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Hyperbilirubinemia after liver transplantation

Michael Sorrell, Alvaro Moreira, Kay Green, Rachel Jacobs, Robin Tragus, Laura Keller, Amy Quinn, Donald McCurnin, Alice Gong, Abeer El Sakka, Naveen Mittal, Cynthia Blanco
OBJECTIVES: To study the acute and long-term outcomes of preterm infants treated with an intravenous (IV) fish oil-based lipid emulsion (FishLE) for parenteral nutrition-associated liver disease (PNALD). METHODS: Preterm infants 14 days to 24 months of age with anatomic short gut or severe intestinal dysmotility, serum direct bilirubin ≥4 mg/dL, and requiring >60% calories from PN were eligible. Enrolled infants received 1 g/kg/day of FishLE until resolution of direct hyperbilirubinemia or return of enteral nutrition...
August 27, 2016: Journal of Pediatric Gastroenterology and Nutrition
Manuel Eckenschwiller, Hanns Ackermann, Wolf O Bechstein, Frank Grünwald
Background and Aims. Biliary complications are the most frequent complications after common liver surgeries. In this study, accuracy of hepatobiliary scintigraphy (HBS) and impact of hyperbilirubinemia were evaluated. Methods. Between November 2007 and February 2016, 131 patients underwent hepatobiliary scintigraphy after having liver surgery. 39 patients with 42 scans after LTX (n = 13) or hepatic resection (n = 26) were evaluated in the study; 27 were male, with mean age 60 years. The subjects underwent hepatobiliary scintigraphy with Tc-99m labeled Mebrofenin...
2016: International Journal of Molecular Imaging
Shin Jie Choi, Jong Sub Choi, Peter Chun, Jung Kyung Yoo, Jin Soo Moon, Jae Sung Ko, Woo Sun Kim, Gyeong Hoon Kang, Nam-Joon Yi
Neonatal hemochromatosis (NH) is a severe neonatal liver injury that is confirmed by extra-hepatic iron accumulation. Although a recent study described treating NH with exchange transfusions and intravenous immunoglobulin, liver transplantation should be considered for patients with severe liver failure that does not respond to other medical treatment. Herein, we report the case of a two-month-old female infant who presented with persistent ascites and hyperbilirubinemia. Her laboratory findings demonstrated severe coagulopathy, high indirect and direct bilirubin levels, and high ferritin levels...
June 2016: Pediatric Gastroenterology, Hepatology & Nutrition
James J Pomposelli, Nathan P Goodrich, Jean C Emond, Abhinav Humar, Talia B Baker, David R Grant, Robert A Fisher, John P Roberts, Kim M Olthoff, Brenda W Gillespie, Robert M Merion
BACKGROUND: Early allograft dysfunction (EAD) after living donor liver transplantation (LDLT) has often been attributed to inadequate graft size, and termed small-for-size syndrome. Early allograft dysfunction definitions include a variable constellation of findings, including hyperbilirubinemia, coagulopathy, encephalopathy, and ascites formation. Among putative causes of EAD after LDLT are excessive portal pressure and/or flow. Our objective was to evaluate patterns of EAD after LDLT...
July 2016: Transplantation
Mihai Oltean, Christian Barrenäs, Paulo Ney Martins, Gustaf Herlenius, Bengt Gustafsson, Styrbjörn Friman, William Bennet
Background. Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx). Methods. In 427 LTx patients, the AUROC curve based on bilirubin and AST at day 1 identified a cutoff of 2.04 mg/dL for the recipient pretransplant bilirubin. Recipients were grouped as having low (group L, n = 152) or high (group H, n = 275) bilirubin...
2016: Gastroenterology Research and Practice
Wonho Choe, Seog-Woon Kwon, Sung-Soo Kim, Shin Hwang, Gi-Won Song, Sung-Gyu Lee
BACKGROUND: Early allograft dysfunction (EAD) is a serious complication of liver transplantation (LT) and is associated with graft failure, which can result in patient mortality. Due to the shortage of organs for retransplantation, only a small proportion of EAD patients undergo retransplantation. Thus, liver support is needed for most patients with EAD. METHODS: We evaluated the effects of therapeutic plasma exchange (TPE) in EAD patients. EAD was defined as a sustained hyperbilirubinemia (≥10 mg/dL) within 30 days of LT without concurrent biliary complications...
June 16, 2016: Journal of Clinical Apheresis
Jane Maestri Brittain, Lise Borgwardt
Biliary atresia (BA) is an obliterative cholangiopathy affecting 1:10.000-14.000 of newborns. Infants with Biliary Atresia Splenic Malformation syndrome (BASM) are a subgroup of BA patients with additional congenital anomalies. Untreated the disease will result in fatal liver failure within the first years of life. Kasai portoenterostomy restores bile flow and delay the progressive liver damage thereby postponing liver transplantation. An early diagnosis is of most importance to ensure the effectiveness of the operation...
