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Liver transplantation for alcoholic liver disease

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World Journal of Gastroenterology 2010年第35期16卷 4377-4393页

作者： Vibha Varma Kerry Webb darius F mirza Liver Unit Queen Elizabeth HospitalUniversity Hospitals Birmingham

Alcoholic liver disease(ALD) is the second commonest indication for liver transplantation after viral hepatitis in the United States and *** surround the indications and allocation of scarce and expensive resource for this so called self inflicted *** stem from the apprehension that alcoholic recipients are likely to relapse and cause damage to the *** is a need to select those candidates with lower risk for relapse with the available predictive factors and *** abuse specialist and psychiatrists are mandatory in the pre-transplant evaluation and in the post-transplant *** is conflicting evidence to support a fixed period of pretransplant abstinence,although most units do follow *** hepatitis(AH) continues to be a contraindication for transplantation,however there is a need for further research in this f ield as a subset of patients with AH who do not respond to medical treatment,have high early mortality and could benefit from *** year,3-year,and 5-year survival post-transplant is similar for both ALD and non-ALD *** incidence of post-transplant rejection and retransplantation is also similar to other *** with viral hepatitis especially hepatitis C virus leads to a more aggressive liver disease with early presentation for *** patients are more prone to develop de-novo malignancy;this is attributed to the long term effect of alcohol,tobacco combined with ***-transplant surveillance is important to detect early relapse to alcoholism,presence of de-novo malignancy and treat the same adequately.

关键词： Alcoholic liver disease Orthotopic liver transplantation Pre-transplant abstine nce Acute alcoholic hepatitis De-novo malignancy Predictors of relapse Hepatitis C virus

Adefovir dipivoxil for the treatment of lamivudine-resistant hepatitis B mutants

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Hepatobiliary & Pancreatic Diseases International 2006年第1期5卷 154-156页

作者： Vincent Lai David Mutimer darius mirza Department of Liver Surgery

BACKGROUND: The recurrence of chronic hepatitis B after liver transplantation results in increased risk for graft failure and death of patients. Lamivudine has been shown to be effective in the treatment of chronic hepatitis B, but resistance to this agent is common after prolonged administration. METHODS: One patient with chronic hepatitis B virus (HBV) infection developed resistance to lamivudine after 15 months of treatment. The resistance was confirmed by mutation in the HBV DNA polymerase gene. The patient was treated subsequently with adefovir dipivoxil for 7 months. RESULT: HBV DNA and HBsAg were tested negative, but HBeAb and HBsAb were positive. CONCLUSION: This study provides an evidence that adefovir dipivoxil can be effective in the treatment of lamivudine-resistant HBV mutants.

关键词： adefovir dipivoxil hepatitis B virus liver transplantation lamivudine

Venous resection at pancreaticoduodenectomy can be safely performed in the presence of jaundice

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 488-491页

作者： Rupaly Pande James Hodson Ravi Marudanayagam darius mirza John Isaac Keith J Roberts HPB Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK Institute of Translational Medicine University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK Institute of Immunology and Immunotherapy University of BirminghamBirmingham B152THUK

Venous resection at pancreaticoduodenectomy(PD)has established itself as a viable treatment for borderline resectable cancer,with equivalent survival to those patients undergoing PD for cancer without venous resection[1].Thus surgery for these patients is clearly desirable,when possible,compared to palliative ***,there is concern and debate about the safety of venous resection at PD[2].There is a need to improve patient pathways,outcome and experience[3].To this end,in patients who present with jaundice,it is clear that surgery without preoperative biliary drainage(PBD)reduces complications[4].In 2015,our team introduced a‘fast track’program to routinely perform PD in the presence of jaundice[5].This change of practice has become routine,with most patients now undergoing surgery without *** is,however,unclear whether portal vein(PV)resection+PD is safe in the setting of *** aim of this study,therefore,was to compare outcomes and complications between patients with or without jaundice undergoing PD with associated resection of the superior mesenteric vein(SMV)and/or PV.

关键词： jaundice resection routine

Ventilation after pancreaticoduodenectomy increases perioperative mortality: Identification of risk factors and their relevance in Germany that do not apply in England

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Hepatobiliary & Pancreatic Diseases International 2019年第4期18卷 379-388页

作者： Rieke-Sophie Homeyer Keith JRoberts Robert P Sutcliffe Alexander Kaltenborn darius mirza Zhi Qu Jurgen Klempnauer Harald Schrem Core Facility Quality Management Transplantation Integrated Research and Treatment Center Transplantation(IFB-Tx)Hannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany General Visceral and Transplant SurgeryHannover Medical SchoolCarl-Neuberg-Str.130625 HannoverGermany Department of HPB Surgery Queen Elizabeth Hospital BirminghamMindelsohn Way EdgbastonBirmingham B15 2GWUnited Kingdom Department of General Visceral and Transplant SurgeryMedical University GrazAuenbrugger Platz 58036 GrazAustria

