOD/SCID/γ(c)(null) Mice with Acute Hepatitis Induced by CCl(4).

Sat, 02/16/2013 - 13:27

Accumulation of Xenotransplanted Canine Bone Marrow Cells in NOD/SCID/γ(c)(null) Mice with Acute Hepatitis Induced by CCl(4).

J Vet Med Sci. 2013 Feb 15;

Authors: Kato T, Hisasue M, Segawa K, Fujimoto A, Makiishi E, Neo S, Yasuno K, Kobayashi R, Tsuchiya R

Abstract
Bone marrow cell infusion (BMI) has recently been suggested as an effective therapy for refractory liver disease; however, the efficiency of BMI using canine bone marrow cells (cBMCs) has not been reported. We evaluated the accumulation potential of cBMCs in a mouse model of acute liver failure. Acute hepatitis was induced by carbon tetrachloride (CCl(4)) treatment in NOD/SCID/γ(c)(null) (NOG) mice and wild-type (WT) C57BL mice and the characteristics of liver dysfunction and the degree of hepatic injury and regeneration was compared between the two mouse models. Next, female CCl(4)-treated NOG mice were xenotransplanted with male PKH26-labeled cBMCs and the potential of cBMCs to accumulate in injured liver tissue compartments was examined. Fluorescence microscopy was performed to histologically detect the infused cBMCs and DNA polymerase chain reaction was performed for detection of the male Y chromosome (SRY gene) in the recipient female NOG mice. The number of PKH26-positive cBMCs transplanted in the liver tissue gradually increased in the NOG mice. The infused cBMCs were located in the necrotic area of the liver at an early stage after transplantation, and most had accumulated a week after transplantation. However, the therapeutic efficacy of the xenotransplantation remained unclear because no significant differences were observed an extent of the liver injury and regeneration between the cBMCs transplanted and saline control mice. These results suggest that cBMCs will specifically accumulate in injured liver tissue and that BMC transplant may have the potential to repair liver deficiency.

PMID: 23411484 [PubMed - as supplied by publisher]

Etiology and prognosis of fulminant hepatitis and late-onset hepatic failure in Japan: Summary of the annual nationwide survey between 2004 and 2009.

Sat, 02/16/2013 - 13:27

Etiology and prognosis of fulminant hepatitis and late-onset hepatic failure in Japan: Summary of the annual nationwide survey between 2004 and 2009.

Hepatol Res. 2013 Feb;43(2):97-105

Authors: Oketani M, Ido A, Nakayama N, Takikawa Y, Naiki T, Yamagishi Y, Ichida T, Mochida S, Onishi S, Tsubouchi H, Intractable Hepato-Biliary Diseases Study Group of Japan

Abstract
AIM: To summarize the annual nationwide survey on fulminant hepatitis (FH) and late-onset hepatic failure (LOHF) between 2004 and 2009 in Japan.
METHODS: The annual survey was performed in a two-step questionnaire process to detail the clinical profile and prognosis of patients in special hospitals.
RESULTS: Four hundred and sixty (n = 227 acute type; n = 233 subacute type) patients had FH and 28 patients had LOHF. The mean age of patients with FH and LOHF were 51.1 ± 17.0 and 58.0 ± 14.4 years, respectively. The causes of FH were hepatitis A virus in 3.0%, hepatitis B virus (HBV) in 40.2%, other viruses in 2.0%, autoimmune hepatitis in 8.3%, drug allergy-induced in 14.6% and indeterminate etiology in 29.6% of patients. HBV reactivation due to immunosuppressive therapy was observed in 6.8% of FH patients. The short-term survival rates of patients without liver transplantation (LT) were 48.7% and 24.2% for the acute and subacute type, respectively, and 13.0% for LOHF. The prognosis was poor in patients with HBV reactivation. The implementation rate for LT in FH patients was equivalent to that in the previous survey. The short-term survival rates of total patients, including LT patients, were 54.2% and 40.8% for the acute and subacute type, respectively, and 28.6% for LOHF.
CONCLUSION: The demographic features and etiology of FH patients has gradually changed. HBV reactivation due to immunosuppressive therapy is problematic. Despite advances in therapeutic approaches, the prognosis of patients without LT has not improved.

PMID: 23409848 [PubMed - in process]

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study.

Sat, 02/16/2013 - 13:27

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study.