2016: Diagnostics
Keiichi Morita, Hiroaki Fukuzawa, Kosaku Maeda
The first-choice therapy for biliary atresia (BA) is Kasai hepatoportoenterostomy, which has been shown to greatly improve outcome. Various long-term complications, however, such as portal hypertension and hepatopulmonary syndrome (HPS), can occur in patients with native liver. A rare case of brain abscess in an 11-year-old girl with HPS associated with BA is reported. The patient underwent hepatoportoenterostomy for BA at 53 days of age, with resolution of hyperbilirubinemia. At 10 years of age, she was diagnosed with severe HPS with right-to-left shunting, and preparations for liver transplantation proceeded...
December 2015: Pediatrics International: Official Journal of the Japan Pediatric Society
W H Kang, S Hwang, G W Song, D H Jung, K H Kim, G C Park, T Y Ha, C S Ahn, D B Moon, Y I Yoon, M H Shin, W J Kim, S H Kim, S G Lee
BACKGROUND: Donor safety is the most important aspect in living-donor liver transplantation (LDLT). Gilbert syndrome is an autosomal recessive condition that is a common cause of isolated unconjugated hyperbilirubinemia, and its prevalence is not negligibly low in the general population. This study intended to assess donor safety and recipient liver function after LDLT with the use of right liver grafts from living donors with Gilbert syndrome. METHODS: Among 2,140 right liver transplantations performed from January 2002 to December 20113 at our institution, we identified 12 living donors (0...
December 2015: Transplantation Proceedings
Alpaslan Tanoglu, Tarik Artis, Ramazan Donmez, Ahmet Kargi, Mustafa Sit, Serdar Aslan, Serafettin Yazar, Yavuz Beyazit, Kamil Yalcin Polat
Liver transplantation (LT) has become a favorable therapeutic option for patients with end-stage liver diseases. Gilbert's syndrome (GS) is a benign condition characterized by intermittent mild jaundice due to unconjugated hyperbilirubinemia. It is not obvious whether living-donor liver transplantation (LDLT) from a donor with GS could result in a normal outcome for both the recipient and the donor. We aimed to determine whether right lobe hepatectomy is a safe procedure for living donors with GS and LT recipients...
November 2015: Clinical Transplantation
Yong Chen, Yanfeng Li, Xia Wang, Wei Zhang, Vanessa Sauer, Chan-Jung Chang, Bing Han, Tatyana Tchaikovskaya, Yesim Avsar, Edgar Tafaleng, Sanal Madhusudana Girija, Krisztina Tar, Zsuzsanna Polgar, Stephen Strom, Eric E Bouhassira, Chandan Guha, Ira J Fox, Jayanta Roy-Chowdhury, Namita Roy-Chowdhury
Hepatocyte transplantation has the potential to cure inherited liver diseases, but its application is impeded by a scarcity of donor livers. Therefore, we explored whether transplantation of hepatocyte-like cells (iHeps) differentiated from human induced pluripotent stem cells (iPSCs) could ameliorate inherited liver diseases. iPSCs reprogrammed from human skin fibroblasts were differentiated to iHeps, which were transplanted into livers of uridinediphosphoglucuronate glucuronosyltransferase-1 (UGT1A1)-deficient Gunn rats, a model of Crigler-Najjar syndrome 1 (CN1), where elevated unconjugated bilirubin causes brain injury and death...
July 14, 2015: Stem Cell Reports
Molly A Weingarten, Allison A Sande
OBJECTIVE: To define acute liver failure (ALF), review the human and veterinary literature, and discuss the etiologies and current concepts in diagnostic and treatment options for ALF in veterinary and human medicine. ETIOLOGY: In veterinary medicine ALF is most commonly caused by hepatotoxin exposure, infectious agents, inflammatory diseases, trauma, and hypoxic injury. DIAGNOSIS: A patient may be deemed to be in ALF when there is a progression of acute liver injury with no known previous hepatic disease, the development of hepatic encephalopathy of any grade that occurs within 8 weeks after the onset of hyperbilirubinemia (defined as plasma bilirubin >50 μM/L [>2...
July 2015: Journal of Veterinary Emergency and Critical Care
Laia Tolosa, Silvia López, Eugenia Pareja, María Teresa Donato, Anne Myara, Tuan Huy Nguyen, José Vicente Castell, María José Gómez-Lechón
Crigler-Najjar type 1 disease is a rare inherited metabolic disease characterized by high levels of unconjugated bilirubin due to the complete absence of hepatic uridine diphosphoglucuronate-glucuronosyltransferase activity. Hepatocyte transplantation (HT) has been proposed as an alternative treatment for Crigler-Najjar syndrome, but it is still limited by the quality and the low engraftment and repopulation ability of the cells used. Because of their attachment capability and expression of adhesion molecules as well as the higher proportion of hepatic progenitor cells, neonatal hepatocytes may have an advantage over adult cells...
