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Human heterologous liver cells transiently improve hyperammonemia and ureagenesis in individuals with severe urea cycle disorders.

Sun, 10/15/2017 - 18:48
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Human heterologous liver cells transiently improve hyperammonemia and ureagenesis in individuals with severe urea cycle disorders.

J Inherit Metab Dis. 2017 Oct 12;:

Authors: Meyburg J, Opladen T, Spiekerkötter U, Schlune A, Schenk JP, Schmidt J, Weitz J, Okun J, Bürger F, Omran TB, Abdoh G, Al Rifai H, Monavari A, Konstantopoulou V, Kölker S, Yudkoff M, Hoffmann GF

Abstract
BACKGROUND: Urea cycle disorders (UCDs) still have a poor prognosis despite several therapeutic advancements. As liver transplantation can provide a cure, liver cell therapy (LCT) might be a new therapeutic option in these patients.
METHODS: Twelve patients with severe UCDs were included in this prospective clinical trial. Patients received up to six infusions of cryopreserved human heterologous liver cells via a surgically placed catheter in the portal vein. Portal vein pressure, portal vein flow, and vital signs were monitored continuously. Calcineurin inhibitors and steroids were used for immunosuppression. In four patients, ureagenesis was determined with stable isotopes. Number and severity of hyperammonemic events and side effects of immunosuppression were analyzed during an observation period of up to 2 years.
RESULTS: No study-related mortality was observed. The application catheter dislocated in two children. No significant side effects of catheter application or cell infusion were noted in the other ten patients. The overall incidence of infections did not differ significantly from a historical control group, and no specific side effects of immunosuppression were found. Seven patients were treated per protocol and could be analyzed for efficacy. Severe metabolic crises could be prevented in all of these patients, moderate crises in four of seven. Ureagenesis increased after cell infusion in all patients investigated.
CONCLUSIONS: We found a favorable safety profile with respect to catheter placement, intraportal liver cell infusion, and immunosuppression. More than half of the children treated per protocol experienced metabolic stabilization and could be safely bridged to liver transplantation.

PMID: 29027067 [PubMed - as supplied by publisher]

The Clinical Implications of Liver Resection Margin Size in Patients with Hepatocellular Carcinoma in Terms of Positron Emission Tomography Positivity.

Sun, 10/15/2017 - 18:48
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The Clinical Implications of Liver Resection Margin Size in Patients with Hepatocellular Carcinoma in Terms of Positron Emission Tomography Positivity.

World J Surg. 2017 Oct 12;:

Authors: Park JH, Kim DH, Kim SH, Kim MY, Baik SK, Hong IS

Abstract
BACKGROUND: The positivity of positron emission tomography (PET) in hepatocellular carcinoma (HCC) correlates with aggressive tumor factors and poor survival. Adequate resection margin size is still a topic of debate. We analyzed the clinical implications of resection margin size in patients with HCC in terms of PET positivity.
METHODS: We retrospectively reviewed the medical records of 92 patients who underwent liver resection from March 2012 to October 2015. We investigated prognostic factors for recurrence and survival. We analyzed the correlation of resection margin size and PET positivity. Resection margins were classified as less than 1 cm and more than 1 cm.
RESULTS: Twenty six (31.3%) patients had PET-positive HCC. Multivariate analysis showed PET, satellite nodules, microvessel invasion, and multicentric occurrence were significant prognostic factors for HCC recurrence. Multivariate analysis also showed satellite nodules and microscopic portal vein invasion were significant prognostic factors for overall survival (OS). Resection margin size did not affect disease-free survival (DFS) (p = 0.681) or OS (p = 0.301) in patients with PET-negative HCC, but showed a difference in DFS [<1 cm at 11 months vs. ≥1 cm at 41 months (p = 0.188)] and OS [<1 cm at 28 months vs. ≥1 cm at 48 months (p < 0.001)] in patients with PET-positive HCC.
CONCLUSIONS: PET has low sensitivity for HCC. However, it is useful to predict treatment outcomes after liver resection or liver transplantation for HCC. Although the extent of liver resection must be decided based on liver function, a resection margin size >1 cm may improve DFS and OS in patients with PET-positive HCC.

PMID: 29026966 [PubMed - as supplied by publisher]

The prognostic value of (18)F-FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases.

Sun, 10/15/2017 - 18:48
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The prognostic value of (18)F-FDG PET/CT prior to liver transplantation for nonresectable colorectal liver metastases.