BMC Nephrol. 2013 Feb 14;14(1):37

Authors: Wenger U, Neff TA, Oberkofler CE, Zimmermann M, Stehberger PA, Scherrer M, Schuepbach RA, Cottini SR, Steiger P, Béchir M

Abstract
ABSTRACT: BACKGROUND: Renal failure with following continuous renal replacement therapy is a major clinical problem in liver transplant recipients, with reported incidences of 3% to 20%. Little is known about the significance of postoperative acute renal failure or acute-on-chronic renal failure to postoperative outcome in liver transplant recipients. METHODS: In this post hoc analysis we compared the mortality rates of 135 consecutive liver transplant recipients over 6 years in our center subject to their renal baseline conditions and postoperative RRT. We classified the patients into 4 groups, according to their preoperative calculated Cockcroft formula and the incidence of postoperative renal replacement therapy. Data then were analyzed in regard to mortality rates and in addition to pre- and peritransplant risk factors. RESULTS: There was a significant difference in ICU mortality (p=.008), hospital mortality (p=.002) and cumulative survival (p<.0001) between the groups. The highest mortality rate occurred in the group with RRT and normal baseline kidney function (20% ICU mortality, 26.6% hospital mortality and 50% cumulative 1-year mortality, respectively). The hazard ratio in this group was 9.6 (CI 3.2-28.6, p=.0001). CONCLUSION: This study shows that in liver transplant recipient's acute renal failure with postoperative RRT is associated with mortality and the mortality rate is higher than in patients with acute-on-chronic renal failure and postoperative renal replacement therapy.

PMID: 23409777 [PubMed - as supplied by publisher]

Repeated versus single transplantation of mesenchymal stem cells in carbon tetrachloride-induced liver injury in mice.

Fri, 02/15/2013 - 13:15

Repeated versus single transplantation of mesenchymal stem cells in carbon tetrachloride-induced liver injury in mice.

Cell Biol Int. 2013 Jan 17;

Authors: Miryounesi M, Piryaei A, Pournasr B, Aghdami N, Baharvand H

Abstract
Despite its numerous limitations, liver transplants are the only definite cure for end-stage liver disease. Various stem cell populations may contribute to liver regeneration, of which there is accumulating evidence of the contribution of mesenchymal stem cells (MSCs). This study examines the hypothesis that repeated infusions of human bone marrow-derived MSCs (hBM-MSCs) can improve liver injury in an experimental model. MSCs were intravenously transplanted into immunosuppressed mice with carbon tetrachloride (CCl(4) )-induced liver fibrosis. Transplanting 3 × 10(6) MSCs in three divided doses improved survival, liver fibrosis and necrosis compared with injection of the same number of MSCs in a single dose. This was accompanied by increased influence on the expression of the fibrogenic/fibrolytic related genes Col1a1, Timp1 and Mmp13 in the repeated transplant group. Repeat administration of MSCs was three times more effective in homing of PKH-tagged transplanted cells 3 weeks post-transplant compared with the single transplant group. The benefits of repeated transplants may be of considerable significance in clinical trials on liver failure.

PMID: 23408711 [PubMed - as supplied by publisher]

The ASC/Caspase-1/IL-1β signaling triggers inflammatory responses by promoting HMGB1 induction in liver ischemia-reperfusion injury.

Fri, 02/15/2013 - 13:15

The ASC/Caspase-1/IL-1β signaling triggers inflammatory responses by promoting HMGB1 induction in liver ischemia-reperfusion injury.

Hepatology. 2013 Feb 13;

