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Pediatric liver transplantation

Dong Jae Shim, Gi-Young Ko, Kyu-Bo Sung, Dong Il Gwon, Heung Kyu Ko
PURPOSE: To evaluate the long-term efficacy of stent placement versus balloon angioplasty for portal vein (PV) stenosis in pediatric liver transplant (LT) recipients. MATERIALS AND METHODS: Fifty patients (<18 years old; median, 14 months) who underwent percutaneous transhepatic balloon angioplasty (n = 12), transhepatic stent placement (n = 18), or intraoperative transmesenteric stent placement (n = 20) between 1994 and 2015 were retrospectively analyzed...
March 13, 2018: Journal of Vascular and Interventional Radiology: JVIR
Kazuaki Tokodai, Shigehito Miyagi, Chikashi Nakanishi, Yasuyuki Hara, Wataru Nakanishi, Koji Miyazawa, Kenji Shimizu, Keigo Murakami, Hironobu Sasano, Masafumi Goto, Michiaki Unno, Takashi Kamei
The aim of this study was to evaluate the significance of post-transplant DSA as a predictor of liver fibrosis during long-term follow-up after pediatric LT. We evaluated the histological findings in 18 LT recipients who underwent liver biopsy after DSA screening. Liver fibrosis was scored based on the METAVIR fibrosis staging. Patients were divided into 2 groups based on histological findings, and clinical characteristics among patients with liver fibrosis were assessed. Of 18 patients, 7 were included in the fibrosis group...
March 14, 2018: Pediatric Transplantation
Lara Danziger-Isakov, William J Steinbach, Grant Paulsen, Flor M Munoz, Leigh R Sweet, Michael Green, Marian G Michaels, Janet A Englund, Alastair Murray, Natasha Halasa, Daniel E Dulek, Rebecca Pellett Madan, Betsy C Herold, Brian T Fisher
Background: Respiratory virus infection (RVI) in pediatric solid organ transplant (SOT) recipients poses a significant risk; however, the epidemiology and effects of an RVI after pediatric SOT in the era of current molecular diagnostic assays are unclear. Methods: A retrospective observational cohort of pediatric SOT recipients (January 2010 to June 2013) was assembled from 9 US pediatric transplant centers. Charts were reviewed for RVI events associated with hospitalization within 1 year after the transplant...
March 10, 2018: Journal of the Pediatric Infectious Diseases Society
Toshihiro Yasui, Tatsuya Suzuki, Fujio Hara, Shunsuke Watanabe, Naoko Uga, Atsuki Naoe, Yasuhiro Kondo
OBJECTIVES: In pediatric patients, renal dysfunction after living-donor liver transplant is a major issue that is difficult to evaluate. Recently, predictive equations for Japanese children have been introduced. MATERIALS AND METHODS: We conducted a retrospective study by prospectively collecting data on 26 patients under 16 years old who underwent living-donor liver transplant between June 2004 and March 2015. Serum creatinine and cystatin C levels were measured...
March 9, 2018: Experimental and Clinical Transplantation
Ashley Suah, J Michael Millis, Adam S Bodzin
Congenital membranous occlusion of the inferior vena cava (IVC) in pediatric liver recipients may present with outflow occlusion and if unrecognized, result in graft loss. Prompt evaluation of outflow obstruction in the setting of unexplained inflow compromise is paramount. We report a case of successful IVC reconstruction in a patient with recurrent hepatic artery thrombosis (HAT). A 2-year-old child with history of two liver transplantations developed fevers, ascites, and abdominal tenderness one month after her second liver transplant...
February 2018: Hepatobiliary Surgery and Nutrition
S M Dehghani, I Shahramian, M Afshari, M Bahmanyar, M Ataollahi, A Sargazi
Background: Acute cellular rejection (ACR), a reversible process, can affect the graft survival. Objective: To evaluate the relation between ACR and clinical factors in recipients of allograft liver transplantation. Methods: 47 recipients of liver were consecutively enrolled in a retrospective study. Their information were retrieved from their medical records and analyzed. Results: Of the 47 recipients, 38 (81%) experienced acute rejection during 24 months of the transplantation...
2018: International Journal of Organ Transplantation Medicine
Rui Zhang, Zhi-Jun Zhu, Li-Ying Sun, Lin Wei, Wei Qu
Background: The outcome of pediatric deceased donor liver transplantation (LT) has not been well studied, especially pediatric deceased donor livers used in adult transplantation. This study aimed to evaluate the efficacy of LT using pediatric deceased donor livers and compare the outcomes between pediatric-to-pediatric LT and pediatric-to-adult LT. Methods: A retrospective review of LT using pediatric deceased donor livers from June 2013 to August 2016 was performed...