Eur J Nucl Med Mol Imaging. 2017 Oct 12;:

Authors: Grut H, Dueland S, Line PD, Revheim ME

Abstract
PURPOSE: The main objective of this study was to evaluate the prognostic value of volumetric and metabolic information derivied from F-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) in combination with computed tomography (CT) prior to liver transplantation (LT) in patients with nonresectable colorectal liver metastases (CLM). Due to scarcity of liver grafts, prognostic information enabling selection of candidates who will gain the highest survival after LT is of vital importance. (18)F-FDG PET/CT was a part of the preoperative study protocol. Patients without evidence of extrahepatic malignant disease on (18)F-FDG PET/CT who also fulfilled all the other inclusion criteria underwent LT.
METHODS: The preoperative (18)F-FDG PET/CT examinations of all patients included in the SECA (secondary cancer) study were retrospectively assessed. Maximum, mean and peak standardized uptake values (SUVmax, SUVmean and SUVpeak), tumor to background (T/B) ratio, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured and calculated for all liver metastases. Total MTV and TLG were calculated for each patient. Cut-off values were determined for each of these parameters by using receiver operating characteristic (ROC) analysis dividing the patients into two groups. One, three and five-year overall survival (OS) and disease free survival (DFS) for patients over and under the cut-off value were compared by using the Kaplan-Meier method and log rank test.
RESULTS: Twenty-three patients underwent LT in the SECA study. Total MTV and TLG under the cut-off values were significantly correlated to improved OS at three and five years (p = 0.027 and 0.026) and DFS (p = 0.01). One, three and five-year OS and DFS were not significantly related to SUVmax, SUVmean, SUVpeak or T/B-ratio.
CONCLUSION: Total MTV and TLG from (18)F FDG PET/CT prior to LT for nonresectable CLM were significantly correlated to improved three and five-year OS and DFS and can potentially improve the patient selection for LT.

PMID: 29026950 [PubMed - as supplied by publisher]

Dietary iron loading negatively affects liver mitochondrial function.

Sun, 10/15/2017 - 18:48
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Dietary iron loading negatively affects liver mitochondrial function.

Metallomics. 2017 Oct 13;:

Authors: Volani C, Doerrier C, Demetz E, Haschka D, Paglia G, Lavdas AA, Gnaiger E, Weiss G

Abstract
Iron is an essential co-factor for several metabolic processes, including mitochondrial respiration, and mitochondria are the major sites of iron-utilization. Cellular iron homeostasis must be tightly regulated, as intracellular iron deficiency can lead to insufficient energy production, whereas iron overload triggers ROS (reactive oxygen species) formation via the Fenton reaction. So far little is known on how iron imbalances affect mitochondrial function in vivo and the impact of the genotype on that, we studied the effects of dietary iron loading on mitochondrial respiratory capacity in liver by comparing two genetically divergent mouse strains, namely C57BL/6N and FVB mice. Both mouse strains differed in their basal iron levels and their metabolic responses to iron loading as determined by expression of iron trafficking proteins (ferritin was increased in livers of animals receiving high iron diet) as well as tissue iron content (2-fold increase, FVB p = 0.0013; C57BL/6N p = 0.0022). Dietary iron exposure caused a significant impairment of mitochondrial oxidative phosphorylation, especially regarding OXPHOS capacity (FVB p = 0.0006; C57BL/6N p = 0.0087) and S-ETS capacity (FVB p = 0.0281; C57BL/6N p = 0.0159). These effects were more pronounced in C57BL/6N than in FVB mice and were paralleled by an iron mediated induction of oxidative stress in mitochondria. The increased susceptibility of C57BL6/N mice to iron loading may be due to reduced expression of anti-oxidant defense mechanisms and altered iron trafficking upon dietary challenge pointing to a role of genetic modifiers for cellular and mitochondrial iron trafficking. Finally, iron-mediated induction of mitochondrial oxidative stress and reduction of oxidative phosphorylation may underlie fatigue in subjects with iron loading diseases.

PMID: 29026901 [PubMed - as supplied by publisher]

Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients.

Sun, 10/15/2017 - 18:48
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Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients.

