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Isolated tuberculosis of transplanted liver, a case report and review of the literature.

Tue, 08/06/2013 - 10:02

Isolated tuberculosis of transplanted liver, a case report and review of the literature.

Hepat Mon. 2013 May;13(5):e6691

Authors: Geramizadeh B, Nikeghbalian S, Janghorban P, Malekhosseini SA

Abstract
INTRODUCTION: Recipients of liver transplantation are prone to different types of infections such as tuberculosis (TB).
CASE PRESENTATION: Herein we report a 59-year-old man with liver transplantation due to HBV cirrhosis who developed isolated hepatic TB, 18 months after OLT (orthotropic liver transplantation). He has been successfully treated with anti-TB regimen and now after 12 months he is completely symptom-free.
CONCLUSIONS: Organ transplantation and treatment of transplanted patients with immunosuppressive drugs would prone them to various unusual infections. One of these is unusual primary involvement of liver by tuberculosis which has been extremely rare in the previous reports.

PMID: 23914226 [PubMed]

Differential migration of passenger leukocytes and rapid deletion of naïve alloreactive CD8 T cells after mouse liver transplantation.

Tue, 08/06/2013 - 10:02

Differential migration of passenger leukocytes and rapid deletion of naïve alloreactive CD8 T cells after mouse liver transplantation.

Liver Transpl. 2013 Aug 2;

Authors: Tay SS, Lu B, Sierro F, Benseler V, McGuffog CM, Bishop GA, Cowan PJ, McCaughan GW, Dwyer KM, Bowen DG, Bertolino P

Abstract
Donor passenger leukocytes (PL) from transplanted livers migrate to recipient lymphoid tissues, where they are thought to induce deletion of donor-specific T cells and tolerance. Difficulties in tracking alloreactive T cells and PL in rats and in performing this complex surgery in mice have limited progress in identifying the contribution of PL subsets and sites and kinetics of T cell deletion. Here, we developed a mouse liver transplant model in which PL, recipient cells and a reporter population of transgenic CD8 T cells specific for the graft could be easily distinguished and quantified in allografts and recipient organs by flow cytometry. All PL subsets circulated rapidly via the blood as soon as 1.5 hours post-transplantation. By 24h, PL distributed differently in lymph nodes and spleen while donor NK and NKT cells remained in the liver. Reporter T cells were activated in both liver and lymphoid tissues, but their numbers dramatically decreased within the first 48h. These results provide the first unequivocal demonstration of differential recirculation of liver PL subsets post-transplantation, and show that alloreactive CD8 T cells are deleted more rapidly than initially reported. This model will be useful for dissecting early events leading to spontaneous acceptance of liver transplants. Liver Transpl , 2013. © 2013 AASLD.

PMID: 23913831 [PubMed - as supplied by publisher]

Operational tolerance in liver transplantation: Shall we predict or promote?

Tue, 08/06/2013 - 10:02

Operational tolerance in liver transplantation: Shall we predict or promote?

Liver Transpl. 2013 Aug 2;

Authors: McCaughan G, Bowen D, Bertolino P

PMID: 23913809 [PubMed - as supplied by publisher]

The changing donor characteristics in liver transplantation over the last 10 years in Canada.

Tue, 08/06/2013 - 10:02

The changing donor characteristics in liver transplantation over the last 10 years in Canada.

