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Post-transplant immunosuppression and COVID-19:From a double whammy to a mixed blessing

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World Journal of Transplantation 2020年第9期10卷 267-276页

作者： ashwin rammohan The Institute of Liver Disease and Transplantation Dr.Rela Institute and Medical CentreChennai 600044India

The coronavirus pandemic(COVID-19)has had an unprecedented effect on various disease processes and their ***-19 is likely to have a complex pathophysiological interplay with the post-transplant patients;one affecting the clinical course and outcome of the *** the absence of validated data from trials,there is strong dependence on experience based on previous similar epidemics(SARS/MERS),and from consensus based on expert *** the fact that our knowledge is rapidly evolving with time,there still is relatively limited objective data on the effect of COVID-19 on the human *** questions remain unanswered,one of which involves the management of immunosuppression in the post-transplant recipient during this *** core tenet of which continues to be that of establishing an equipoise between infection and *** review summarises the current knowledge on immune interactions of the virus,the immunomodulatory effects that may be at play,and its relation to the art of immunosuppression.

关键词： COVID-19 Post-transplant immunosuppression Immunity Review

Robotic donor hepatectomy:Are we there yet?

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World Journal of Gastrointestinal Surgery 2021年第7期13卷 668-677页

作者： ashwin rammohan Mohamed Rela Institute of Liver Disease&Transplantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education&ResearchChennai 600044India

In living donor liver transplantation(LDLT)the safety of the live donor(LD)is of paramount *** all efforts,the morbidity rates approach 25%-40%with conventional open donor hepatectomy(DH)***,most of these complications are related to the operative wound and despite increased selfesteem and satisfaction in various quality of life analyses on LD,the most common grievance is that of the *** safe and precise DH through a conventional laparoscopic approach is a formidable task with a precipitous learning curve for the whole *** to the ramifications the donor operation carries for the donor,the recipient,the transplant team and for the LDLT program in general,the development and acceptance of minimally invasive DH(MIDH)has been *** robotic surgical system overcomes the reduced visualization,restricted range of motion and physiological tremor associated with laparoscopic surgery and allows for a comparatively easier transition from technical feasibility to ***,many questions especially with regards to standardization of surgical technique,comparison of outcomes,understanding of the learning curve,*** *** aim of this review is to provide insights into the evolution of MIDH and highlight the current status of robotic DH,appreciating the existing challenges and its future role.

关键词： Liver transplantation Donor hepatectomy Minimal invasive surgery Robotic surgery Outcomes

Current perspectives on the role of liver transplantation for Langerhans cell histiocytosis:A narrative review

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World Journal of Gastroenterology 2022年第30期28卷 4044-4052页

作者： Jagadeesh Menon ashwin rammohan Mukul Vij Naresh Shanmugam Mohamed Rela Institute of Liver Disease&Transplantation Dr.Rela Institute&Medical CentreBharath Institute of Higher Education&ResearchChennai 600044India

Langerhans cell histiocytosis(LCH)is a malignant disease of the histiocytes involving various organ *** spectrum of liver involvement in LCH ranges from mild transaminitis to end-stage liver *** hallmark of hepatic LCH is secondary sclerosing cholangitis,which manifests due to a progressive destruction of the biliary tree by malignant *** remains the mainstay of treatment for active *** recognition,diagnosis and a systematic approach to the management of LCH can ameliorate the disease ***,the liver involvement in these patients may progress despite the LCH being in *** transplantation(LT)remains central in the management of such *** facets of the management of LCH,especially those with liver involvement remain ***,aspects of LT in LCH with regards to the indication,timing and post-LT management,including immunosuppression and adjuvant therapy,remain *** review summarises the current evidence and discusses the practical aspects of the role of LT in the management of LCH.

关键词： Langerhans cell histiocytosis Liver transplantation Outcomes Management Chemotherapy Ethics

Long-term liver allograft fibrosis:A review with emphasis on idiopathic post-transplant hepatitis and chronic antibody mediated rejection

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World Journal of Hepatology 2022年第8期14卷 1541-1549页

作者： Mukul Vij ashwin rammohan Mohamed Rela Department of Pathology Dr.Rela Institute and Medical CenterChennai 600044Tamil NaduIndia Institute of Liver disease and Transplantation Dr.Rela Institute and Medical CenterChennai 600044Tamil NaduIndia

Liver transplantation(LT)is a life-saving surgical procedure and the current standard of care for most patients with end stage liver *** improvements in organ preservation techniques,perioperative care,and immunosuppression,there is better patient and graft survival following LT,and assessment of the liver allograft in long-term survivors is becoming increasingly *** or de novo viral or autoimmune injury remains the most common causes of chronic hepatitis and fibrosis following liver transplantation in ***,no obvious cause can be identified in many adults with controlled recurrent disease and the majority of pediatric LT recipients,as they have been transplanted for non-recurrent liver *** surveillance liver biopsies post LT have been evaluated in several adult and pediatric centers to identify long-term pathological *** findings are frequently present in liver biopsies obtained after a year post *** significance of these findings is uncertain as many of these are seen in protocol liver biopsies from patients with clinically good allograft function and normal liver chemistry *** narrative review summaries the factors predisposing to long-term liver allograft fibrosis,highlighting the putative role of idiopathic post-LT hepatitis and chronic antibody mediated rejection in its pathogenesis.