Transplant Direct. 2017 Oct;3(10):e213

Authors: Echeverri J, Goldaracena N, Singh AK, Sapisochin G, Selzner N, Cattral MS, Greig PD, Lilly L, McGilvray ID, Levy GA, Ghanekar A, Renner EL, Grant DR, McCluskey SA, Selzner M

Abstract
BACKGROUND: We evaluated patient characteristics of live donor liver transplant (LDLT) recipients undergoing a fast-track protocol without intensive care unit (ICU) admission versus LDLT patients receiving posttransplant ICU care.
METHODS: Of the 153 LDLT recipients, 46 patients were included in our fast-track protocol without ICU admission. Both, fast-tracked patients and ICU-admitted patients were compared regarding donor and patient characteristics, perioperative characteristics, and postoperative outcomes and complications. In a subgroup analysis, we compared fast-tracked patients with patients who were admitted in the ICU for less than 24 hours.
RESULTS: Fast-tracked versus ICU patients had a lower model for end-stage liver disease score (13 ± 4 vs 18 ± 7; P < 0.0001), lower preoperative bilirubin levels (51 ± 50 μmol/L vs 119.4 ± 137.3 μmol/L; P < 0.001), required fewer units of packed red blood cells (1.7 ± 1.78 vs 4.4 ± 4; P < 0.0001), and less fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 5; P < 0.0001) during transplantation. Regarding postoperative outcomes, fast-tracked patients presented fewer bacterial infections within 30 days (6.5% [3] vs 29% [28]; P = 0.002), no episodes of pneumonia (0% vs 11.3% [11]; P = 0.02), and less biliary complications within the first year (6% [3] vs 26% [25]; P = 0.001). Also, fast-tracked patients had a shorter posttransplant hospital stay (10.8 ± 5 vs 21.3 ± 29; P = 0.002). In the subgroup analysis, fast-tracked vs ICU patients admitted for less than 24 hours had lower requirements of packed red blood cells (1.7 ± 1.78 vs 3.9 ± 4; P = 0.001) and fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 4.5; P = 0.0001).
CONCLUSIONS: Fast-track of selected patients after LDLT is safe and feasible. An objective score to perioperatively select LDLT recipients amenable to fast track is yet to be determined.

PMID: 29026876 [PubMed]

Ethylene Glycol Poisoning Should Not Contraindicate Liver Donation.

Sun, 10/15/2017 - 18:48
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Ethylene Glycol Poisoning Should Not Contraindicate Liver Donation.

Transplant Direct. 2017 Oct;3(10):e212

Authors: Burman A, Watson CJE, Kosmoliaptsis V

Abstract
As the number of patients waiting to receive transplants increases, there is a need to explore all possible donation opportunities. In this case report, we describe the transplantation of a liver from a donor who died after ethylene glycol poisoning into a woman with alcoholic liver disease with cirrhosis and associated ascites. Donor management, including ethanol, fomepizol and haemodialysis, hastened clearance of ethylene glycol from the circulation, and after liver transplantation, the recipient exhibited no adverse effects suggestive of ethylene glycol toxicity, although recipient hepatic artery dissection and thrombosis necessitated retransplantation. Our experience suggests that donor death due to ethylene glycol intoxication should not contraindicate liver transplantation, particularly after appropriate donor management.

PMID: 29026875 [PubMed]

Cytomegalovirus Infection under a Hybrid Strategy in Pediatric Liver Transplantation: A Single-Center Experience.

Sun, 10/15/2017 - 18:48
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Cytomegalovirus Infection under a Hybrid Strategy in Pediatric Liver Transplantation: A Single-Center Experience.

Pediatr Gastroenterol Hepatol Nutr. 2017 Sep;20(3):178-185

Authors: Kim R, Joung D, Lee S, Jeong I, Oh SH, Namgoong JM, Kim DY, Kim KM

Abstract
PURPOSE: To evaluate the outcomes of a hybrid prophylactic strategy to prevent cytomegalovirus (CMV) disease in pediatric liver transplantation (LT) patients.
METHODS: CMV DNAemia was regularly monitored by quantitative nucleic acid amplification test (QNAT) and was quantified in all children. CMV infection and disease were defined according to the International Consensus Guidelines. The hybrid strategy against CMV infection consisted of universal 3-week prophylaxis and preemptive treatment of intravenous ganciclovir regardless of the recipient's serostatus.
RESULTS: A total of 143 children who underwent living donor LT were managed using the hybrid strategy. The overall incidence of CMV infection by QNAT was 48.3% (n=69/143). The highest CMV DNAemia positivity was observed in 49.2% (n=60/122) of children in the D+/R+ group, followed by 46.7% (n=7/15) in the D+/R- group. CMV disease was noted in 26.1% (n=18/69) patients. Forty-three (62.3%) children had undergone preemptive therapy consisting of intravenous ganciclovir. No symptomatic patients developed tissue-invasive disease, resulting in no CMV-associated mortality.
CONCLUSION: The incidence of CMV infection was high in pediatric LT patients despite the hybrid strategy. However, tissue-invasive disease in pediatric LT did not occur.

PMID: 29026734 [PubMed]

Endoscopic approach for management of biliary strictures in liver transplant recipients: A systematic review and meta-analysis.