March 20, 2018: Chinese Medical Journal
Chetan Mandelia, Mohammad Nasser Kabbany, Praveen Kumar Conjeevaram Selvakumar, Naim Alkhouri
Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the obesity epidemic. Recent studies have clearly shown that the stage of fibrosis in adults with NAFLD is the most important histological feature in long-term outcomes and the development of liver-related complications. Despite the paucity of data regarding the natural history of pediatric NAFLD, its progression to cirrhosis and end-stage liver disease requiring liver transplantation is well documented. Given the high prevalence of NAFLD in children and adults, there is an urgent need to find safe and cost-effective alternatives to biopsy to determine the stage of liver fibrosis...
March 8, 2018: Biomarkers in Medicine
Karoly Toth, Jacqueline F Spencer, Baoling Ying, Ann E Tollefson, Caroll B Hartline, Eric T Richard, Jiajun Fan, Jinglei Lyu, Boris A Kashemirov, Cheryl Harteg, Dawn Reyna, Elke Lipka, Mark N Prichard, Charles E McKenna, William S M Wold
Human adenoviruses (AdV) cause generally mild infections of the respiratory and GI tracts as well as some other tissues. However, AdV can cause serious infection in severely immunosuppressed individuals, especially pediatric patients undergoing allogeneic hematopoietic stem cell transplantation, where mortality rates are up to 80% with disseminated disease. Despite the seriousness of AdV disease, there are no drugs approved specifically to treat AdV infections. We report here that USC-087, an N-alkyl tyrosinamide phosphonate ester prodrug of HPMPA, the adenine analog of cidofovir, is highly effective against multiple AdV types in cell culture...
March 3, 2018: Antiviral Research
Ellen Mitchell, Kathleen M Loomes, Robert H Squires, David Goldberg
BACKGROUND: Recent data has suggested that pediatric patients waitlisted for a liver transplant frequently have liver offers declined. However, factors associated with liver offer decisions and center-level variability in practice patterns have not been explored. METHODS: We evaluated UNOS data on all match runs from 5/10/07-12/31/15 in which: 1) the liver was offered to ≥1 pediatric patient; 2) the transplant recipient was ranked in the first 40 positions for the organ offer; and 3) the donor was brain-dead and <50 years of age...
March 5, 2018: Liver Transplantation
Anilawan Smitthimedhin, Angela Suarez, Ryan L Webb, Hansel J Otero
Intestinal malrotation is a continuum of congenital anomalies due to lack of rotation or incomplete rotation of the fetal intestine around the superior mesenteric artery axis. The abnormal bowel fixation (by mesenteric bands) or absence of fixation of portions of the bowel increases the risk of bowel obstruction, acute or chronic volvulus, and bowel necrosis. The clinical presentation of patients with malrotation without, with intermittent, or with chronic volvulus can be problematic, with an important minority presenting late or having atypical or chronic symptoms, such as intermittent vomiting, abdominal pain, duodenal obstruction, or failure to thrive...
March 3, 2018: Abdominal Radiology
Stephanie E Cordts, Lukas Schneble, Paul Schnitzler, Jürgen J Wenzel, Tobias Vinke, Susanne Rieger, Alexander Fichtner, Burkhard Tönshoff, Britta Höcker
BACKGROUND: Hepatitis E virus (HEV) infection in immunocompromised patients such as solid organ transplant recipients may bear a high risk of becoming a chronic infection with progression to liver cirrhosis. So far, data on HEV infection in pediatric renal transplant recipients are limited. METHODS: This single-center cohort study investigated period prevalence, morbidity, and treatment of HEV infection in 90 pediatric renal allograft recipients aged 9.9 ± 5...
March 2, 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
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
Dieter C Broering, Yasser Elsheikh, Mohammed Shagrani, Faisal Abaalkhail, Roberto I Troisi
INTRODUCTION: Left lateral sectionectomy for donor hepatectomy is a well-established alternative to deceased donor pediatric liver transplantation. However, very little is available on the laparoscopic approach (L-LLS). With the aim to assess safety, reproducibility under proctorship and outcomes following LDLT in children, a comparative single center series using the propensity score matching (PSM) to evaluate open (O-LLS) vs. L-LLS was carried out in a relatively short time period in a high volume pediatric transplant center...
February 28, 2018: Liver Transplantation
Gianni Biancofiore, Dana Rodica Tomescu, M Susan Mandell
A body of scientific studies has shown that early extubation is safe and cost-effective in a large number of liver transplant (LT) recipients including pediatric patients. However, fast-track practices are not universally accepted, and debate still lingers about whether these interventions are safe and serve the patients' best interest. In this article, we focus on reasons why physicians still have a persistent, although diminishing, reluctance to adopt fast-track protocols. We stress the importance of collection/analysis of perioperative data, adoption of a consensus-based standardized protocol for perioperative care, and formation of LT anesthesia focused teams and leadership...
