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https://www.readbyqxmd.com/read/28631359/management-of-pediatric-hepatocellular-carcinoma-a-multimodal-approach
#1
Mira A Kohorst, Deepti M Warad, Jane M Matsumoto, Julie K Heimbach, Mounif El-Youssef, Carola A S Arndt, Vilmarie Rodriguez, Amulya A Nageswara Rao
HCC is rare in the pediatric population, but is the second most common liver malignancy in children. Survival rates for primary unresectable HCC have been dismal. The objective of this study was to describe our experience with a multimodal approach for the management of unresectable HCC in two adolescent patients and to review the literature. Both patients are currently alive with no recurrence at 51 and 29 months post-transplant. Multimodality treatment involving chemotherapy with doxorubicin, cisplatin, and sorafenib; TACE; timely liver transplantation; and post-transplant therapy with sorafenib and mTOR inhibitors may help improve outcomes and prolong survival in pediatric patients with unresectable HCC...
June 20, 2017: Pediatric Transplantation
https://www.readbyqxmd.com/read/28624108/modification-of-immunosuppressive-therapy-as-risk-factor-for-complications-after-liver-transplantation
#2
REVIEW
Paolo De Simone, Paola Carrai, Laura Coletti, Davide Ghinolfi, Stefania Petruccelli, Franco Filipponi
Management of complications post-liver transplantation (LT) includes immunosuppressive manipulations with the aim to reduce the overall burden of immunologic suppression and compensate for renal, cardiovascular, metabolic toxicities, and for the increased oncologic risk. Two approaches can be implemented to reduce immunosuppression-related adverse events: upfront schedules tailored to the pretransplant individual patient's risk profile versus downstream modifications in the event of immunosuppression-related complications...
April 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28624107/recurrence-of-primary-sclerosing-cholangitis-primary-biliary-cholangitis-and-auto-immune-hepatitis-after-liver-transplantation
#3
REVIEW
T Visseren, S Darwish Murad
Liver transplantation is a well-accepted treatment for decompensated chronic liver disease due to primary sclerosing cholangitis (PSC), primary biliary cholangitis (PBC) and auto-immune hepatitis (AIH). Survival after liver transplantation is generally good with 1 and 5-year survival rates around 90% and 70-85%. After transplantation, however, these diseases recur in 8.6-27% (rPSC), 10.9-42.3% (rPBC) and 7-42% (rAIH), and this poses significant challenges in terms of management and graft outcome in these patients...
April 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28624105/hypo-and-normothermic-perfusion-of-the-liver-which-way-to-go
#4
REVIEW
Jasmijn Selten, Andrea Schlegel, Jeroen de Jonge, Philipp Dutkowski
The demand of donor livers for transplantation exceeds the supply. In an attempt to maximize the number of potentially usable donor livers, several centers are exploring the role of machine perfusion. This review provides an update on machine perfusion strategies and basic concepts, based on current clinical issues, and discuss challenges, including currently used biomarkers for assessing the quality and viability of perfused organs. The potential benefits of machine perfusion on immunogenicity and the consequences on post-operative immunosuppression management are discussed...
April 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28606879/can-immunosuppression-be-stopped-after-liver-transplantation
#5
REVIEW
Pierre-Alain Clavien, Xavier Muller, Michelle L de Oliveira, Philipp Dutkowski, Alberto Sanchez-Fueyo
Liver transplantation has improved dramatically over the past three decades, mainly as a result of advances in surgical techniques and management of post-transplant complications. The focus has now turned towards rescuing additional organs in the face of scarce organ supply, or prevention of long-term toxicity associated with immunosuppression. The liver appears to be privileged in terms of immune tolerance, with a low incidence of antibody-mediated rejection, which is in sharp contrast to other solid organ transplants, such as kidney, lung, and heart transplants...