Sun, 10/15/2017 - 18:48
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Endoscopic approach for management of biliary strictures in liver transplant recipients: A systematic review and meta-analysis.

United European Gastroenterol J. 2017 Oct;5(6):827-845

Authors: Aparício DPDS, Otoch JP, Montero EFS, Khan MA, Artifon ELA

Abstract
The most common biliary complication after liver transplantation is anastomotic stricture (AS) and it can occur isolated or in combination with other complications. Liver graft from a cadaveric donor or a living donor has an influence on the incidence of biliary strictures as well as on the response to endoscopic treatment. Endoscopic treatment using balloon dilation and insertion of biliary stents by endoscopic retrograde cholangiopancreatography (ERCP) is the initial approach to these complications.
AIM: The aim of this article is to compare different endoscopic techniques to treat post-liver transplantation biliary strictures.
METHODS: The search was carried out on MEDLINE, EMBASE, Scielo-LILACS and Cochrane Library databases through June 2015. A total of 1100 articles were retrieved. Ten clinical trials were analyzed, and seven were included in the meta-analysis.
CONCLUSIONS: The endoscopic treatment of AS was equally effective when compared the use of fully covered self-expandable metal stents (FCSEMS) vs. plastic stents, but the use of FCSEMS was associated with a lower complication risk. The treatment of AS with balloon dilation or balloon dilation associated with plastic stents presented similar results. Deceased donor liver transplantation reduced the risk of biliary stenosis and the endoscopic treatment in these patients was more effective when compared with Living donor liver transplantation.

PMID: 29026597 [PubMed]

T-cell allorecognition of donor glutathione S-transferase T1 in plasma cell-rich rejection.

Sun, 10/15/2017 - 18:48
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T-cell allorecognition of donor glutathione S-transferase T1 in plasma cell-rich rejection.

World J Hepatol. 2017 Sep 28;9(27):1115-1124

Authors: Martínez-Bravo MJ, Sánchez B, Sousa JM, Acevedo MJ, Gómez-Bravo MA, Núñez-Roldán A, Aguilera I

Abstract
AIM: To investigate the role of glutathione S-transferase T1 donor-specific T lymphocytes in plasma cell-rich rejection of liver allografts.
METHODS: The study group included 22 liver transplant patients. Among them, 18 patients were mismatched for the glutathione S-transferase T1 (GSTT1) alleles (don+/rec-), and 4 were matched (don+/rec+). Seven of the mismatched patients produced anti-GSTT1 antibodies and developed plasma cell-rich rejection (former de novo immune hepatitis). For the detection of specific T lymphocytes, peripheral blood mononuclear cells were collected and stored in liquid nitrogen. The memory T cell response was studied by adding to the cell cultures to a mix of 39 custom-made, 15-mer overlapping peptides, which covered the entire GSTT1 amino acid sequence. The specific cellular response to peptides was analyzed by flow cytometry using the markers CD8, CD4, IL-4 and IFNγ.
RESULTS: Activation of CD8(+) T cells with different peptides was observed exclusively in the group of patients with plasma-cell rich rejection (3 out of 7), with production of IL-4 and/or IFNγ at a rate of 1%-4.92% depending on the peptides. The CD4(+) response was most common and not exclusive for patients with the disease, where 5 out of 7 showed percentages of activated cells from 1.24% to 31.34%. Additionally, two patients without the disease but with the mismatch had cells that became stimulated with some peptides (1.45%-5.18%). Highly unexpected was the finding of a double positive CD4(+)CD8(low) T cell population that showed the highest degree of activation with some of the peptides in 7 patients with the mismatch, in 4 patients with plasma cell-rich rejection and in 3 patients without the disease. Unfortunately, CD4(+)CD8(low) cells represent 1% of the total number of lymphocytes, and stimulation could not be analyzed in 9 patients due to the low number of gated cells. Cells from the 4 patients included as controls did not show activation with any of the peptides.
CONCLUSION: Patients with GSTT1 mismatch can develop a specific T-cell response, but the potential role of this response in the pathogenesis of plasma cell-rich rejection is unknown.

PMID: 29026463 [PubMed]

The Effect of Recipient Body Mass Index and Its Extremes on Survival and Graft Vascular and Biliary Complications After Liver Transplantation: A Single Center Retrospective Study.

Sun, 10/15/2017 - 18:48
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The Effect of Recipient Body Mass Index and Its Extremes on Survival and Graft Vascular and Biliary Complications After Liver Transplantation: A Single Center Retrospective Study.

