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Hyperbilirubinemia after liver transplantation

Hans U Gerth, Michele Pohlen, Gerold Thölking, Hermann Pavenstädt, Marcus Brand, Christian Wilms, Anna Hüsing-Kabar, Dennis Görlich, Iyad Kabar, Hartmut H J Schmidt
BACKGROUND: The primary therapeutic goals in the treatment of liver injury are to support liver regeneration or bridge the gap to liver transplantation (LT). Molecular adsorbent recirculating system (MARS) therapy has shown beneficial effects for specific symptoms of liver failure; however, general survival advantages have not yet been demonstrated. AIM: We studied the effects of MARS therapy compared to standard medical treatment (SMT) in two patient cohorts: in patients with an acute liver injury and in those with graft dysfunction (GD)...
2017: PloS One
K B Sarici, S Karakas, E Otan, V Ince, C Koc, S Koc, H Bayraktar, C Aydin, C Kayaalp, S Gungor, Y Kablan, S Yilmaz
BACKGROUND: The outcome of medical treatment is worse in fulminant liver failure (FLF) developing on acute or chronic ground. Recently, liver transplantations with the use of living and cadaveric donors have been performed in these diseases and good results obtained. In this study, we aimed to present the factors affecting the recovery of cerebral functions after liver transplantation in hepatic encephalopathy (HE) developing in FLF, to identify irreversible patient groups and to prevent unnecessary liver transplantation...
April 2017: Transplantation Proceedings
Dong-Bo Wu, En-Qiang Chen, Lang Bai, Hong Tang
BACKGROUND: Antithyroid drugs carry a potential risk of hepatotoxicity. Propylthiouracil (PTU) is commonly prescribed for patients with hyperthyroidism. PTU, however, can induce liver injury, ranging from mild asymptomatic elevation of aminotransferases to acute liver failure (ALF). CASE PRESENTATION: This case reports on a 16-year-old Chinese girl with hyperthyroidism, who was admitted to our hospital for jaundice, nausea, and fatigue associated with severe hyperbilirubinemia and coagulopathy...
2017: Therapeutics and Clinical Risk Management
Roberto Gandini, Daniel Konda, Luca Toti, Sergio Abrignani, Stefano Merolla, Giuseppe Tisone, Roberto Floris
A 56-year-old male Patient presented 27 days after a liver transplantation (LT) with fever and hyperbilirubinemia. He underwent CT examination resulting in a diagnosis of right hepatic artery (HA) occlusion with hepatic bilomas. Once placed a long right femoral 6F introducer at the origin of the HA, a 0.014" guidewire was advanced over the thrombus, in a segmental branch. A 4MAX (Penumbra, Alameda, USA) catheter was advanced and withdrawn under constant aspiration until complete clot removal was achieved. Follow-up CT and D-US assessments at 12 months demonstrated regular HA patency and bilomas reduction...
December 28, 2016: Cardiovascular and Interventional Radiology
H Okabe, T Yoshizumi, T Ikegami, H Uchiyama, N Harimoto, S Itoh, K Kimura, H Baba, Y Maehara
Portal decompression is an approach for reducing portal overflow caused by small-for-size syndrome. We report the case of a patient who recovered from rapidly progressing hyperbilirubinemia caused by a small graft by decompressing portal overflow with splenic artery embolization following a living donor liver transplantation (LDLT). The patient was a 54-year-old man with end-stage liver disease secondary to alcoholic liver cirrhosis; the donor was his 54-year-old wife. The graft volume of the left lobe was 444 mL, which was 34...
November 2016: Transplantation Proceedings
Bailey E Sparks, Nicholas C Cavarocchi, Hitoshi Hirose
BACKGROUND: Liver dialysis, molecular adsorbent recirculating system (MARS) particularly, has been used in liver failure to bridge to transplantation. We expanded the indication for MARS to patients with acute shock liver failure and cardiopulmonary failure on extracorporeal membrane oxygenation (ECMO), aiming to improve survival to wean from ECMO. METHODS: Retrospective chart analysis of patients on ECMO between 2010 and 2015 found 28 patients who met the criteria for acute liver failure, diagnosed by hyperbilirubinemia (total bilirubin ≥10 mg/dl) or by elevated transaminase (alanine transaminase >1,000 IU/liter)...
January 2017: Journal of Heart and Lung Transplantation
Kazushige Sato, Yoshinobu Kobayashi, Atsushi Nakamura, Daizo Fukushima, Susumu Satomi
The cause of post-transplant CNI-NCs is multifactorial and not ascribed solely to CNI toxicity. A total of 90 children (aged <20 years) who underwent LDLT were evaluated to investigate the predictive factors associated with CNI-NCs. Twelve patients (13.3%) developed CNI-NCs after LDLT (age range, 2-15 years). The symptoms of CNI-NCs were seizures, VD, and stupor. The median onset of CNI-NCs was 10 days (range, 5-30 days) post-transplant. In the univariate analysis, higher recipient age at LDLT, donor age and recipient's BW, lower actual GV/SLV and TAC dosage/BW, and higher mean T-Bil and sodium level for 7 days after transplantation were independently significantly associated with TAC-NCs...
November 1, 2016: Pediatric Transplantation
Koichiro Haruki, Hiroaki Shiba, Junichi Shimada, Norimitsu Okui, Tomonori Iida, Katsuhiko Yanaga
Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication of solid organ transplantation. We herein report a case of PTLD after living-donor liver re-transplantation (reLDLT) for recurrent primary sclerosing cholangitis (PSC), for which complete response was achieved by surgical resection and rituximab. A 47-year-old man, who had undergone living-donor liver transplantation (LDLT) twice at age of 43 and 45 years for end-stage liver disease firstly for PSC and secondary for recurrent PSC, suffered liver dysfunction due to an acute cellular rejection (ACR) 17 months after reLDLT...
February 2017: Clinical Journal of Gastroenterology
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
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