July 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28602070/a-prognostic-evaluation-and-management-of-alcoholic-hepatitis
#6
Ramesh Rana, Sheng-Lan Wang, Jing Li, Lu Xia, Mei-Yi Song, Chang-Qing Yang
Alcoholic hepatitis is an acute and severe form of alcoholic liver disease associated with high morbidity and mortality of 30-50% worldwide, severity ranging from asymptomatic derangement of liver biochemistries to fulminant liver failure or death. Rapidly progressing jaundice and coagulopathy in prolonged excessive alcohol abusers with or without fever, malnutrition, and tender liver are the clinical hallmarks. The prognostic models (MELD, MDF, ABIC, GAHS, Lille's score) not only predict the short term mortality, but also guide the clinicians to choose appropriate specific therapy (corticosteroid or pentoxifylline) and as a stopping rule if there is no significant benefits of it...
June 9, 2017: Minerva Medica
https://www.readbyqxmd.com/read/28600688/endoscopic-management-of-biliary-strictures-after-living-donor-liver-transplantation
#7
REVIEW
Takeshi Tsujino, Hiroyuki Isayama, Hirofumi Kogure, Tatsuya Sato, Yousuke Nakai, Kazuhiko Koike
Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP...
June 9, 2017: Clinical Journal of Gastroenterology
https://www.readbyqxmd.com/read/28598458/multidisciplinary-cooperation-in-a-simultaneous-combined-liver-and-kidney-transplantation-patient-of-primary-hyperoxaluria-1
#8
Q Ren, W Ju, D Wang, Z Guo, M Chen, X He
Primary hyperoxaluria type 1 is an autosomal recessive hereditary glyoxylate metabolism disorder characterized by excessive production of oxalate, caused by the deficiency of liver specific peroxisomal enzyme: alanineglyoxylate aminotransferase. For patients with end-stage renal disease, combined liver and kidney transplantation was needed. This report describes one patient, with a diagnosis of end-stage renal disease and primary hyperoxaluria 1 confirmed by PCR and direct sequencing with genomic DNA, received the simultaneous combined liver and kidney transplantation after seven months' waiting...
January 2017: JNMA; Journal of the Nepal Medical Association
https://www.readbyqxmd.com/read/28585715/does-liver-resection-transplantation-affect-respiratory-induced-liver-motion-in-patients-with-hepatocellular-carcinoma
#9
Yong Hu, Yong-Kang Zhou, Yi-Xing Chen, Lu-Xi Ye, Zhao-Chong Zeng
The purpose of this study was to evaluate the changes in magnitude of three-dimensional (3D) liver motion after liver resection/transplantation in patients with hepatocellular carcinoma (HCC) using four-dimensional (4D)-computed tomography (CT) images. From January 2012 to April 2016, 74 HCC patients underwent 4D-CT scans under a free-breathing state to assess respiratory liver motion. Of the 74 patients, 40 did not have a liver resection/transplantation (Group A), 34 with liver resection/transplantation. 15 underwent major or minor resection in the right liver lobe (Group B), 14 underwent major or minor resection in the left liver lobe (Group C), and five underwent liver transplantation (Group D)...
June 6, 2017: Journal of Applied Clinical Medical Physics
https://www.readbyqxmd.com/read/28583555/veno-arterial-venous-hybrid-mode-of-extracorporeal-membrane-oxygenation-for-acute-respiratory-distress-syndrome-combined-with-septic-shock-in-a-liver-transplant-patient-a-case-report
#10
J-I Park, B-H Jung, S-G Lee
BACKGROUND: Post-operative respiratory failure is common in liver transplant patients, with a direct effect on graft and recipient outcomes. We present a case of successful treatment for a patient who had acute respiratory distress syndrome combined with septic shock after living-donor liver transplantation with veno-arterial-venous hybrid mode of extracorporeal membrane oxygenation (ECMO) support. METHODS: A 49-year-old male patient underwent successful emergency living-donor liver transplantation for acute-on-chronic liver failure associated with alcoholic liver cirrhosis...
June 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28582321/cytomegalovirus-in-liver-transplant-recipients
#11
David Herman, Hyosun Han
PURPOSE OF REVIEW: Cytomegalovirus (CMV) is the most common opportunistic infection following solid-organ transplant and remains a cause of life-threatening disease and allograft rejection in liver transplant recipients. The purpose of this review is to highlight the current strategies in diagnosis and management of this disease in this vulnerable population. RECENT FINDINGS: Identification of high-risk individuals and aggressive treatment with antiviral agents, either via prophylaxis or by early initiation during active disease, has become the standard of care...