Background:Pre-operative risk factors for post-operative ventilation and their influence on survival after pancreaticoduodenectomy for malignancy are ***:Totally 391 patients operated in Hannover,Germany were investigated with multivariable logistic regression and Cox regression modeling to identify independent risk factors for post-operative ventilation≥6 h,patient survival and 90-day *** 84 patients operated in Birmingham,United Kingdom were analyzed to assess the external relevance of ***:Longer operations,history of thrombosis,intra-operative blood transfusion,lower estimated glomerular filtration rates(eGFR)and higher values of the age at operation divided by the Horovitz Quotient independently increased the risk of post-operative ventilation≥6 h in German patients(n=108;27.6%)(P75 years,had a history of thrombosis,received blood transfusions,and had significantly worse lung function ***4 tumors were detected in 18 German patients(4.6%),but not in the English ***:Identified risk factors for post-operative ventilation are clinically relevant in Germany but not in England and may be used to lower mortality *** German and the English cohorts displayed significant differences in the approach to patient selection and early post-operative extubation.

关键词： Pancreatic cancer Cholangiocellular carcinoma Periampullary carcinoma Comorbidity Outcome

Mechanisms of autophagy activation in endothelial cell and their targeting during normothermic machine liver perfusion

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World Journal of Gastroenterology 2017年第48期23卷 8443-8451页

作者： Yuri L Boteon Richard Laing Hynek Mergental Gary M Reynolds darius F mirza Simon C Afford Ricky H Bhogal The Liver Unit University Hospitals of BirminghamMindelsohn Way The Centre for Liver Research Institute for Biomedical ResearchUniversity of Birmingham

Ischaemia-reperfusion injury(IRI) is the leading cause of injury seen in the liver following transplantation. IRI also causes injury following liver surgery and haemodynamic shock. The first cells within the liver to be injured by IRI are the liver sinusoidal endothelial cells(LSEC). Recent evidence suggests that LSEC coordinate and regulates the livers response to a variety of injuries. It is becoming increasingly apparent that the cyto-protective cellular process of autophagy is a key regulator of IRI. In particular LSEC autophagy may be an essential gatekeeper to the development of IRI. The recent availability of liver perfusion devices has allowed for the therapeutic targeting of autophagy to reduce IRI. In particular normothermic machine liver perfusion(NMP-L) allow the delivery of pharmacological agents to donor livers whilst maintaining physiological temperature and hepatic flow rates. In this review we summarise the current understanding of endothelial autophagy and how this may be manipulated during NMP-L to reduce liver IRI.

关键词： Autophagy Liver transplant Ischaemiareperfusion injury Normothermic machine liver perfusion

Incidental gallbladder cancer diagnosis confers survival advantage irrespective of tumour stage and characteristics

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World Journal of Gastroenterology 2022年第18期28卷 1996-2007页

作者： Moath Alarabiyat Syed Soulat Raza John Isaac darius mirza Ravi Marudanayagam Keith Roberts Manuel Abradelo David C Bartlett Bobby V Dasari Robert P Sutcliffe Nikolaos A Chatzizacharias HPB and Liver Transplant Unit Queen Elizabeth HospitalBirmingham B152GWUnited Kingdom Department of HPB and Liver Transplantation Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152THUnited Kingdom

BACKGROUND Incidental gallbladder cancer(IGBC)represents 50%-60%of gallbladder cancer *** are conflicting on the role of IGBC diagnosis in oncological *** studies suggest that IGBC diagnosis does not affect outcomes,while others that overall survival(OS)is longer in these cases compared to non-incidental diagnosis(NIGBC).Furthermore,some studies reported early tumour stages and histopathologic characteristics as possible confounders,while others *** To investigate the role of IGBC diagnosis on patients’overall survival,especially after surgical treatment with curative *** Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary *** comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was *** analysis for the whole cohort,surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank *** analysis was performed with univariable and multivariable Cox regression *** The cohort included 261 patients with gallbladder cancer.65%of cases had NIGBC and 35%had IGBC.A total of 90 patients received surgical treatment(66%of IGBC cases and 19%of NIGBC cases).NIGBC patients had more advanced T stage and required more extensive resections than IGBC *** was longer in patients with IGBC in the whole cohort(29 vs 4 mo,P<0.001),as well as in the non-surgical(14 vs 2 mo,P<0.001)and surgical subgroups(29 vs 16.5 mo,P=0.001).Disease free survival(DFS)after surgery was longer in patients with IGBC(21.5 mo vs 8.5 mo,P=0.007).N stage and resection margin status were identified as independent predictors of OS and *** diagnosis was identified as an independent predictor of *** IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour *** studies are required to further investigate this,including detailed