Authors: Kamo N, Ke B, Ghaffari AA, Busuttil RW, Cheng G, Kupiec-Weglinski JW

Abstract
Apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC), an adaptor protein for inflammasome receptors, is essential for inducing the caspase-1 activaton and the consequent secretion of IL-1β, which associates with local inflammation during liver ischemia/reperfusion injury (IRI). However, little is known on mechanisms by which ASC/Caspase-1/IL-1β axis exerts its function in hepatic IRI. This study was designed to explore the functional roles and molecular mechanisms of ASC/Caspase-1/IL-1β signaling in the regulation of inflammatory responses in vitro and in vivo. Using a partial lobar liver warm ischemia (90min) model, ASC-deficient and WT mice (C57BL/6) were sacrificed at 6h of reperfusion. Separate animal cohorts were treated with anti-IL-1β Ab or control IgG (10mg/kg, day -1, i.p.). We found that ASC deficiency inhibited Caspase-1/IL-1β signaling, leading to the protection against liver IR-damage, local enhancement of antiapoptotic functions, and downregulation of HMGB1-mediated TLR4-driven inflammation. Interestingly, treatment of ASC-deficient mice with rHMGB1 recreated liver IRI. Moreover, neutralization of IL-1β ameliorated the hepatocellular damage by inhibiting NF-κB/COX2 signaling in lR-stressed livers. In parallel in vitro studies, knockout of ASC in LPS-stimulated bone marrow derived-macrophages depressed HMGB1 activity via p38 MAPK pathway, leading to the inhibition of TLR4/NF-κB, and ultimate depression of proinflammatory cytokine programs. Conclusion: ASC-mediated Caspase-1/IL-1β signaling promotes HMGB1 to produce TLR4-dependent inflammatory phenotype, leading to hepatocellular injury. Hence, the ASC/Caspase-1/IL-1β signaling mediates inflammatory response by triggering HMGB1 induction in hepatic IRI. Our findings provide the rationale for a novel therapeutic strategy to manage liver injury due to IR. (HEPATOLOGY 2013.).

PMID: 23408710 [PubMed - as supplied by publisher]

The effect of telaprevir on the pharmacokinetics of sirolimus in Liver Transplant recipients.

Fri, 02/15/2013 - 13:15

The effect of telaprevir on the pharmacokinetics of sirolimus in Liver Transplant recipients.

Liver Transpl. 2013 Feb 13;

Authors: O'Leary JG, McKenna GJ, Klintmalm GB, Davis GL

PMID: 23408534 [PubMed - as supplied by publisher]

Sorafenib delays recurrence and metastasis after liver transplantation in a rat model of hepatocellular carcinoma with high expression of pERK.

Fri, 02/15/2013 - 13:15

Sorafenib delays recurrence and metastasis after liver transplantation in a rat model of hepatocellular carcinoma with high expression of pERK.

Liver Transpl. 2013 Feb 13;

Authors: Yan J, Tan C, Gu F, Jiang J, Xu M, Huang X, Dai Z, Wang Z, Fan J, Zhou J

Abstract
Liver transplantation is one of the curative treatments for hepatocellular carcinoma (HCC). However, cancer recurrence and metastasis after liver transplantation are common in some HCC patients with high-risk factors, even within the Milan criteria. It remains unclear whether adjuvant therapy with sorafenib inhibits HCC recurrence and metastasis after liver transplantation. Therefore, we performed orthotopic liver transplantation in an ACI rat model of HCC. Because liver transplantation involves immune rejection and tolerance and it is unknown whether sorafenib influences the immune response, we also investigated the effects of sorafenib on immune balance. In this study, we established an allogeneic rat liver transplantation model with a liver graft from Lewis to ACI rats bearing orthotopic HCC and administrated cyclosporine to prevent acute allograft rejection. From day 7 after liver transplantation, sorafenib was administrated at 30 mg/kg/day for 3 weeks. Our results showed that the serum levels of vascular endothelial growth factor and hepatocyte growth factor significantly increased after liver transplantation, and the Th1/Th2 immune balance was shifted toward a Th2 response after immunosuppressant administration. Compared with controls, sorafenib significantly inhibited ERK phosphorylation, improved progression-free survival and overall survival. The tumor proliferation rate and angiogenesis in the post-transplant recurrent tumor tissues decreased, and the tumor apoptosis rate increased in the sorafenib group. There was no significant difference in the Th1/Th2 immune balance between the sorafenib and control groups. In conclusion, adjuvant therapy with sorafenib is highly effective at inhibiting cancer recurrence and metastasis without influencing the immune balance after liver transplantation for HCC with high expression of pERK. This study suggests that sorafenib may have potential particularly as part of a stratified medicine approach to HCC treatment after liver transplantation. © 2013 American Association for the Study of Liver Diseases.

PMID: 23408515 [PubMed - as supplied by publisher]

Increased morbidity in overweight and obese liver transplant recipients: A single centre experience of 1325 patients from the United Kingdom.

Fri, 02/15/2013 - 13:15

Increased morbidity in overweight and obese liver transplant recipients: A single centre experience of 1325 patients from the United Kingdom.