February 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
C M Jaramillo-Esparza, A Consuelo-Sánchez, C P Acosta-Rodríguez-Bueno, G Ramón-García, S W Sadowinski-Pine, M A Escobar-Sánchez, I Castorena-Villa, F Gaytán-Morales, R Vázquez-Frias
INTRODUCTION AND AIMS: Graft-versus-host disease (GVHD) is a common multisystemic complication of allogeneic hematopoietic cell transplantation. The most frequent presentations of graft-versus-host disease involve the skin, the gastrointestinal tract, and the liver. The aim of the present study was to know the frequency of gastrointestinal tract and liver GVHD and the characteristics of disease presentation in pediatric patients that underwent hematopoietic stem cell transplantation (HSCT) at a tertiary care hospital center in Mexico City...
February 24, 2018: Revista de Gastroenterología de México
Akinari Fukuda, Seisuke Sakamoto, Kengo Sasaki, Soichi Narumoto, Toshihiro Kitajima, Yoshihiro Hirata, Tomoro Hishiki, Kasahara Mureo
Hepatic venous outflow obstruction (HVOO) can be a critical complication in pediatric living-donor liver transplantation (LDLT). The aim of this study was to evaluate a modified triangular technique of hepatic vein reconstruction for preventing HVOO in pediatric LDLT. METHODS: A total of 298 pediatric LDLTs were performed using a left lateral segment graft by two methods for reconstruction of the hepatic vein. In 177 recipients, slit-shaped anastomosis were indicated with partial clamp of the inferior vena cava (IVC)...
February 27, 2018: Pediatric Transplantation
Ida Giardino, Maria D'Apolito, Michael Brownlee, Angela Bruna Maffione, Anna Laura Colia, Michele Sacco, Pietro Ferrara, Massimo Pettoello-Mantovani
Chronic kidney disease in children is an irreversible process that may lead to end-stage renal disease. The mortality rate in children with end-stage renal disease who receive dialysis increased dramatically in the last decade, and it is significantly higher compared with the general pediatric population. Furthermore, dialysis and transplant patients, who have developed end-stage renal disease during childhood, live respectively far less as compared with age/race-matched populations. Different reports show that cardiovascular disease is the leading cause of death in children with end-stage renal disease and in adults with childhood-onset chronic kidney disease, and that children with chronic kidney disease are in the highest risk group for the development of cardiovascular disease...
December 2017: Türk Pediatri Arşivi
Eberhard Lurz, Claudia Quammie, Michael Englesbe, Estella M Alonso, Henry C Lin, Evelyn K Hsu, Katryn N Furuya, Nitika A Gupta, Veena L Venkat, James F Daniel, Mike A Leonis, Tamir Miloh, Grzegorz W Telega, Jason Yap, Jerome Menendez, Linda S Book, Ryan W Himes, Shikha S Sundaram, Rulan Parekh, Chris Sonnenday, John Bucuvalas, Vicky L Ng, Binita M Kamath
OBJECTIVE: To assess frailty, a measure of physiologic declines in multiple organ systems, in children with chronic liver disease using a novel pediatric frailty tool. STUDY DESIGN: We performed a prospective cross-sectional multicenter study at 17 liver transplantation (LT) centers. 71 children (5-17 years of age), 36 with compensated chronic liver disease (CCLD) and 35 with end-stage liver disease (ESLD) and listed for LT, were assessed for frailty using validated pediatric tools to assess the 5 classic Fried Frailty Criteria-slowness, weakness, exhaustion, diminished physical activity, and shrinkage...
March 2018: Journal of Pediatrics
Marek Szymczak, Piotr Kaliciński, Grzegorz Kowalewski, Dorota Broniszczak, Małgorzata Markiewicz-Kijewska, Hor Ismail, Marek Stefanowicz, Adam Kowalski, Joanna Teisseyre, Irena Jankowska, Waldemar Patkowski
OBJECTIVES: Living donor liver transplantation (LDLT) in patients with acute liver failure (ALF) has become an acceptable alternative to transplantation from deceased donors (DDLT). The aim of this study was to analyze outcomes of LDLT in pediatric patients with ALF based on our center's experience. MATERIAL AND METHODS: We enrolled 63 children (at our institution) with ALF who underwent liver transplantation between 1997 and 2016. Among them 24 (38%) underwent a LDLT and 39 (62%) received a DDLT...
2018: PloS One
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