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post liver transplant management

Alexander Lemmer, Lisa B Van-Wagner, Daniel Ganger
Congestive hepatopathy (CH) arises from chronically elevated right sided heart pressures transmitted to the liver by passive venous congestion. Over time CH can lead to hepatic bridging fibrosis, decompensated cirrhosis, and hepatocellular carcinoma. Currently there are no evidence-based guidelines to direct appropriate screening or management of patients with CH partly because of the inability of current clinical tools (serum tests, imaging studies, liver stiffness measurements, and liver biopsy) to accurately estimate hepatic fibrosis or the risk for hepatic decompensation...
April 19, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
Y Puri, P Srinivasan, P Peddu, N Heaton
Multiple intrahepatic arterio-portal fistulas are rare. The majority are isolated and occur secondary to liver trauma including iatrogenic interventions such as liver biopsy. Post-liver transplantation 18 cases have been reported, all secondary to an interventional radiological procedure. We report multiple bi-lobar arterio-portal fistulas in a liver transplant recipient recognized 1 year after transplantation. The donor died due to intracerebral bleeding following blunt head and abdominal trauma. In the present case, the etiology is not very clear...
April 2018: Transplantation Proceedings
Ranjit Chauhan, Shilpa Lingala, Chiranjeevi Gadiparthi, Nivedita Lahiri, Smruti R Mohanty, Jian Wu, Tomasz I Michalak, Sanjaya K Satapathy
Chronic hepatitis B (CHB) is a major global health problem affecting an estimated 350 million people with more than 786000 individuals dying annually due to complications, such as cirrhosis, liver failure and hepatocellular carcinoma (HCC). Liver transplantation (LT) is considered gold standard for treatment of hepatitis B virus (HBV)-related liver failure and HCC. However, post-transplant viral reactivation can be detrimental to allograft function, leading to poor survival. Prophylaxis with high-dose hepatitis B immunoglobulin (HBIG) and anti-viral drugs have achieved remarkable progress in LT by suppressing viral replication and improving long-term survival...
March 27, 2018: World Journal of Hepatology
A Cambier, J B Giot, P Leonard, N Bletard, P Meunier, R Hustinx, J Delwaide, N Meurisse, P Honore, B Losson, M P Hayette, O Detry
Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis. However, recent studies carried out in southern Belgium have revealed, through post-mortem examination, high prevalences (up to 62 %) in foxes. Cats and dogs can act as definitive hosts. Human are accidentally infected by ingestion of food contaminated by the feces. After a long incubation period, invasive hepatic lesions may appear, as well as extra-hepatic lesions...
March 2018: Revue Médicale de Liège
Osama Siddique, Ayesha S Siddique, Jason T Machan, Kittichai Promrat
Introduction: Post-transplant infections have been studied widely but data on comparisons of deceased donor liver transplants (DDLT) and living donor liver transplants (LDLT), type and timings of infections, and their relations to outcomes are not explored. Material and methods: We analysed data from 612 participants of the Adult-to-Adult Living Donor Liver Transplantation Study (A2ALL), a retrospective data set of LDLT and DDLT. We compared the type and timing of the first post-transplant infection in relation to transplant outcomes between the two groups...
March 2018: Clinical and Experimental Hepatology
Sandra A Carey, Kristen M Tecson, Aayla K Jamil, Joost Felius, Theresa K Wolf-Doty, Shelley A Hall
BACKGROUND: Serial gene expression profiling (GEP) may reduce the need for endomyocardial biopsies for detecting acute cellular rejection (ACR) after transplantation, but its performance in dual organ transplant recipients is currently unknown. METHODS: We analyzed 18 months of follow-up in a national cohort of 27 dual organ recipients (18 heart-kidney, 8 heart-liver, 1 heart-lung) matched to 54 heart-only recipients for gender, age, and time to first GEP (AlloMap®) test...
March 24, 2018: Transplant Immunology
M R González-Sánchez, P A Cascales-Campos, J J López-Espín, B Febrero, J A Pons, A Vargas Acosta, J Ros, F Sánchez-Bueno, R Robles, L Sáenz, P Ramírez, P Parilla
BACKGROUND: In recent years, several studies have shown that the age of the donor may be related to an increase in the occurrence of biliary complications (BCs), which remain the main cause of morbidity after liver transplantation. This study analyzed the type and management of these BCs, the impact of BCs on graft and patient survival rates, and the influence of some characteristics of donors and recipients on BC appearance in patients transplanted with donors 75 years of age or older...