Liver Transpl. 2013 Aug 2;

Authors: Sela N, Croome KP, Chandok N, Marotta P, Wall W, Hernandez-Alejandro R

Abstract
Background: Liver organ donor characteristics have a significant impact on graft quality and in turn recipient outcome. In this study, we examined deceased liver donor characteristics and Donor Risk Index (DRI) trends in Canada over the past decade. Methods: Data were extracted from the Canadian Organ Replacement Register (CORR) and Quebec Transplant for the decade (2000-2010). Trends in the DRI and donor characteristics were examined including: age, race, height, cause of death (COD), location, cold ischemia time (CIT), and type of donation. Results: 3745 transplants using deceased liver donors were analyzed. Donor age, proportion of black donors, proportion of cerebrovascular accident as a COD, and proportion of donation after cardiac death (DCD) donors all increased over the aforementioned time period. The proportion of transplants classified geographically as local increased and the CIT for donor livers decreased. Although many of the parameters that adversely affect DRI increased over the study period, the DRI only showed a small significant trend in increasing value. The increase in these parameters has been counteracted by a decrease in modifiable risk factors such as CIT and distance traveled. Recipient 5-year survival rates increased from 71.43% (1999-2001) to 75.5% (2005-2007), however this trend was not significant. Although there was an increase in the utilization of older and DCD donor organs, recipient survival was not compromised. Conclusions: Liver donor demographic trends in Canada suggest an increase in utilization of higher risk donors. However, overall graft quality is not compromised due to a decreasing trend in CIT and increase in local transplants. Better coordination and allocation practices in liver transplantation across Canada minimize the risk for graft failure and results in good recipient outcomes. Liver Transpl , 2013. © 2013 AASLD.

PMID: 23913790 [PubMed - as supplied by publisher]

Generation of general and tissue-specific gene knockout mouse models.

Tue, 08/06/2013 - 10:02

Generation of general and tissue-specific gene knockout mouse models.

Methods Mol Biol. 2013;1027:253-71

Authors: Jiang XC

Abstract
Knockout technology has established the functions of many genes affecting plasma lipid and lipoprotein levels and the development of atherosclerosis. However, many genes remain to be characterized. The ability to produce mice lacking whole-body expression of a given gene is still one of the most powerful techniques available for determining gene function. A complementary approach, underutilized yet vitally important to understanding lipoprotein metabolism, is the ability to create mice with gene deficiency only in a specific tissue. Liver, intestine, and macrophages are the major tissues and cells involved in lipoprotein metabolism and atherosclerosis, and additional tissues such as adipose tissue and brain are also of interest. Thus, feasible approaches to prepare general and tissue-specific gene knockout mouse models are necessary. Here, we describe our general procedure for generating whole-body knockout mice, using as an example the preparation of general (whole-body) phospholipid transfer protein (PLTP) gene knockout mice. We also describe several approaches to generating liver, intestine, and myeloid cell-specific tissue-specific knockout mice, using as an example the preparation of tissue-specific knockout mice for the subunit 2 of serine palmitoyltransferase (SPT), a key enzyme for sphingomyelin de novo synthesis. Bone marrow transplantation is an alternative means of creating myeloid cell-specific knockout mice. The general principles and techniques described here apply to the establishment of other gene knockout mouse models as well. The ability to manipulate gene expression in specific tissues as well as throughout the entire body of the mouse is anticipated to yield novel insights into lipid and lipoprotein metabolism and the development of atherosclerosis.

PMID: 23912991 [PubMed - in process]

Posttransplant Sarcopenia: An Underrecognized Early Consequence of Liver Transplantation.

Tue, 08/06/2013 - 10:02

Posttransplant Sarcopenia: An Underrecognized Early Consequence of Liver Transplantation.

Dig Dis Sci. 2013 Aug 4;