Liver Transpl. 2013 Feb 13;

Authors: Hakeem AR, Cockbain AJ, Raza SS, Pollard SG, Toogood GJ, Attia MA, Ahmad N, Hidalgo EL, Prasad KR, Menon KV

Abstract
INTRODUCTION: Obesity levels in the UK have risen over the years. Studies from the US and elsewhere have reported variable outcomes in terms of post liver transplant morbidity, mortality and graft survival in obese liver transplant recipients. This study aims to analyse the impact of body mass index (BMI) on outcomes following adult liver transplantation. METHODS: Data was retrieved from a prospectively maintained database from 1994-2009. Patients were stratified into 5 WHO BMI categories: underweight (<18.5 kg/m(2) ), normal weight (18.5-24.9 kg/m(2) ), overweight (25.0-29.9 kg/m(2) ), obese (30.0-34.9 kg/m(2) ) and morbidly obese (≥35.0 kg/m(2) ). Primary outcome was to evaluate graft and patient survival and secondary outcome was to assess post-operative morbidity. Bonferroni correction applied with statistical significance set at p<0.012. Kaplan-Meier curves were used to study the effect of BMI on graft and patient survival. RESULTS: A total of 1325 patients were included in the study - underweight (47, 3.5%), normal weight (643, 48.5%), overweight (417, 31.5%), obese (145, 11.0%) and morbidly obese (73, 5.5%). Post-operative infective complications were significantly higher in overweight (60.6%, p=0.001) and obese (65.5%, p=0.001) in comparison to normal weight (50.4%) recipients. Morbidly obese had longer intensive care stay than normal weight (mean 4.7 vs. 3.2 days, p=0.030). Mean hospital stay was longer in overweight (22.4 days, p<0.001), obese (21.3 days, p=0.039) and morbidly obese (22.4 days, p=0.047) recipients in comparison to normal weight (18.0 days). There was no difference in death-censored graft survival and patient survival between the groups. CONCLUSIONS: This is the largest and the only reported UK series on BMI and outcome following liver transplantation. Overweight and obese patients have significantly increased morbidity in terms of infective complications following liver transplantation, with consequent longer intensive care and hospital stay. © 2013 American Association for the Study of Liver Diseases.

PMID: 23408499 [PubMed - as supplied by publisher]

Management of dysplasia in IBD after liver transplantation.

Fri, 02/15/2013 - 13:15

Management of dysplasia in IBD after liver transplantation.

Liver Transpl. 2013 Feb 13;

Authors: Yarze JC

PMID: 23408473 [PubMed - as supplied by publisher]

Assessment of hepatic steatosis by transplant surgeon and expert pathologist a prospective, double-blind evaluation of 201 donor livers.

Fri, 02/15/2013 - 13:15

Assessment of hepatic steatosis by transplant surgeon and expert pathologist a prospective, double-blind evaluation of 201 donor livers.

Liver Transpl. 2013 Feb 13;

Authors: Yersiz H, Lee C, Kaldas FM, Hong JC, Rana A, Schnickel GT, Wertheim JA, Zarrinpar A, Agopian VG, Gornbein J, Naini BV, Lassman CR, Busuttil RW, Petrowsky H

Abstract
Accurate clinical assessment of hepatic steatosis before transplantation is critical for successful outcomes after liver transplantation especially if a pathologist is not available at time of procurement. The present prospective study investigated the surgeon's accuracy in predicting hepatic steatosis and organ quality in 201 adult donor livers. Steatosis assessment by a blinded expert pathologist served as the reference "gold standard". The surgeon's steatosis estimate was more strongly correlated with large droplet macrovesicular (ld-MaS) (r(S) =0.504) rather than small droplet macrovesicular stetaosis (sd-MaS) (r(S) =0.398). True microvesicular steatosis was present in only 2 donors (1%). Liver texture criteria (yellowness, absence of scratch marks, round edges) were mainly associated with ld-MaS (variance 0.62) and less with sd-MaS (variance 0.26). Prediction for ld-MaS?30% vs. <30% was excellent when liver texture criteria were used (accuracy 86%) but was less accurate for the surgeon's direct estimation of steatosis percentage (accuracy 75%). The surgeon's quality grading correlated with the degree of ld-MaS and surgeon's steatosis estimate as well as with the incidence of initial poor and primary non-function. In conclusion, the precise estimation of steatosis remains challenging even in experienced hands. Liver texture characteristics were more helpful in identifying macrosteatotic organs than the actual steatosis perception of the surgeon. These findings are especially important when the histological assessment in the donor hospital is not available. © 2013 American Association for the Study of Liver Diseases.