Ann Transplant. 2017 Oct 13;22:611-621

Authors: Giorgakis E, Tedeschi M, Bonaccorsi-Riani E, Khorsandi SE, Menon K, Vilca-Melendez H, Jassem W, Srinivasan P, Prachalias A, Heaton N

Abstract
BACKGROUND This is the largest UK-based study on the effect of recipient body mass index (BMI) and its extremes (BMI <18.5 and BMI ≥35 kg/m²) on liver transplant (LT) outcomes. Its purpose was to analyze the BMI effect on post-LT mortality, graft loss, primary non-function (PNF), and graft vascular and biliary complications. MATERIAL AND METHODS Data were retrieved from a single-center LT database of 2,115 consecutive patients receiving first LT during period February 2004 to September 2015. Survivals were compared across the BMI groups; the effects of recipient BMI on survival, PNF, and graft vascular and biliary complications were analyzed via regression. RESULTS Autoimmune disease and nonalcoholic steatohepatitis were prevalent among underweight and morbidly obese adults, respectively. Graft survival was similar across BMI classes at 30 days and in 1, 2, 5, and 10 years (p=0.75) and on obese versus non-obese (p=0.33). BMI <35 kg/m² versus BMI ≥35 kg/m² mean graft survival was similar (p=0.84). BMI <18.5 kg/m² recipients tended to have inferior mean graft and patient survivals; however, the difference was non-significant (p=0.09 and p=0.1 respectively). BMI <18.5 kg/m² recipients were at higher risk of hepatic artery thrombosis (HR, 1.73, 95% CI 1.73-3, p<0.05). Adult underweight status was an independent HAT risk factor (HR 3, 95% CI 1-8.6, p=0.046). BMI class did not affect ischemic cholangiopathy risk (p=0.84). However, the overall biliary complication risk increased by 3% for every 1 kg/m² BMI rise. CONCLUSIONS Post-LT survival is independent of recipient BMI. Underweight status is linked to higher HAT risk. Biliary complication risk increases with rising recipient BMI. After appropriate recipient selection, recipient BMI extremes are not a contraindication for LT.

PMID: 29026064 [PubMed - in process]

Cryptococcus neoformans osteomyelitis and intramuscular abscess in a liver transplant patient.

Sun, 10/15/2017 - 18:48
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Cryptococcus neoformans osteomyelitis and intramuscular abscess in a liver transplant patient.

BMJ Case Rep. 2017 Oct 11;2017:

Authors: Poenaru SM, Rofaiel R, Hosseini-Moghaddam SM

Abstract
Cryptococcus neoformans is an important pathogen that can cause severe illness and mortality in immunocompromised patients. We highlight here the case of a 53-year-old man presenting to hospital 4 years postliver transplant with fever, acute renal failure and a medial thigh lesion. Initially treated as bacterial sepsis, the patient failed to improve on broad-spectrum antibiotics. Further investigations revealed disseminated cryptococcemia complicated by patellar osteomyelitis and an intramuscular abscess. Unfortunately, although the patient initially showed signs of clinical improvement after starting standard antifungal agents, he deteriorated and died secondary to acute renal failure. Osteomyelitis is a rare manifestation of cryptococcal infection for which there is often a significant delay to diagnosis and treatment. This is the fourth reported case of cryptococcal osteomyelitis in a liver transplant patient and underlines the importance of considering fungal infections in the differential diagnosis of osseous lesions in solid organ transplant and other immunocompromised patients.

PMID: 29025780 [PubMed - in process]

The Impact of Preoperative Variables on Intraoperative Blood Loss and Transfusion Requirements During Orthotopic Liver Transplant.

Sun, 10/15/2017 - 18:48
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The Impact of Preoperative Variables on Intraoperative Blood Loss and Transfusion Requirements During Orthotopic Liver Transplant.

Exp Clin Transplant. 2017 Oct 12;:

Authors: Eghbal MH, Samadi K, Khosravi MB, Sahmeddini MA, Ghaffaripoor S, Ghorbani M, Shokrizadeh S