March 2018: Transplantation Proceedings
M I Sánchez-Lorencio, L Saenz, P Ramirez, F Villalba-López, V de la Orden, B Mediero-Valeros, B Revilla Nuin, M R Gonzalez, P A Cascales-Campos, D Ferreras-Martínez, J A Noguera-Velasco, E Díaz-Rubio, P Parrilla
INTRODUCTION: Orthotopic liver transplantation (LT) is considered to be one of the few curative treatments available for early stages of hepatocellular carcinoma (HCC). Alfa-fetoprotein (AFP) is the most-used biomarker for HCC despite low sensitivity and specificity. Matrix metalloproteinase 1 (MMP-1) has been considered to be involved in the process of vascular invasion of the malignant cells. The objective of this study was to assess the use of MMP-1 for the management of HCC patients for LT...
March 2018: Transplantation Proceedings
E Brea-Gómez, R Villar-Quintana, C Plata-Illescas, N Zambudio-Carroll, M A Lopez-Garrido, F Nogueras-Lopez, K Muffak-Granero, A Becerra-Massare, M T Villegas-Herrera, I Segura Jiménez, N Muñoz Pérez, J M Villar-Del-Moral
INTRODUCTION: The current imbalance between available donors and potential recipients for orthotopic liver transplantation (OLT) has led to a liberalization of organ acceptance criteria, increasing the risk of post-transplant complications such as early allograft dysfunction (EAD). Consequently, we need accurate criteria to detect patients with early poor graft function to guide the strategies of management. We evaluated the usefulness of two frequently used criteria: the definition from Olthoff et al and the Model for Early Allograft Function (MEAF) scoring...
March 2018: Transplantation Proceedings
Alberto Ferrarese, Alberto Zanetto, Chiara Becchetti, Salvatore Stefano Sciarrone, Sarah Shalaby, Giacomo Germani, Martina Gambato, Francesco Paolo Russo, Patrizia Burra, Marco Senzolo
Bacterial infection (BI) is a common cause of impairment of liver function in patients with cirrhosis, especially in the liver transplant candidates. These patients share an immunocompromised state and increased susceptibility to develop community and hospital-acquired infections. The changing epidemiology of BI, with an increase of multidrug resistant strains, especially in healthcare-associated settings, represents a critical issue both in the waiting list and in the post-operative management. This review focused on the role played by BI in patients awaiting liver transplantation, evaluating the risk of drop-out from the waiting list, the possibility to undergo liver transplantation after recovery from infection or during a controlled infection...
February 27, 2018: World Journal of Hepatology
Giuliano Ramadori, Patrizia Bosio, Federico Moriconi, Ihtzaz A Malik
BACKGROUND: After orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC), recurrent HCC mostly develops within 2 years. All cases of de novo HCC described so far occurred later than 2 years after OLT. Prevention of post-transplantation HCC has usually been tried to achieve by curing or controlling recurrent liver disease. This has been rationale for treatment with interferon (IFN)/ribavirin of HCV-recurrence in patients after OLT, transplanted for advanced HCV-induced liver disease and/or HCC...
March 6, 2018: BMC Cancer
Akash Deep, Romit Saxena, Bipin Jose
Acute kidney injury (AKI) is a common accompaniment in patients with liver disease. The causes, risk factors, manifestations and management of AKI in these patients vary according to the liver disease in question (acute liver failure, acute-on-chronic liver failure, post-liver transplantation or metabolic liver disease). There are multiple causes of AKI in patients with liver disease-pre-renal, acute tubular necrosis, post-renal, drug-induced renal failure and hepatorenal syndrome (HRS). Definitions of AKI in liver failure are periodically revised and updated, but pediatric definitions have still to see the light of the day...
March 1, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Matias E Czerwonko, Pablo Huespe, Cristina M Elizondo, Juan Pekolj, Adrian Gadano, Laura Barcán, Sung-Ho Hyon, Eduardo de Santibañes, Martín de Santibañes
BACKGROUND: Adult liver recipients (ALR) differ from the general population with pyogenic liver abscess (PLA) as they exhibit: reconstructed biliary anatomy, recurrent hospitalizations, poor clinical condition and are subjected to immunosuppression. The aim of this study was to identify risk factors associated with PLA in ALR and to analyze the management experience of these patients. METHODS: Between 1996 and 2016, 879 adult patients underwent liver transplantation (LT), 26 of whom developed PLA...
February 26, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
S Camagni, P Stroppa, A Tebaldi, A Lucianetti, D Pinelli, I Pellicioli, L D'Antiga, M Colledan
Mycotic aneurysm of the hepatic artery (HA) is a rare, unpredictable and potentially lethal complication of liver transplantation (LT). Paediatric LT is not exempt from it but the related literature is rather scanty. We present our experience with post-LT mycotic aneurysm of the HA in paediatric age, describing four cases occurred with a special focus on the possible risk factors for its development and a proposal for the management of high-risk recipients. This article is protected by copyright. All rights reserved...