PMID: 23408461 [PubMed - as supplied by publisher]

Hemodynamic response to propranolol in patients with recurrent HCV-related cirrhosis after liver transplantation: A case-control study.

Fri, 02/15/2013 - 13:15

Hemodynamic response to propranolol in patients with recurrent HCV-related cirrhosis after liver transplantation: A case-control study.

Liver Transpl. 2013 Feb 13;

Authors: Schepis F, Vukotic R, Berzigotti A, Carrión JA, Forns X, G Abraldes J, García-Valdecasas JC, Navasa M, García-Pagán JC, Bosch J

Abstract
BACKGROUND/AIMS: Cirrhosis recurrence is frequent after orthotopic liver transplantation (OLT) for hepatitis C (HCV). Since transplantation causes liver denervation, we hypothesized that the response to propranolol might differ in transplanted than in non-transplanted patients with cirrhosis and portal hypertension. METHODS: Twenty-one patients with cirrhosis recurrence after OLT with portal hypertension were compared to 20 HCV portal hypertensive non-transplanted patients with cirrhosis, matched for sex, age, presence of varices and Child-Pugh score. Patients underwent systemic and hepatic hemodynamic measurements at baseline and 20 minutes after i.v. propranolol (0.15 mg/Kg). RESULTS: At baseline, transplanted cirrhotics had lower HVPG (14.8 ± 2.9 vs.17.3 ± 4.4 mmHg, p=0.035) but higher mean arterial pressure (100.3 ± 12.3 vs. 91.8 ± 11.6 mmHg, p=0.044) and systemic vascular resistance (2253 ± 573 vs. 1883 ± 525 dyn.sec.cm-5, p=0.028) than non-transplanted cirrhotics. There were no differences in cardiac index. Propranolol significantly decreased HVPG, to a similar extent in transplanted and non-transplanted cirrhotics (-14.1 ± 8.0% vs -16.9 ± 9.5%, NS). MAP tended to increase in transplanted cirrhotics while it slightly decreased in non-transplanted (+5.1 ± 14.2% vs -4.8 ± 6.4%, p=0.007), whereas reduction of cardiac index was less marked in transplanted cirrhotics (-18.6 ± 7.6% vs -26.9 ± 9.0%, p=0.005). CONCLUSIONS: Patients with HCV-related cirrhosis and portal hypertension after OLT have lower baseline HVPG but similar HVPG response to propranolol infusion as compared to non-transplanted cirrhotics. Contrary to non-transplanted patients, propranolol increased systemic vascular resistance and arterial pressure in transplanted cirrhotics and attenuated the fall in cardiac index. © 2013 American Association for the Study of Liver Diseases.

PMID: 23408436 [PubMed - as supplied by publisher]

Distinct MicroRNA profiles are associated with severity of HCV recurrence and acute cellular rejection after liver transplant.

Fri, 02/15/2013 - 13:15

Distinct MicroRNA profiles are associated with severity of HCV recurrence and acute cellular rejection after liver transplant.

Liver Transpl. 2013 Feb 13;

Authors: Joshi D, Salehi S, Brereton H, Arno M, Quaglia A, Heaton N, O'Grady J, Agarwal K, Aluvihare V

Abstract
Recurrent hepatitis C virus infection (rHCV) is associated with accelerated fibrosis rates post liver transplantation (LT) and is the leading cause for graft failure. Furthermore, distinguishing rHCV from acute cellular rejection (ACR) can be problematic, leading to inappropriate treatment and adverse outcomes. We hypothesized that intra-graft microRNA (miRNA) expression profiles can distinguish severity of rHCV, and differentiate rHCV from ACR. We established meticulously matched post-LT patient cohorts In order to derive robust global miRNA expression profiles and minimise the impact of variables known to influence HCV recurrence. These cohorts consisted of patients with slow HCV fibrosis progression (F<2 Ishak), fast HCV fibrosis progression (F≥2 Ishak), ACR and non-viral aetiologies. We demonstrate increased intra-graft expression of miRNA-146a, -19a, - 20a and let-7e in slow-progressors compared to fast-progressors and validate these findings using qPCR. This miRNA network regulates expression of cardinal genes implicated in promoting anti-fibrogenic, anti-angiogenic and anti-inflammatory pathways. miRNA -19a and -20a were also specifically detected in the serum of slow-progressors. Furthermore, intra-graft miRNA expression distinguishes fast HCV progression from ACR. Here, changes in expression of key miRNA regulating fibrogenic and angiogenic pathways were associated with fast HCV progression. We demonstrate specific miRNA expression signatures that discriminate rate of fibrosis progression in rHCV, and distinguish rHCV from ACR post-LT. Pathway analysis indicates that specific miRNA may play a regulatory role in these processes. Selected miRNA may serve as intra-graft and serum biomarkers for rHCV post-LT and help distinguish between ACR and rHCV. Liver Transpl, 2013. © 2013 AASLD.