June 2, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28579340/apri-test-and-hyaluronic-acid-as-non-invasive-diagnostic-tools-for-post-hcv-liver-fibrosis-systematic-review-and-meta-analysis
#12
REVIEW
Magdy Amin El Serafy, Abdel Meguid Kassem, Heba Omar, Mohammad Shaaban Mahfouz, Maissa El Said El Raziky
BACKGROUND AND STUDY AIMS: Hepatitis C virus (HCV) accounts for a sizable proportion of chronic liver disease cases and represents the most common indication for liver transplantation. Precise diagnosis of hepatic fibrosis stage is considered a funnel-neck in proper management and follow-up of HCV-infected patients. Given the possible complications of liver biopsy, a non-invasive method for assessing hepatic fibrosis is needed. This study aimed to evaluate the diagnostic accuracy of APRI and hyaluronic acid as non-invasive diagnostic assessment tools for post HCV liver fibrosis...
June 1, 2017: Arab Journal of Gastroenterology: the Official Publication of the Pan-Arab Association of Gastroenterology
https://www.readbyqxmd.com/read/28574999/predictors-of-renal-function-recovery-among-patients-undergoing-renal-replacement-therapy-following-orthotopic-liver-transplantation
#13
Maria Claudia Cruz Andreoli, Nádia Karina Guimarães de Souza, Adriano Luiz Ammirati, Thais Nemoto Matsui, Fabiana Dias Carneiro, Ana Claudia Mallet de Souza Ramos, Ilson Jorge Iizuca, Maria Paula Vilela Coelho, Rogério Carballo Afonso, Ben-Hur Ferraz-Neto, Marcio Dias de Almeida, Marcelino Durão, Marcelo Costa Batista, Julio Cesar Monte, Virgílio Gonçalves Pereira, Oscar Pavão Dos Santos, Bento Cardoso Dos Santos
Renal dysfunction frequently occurs during the periods preceding and following orthotopic liver transplantation (OLT), and in many cases, renal replacement therapy (RRT) is required. Information regarding the duration of RRT and the rate of kidney function recovery after OLT is crucial for transplant program management. We evaluated a sample of 155 stable patients undergoing post-intensive care hemodialysis (HD) from a patient population of 908 adults who underwent OLT. We investigated the average time to renal function recovery (duration of RRT required) and determined the risk factors for remaining on dialysis > 90 days after OLT...
2017: PloS One
https://www.readbyqxmd.com/read/28564127/impact-of-terlipressin-infusion-during-and-after-live-donor-liver-transplantation-on-incidence-of-acute-kidney-injury-and-neutrophil-gelatinase-associated-lipocalin-serum-levels-a-randomized-controlled-trial
#14
Mohamed Abdelrauf Kandil, Khalid Mousa Abouelenain, Ayman Alsebaey, Hanaa Said Rashed, Mohamed Helmi Afifi, Mohamed Abdelmoneem Mahmoud, Khaled Ahmed Yassen
Acute kidney injury (AKI) with liver transplantation is not uncommon. Impact of Terlipressin infusion on AKI, haemodynamics and plasma concentration of Neutrophil Gelatinase Associated Lipocalin (NGAL) was studied METHODS: Patients (n=50) were randomized (NCT02059460, USA) into 2 equal groups; Terlipressin vs Controls. Terlipressin (1-4 μg/kg/h) was administrated for 5 days. Intraoperative Transoesophageal Doppler for haemodynamic management. Renal functions, peak portal vein blood flow velocity (PPV) and hepatic artery resistive index (HARI) were recorded...
May 31, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28561199/efficacy-of-self-expandable-metal-stents-in-management-of-benign-biliary-strictures-and-comparison-with-multiple-plastic-stents-a-meta-analysis
#15
Muhammad Ali Khan, Todd H Baron, Faisal Kamal, Bilal Ali, Richard Nollan, Mohammad Kashif Ismail, Claudio Tombazzi, Everson L A Artifon, Alessandro Repici, Mouen A Khashab
Background and study aims There is burgeoning interest in the utilization of covered self-expandable metal stents (CSEMSs) for managing benign biliary stricture (BBS). This systematic review and meta-analysis evaluated cumulative stricture resolution and recurrence rates using CSEMSs and compared performance of CSEMSs and multiple plastic stents (MPS) in BBS management. Method Searches in several databases identified studies including ≥ 10 patients that utilized CSEMSs for BBS treatment. Weighted pooled rates were calculated for stricture resolution and recurrence...