June 2015: Liver Transplantation
Shozo Mori, Min-Su Park, Hyeyoung Kim, Youngrok Choi, Geun Hong, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh
The relationship between postoperative percentage fall of platelet (PLT) counts and graft dysfunction after living donor liver transplantation (LDLT) in recipients with small-for-size (SFS) graft has not been fully evaluated. We retrospectively studied 50 adult-to-adult LDLT recipients with a graft-to-recipient weight ratio of <0.8% between 1999 and 2011. Graft dysfunction was defined as the presence of hyperbilirubinemia, coagulopathy, or ascites on 3 consecutive days during the first postoperative week...
March 2015: International Surgery
Chandrashekhar A Kubal, Richard S Mangus, A Joseph Tector
Intestinal failure and associated parenteral nutrition-induced liver failure cause significant morbidity, mortality, and health care burden. Intestine transplantation is now considered to be the standard of care in patients with intestinal failure who fail intestinal rehabilitation. Intestinal failure-associated liver disease is an important sequela of intestinal failure, caused by parenteral lipids, requiring simultaneous liver-intestine transplant. Lipid minimization and, in recent years, the emergence of fish oil-based lipid emulsions have been shown to reverse parenteral nutrition-associated hyperbilirubinemia, but not fibrosis...
January 2015: Current Gastroenterology Reports
H Takamura, S Nakanuma, H Hayashi, H Tajima, K Kakinoki, M Kitahara, S Sakai, I Makino, H Nakagawara, T Miyashita, K Okamoto, K Nakamura, K Oyama, M Inokuchi, I Ninomiya, H Kitagawa, S Fushida, T Fujimura, I Onishi, M Kayahara, T Tani, K Arai, Taro Yamashita, Tatsuya Yamashita, H Kitamura, H Ikeda, S Kaneko, Y Nakanuma, O Matsui, T Ohta
Veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) occurring after liver transplantation is a relatively rare complication but it often takes a life-threatening course. However, the detailed etiology and mechanism of VOD/SOS after liver transplantation (LT) remains unclear. We report two cases with rapidly progressive VOD/SOS after ABO-identical LT resistant to various therapies. In case 1, in which the patient underwent deceased-donor LT, the first episode of acute allograft rejection was triggered VOD/SOS, and the presence of donor non-specific anti-HLA antibodies was confirmed...
December 2014: Transplantation Proceedings
Satheesh Nair, Shilpa Lingala, Sanjaya K Satapathy, James D Eason, Jason M Vanatta
OBJECTIVES: Severe cholestasis after liver transplant is common. In this study, our aim was to develop an algorithm to guide biliary intervention in these patients. MATERIALS AND METHODS: A retrospective review was performed on patients who had undergone a hepatobiliary scan, with or without subsequent endoscopic retrograde cholangiogram, during the immediate postoperative period. These findings were evaluated along with laboratory values to determine the benefit for this evaluative process...
December 2014: Experimental and Clinical Transplantation
Maya Koren-Michowitz, Hannah Maayan, Arie Apel, Noga Shem-Tov, Ronit Yerushalmi, Yulia Volchek, Abraham Avigdor, Avichai Shimoni, Arnon Nagler
Acute myeloid leukemia (AML) relapse is often associated with a poor outcome, especially after allogeneic stem cell transplantation (Allo-SCT). In patients relapsing early after SCT treatment, options are further limited by the fear for increased toxicity. We report our experience with ARA-C and gemtuzumab ozogamicin (GO) combination in relapsed post-SCT AML patients. Therapy consisted of ARA-C (1 gr/m(2)) for 4 days followed by one dose of GO 9 mg/m(2) on day 5 and was supported by donor stem cells when possible...
March 2015: Annals of Hematology
Yi-Chiao Cheng, Teng-Wei Chen, Hsiu-Lung Fan, Chih-Yung Yu, Heng-Cheng Chang, Chung-Bao Hsieh
BACKGROUND: Transarterial chemoembolization (TACE) can reduce tumor progression and help achieve good locoregional effect in hepatocellular carcinoma (HCC) patients with intrahepatic multiple recurrence (IHMR) after liver resection (LR). The effect of TACE on HCC patients with IHMR after liver transplantation (LT) remains unclear. The purpose of this study was to investigate the effect of TACE on IHMR after LR or LT. MATERIAL AND METHODS: This hospital-based retrospective study included 968 and 180 HCC patients who had undergone LR or LT, respectively, in the past decade...
2014: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Yukihiro Sanada, Taizen Urahashi, Yoshiyuki Ihara, Noriki Okada, Naoya Yamada, Yuta Hirata, Koichi Mizuta
BACKGROUND: Although endotoxin (Et) has been used as a biological index of bacterial infections, Et can also be used to evaluate liver functions because Et present in the portal vein blood is processed by the hepatic reticuloendothelial system. In the field of posttransplant management, it is important for liver transplant recipients to monitor the presence of posttransplant bacterial infections and graft liver functions because these results are directly correlated with a graft prognosis...
June 2015: European Journal of Pediatric Surgery
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