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Elevated gamma‐glutamyltransferase is associated with mortality in lung transplantation for cystic fibrosis

Mon, 10/24/2011 - 08:14
SummaryCystic fibrosis (CF) is a life‐threatening autosomal recessive hereditary disease, affecting multiple organs. In end stage disease, lung transplantation improves the quality of life and prolongs survival. CF liver disease (CFLD) as co‐morbidity develops in 8–17% of CF patients. We aimed to investigate the impact of liver injury on prognosis following lung transplantation. Thirty‐one patients with CF who underwent double lung transplantation (DLTx) from 1999 to 2009 were included. Post‐transplant survival, liver serum parameters as well as INR, creatinine and the MELD‐Score were determined preoperatively, 1 day and 4 weeks postoperatively. Prognostic impact of liver function on outcome was analysed. Mean patient age was 25 (15–38) and post‐transplant 1 year‐su...
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Effects of cyclosporin-a on rat skeletal biomechanical properties

Mon, 10/24/2011 - 03:00
Conclusion: Long-term use of CsA can weaken the biomechanical properties and thus increase the fracture rate of the lumbar vertebra and the proximal femur. However, CsA therapy has less effect on the middle femur shaft. The effects of CsA on skeleton are site-specific. (Source: BMC Musculoskeletal Disorders)
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Central pontine myelinolysis: A case report and clinical–pathological review

Mon, 10/24/2011 - 03:00
Cui R, Fayek S, Rand EB, Feygin T, Khrichenko D, Shaked A. Central pontine myelinolysis: A case report and clinical–pathological review. Pediatr Transplantation 2011. © 2011 John Wiley & Sons A/S.Abstract:  An 11‐yr‐old child presented with acute mental status changes and spastic quadriplegia after orthotopic liver transplantation. Magnetic resonance (MR) imaging findings were consistent with central pontine and EPM. Initial immunosuppression included tacrolimus, mycophenolate mofetil, and corticosteroids. Given that neurotoxicity is a well‐established side effect of CNI, the patient was converted to rapamycin and subsequently experienced significant neurologic recovery. The temporal resolution of the patient’s symptoms suggests that prompt recognition of central pontine a...
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[Contrast-Enhanced Sonographic Drainage Control: A Feasibility Study.]

Mon, 10/24/2011 - 03:00
Authors: Girlich C, Büttner R, Schacherer D, Klebl F Abstract Liver abscesses still represent a life-threatening disease. Interventional abscess puncture and/or drainage are often the most adequate treatment. The aim of our study was the evaluation of drainage control with contrast-enhanced sonography. We included 15 patients in our feasibility study, three of whom had infected liver cysts, three had abscesses after liver resection or transplantation, six had intrahepatic abscesses and three had abscesses of other localisations. For drainage control with contrast-enhanced sonography we administered 1 mL of the contrast agent SonoVue® (Bracco, Germany) diluted in 10 mL of 0.9 % of NaCl through the indwelling drainage or an 18-G Chiba needle. A total of 28 sonographic controlled e...

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Renal histological lesions and outcome in liver transplant recipients

Sun, 10/23/2011 - 03:00
Conclusion:  Renal histology is variable and not limited to CNI toxicity in OLT recipients referred for KB. Whether management based on KB findings can directly improve outcomes remains unclear. (Source: Clinical Transplantation)
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‘Extreme’ vasculobiliary injuries: association with fundus‐down cholecystectomy in severely inflamed gallbladders

Sun, 10/23/2011 - 03:00
Conclusions:  Extreme vasculobiliary injuries tend to occur when fundus‐down cholecystectomy is performed in the presence of severe inflammation. Contractive inflammation thickens and shortens the cystic plate, making separation of the gallbladder from the liver hazardous. (Source: HPB: official journal of the International Hepato Pancreat Biliary Association)
Categories: Publications

Blood Test Discovered to Detect Graft-Versus-Host

Sat, 10/22/2011 - 12:53
Researchers at the University of Michigan have discovered a "marker" in blood samples that can detect graft- versus- host disease (GVHD) of the intestines without a biopsy. GVHD is one of the most fatal complications of allogeneic stem cell transplant. GVHD is caused by the healthy immune system of the stem cell donor attacking the cells of the stem cell recipient (or the "host"). While there are many sites of the body that can be affected by GVHD, the skin , liver, eyes, joints and intestines are among the most common. In fact, for about 30% of patients who have received an allogeneic stem cell transplant for leukemia, lymphoma or other blood disorders, GVHD of the intestine can develop and it is the site that is most resistant to treatment....Read Full Post (Source: About.com Lymphoma)
Categories: Publications