Authors: Dasarathy S

Abstract
Liver transplantation is believed to reverse the clinical and metabolic abnormalities of cirrhosis. Reduced skeletal muscle mass or sarcopenia contributes to increased mortality and adverse consequences of cirrhosis. Failure of reversal of sarcopenia of cirrhosis after liver transplantation is not well recognized. Six temporally, geographically, and methodologically distinct follow-up studies in 304 cirrhotics reported conflicting data on changes in indirect measures of skeletal muscle mass after transplantation. Distinct measures of body composition but not skeletal muscle mass were used and did not focus on the clinical consequences of sarcopenia after transplantation. A number of studies reported an initial rapid postoperative loss of lean mass followed by incomplete recovery with a maximum follow-up of 2 years. Posttransplant sarcopenia may be responsible for metabolic syndrome and impaired quality of life after liver transplantation. Potential reasons for failure to reverse sarcopenia after liver transplantation include use of immunosuppressive agents [mammalian target of rapamycin (mTOR) and calcineurin inhibitors] that impair skeletal muscle growth and protein accretion. Repeated hospitalizations, posttransplant infections, and renal failure also contribute to posttransplant sarcopenia. Finally, recovery from muscle deconditioning is limited by lack of systematic nutritional and physical-activity-based interventions to improve muscle mass. Despite the compelling data on sarcopenia before liver transplantation, the impact of posttransplant sarcopenia on clinical outcomes is not known. There is a compelling need for studies to examine the mechanisms and consequences of sarcopenia post liver transplantation to permit development of therapies to prevent and reverse this disorder.

PMID: 23912247 [PubMed - as supplied by publisher]

Immunogenicity of inactivated seasonal influenza vaccine in adult and pediatric liver transplant recipients over two seasons.

Tue, 08/06/2013 - 10:02

Immunogenicity of inactivated seasonal influenza vaccine in adult and pediatric liver transplant recipients over two seasons.

Microbiol Immunol. 2013 Aug 1;

Authors: Suzuki M, Torii Y, Kawada JI, Kimura H, Kamei H, Onishi Y, Kaneko K, Ando H, Kiuchi T, Ito Y

Abstract
Immunological responses to influenza vaccination to patients after liver transplantation are not fully elucidated. To compare immunogenicity between adult and pediatric recipients, 16 adult and 15 pediatric living donor liver transplantation recipients in the 2010-11 influenza season, and 53 adult and 21 pediatric recipients in the 2011-12 season with inactivated influenza vaccines were investigated. Seroprotection rates (hemagglutinin-inhibition [HI] antibody titer 1:40) were 50-94% to all three antigens among adults and 27-80% among children through the two seasons. Seroconversion rates (4-fold or more HI antibody rise) were 32-56% among adults and 13-67% among children through the two seasons. No significant differences were observed between the two groups. Next, 20 of 53 adult and 13 of 21 pediatric recipients received a vaccine including identical antigens over the two seasons. Geometric mean titer fold increases of all three antigens in adult recipients were significantly lower compared with recipients without the preceding vaccination. In contrast, in pediatric recipients, no remarkable differences were found between the group with and without the preceding vaccination. The number of patients with rejection did not differ significantly between the two groups (0/53 vs. 1/21) in the 2011-12 season. The incidence of influenza after vaccination was significantly different between adult and pediatric recipients, respectively (0/16 vs. 5/15 in 2010-11, 0/53 vs. 3/21 in 2011-12). Overall, there were no significant differences in antibody responses between adult and pediatric groups. Influenza infection was more frequent in pediatric recipients. Long-term response to the preceding vaccination appeared to be insufficient in both groups.

PMID: 23909408 [PubMed - as supplied by publisher]

[Reactivation of chronic hepatitis B].

Tue, 08/06/2013 - 10:02

[Reactivation of chronic hepatitis B].