Abstract
OBJECTIVES: Liver transplant traditionally and potentially is associated with the risk of massive blood loss and transfusion, which can adversely affect transplant outcomes. Many variables influence the amount of bleeding, and these can be categorized as patient related, surgery related, and graft related. We aimed to assess the effects of these variables on the amount of bleeding and transfusion during liver transplant; predicting the risk of massive blood loss can help transplant teams to select and manage patients more effectively.
MATERIALS AND METHODS: We retrospectively studied 754 patients who underwent liver transplant from 2013 to 2016 and analyzed more than 20 variables that could influence the volume of blood loss and packed cell transfusion.
RESULTS: We found that at least 4 variables are strongly and independently correlated with blood loss volume: age, Model for End-Stage Liver Disease score, warm ischemia time, and total bilirubin. Furthermore, intraoperative blood loss had a weak but clinically important correlation with the underlying disease (ie, the cause of liver cirrhosis). Some variables, including international normalized ratio, platelet count, albumin, serum urea nitrogen, creatinine level, sodium level, and the amount of ascites, could be considered as 'dependent' and weak predictors of massive blood loss. Sex of patient, cold ischemia time, surgery technique, and history of previous abdominal surgery were not correlated with the amount of bleeding.
CONCLUSIONS: With the use of the variables identified, we can properly select patients and surgical teams and promptly use modalities for decreasing and managing blood loss.

PMID: 29025385 [PubMed - as supplied by publisher]

Repair of Bile Duct Injury With Autologous Vein Graft and Stent.

Sun, 10/15/2017 - 18:48
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Repair of Bile Duct Injury With Autologous Vein Graft and Stent.

Exp Clin Transplant. 2017 Oct 12;:

Authors: Xie B, Luo H, Yang X, Zhao Y, He C, Wan X, Xu Z, Yu X, Liu W, Liu Q

Abstract
OBJECTIVES: We investigated the effects of autologous vein transplant on bile duct injury repair, through observation of the hepatic and biliary system tissue morphology changes and animal survival after bile duct injury repair.
MATERIALS AND METHODS: Rabbits were equally divided into groups. Group A had cholecystectomy and common bile duct resection (length of 0.5 cm), transplant of an autologous vein (length of 0.5 cm), and stent implant. Group B had cholecystectomy and common bile duct resection (length of 1.0 cm), transplant of an autologous vein (length of 1.0 cm), and stent implant. The third group (group C) had cholecystectomy only.
RESULTS: Two rabbits died in group A and group B; all experimental animals from group C survived. Regarding liver biochemical indexes at preoperative week 1, at postoperative month 1, and at postoperative month 3, we found no significant differences (paired t test, P > .05). Liver biochemical indexes between groups were also not significantly different (P > .05). At month 3, postoperative liver pathology of experimental animals showed no significant changes and no cholestasis; biliary epithelial cells were seen in the transplant vascular.
CONCLUSIONS: We conclude that autologous vein graft can effectively repair bile duct injury for a short coloboma.

PMID: 29025383 [PubMed - as supplied by publisher]

Biliary Complications in Recipients of Living-Donor Liver Transplant: A Single-Center Review of 120 Patients.

Sun, 10/15/2017 - 18:48
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Biliary Complications in Recipients of Living-Donor Liver Transplant: A Single-Center Review of 120 Patients.

Exp Clin Transplant. 2017 Oct 12;:

Authors: Sarhan MD, Osman AMA, Mohamed MA, Abdelaziz O, Serour DK, Mansour DA, Mogawer S, Helmy AS, El-Shazli MA, Hosny AA

Abstract
OBJECTIVES: Biliary complications are common after living-donor liver transplant. This retrospective study reviewed our experience with biliary complications in recipients of living-donor liver transplant.
MATERIALS AND METHODS: Over our 9-year study period, 120 patients underwent living-donor liver transplant. Patients were divided into 2 groups, with group A having biliary complications and group B without biliary complications. Both groups were compared, and different treatment modalities for biliary complications were evaluated.
RESULTS: Group A included 45 patients (37.5%), whereas group B included 75 patients (62.5%). Biliary complications included bile leak in 17 patients (14.2%), biliary stricture in 11 patients (9.2%), combined biliary stricture with bile leak in 15 patients (12.5%), and sphincter of Oddi dysfunction and cholangitis in 1 patient each (0.8%). Cold ischemia time was significantly longer in group A (P = .002). External biliary drainage was less frequently used in group A (P = .031). Technical success rates of endoscopic biliary drainage and percutaneous transhepatic biliary drainage were 68.3% and 41.7%. Survival rate following relaparotomy for biliary complications was 62.5%.
CONCLUSIONS: Graft ischemia is an important risk factor for biliary complications. Bile leaks can predispose to anastomotic strictures. The use of external biliary drainage seems to reduce the incidence of biliary complications. Endoscopic and percutaneous trans-hepatic approaches can successfully treat more than two-thirds of biliary complications. Relaparotomy can improve survival outcomes and is usually reserved for patients with intractable biliary complications.

PMID: 29025382 [PubMed - as supplied by publisher]

Early Tracheostomy Reduces Time of Mechanical Ventilation in Respiratory High-Risk Patients After Liver Transplant.