PMID: 23408392 [PubMed - as supplied by publisher]

Thrombolysis of Portal Vein Thrombosis After Splenectomy Post Liver Transplant.

Fri, 02/15/2013 - 13:15

Thrombolysis of Portal Vein Thrombosis After Splenectomy Post Liver Transplant.

Liver Transpl. 2013 Feb 13;

Authors: Kim DY, Brown L, Abou Abbass A, Nagai S, Patil V, Abouljoud M, Getzen T, Yoshida A, Kazimi M

PMID: 23408382 [PubMed - as supplied by publisher]

Early biochemical response to ursodeoxycholic acid and long-term prognosis of primary biliary cirrhosis: Results of a 14-year cohort study.

Fri, 02/15/2013 - 13:15

Early biochemical response to ursodeoxycholic acid and long-term prognosis of primary biliary cirrhosis: Results of a 14-year cohort study.

Hepatology. 2013 Feb 13;

Authors: Zhang LN, Shi TY, Shi XH, Wang L, Yang YJ, Liu B, Gao LX, Shuai ZW, Kong F, Chen H, Han W, Han SM, Fei YY, Cui QC, Wang Q, Shen M, Xu D, Zheng WJ, Li YZ, Zhang W, Zhang X, Zhang FC

Abstract
The biochemical response to ursodeoxycholic acid (UDCA) in primary biliary cirrhosis (PBC) is a strong predictor of long-term outcome and thus facilitates the rapid identification of patients needing new therapeutic approaches. Numerous criteria for predicting outcome of treatment have been studied based on biochemical response to UDCA at 1 year. We sought to determine whether an earlier biochemical response at 3 or 6 months could as efficiently identify patients at risk of poor outcome, as defined by liver-related death, liver transplantation, and complications of cirrhosis. We analyzed the prospectively collected data of 187 patients with a median follow-up of 5.8 years (range: 1.3-14 years). The survival rates without adverse outcome at 5 years and 10 years were 86% and 63%. Under UDCA therapy, laboratory liver parameters experienced a most prominent improvement in the first 3 months (P < 0.0001) and then stayed relatively stable for the following months. The Paris, Barcelona, Toronto, and Ehime, but not the Rotterdam definition applied at 3, 6, and 12 months significantly discriminated the patients in terms of long-term outcome. Compared to biochemical responses evaluated after 1 year of UDCA therapy, biochemical responses at the third month demonstrated higher positive predictive value (PPV) but lower negative predictive value (NPV) and increased negative likelihood ratio (NLR) by all definitions; biochemical responses at the sixth month showed higher or the same PPV and NPV and lower NLR by all definitions.Conclusion: For the previously published criteria, biochemical responses at the sixth month can be used in place of those evaluated after 1 year of UDCA therapy. Our findings justify a more rapid identification of patients who need new therapeutic approaches. (HEPATOLOGY 2013.).

PMID: 23408380 [PubMed - as supplied by publisher]

Effects of red blood cell storage in heavily transfused patients.

Fri, 02/15/2013 - 13:15

Effects of red blood cell storage in heavily transfused patients.