Vnitr Lek. 2013 Jul;59(7):591-6

Authors: Sperl J

Abstract
Hepatitis B (HBV) is a DNA virus, which cannot be eradicated completely from the organism by treatment, only its replication can be suppressed to low levels. The pathogenesis of liver damage due to HBV is immune mediated, the infected hepatocytes represent the target structures of immune reaction. In individuals who spontaneously achieved the state of inactive carriage of the virus or even achieved HBsAg negativity, we deal only with immune control of viral replication. Chemotherapy or immunosuppressive treatment disrupt the immune control of HBV infection, the virus replication substantially increases and hepatitis B reactivates. HBV reactivation manifests as further flareup of chronic inflammation with rapid progression of liver cirrhosis or even as a fulminant hepatitis with liver failure. The risk of reactivation increases with degree of induced immunosuppression, the highest risk is associated with corticosteroid and rituximab therapy. HBV reactivation threatens patients during solid tumours treatment as well as haemato oncological malignancies, patients treated with immunosuppressive and bio-logical therapies for systemic inflammatory diseases and inflammatory bowel diseases, as well as patients on maintenance haemodialysis, after kidney transplantation and patients with HBV/ HIV co infection. HBV reactivation increases both morbidity and mortality in listed groups of patients. The patients threatened by HBV reactivation can be identified easily based on HBV serological markers assessment. Preemptive therapy with nucleos(t)ide analogues significantly reduces the risk of HBV reactivation, the effect of longterm antiviral therapy is described in detail in kidney transplant recipients in whom the 3rd generation antivirals (entecavir and tenofovir) completely obviate the negative impact of HBV on longterm survival. In oncological patients who are treated for a determined time period, we can use lamivudine, which is not suitable for longterm treatment due to high risk of resistance emergence. Key words: hepatitis B -  reactivation -  screening -  preemptive therapy.

PMID: 23909265 [PubMed - in process]

[Wilsons disease].

Tue, 08/06/2013 - 10:02

[Wilsons disease].

Vnitr Lek. 2013 Jul;59(7):578-83

Authors: Mareček Z, Brůha R

Abstract
Wilsons disease is an autosomal recessive genetic disorder in which copper accumulates in tissues, especially in the liver and the brain. The genetic defect affects the P type ATPase gene (ATP7B). More than 500 mutations causing Wilsons disease have been described. The most common mutation in Central Europe concerns H1069Q. The symptoms of Wilsons disease include hepatic or neurological conditions. The hepatic condition is manifested as steatosis, acute or chronic hepatitis or cirrhosis. The neurological conditions are most often manifested after the age of 20 as motor disorders (tremor, speech and writing disorders), which may result in severe extrapyramidal syndrome with rigidity, dysarthria and muscle contractions. The dia-gnosis is based on clinical and laboratory assessments (neurological signs, liver lesions, low ceruloplasmin, increased free serum copper, high Cu volumes in urine, KayserFleischer ring). The dia-gnosis is confirmed by a high Cu level in liver tissue or genetic proof. Untreated Wilsons disease causes death of the patient. If treated properly the survival rate approximates to the survival rate of the common population. The treatment concerns either removal of copper from the body using chelating agents excreted into the urine (Penicillamine, Trientine) or limitation of copper absorption from the intestine and reducing the toxicity of copper (zinc, ammonium tetrathiomolybdate). In the Czech Republic, Penicillamine or zinc is used. A liver transplant is indicated in patients with fulminant hepatic failure or decompensated liver cirrhosis. In the family all siblings of the affected individual need to be screened in order to treat any asymptomatic subjects. Key words: Wilsons disease -  treatment -  Dpenicillamine -  zinc.

PMID: 23909262 [PubMed - in process]

Hepatitis C virus-associated cholestatic hepatitis: we cannot seem to agree on diagnostic criteria.

Tue, 08/06/2013 - 10:02
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Hepatitis C virus-associated cholestatic hepatitis: we cannot seem to agree on diagnostic criteria.

Liver Transpl. 2013 Feb;19(2):115-7

Authors: Berenguer M, McCaughan G

PMID: 23197377 [PubMed - indexed for MEDLINE]

Deceased organ donor research: the last research frontier?

Tue, 08/06/2013 - 10:02
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Deceased organ donor research: the last research frontier?

Liver Transpl. 2013 Feb;19(2):118-21

Authors: Mone T, Heldens J, Niemann CU

PMID: 23193057 [PubMed - indexed for MEDLINE]

Small-for-size syndrome and transjugular intrahepatic portosystemic shunt.

Tue, 08/06/2013 - 10:02
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Small-for-size syndrome and transjugular intrahepatic portosystemic shunt.