Sun, 10/15/2017 - 18:48
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Early Tracheostomy Reduces Time of Mechanical Ventilation in Respiratory High-Risk Patients After Liver Transplant.

Exp Clin Transplant. 2017 Oct 12;:

Authors: Cammann S, Timrott K, Vondran FWR, Schrem H, Lehner F, Klempnauer J, Knitsch W, Kleine M

Abstract
OBJECTIVES: Weaning from mechanical ventilation after liver transplant can be demanding. In selected cases, tracheostomy is helpful. The optimal timing for tracheostomy in ventilator-dependent liver transplant recipients is not well known.
MATERIALS AND METHODS: We retrospectively analyzed data of 447 patients who had undergone liver transplant in our hospital. Thirty-nine patients who had high risk of prolonged mechanical ventilation according to the Respiratory Risk Score were identified from 95 patients who received tracheostomy after liver transplant.
RESULTS: When compared with tracheostomy performed > 3 days after transplant, early tracheostomy (≤ 3 days) had a higher likelihood of a brief duration of mechanical ventilation (62.5% vs 9.7%; P = .001). Accordingly, time spent in an intensive care unit was shorter with early tracheostomy.
CONCLUSIONS: This study provides a retrospective analysis of a small study cohort; therefore, validation of our findings requires a prospective randomized multicenter study on early tracheostomy in respiratory high-risk liver transplant recipients.

PMID: 29025380 [PubMed - as supplied by publisher]

Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO) in Liver Transplantation: A Case Report and Focused Review.

Sun, 10/15/2017 - 18:48
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Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO) in Liver Transplantation: A Case Report and Focused Review.

Semin Cardiothorac Vasc Anesth. 2017 Oct 01;:1089253217736298

Authors: Smith NK, Kim S, Hill B, Goldberg A, DeMaria S, Zerillo J

Abstract
Liver transplantation (LT) is a complex procedure in a patient with multi-organ system dysfunction and coagulation defects. The surgical procedure involves dissection, major vessel manipulation, and pathophysiologic effects of graft storage and reperfusion. As a result, LT frequently involves significant hemorrhage. Subsequent massive transfusion carries high risk of transfusion-associated complications. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion associated mortality. In this case report and focused review, we present data that suggest that patients undergoing liver transplantation may be at higher risk for TRALI and TACO than the general population. Anesthesiologists can play a role in decreasing these risks by increasing recognition and reporting of TRALI and TACO, using point of care testing with thromboelastography to guide and decrease transfusion, and considering alternatives to traditional blood products like solvent/detergent plasma.

PMID: 29025378 [PubMed - as supplied by publisher]

Liver Transplantation in Patients With Cardiac Disease.

Sun, 10/15/2017 - 18:48
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Liver Transplantation in Patients With Cardiac Disease.

Semin Cardiothorac Vasc Anesth. 2017 Oct 01;:1089253217736050

Authors: Wray CL

Abstract
Liver transplantation (LT) is a unique surgical procedure that has major hemodynamic and cardiovascular implications. Recently, there has been significant interest focused on cardiovascular issues that affect LT patients in all phases of the perioperative period. The preoperative cardiac evaluation is a major step in the selection of LT candidates. LT candidates are aging in concordance with the general population; cardiovascular disease and their risk factors are highly associated with older age. Underlying cardiovascular disease has the potential to affect outcomes in LT patients and has a major impact on candidate selection. The prolonged hemodynamic and metabolic instability during LT may contribute to adverse outcomes, especially in patients with underlying cardiovascular disease. Cardiovascular events are not unusual during LT; transplant anesthesiologists must be prepared for these events. Advanced cardiovascular monitoring techniques and treatment modalities are now routinely used during LT. Postoperative cardiovascular complications are common in both the early and late posttransplant periods. The impact of cardiac complications on posttransplant mortality is well recognized. Emerging knowledge regarding cardiovascular disease in LT patients and its impact on posttransplant outcomes will have an important role in guiding the future perioperative management of LT patients.

PMID: 29025297 [PubMed - as supplied by publisher]

Combined Liver-kidney Perfusion Enhances Protective Effects of Normothermic Perfusion on Livers Grafts from Donation after Cardiac Death.

Fri, 10/13/2017 - 12:45

Combined Liver-kidney Perfusion Enhances Protective Effects of Normothermic Perfusion on Livers Grafts from Donation after Cardiac Death.