Curr Opin Anaesthesiol. 2013 Feb 13;

Authors: van de Watering LM

Abstract
PURPOSE OF REVIEW: Most publications on Red Blood Cell (RBC) storage time are performed in patient groups receiving on average 1-4 RBC transfusions. Here we look at the observational results in the more heavily transfused patient populations studied, which are mostly in trauma or cardiac surgery patients. RECENT FINDINGS: New heavily transfused patient groups in which the possible detrimental effects of prolonged RBC storage were studied are HSCT and liver transplant patients. In these studies no associations of prolonged RBC storage with outcome were seen. Apart from these studies, new studies were also reported on ICU patients and cardiac surgery patients. These latter studies reported associations with infections, postoperative length of stay, and renal complications. In these studies similar shortcomings in study design and analysis were encountered as in earlier studies, leading to overestimation of the studied association. Some of the recent studies suggest, contrary to the most encountered opinion, that fresh RBC might be detrimental on some outcomes. Similar observations have recently been presented in other, less heavily transfused populations. SUMMARY: Clinical effects of RBC storage turn out to be determined by far more aspects than storage time alone.

PMID: 23407152 [PubMed - as supplied by publisher]

[Renal transplantation with kidneys procured from cardiac deceased post-liver transplantation donor: 2 cases report and literature review].

Fri, 02/15/2013 - 13:15

[Renal transplantation with kidneys procured from cardiac deceased post-liver transplantation donor: 2 cases report and literature review].

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2013 Jan;38(1):90-4

Authors: Peng F, Zhang L, Peng L, Xie X, Lan G, Wang Y, Yu S, Tang X, Tan L, Fang C, Nie M, Yang J, Zhao X

Abstract
Objective: To better understand the pre-operation evaluation of donor kidneys from extended criteria donation after cardiac death and to improve the management during and after renal transplantation. Methods: Both of the donor kidneys were from the donor who underwent liver transplantation 5 years ago in the Center of Organ Transplantation of Central South University. The donor was admitted because of liver function deterioration which led to hepatic coma, brain death, hepatorenal syndrome and cardiac death sequentially. Deceased donor score (DDS) and "zero point" kidney biopsy were applied to evaluate the donor kidney. After thorough examination of the donor and the renal function, renal transplantation was performed on 2 recipients. Results: The recipients were followed up by 6 months, both of whom developed pulmonary infection and relieved after treatments. The kidney grafts functioned well and no surgical complication and no acute rejection occurred during the follow-up. Conclusion: Proper evaluation of the donor organs ensures the safety of renal transplantation with kidneys from cardiac death donors who underwent liver transplantation, which is an important way to increase the number of organs for transplantation, yet the long-term effects need further observation.

PMID: 23406862 [PubMed - in process]

MELD-XI score and cardiac mortality or transplantation in patients after Fontan surgery.

Fri, 02/15/2013 - 13:15

MELD-XI score and cardiac mortality or transplantation in patients after Fontan surgery.

Heart. 2013 Feb 13;

Authors: Assenza GE, Graham DA, Landzberg MJ, Valente AM, Singh MN, Bashir A, Fernandes S, Mortele KJ, Ukomadu C, Volpe M, Wu F

Abstract
OBJECTIVE: The Fontan operation is a staged palliation for complex congenital heart disease and single ventricle physiology. Perioperative survivors of the Fontan operation experience long-term cardiac complications, including death. Liver and renal dysfunction are reported in these patients and have a direct effect on morbidity and mortality. This study aims to investigate whether the Model for End-stage Liver Disease eXcluding INR score (function of creatinine and total bilirubin, MELD-XI) predicts risk for cardiac mortality or transplantation in patients with Fontan circulation. DESIGN AND SETTING: Retrospective, single-centre study. Time of first evaluation was the time of the earliest available MELD-XI score measurement, and follow-up was terminated by a cardiac event or by the last clinical evaluation. PATIENTS: Patients surviving after Fontan surgery and evaluated at Boston Children's Hospital between 1993 and 2008. MAIN OUTCOME MEASURE: Composite endpoint of sudden death, death from congestive heart failure or cardiac transplantation. RESULTS: The MELD-XI score was calculated as MELD-XI=11.76(log(e) creatinine)+5.112(log(e) total bilirubin)+9.44. Ninety-six patients were included (52 male, median age 26 years). After a mean follow-up period of 5.7 years, 18 patients (19%) experienced the composite end point. Baseline MELD-XI score was independently and directly related to the incidence of the composite endpoint (HR for high MELD-XI score group of 7.76, 95% CI 2.05 to 29.33, p=0.008). CONCLUSIONS: Fontan patients with a higher MELD-XI score have shorter freedom from sudden cardiac death, death from congestive heart failure and cardiac transplantation.

PMID: 23406689 [PubMed - as supplied by publisher]

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