Liver Transpl. 2013 Feb;19(2):238

Authors: Tamura S, Sugawara Y, Kokudo N

PMID: 23172793 [PubMed - indexed for MEDLINE]

Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS.

Tue, 08/06/2013 - 10:02
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Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS.

Ultraschall Med. 2013 Feb;34(1):11-29

Authors: Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolsøe CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, Chaubal NG, Chen MH, Clevert DA, Correas JM, Ding H, Forsberg F, Fowlkes JB, Gibson RN, Goldberg BB, Lassau N, Leen EL, Mattrey RF, Moriyasu F, Solbiati L, Weskott HP, Xu HX

Abstract
Initially, a set of guidelines for the use of ultrasound contrast agents was published in 2004 dealing only with liver applications. A second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some non-liver applications. Time has moved on, and the need for international guidelines on the use of CEUS in the liver has become apparent. The present document describes the third iteration of recommendations for the hepatic use of contrast enhanced ultrasound (CEUS) using contrast specific imaging techniques. This joint WFUMB-EFSUMB initiative has implicated experts from major leading ultrasound societies worldwide. These liver CEUS guidelines are simultaneously published in the official journals of both organizing federations (i.e., Ultrasound in Medicine and Biology for WFUMB and Ultraschall in der Medizin/European Journal of Ultrasound for EFSUMB). These guidelines and recommendations provide general advice on the use of all currently clinically available ultrasound contrast agents (UCA). They are intended to create standard protocols for the use and administration of UCA in liver applications on an international basis and improve the management of patients worldwide.

PMID: 23129518 [PubMed - indexed for MEDLINE]

Microvesicles derived from human bone marrow mesenchymal stem cells inhibit tumor growth.

Tue, 08/06/2013 - 10:02
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Microvesicles derived from human bone marrow mesenchymal stem cells inhibit tumor growth.

Stem Cells Dev. 2013 Mar 1;22(5):758-71

Authors: Bruno S, Collino F, Deregibus MC, Grange C, Tetta C, Camussi G

Abstract
Mesenchymal stem cells (MSCs) have opposite effects on tumor growth, being able either to favor angiogenesis and tumor initiation or to inhibit progression of established tumors. Factors produced by MSCs within the tumor microenvironment may be relevant for their biological effects. Recent studies demonstrated that microvesicles (MVs) are an integral component of inter-cellular communication within the tumor microenvironment. In the present study, we evaluated whether MVs derived from human bone marrow MSCs may stimulate or inhibit in vitro and in vivo growth of HepG2 hepatoma, Kaposi's sarcoma, and Skov-3 ovarian tumor cell lines. We found that MVs inhibited cell cycle progression in all cell lines and induced apoptosis in HepG2 and Kaposi's cells and necrosis in Skov-3. The observed activation of negative regulators of cell cycle may explain these biological effects. In vivo intra-tumor administration of MVs in established tumors generated by subcutaneous injection of these cell lines in SCID mice significantly inhibited tumor growth. In conclusion, MVs from human MSCs inhibited in vitro cell growth and survival of different tumor cell lines and in vivo progression of established tumors.

PMID: 23034046 [PubMed - indexed for MEDLINE]

Scheie syndrome: enzyme replacement therapy does not prevent progression of cervical myelopathy due to spinal cord compression.

Tue, 08/06/2013 - 10:02
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Scheie syndrome: enzyme replacement therapy does not prevent progression of cervical myelopathy due to spinal cord compression.