Management of excluded bile ducts in paediatric orthotopic liver transplant recipients of technical variant allografts

Sat, 10/22/2011 - 08:46
We present four cases and describe an algorithm to correct these complications.Methods:  A retrospective review of the paediatric orthotopic liver transplantation database (2000–2010) at Washington University in St. Louis/St. Louis Children's Hospital was conducted.Results:  Sixty‐eight patients (55%) received technical variant allografts. Four complications of excluded segmental bile ducts were identified. Percutaneous cholangiography provided diagnostic confirmation and stabilization with external biliary drainage. All patients required interval surgical revision of their hepaticojejunostomy for definitive drainage. Indwelling biliary stents aided intra‐operative localization of the excluded ducts. All allografts were salvaged.Discussion:  Aggressive diagnosis, percutaneous d...
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Flupirtine: Acute hepatic failure requiring liver transplant: case report

Sat, 10/22/2011 - 04:54
(Source: Reactions)

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Acute liver failure in Scotland between 1992 and 2009; incidence, aetiology and outcome

Sat, 10/22/2011 - 03:00
Conclusions: This large, prospective, single centre study with a defined geographical area and well-recorded population provides accurate data regarding ALF between 1992 and 2009. (Source: QJM)
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Duct‐to‐duct biliary reconstruction in orthotopic liver transplantation for primary sclerosing cholangitis: a viable and safe alternative

Sat, 10/22/2011 - 03:00
SummaryRoux‐en‐Y loop is considered the reconstruction method of choice in Orthotopic Liver Transplantation (OLT) for Primary Sclerosing Cholangitis (PSC). We have adopted an approach of duct‐to‐duct (D‐D) reconstruction when recipient common bile duct is free of gross disease. Patients were divided into two groups: patients who underwent a Roux‐en‐Y choledochojejunostomy and patients who had a D‐D anastomosis. Morbidity, mortality, disease recurrence and graft and patient survival were compared between the two groups and analyzed. Ninety‐one patients had OLT for PSC. Sixty‐three patients underwent a D‐D biliary reconstruction, whereas 28 patients had a Roux‐en‐Y loop. Biliary leak complicated 8% from the D‐D group, and 14% from the Roux‐en‐Y group (P = ...
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Survival advantage of primary liver transplantation for hepatocellular carcinoma within the up-to-7 criteria with microvascular invasion

Fri, 10/21/2011 - 04:47
Conclusion  Primary LT for HCC with microvascular invasion and within the up-to-7 criteria doubled the chance of cure as compared with LR. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s12072-011-9318-3Authors See Ching Chan, State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, ChinaSheung Tat Fan, State Key Laboratory for Liver Research, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, ChinaKenneth S. H. Chok, Department of Surgery, The University of Hong Kong, Hong Kong, ChinaTan To Cheung, Department of Surgery, The University of Hong Kong, Hong Kong, ChinaAlbert C. Y. Chan, Department of Surgery, The University of Hong Kong, Hong Kong, ChinaJames Y. Y. Fung, Department of Medicin...
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[Small-for-size : Experimental findings for liver surgery.]

Fri, 10/21/2011 - 03:00
[Small-for-size : Experimental findings for liver surgery.] Chirurg. 2011 Oct 21; Authors: Eipel C, Abshagen K, Vollmar B Abstract The characteristics of the hepatic macrocirculation, i.e., the parallel portal-venous and arterial blood supply, is of utmost relevance for liver surgery. With extended hepatectomy or transplantation of a reduced-size liver the remaining or transplanted liver tissue is overperfused because the liver fails to regulate the portal-venous inflow. This portal hyperperfusion is responsible for the initiation of liver cell proliferation but represents at the same time one of the substantial events in the pathogenesis of the small-for-size syndrome. Portal-venous hyperperfusion, the so-called hepatic arterial buffer response, which describes the semi-re...
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Successful allogeneic hematopoietic stem cell transplantation for chronic granulomatous disease with inflammatory complications and severe infection.

Fri, 10/21/2011 - 03:00
We report two patients with chronic granulomatous disease (CGD). The first patient presented with granulomatous colitis and pulmonary aspergillosis, and the second patient with liver abscess and restrictive pulmonary disorder. Both patients underwent allogeneic hematopoietic stem cell transplantation, the first from an HLA-matched sibling donor, and the second from an HLA-matched unrelated donor, after preconditioning with fludarabine, anti-thymocyte globulin, cyclophosphamide, and total-body irradiation of 3 Gy. The engraftment was prompt and the regimen-related toxicity was mild. The patients are able to return to their daily lives with full donor chimerism, although the second patient underwent a living-related-donor orthotopic liver transplantation from his mother for chronic liver gr...