关键词： Gallbladder cancer Incidental gallbladder cancer Non-incidental gallbladder cancer Gallbladder cancer survival

Para-aortic lymph node involvement should not be a contraindication to resection of pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 429-441页

作者： Rupaly Pande Shafiq Chughtai Manish Ahuja Rachel Brown David C Bartlett Bobby V Dasari Ravi Marudanayagam darius mirza Keith Roberts John Isaac Robert P Sutcliffe Nikolaos A Chatzizacharias Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of Pathology University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom

BACKGROUND Para-aortic lymph nodes(PALN)are found in the aortocaval groove and they are staged as metastatic disease if involved by pancreatic ductal adenocarcinoma(PDAC).The data in the literature is conflicting with some studies having associated PALN involvement with poor prognosis,while others not sharing the same *** resection is not included in the standard lymphadenectomy during pancreatic resections as per the International Study Group for Pancreatic Surgery and there is no consensus on the management of these *** To investigate the prognostic significance of PALN metastases on the oncological outcomes after resection for *** This is a retrospective cohort study of data retrieved from a prospectively maintained database on consecutive patients undergoing pancreatectomies for PDAC where PALN was sampled between 2011 and *** comparison of the data between PALN+and PALN-subgroups,survival analysis with the Kaplan-Meier method and risk analysis with univariable and multivariable time to event Cox regression analysis were performed,specifically assessing oncological outcomes such as median overall survival(OS)and disease-free survival(DFS).RESULTS 81 cases had PALN sampling and 17(21%)were *** N stage was significantly different between PALN+and PALN-patients(P=0.005),while no difference was observed in any of the other *** imaging diagnosed PALN positivity in one *** and DFS were comparable between PALN+and PALN-patients with lymph node positive disease(OS:13.2 mo vs 18.8 mo,P=0.161;DFS:13 mo vs 16.4 mo,P=0.179).No difference in OS or DFS was identified between PALN positive and negative patients when they received chemotherapy either in the neoadjuvant or in the adjuvant setting(OS:23.4 mo vs 20.6 mo,P=0.192;DFS:23.9 mo vs 20.5 mo,P=0.718).On the contrary,when patients did not receive chemotherapy,PALN disease had substantially shorter OS(5.5 mo vs 14.2 mo;P=0.015)and DFS(4.4 mo

关键词： Para-aortic lymph node Pancreatectomy Survival Pancreatic adenocarcinoma Chemotherapy Lymph node sampling

Late post liver transplant protein losing enteropathy: Rare complication of incisional hernia

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World Journal of Gastroenterology 2013年第27期19卷 4409-4412页

作者： Jonathan D Evans M Thamara PR Perera CY Pal James Neuberger darius F mirza The Liver Unit The Queen Elizabeth Hospital

Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.

关键词： Protein losing enteropathies Bacterial overgrowth Hypoproteinaemia Incarcerated hernia Liver transplantation.

Associated Factors with Early Sexual Intercourse among In-School Adolescents in Brazzaville

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Open Journal of Pediatrics 2024年第5期14卷 898-907页

作者： Aymar Pierre Gildas Oko Dumez Ngoma Judicaël Kambourou Eryx darius Mbou Essie Neli Yvette Ngakengni Lynda Tchidjo Ngamo Georges Marius Moyen Faculty of Health Sciences Marien Ngouabi University of Brazzaville Brazzaville Congo Department of Pediatrics Teaching Hospital Center of Brazzaville Brazzaville Congo

Background: Early sexual intercourse (ESI) is a global public health problem. In Congo, associated factors with ESI have been under-studied. Objective: To analyse factors associated with early sexual intercourse among in-school adolescents in Brazzaville. Method: A cross-sectional analytic study with three-stage random sampling was carried out from March 2 to June 2, 2022 in Brazzaville secondary and high schools. Adolescents in the selected schools were interviewed about their sexual and social behaviour, and their family and school environment. Multivariate analysis using logistic regression was used to identify factors associated with ESI. The significance level of the p-value was set at 5% and the confidence interval at 95%. Results: Of a total of 1100 adolescents surveyed, 800 (72.7%) had ESI, 98% of them were female. The main reason for early initiation of sexual intercourse was curiosity (81.8%). Non-use of condoms and multiple sexual partnerships were noted respectively in 98.7% and 68.7% of adolescents who had experienced ESI. Female gender (p Conclusion: The prevalence of ESI is high, and the factors identified in this study may help to reduce it.

关键词： Associated Factors Early Sex Adolescents Brazzaville