J Inherit Metab Dis. 2009 Dec;32 Suppl 1:S321-5

Authors: Illsinger S, Lücke T, Hartmann H, Mengel E, Müller-Forell W, Donnerstag F, Das AM

Abstract
Hurler-Scheie syndrome is caused by alpha-l-iduronidase deficiency. Enzyme replacement therapy (ERT) can improve physical capacity and reduces organomegaly. However, the effect on bradytrophic connective tissue is limited. As intravenously administered enzyme cannot cross the blood-brain barrier, the therapy of choice for the more severe Hurler syndrome is haematopoietic stem cell transplantation (HCT). In the more attenuated Scheie syndrome, neurological impairment is less severe; therefore, ERT may be appropriate to treat these patients. Information on long-term outcome in Scheie patients undergoing ERT is scarce. We report a 38-year-old female Scheie patient who has been on ERT for 8 years. While non-neurological symptoms improved, she developed paresthesias in her hands and feet and progressive pain in her legs. Somatosensory evoked potentials were abnormal, suggesting dysfunction of the dorsal funiculus and lemniscus medialis. After 6 years of ERT, a spinal MRI showed dural thickening at the upper cervical spine. These soft-tissue deposits are presumably due to the accumulation of mucopolysaccharides. Intramedullary hyperintensities at the level of C1/2 revealed cervical myelopathy. An MRI before the start of ERT had shown milder spinal lesions. Cystic lesions in the white matter of the centrum semiovale due to dilated Virchow-Robin spaces were essentially unchanged compared with the MRI scan before ERT. Decompression of the spinal cord resulted in clinical improvement. In an adult patient with Scheie syndrome, ERT failed to prevent progression of cervical myelopathy. Clinical significance of cerebral changes is unclear. Whether early HCT or intrathecal ERT could have prevented these lesions remains speculative.

PMID: 19894140 [PubMed - indexed for MEDLINE]

Recurrence of hepato pulmonary syndrome post orthoptic liver transplantation in a patient with non cirrhotic portal hypertension.

Sat, 08/03/2013 - 10:09

Recurrence of hepato pulmonary syndrome post orthoptic liver transplantation in a patient with non cirrhotic portal hypertension.

Hepatology. 2013 Jul 31;

Authors: Casey DS, Schelleman A, Angus P

PMID: 23908097 [PubMed - as supplied by publisher]

Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma. A multicenter case-control study.

Sat, 08/03/2013 - 10:09

Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma. A multicenter case-control study.

Hepatology. 2013 Jul 31;

Authors: Ripoll C, Genescà J, Araujo IK, Graupera I, Augustin S, Tejedor M, Cirera I, Aracil C, Sala M, Hernandez-Guerra M, Llop E, Escorsell A, Catalina MV, Cañete N, Albillos A, Villanueva C, Abraldes JG, Bañares R, Bosch J

Abstract
Outcome of variceal bleeding (VB) in patients with hepatocellular carcinoma (HCC) is unknown. We compared outcomes after VB in patients with and without HCC. All patients with HCC and esophageal VB admitted between 2007-2010 were included. Follow up was prolonged until death, transplantation or 06.2011. For each HCC-patient, a patient without HCC matched by age and Child class was selected. 292 patients were included, 146 HCC (BCLC class 0-3 patients, A-25, B-29, C-45, D-41) and 146 without HCC. No differences were observed regarding prior use of prophylaxis, clinical presentation, endoscopic findings, and initial endoscopic treatment. 5-day failure was similar (25% in HCC vs 18% in non-HCC, p=0.257). HCC patients had greater 6-week rebleeding rate (16 vs 7%, respectively, p=0.025) and 6-week mortality (30% vs 15%, p=0.003). Fewer patients with HCC received secondary prophylaxis after bleeding (77% vs 89%, p=0.009) and standard combination therapy was used less frequently (58% vs 70%, p=0.079). Secondary prophylaxis failure was more frequent (50% vs 31%, p=0.001) and survival significantly shorter in patients with HCC (median survival: 5 months Vs greater than 38 months in patients without HCC; p<0.001). Lack of prophylaxis increased rebleeding and mortality. On multivariate analysis Child score, presence of HCC, portal vein thrombosis and lack of secondary prophylaxis were predictors of death. Conclusions: Patients with HCC and variceal bleeding have worse prognosis than patients with variceal bleeding without HCC. Secondary prophylaxis offers survival benefit in HCC patients. (Hepatology 2013;).