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Diagnostic utility of a soluble cytokeratin 18 assay for gastrointestinal graft-vs.-host disease detection

Fri, 10/21/2011 - 01:35
Conclusions: Soluble cytokeratin 18 seems to be a suitable biomarker for gastrointestinal/liver graft-vs.-host disease detection, particularly when a biopsy is not feasible. (Source: Clinical Chemistry and Laboratory Medicine)
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Epstein–Barr virus gene expression and latent membrane protein 1 gene polymorphism in pediatric liver transplant recipients

Thu, 10/20/2011 - 12:33
AbstractImmunosuppressed pediatric transplant recipients are at risk of developing Epstein–Barr virus (EBV)‐associated complications (such as post‐transplant lymphoproliferative disorders). Monitoring of the EBV DNA level in blood alone has a low predictive value for the post‐transplant course of EBV infection and its complications. Therefore, additional prognostic markers are widely sought. The study aim was to analyze EBV gene expression patterns and LMP1 polymorphism in relation to EBV DNA levels in pediatric liver transplant recipients. EBV load measurement, LMP1 variant, and gene expression analysis were performed in collected prospectively multiple blood samples from 30 patients. Several distinct patterns of EBV gene expression were identified: latency 2 (71%), latency 3 (13%...
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Sirolimus as renal and immunological rescue agent in pediatric liver transplant recipients

Thu, 10/20/2011 - 03:20
Basso M‐S, Subramaniam P, Tredger M, Verma A, Heaton N, Rela M, Mieli‐Vergani G, Dhawan A. Sirolimus as renal and immunological rescue agent in pediatric liver transplant recipients.
Pediatr Transplantation 2011: 15: 722–727. © 2011 John Wiley & Sons A/S.Abstract:  CNI have improved the outcome of LT. However, their inherent potential to nephrotoxic and sometimes‐inadequate immunosuppressive effect has lead to the usage of newer drugs like SRL. Aim of this study was to review children who received SRL. Thirty‐seven (20 women) children post‐LT, median age 10.4 yr (0.8–17.4) with a minimum follow‐up of six months comprised the study group. Indications for SRL were biopsy‐proven resistant acute allograft rejection (n = 12), early CR (n = 12), and CNI‐i...
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Pregnancy following liver transplantation during childhood and adolescence

Thu, 10/20/2011 - 03:20
We report on outcomes and management of five pregnancies in four women undergoing orthotopic liver transplantation during childhood or adolescence and followed up at our Transplant Center. A retrospective clinical folder audit was performed. Mean age at transplantation was 13.3 ± 3.4 yr (range, 10–18 yr). Mean interval between transplantation and pregnancy was 15.4 ± 4.9 yr (range, 10–22 yr). Mean maternal age at conception was 28 ± 3.5 yr (range, 23–32 yr). Mean gestational age was 36.6 ± 1.7 wk. Mean birth weight was 2672 ± 249 g. Immunosuppression was cyclosporin based in three women and tacrolimus based in one woman. Pregnancy complications necessitating the induction of labor included fetal distress and rising maternal liver enzymes in tw...
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Transcapsular Arterial Neovascularization after Liver Transplantation in Pediatric Patients Indicates Transplant Failure [Pediatric Imaging]

Wed, 10/19/2011 - 03:00
Conclusion: Transcapsular arterial neovascularization, detected with color Doppler US, occurred in 9.5% (13 of 137) of pediatric patients and 8.4% (13 of 155) of liver transplants and was associated with underlying malperfusion and inflammation. The diagnosis of transcapsular arterial neovascularization was associated with reduced graft survival times and a high retransplantation rate. The negative prognostic value of the sign may assist in a strategy of organ allocation. © RSNA, 2011 (Source: Radiology)

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The Protective Role of CD59 and Pathogenic Role of Complement in Hepatic Ischemia and Reperfusion Injury.

Wed, 10/19/2011 - 03:00
Authors: Zhang J, Hu W, Xing W, You T, Xu J, Qin X, Peng Z Abstract Hepatic ischemia-reperfusion injury (IRI) is a major factor influencing graft outcome in liver transplantation, but its mechanism is not well defined. Although complement, including the membrane attack complex (MAC), a terminal product of complement activation, is thought to be involved in the multiple reactions subsequent to the ischemia-reperfusion (IR) process, the role of MAC in the pathogenesis of hepatic IRI requires further investigation. We used a warm ischemia-reperfusion injury model in mice and a syngeneic orthotopic liver transplantation model in rats to define the role of complement, including MAC, in hepatic IR. CD59-deficient mice had more severe liver dysfunction, evidenced by increased aspartate am...
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