February 26, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
Iyoni Ranasinghe, Jacqueline Sin, Ian Norman, Margaret Lau-Walker
BACKGROUND: despite a 450% increase in UK alcohol-related liver disease mortality over the past 30 years, little evidence-based guidance exists regarding preventing recidivism post-liver transplant for alcohol-related liver disease. METHOD: a systematic literature review was conducted to identify demographic variables predictive of alcohol relapse and effective psychosocial interventions for alcohol-related liver disease patients post-liver transplant. RESULTS: variables most significantly predictive of alcohol relapse post-transplant were-less than 12 months pre-liver transplant abstinence; patients with children; poor pre-liver transplant psychosomatic evaluation; non-compliance with post-liver transplant treatment plan; and patients with active insurance policies...
February 22, 2018: British Journal of Nursing: BJN
Yohei Yamada, Ken Hoshino, Takayuki Oyanagi, Ryohei Gatayama, Jun Maeda, Nobuyuki Katori, Yasushi Fuchimoto, Taizo Hibi, Masahiro Shinoda, Kentaro Matsubara, Hideaki Obara, Ryo Aeba, Yuko Kitagawa, Hiroyuki Yamagishi, Tatsuo Kuroda
Children with single ventricle physiology have complete mixing of the pulmonary and systemic circulations, requiring staged procedures to achieve a separation of these circulations, or Fontan circulation. The single ventricle physiology significantly increases the risk of mortality in children undergoing non-cardiac surgery. As liver transplantation for patients with single ventricle physiology is particularly challenging, only a few reports have been published. We herein report a case of successful LDLTx for an 8-month-old pediatric patient with biliary atresia, heterotaxy, and complex heart disease of single ventricle physiology...
February 19, 2018: Pediatric Transplantation
Ana Rita Alves, Dário Gomes, Emanuel Furtado, Luís Tomé
Background and Aims: Biliary tract complications following liver transplant remain an important source of morbidity and mortality. Endoscopic retrograde cholangiopancreatography (ERCP) has become a common therapeutic option before other invasive procedures. The aim of this study was to evaluate ERCP efficacy in managing this type of complications. Methods: Retrospective study of all patients who underwent therapeutic ERCP due to post-liver transplant biliary complications between September 2005 and September 2015, at a deceased donor liver transplantation centre...
January 2018: GE Portuguese Journal of Gastroenterology
Tanguy Demaret, Sharat Varma, Xavier Stephenne, Françoise Smets, Isabelle Scheers, Ronald Wanders, Lionel Van Maldergem, Raymond Reding, Etienne Sokal
Mild Zellweger spectrum disorder, also described as Infantile Refsum disease, is attributable to mutations in PEX genes. Its clinical course is characterized by progressive hearing and vision loss, and neurodevelopmental regression. Supportive management is currently considered the standard of care, as no treatment has shown clinical benefits. LT was shown to correct levels of circulating toxic metabolites, partly responsible for chronic neurological impairment. Of three patients having undergone LT for mild ZSD, one died after LT, while the other two displayed significant neurodevelopmental improvement on both the long-term (17 years post-LT) and short-term (9 months post-LT) follow-up...
February 16, 2018: Pediatric Transplantation
T Chan, M S Bleszynski, D S Youssef, M Segedi, S Chung, C H Scudamore, A K Buczkowski
INTRODUCTION: Damage control laparotomy with vacuum assisted closure (VAC) is used for selective cases in trauma. In liver transplantation, VAC has also been applied for management of intra-operative hemorrhage. The primary objective was to evaluate peri-operative blood loss and blood product utilization in VAC compared to primary abdominal closure (PAC) at the index transplant operation. METHODS: Retrospective review of all adults undergoing deceased donor liver transplantation (2007-2011) at a single center tertiary care institution...
January 31, 2018: American Journal of Surgery
Oriol Sendino, Alejandro Fernández-Simon, Ryan Law, Barham Abu Dayyeh, Michael Leise, Karina Chavez-Rivera, Henry Cordova, Jordi Colmenero, Gonzalo Crespo, Cristina Rodriguez de Miguel, Constantino Fondevila, Josep Llach, Miquel Navasa, Todd Baron, Andrés Cárdenas
Background: Bile leak after liver transplantation (LT) is commonly treated with endoscopic retrograde cholangiopancreatography (ERCP); however, there are limited data regarding the optimal treatment strategy. Objective: We aimed to examine the role of ERCP in LT recipients with bile leaks at two large institutions. Methods: We reviewed all ERCPs performed in LT recipients with bile leak and duct-to-duct biliary anastomosis at two high-volume transplant centers...
February 2018: United European Gastroenterology Journal
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