PMID: 23908019 [PubMed - as supplied by publisher]

Treatment of chronic hepatitis C with protease inhibitor-based therapy after liver transplantation.

Sat, 08/03/2013 - 10:09

Treatment of chronic hepatitis C with protease inhibitor-based therapy after liver transplantation.

Hepatology. 2013 Jul 31;

Authors: Reddy KR, Everson GT

PMID: 23908010 [PubMed - as supplied by publisher]

Inferior survival in liver transplant recipients with hepatocellular carcinoma receiving donation after cardiac death liver allografts.

Sat, 08/03/2013 - 10:09

Inferior survival in liver transplant recipients with hepatocellular carcinoma receiving donation after cardiac death liver allografts.

Liver Transpl. 2013 Aug 1;

Authors: Croome KP, Wall W, Chandok N, Beck G, Marotta P, Hernandez-Alejandro R

Abstract
Background: The impact of Ischemia reperfusion Injury (IRI) in the setting of transplantation for Hepatocellular Carcinoma (HCC) has not been thoroughly investigated. Methods: The present study examined data from the Scientific Registry of Transplant Recipients (SRTR) on all deceased donor liver transplant recipients performed from January 1 1995 to October 31 2011. Results: On multivariate Cox analysis significant predictors of graft and patient survival included a diagnosis of HCC (p<0.001), receiving a DCD allograft (p<0.001), HCV+ status (p<0.001), recipient age (p<0.001), donor age (p<0.001), and MELD score (p<0.001) recipient race and an AFP level>400 at the time of transplant.. In order to test if the decreased survival seen in Group 3(HCC DCD) was more than would be expected given the inferior nature of DCD grafts and having a diagnosis of HCC, an interaction term was created between receiving a DCD allograft and a diagnosis of HCC to examine for potentiation of effect. In the multivariate analysis adjusting for all other covariates this interaction term was statistically significant (p=0.049) confirming that there was potentiation of inferior survival with the use of DCD allografts in recipients with HCC. In a subgroup survival analysis on HCC recipients receiving a DCD allograft, recipients with a donor Warm ischemia time (WIT) ≤15min had a trend of better survival than recipients with a WIT>15min. In addition recipients with Cold ischemia time (CIT) <380min (6h 20min) had significantly better survival than recipients with CIT>380min (p<0.036). Conclusion: There is an inferior patient and graft survival in HCC recipients of DCD allografts compared to those receiving DBD allografts. This potentiation of effect of inferior survival remains even after adjustment for the inherent inferiority observed in DCD allografts as well as other known risk factors. It is hypothesized that this difference could reflect an increased rate of recurrence of HCC. Liver Transpl, 2013. © 2013 AASLD.

PMID: 23907778 [PubMed - as supplied by publisher]

Unconventional Extrahepatic Neovascularization After Transplant Hepatic Artery Thrombosis: A Case Report.

Sat, 08/03/2013 - 10:09

Unconventional Extrahepatic Neovascularization After Transplant Hepatic Artery Thrombosis: A Case Report.

Transplant Proc. 2013 Jul 29;

Authors: Casadaban L, Parvinian A, Tzvetanov IG, Jeon H, Oberholzer J, Benedetti E, Bui JT, Gaba RC

Abstract
Liver neovascularization preserves hepatic function and improves survival in the setting of post-transplant hepatic artery thrombosis (HAT). In this report, we have presented a unique case of a neovascularized liver after subclinical HAT in a 46-year-old liver transplant patient in whom a collateral supply was recruited from three unconventional sources: The right colic, right intercostal, and right inferior adrenal arteries. We propose systematic angiographic evaluation of all potential sources of collateral vessel formation for patients with HAT to accurately assess patient risk and determine the need for further intervention or revascularization.

PMID: 23906676 [PubMed - as supplied by publisher]

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