Liver Transpl. 2017 Oct 10;:

Authors: He X, Ji F, Zhang Z, Tang Y, Yang L, Huang S, Li W, Su Q, Xiong W, Zhu Z, Wang L, Lv L, Yao J, Zhang L, Zhang L, Guo Z

Abstract
It has been showed that combined liver-kidney normothermic machine perfusion (NMP) is able to better maintain the circuit's biochemical milieu. Nevertheless, whether the combined perfusion is superior to liver perfusion alone in protecting livers from donation after cardiac death (DCD) is unclear. We aimed to test the hypothesis and explored the mechanisms. Livers from 15 DCD pig donors were subjected to either static cold storage group (Group A), liver alone NMP group (Group B), or combined liver-kidney NMP group (Group C). Livers were preserved for six hours and re-perfused ex vivo for two hours to simulate transplantation, or transplanted in situ. During perfusion, Group C showed improved acid-base and biochemical environment in the circuit over Group B. After re-perfusion, the architecture of liver grafts was best preserved in group C, followed by Group B, then Group A, as shown by the histology and TUNEL staining of both hepatocytes and biliary epithelium. Ki-67 staining showed substantial hepatocyte proliferation and biliary epithelial regeneration after perfusion in Group B and Group C. Group C produced more bile in reperfusion phase than those in Group A and Group B, with more physiological bile composition and less severe biliary epithelium injury. vWF positive endothelial cells and E-selectin expression decreased in both Group B and Group C. Combined liver-kidney NMP not only produced more ATP, protected the NO signaling pathway, but also diminished oxidative stress (HMGB1 and 8-OHdG levels) and inflammatory cytokine (IL-6 and IL-8) release when compared to liver alone NMP and CS. In addition, the 7-day survival rate of liver transplant recipient was higher in Group C than those in Group A and B.
CONCLUSION: Combined liver-kidney NMP perfusion can better protect DCD livers from warm ischemia and reperfusion injury probably by maintaining the stability of internal environment and abolishing oxidative stress injury. This article is protected by copyright. All rights reserved.

PMID: 29024427 [PubMed - as supplied by publisher]

"DAA in patients with Hepatocellular carcinoma before Liver Transplantation: are we sure is still an open issue?"

Fri, 10/13/2017 - 12:45

"DAA in patients with Hepatocellular carcinoma before Liver Transplantation: are we sure is still an open issue?"

Liver Transpl. 2017 Oct 11;:

Authors: Shalaby S, Zanetto A, Vitale A, Gambato M, Cillo U, Farinati F, Burra P, Russo FP

PMID: 29024423 [PubMed - as supplied by publisher]

Risk of post-transplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation.

Fri, 10/13/2017 - 12:45

Risk of post-transplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation.

Liver Transpl. 2017 Oct 11;:

Authors: Han S, Lee S, Yang JD, Leise MD, Ahn JH, Kim S, Jung G, Gwak MS, Kim GS, Ko JS

Abstract
Platelets interact with tumor cells and promote metastasis. The importance of platelets in post-transplant hepatocellular carcinoma (HCC) recurrence is unclear. Thus, we aimed to evaluate the association between preoperative platelet count and HCC recurrence after living donor liver transplantation. Of 359 recipients of livers from living donors for HCC, 209 of 240 patients who had preoperative platelet count ≤75 × 10(9) /L were matched with 97 of 119 patients who had preoperative platelet count >75 × 10(9) /L using propensity score matching, with an unfixed matching ratio based on factors such as tumor biology. The cutoff value 75 × 10(9) /L was set based on optimum stratification analysis. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence. The median follow-up time was 59 months. Before matching, recurrence probability at 1, 2, and 5 years after transplantation was 4.7%, 9.2%, and 11.3% for low platelet group and 14.5%, 23.0%, and 30.5% for high platelet group. Recurrence risk was significantly greater in high platelet group in both univariable (HR=3.09 [1.86-5.14], P <0.001) and multivariable analyses (HR=2.10 [1.23-3.60], P=0.007). In the matched analysis, recurrence risk was also greater in high platelet group in both univariable (HR=2.33 [1.36-4.01], P=0.002) and multivariable analyses (HR=1.90 [1.02-3.54], P=0.04). Preoperative platelet count had no interaction with the Milan criteria, alpha-fetoprotein level, Edmonson grade, microvascular invasion, or intrahepatic metastasis. Incorporation of preoperative platelet count into the Milan criteria significantly improved predictive power. Inflammation-based scores including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and inflammation-based index did not show superiority to preoperative platelet count in predicting HCC recurrence. In conclusion, preoperative platelet count appears to be an important host factor affecting HCC recurrence after living donor liver transplantation. This article is protected by copyright. All rights reserved.

PMID: 29024412 [PubMed - as supplied by publisher]

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