May 24, 2017: Endoscopy
https://www.readbyqxmd.com/read/28508004/tacrolimus-associated-dilated-cardiomyopathy-in-adult-patient-after-orthotopic-liver-transplant
#16
Jennifer McLeod, Stephanie Wu, Luanda Grazette, Anna Sarcon
This report presents a case of tacrolimus cardiotoxicity in an adult patient who received tacrolimus immunosuppression for orthotopic liver transplant (OLT). Tacrolimus-associated cardiotoxicity has been described in the literature, however this is the first case to document the development of a dilated cardiomyopathy in a patient shortly after initiating tacrolimus therapy post transplant. With the growing use of tacrolimus in transplant medicine, this case report expands the literature of tacrolimus cardiotoxicity and can aid clinicians in the evaluation and management of patients exposed to this form of immunosuppression...
April 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28501036/tuberculosis-in-liver-transplant-recipients-a-report-of-eight-cases-during-a-five-year-period
#17
Diana Póvoas, João Machado, Rui Perdigoto, Ana Morbey, Júlio Veloso, Helena Glória, Élia Mateus, Américo Martins, Fernando Maltez, Eduardo Barroso
INTRODUCTION: Tuberculosis incidence in Portugal ranged from 20 to 22 cases per 100 000 inhabitants between 2010 and 2014. Tuberculosis incidence in liver transplant recipients is not precisely known, but it is estimated to be higher than among the general population. Tuberculosis in liver transplant recipients is particularly challenging because of the atypical clinical presentation and side effects of the antibacillary drugs and their potential interactions with immunosuppressive therapies...
January 31, 2017: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/28494530/radioembolization-for-the-treatment-of-hepatocellular-carcinoma
#18
Hyo-Cheol Kim
Transarterial radioembolization (TARE) with yttrium 90 (90Y), an intra-arterial procedure performed by interventional radiologists, has begun being utilized in managing hepatocellular carcinoma (HCC) in Korea. There are two available TARE products: glass and resin microspheres with different physical characteristics. All patients undergoing TARE must be assessed with clinical examination and laboratory tests as well as a thorough angiographic evaluation. TARE is safe and effective in the treatment of unresectable HCC, as it has longer time-to-progression, greater ability to downsize tumors for liver transplantation, less post-embolization syndrome, and shorter hospitalization compared with chemoembolization...
May 10, 2017: Clinical and Molecular Hepatology
https://www.readbyqxmd.com/read/28489436/liver-transplantation-post-transplant-management
#19
Neil Halliday, Rachel H Westbrook
Medical care for patients following liver transplantation is complex and requires a holistic approach to management. Patients and clinicians are faced with multiple challenges: immunosuppressive regimens must be optimized to avoid and treat graft rejection, the risk and atypical features of sepsis in the immunocompromised patient must be recognized, steps are required to reduce the recurrence of liver disease and the long-term increased risks of malignancy, renal failure and metabolic complications need managing...
May 2, 2017: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/28489254/use-of-intra-aortic-counterpulsation-in-cardiogenic-shock-post-liver-transplantation
#20
Arun P Palanisamy, Satish N Nadig, Gabriel R Chedister, Jacob E Dowden, David G Koch, William D Stoll, John W McGillicuddy, Kenneth D Chavin
Left ventricular dysfunction resulting in cardiogenic shock occurs infrequently following organ reperfusion in liver transplantation. The etiology of the cardiogenic shock is often multifactorial and difficult to manage due to the complex nature of the procedure and the patient's baseline physiology. Traditionally, this hemodynamic instability is managed medically using inotropic agents and vasopressor support. If medical treatment is insufficient, the use of an intra-aortic balloon pump for counterpulsation may be employed to improve the hemodynamics and stabilize the patient...
May 10, 2017: Clinical Transplantation
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