关键词： Liver allograft fibrosis Long term Idiopathic hepatitis Chronic antibody mediated rejection

Pathological,molecular,and clinical characteristics of cholangiocarcinoma:A comprehensive review

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World Journal of Gastrointestinal Oncology 2022年第3期14卷 607-627页

作者： Mukul Vij Yogesh Puri ashwin rammohan Gowripriya G Rajesh Rajalingam Ilankumaran Kaliamoorthy Mohamed Rela Department of Pathology Dr Rela Institute and Medical centerChennai 600044Tamil NaduIndia Institute of Liver Disease and Transplantation Dr Rela Institute and Medical CenterChennai 600044Tamil NaduIndia

Cholangiocarcinomas are a heterogeneous group of highly aggressive cancers that may arise anywhere within the biliary *** is a wide geographical variation with regards to its incidence,and risk-factor associations which may include liver fluke infection,primary sclerosing cholangitis,and hepatolithiasis amongst *** tumours are classified into intrahepatic,perihilar and distal based on their anatomical ***,intrahepatic cholangiocarcinomas are further sub-classified into small and large duct *** and distal cholangiocarcinomas are usually mucin-producing tubular *** develop through a multistep carcinogenesis and are preceded by dysplastic and in situ *** clinical characteristics and management of these tumours have been extensively elucidated in literature,their ultra-structure and tumour biology remain relatively *** review focuses on the current knowledge of pathological characteristics,molecular alterations of cholangiocarcinoma,and its precursor lesions(including biliary intraepithelial neoplasia,intraductal papillary neoplasms of the bile duct,intraductal tubulopapillary neoplasms and mucinous cystic neoplasm).

关键词： Cholangiocarcinoma Classification Pathology Molecular features Precursors lesions Treatment

Non-invasive real-time assessment of hepatic macrovesicular steatosis in liver donors:Hypothesis,design and proof-of-concept study

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World Journal of Hepatology 2021年第10期13卷 1208-1214页

作者： Allwyn S Rajamani ashwin rammohan VV Raghavendra Sai Mohamed Rela Department of Applied Mechanics Indian Institute of Technology MadrasChennai 600036India Institute of Liver Disease and Transplantation Dr.Rela Institute and Medical CentreBharath Institute of Higher Education and ResearchChennai 600044India

Macrovesicular Steatosis(MS)is an independent risk factor for adverse post-liver transplant(LT)*** degree of MS is intimately related to the viability of the liver graft,which in turn is crucial to the success of the *** ideal liver graft should have no MS and most centres would find it unacceptable to use a donor liver with severe MS for *** a formal liver biopsy is the goldstandard diagnostic test for MS,given the logistical and time constraints it is not universally *** tests like a frozen section biopsy are plagued by issues of fallibility with reporting and sampling bias making them inferior to a liver ***,the development of an accurate,non-invasive,easy-to-use,handheld,real-time device for quantification of MS would fill this lacuna in the deceased donor selection *** present the hypothesis,design and proof-ofconcept of a study,which aims to standardise and determine the feasibility and accuracy of a novel handheld device applying the principle of diffuse reflectance spectroscopy for real-time quantification of MS.

关键词： Macrovesicular steatosis Deceased donors Liver transplantation Real-time devices Diffuse reflectance spectroscopy

Post-COVID-19 cholangiopathy:Current understanding and management options

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World Journal of Gastrointestinal Surgery 2023年第5期15卷 788-798页

作者： Fadl H Veerankutty Kushan Sengupta Mukul Vij ashwin rammohan Dinesh Jothimani Ananthavadivelu Murali Mohamed Rela Institute of Liver Disease and Transplantation Dr.Rela Institute and Research CentreChennai 600044India Institute of Liver Disease and Transplantation Dr.Rela Institute and Medical CentreChennai 600044India Department of Pathology Institute of Liver Disease and TransplantationChennai 600044India Gastroenterology and Hepatology Clinician’s PointChennai 600014Tamil NaduIndia

Post-coronavirus disease 2019(COVID-19)cholangiopathy(PCC)is a rare but lifethreatening complication of COVID-19 *** typically presents when patients recovering from the contagion and manifests as cholestasis in patients with no history of pre-existing liver *** pathogenesis of PCC is little *** injury in PCC could be mediated by the predilection of severe acute respiratory syndrome coronavirus 2 for *** PCC shows some resemblance to secondary sclerosing cholangitis in critically ill patients,it is considered as a separate and unique entity in the *** treatment options like ursodeoxycholic acid,steroids,plasmapheresis,and endoscopic retrograde cholangiopancreatography guided interventions have been tried but with limited *** have noticed significant improvement in liver function with antiplatelet therapy in a couple of *** can progress to end-stage liver disease necessitating liver *** this article,we discuss the current knowledge of PCC focusing on its pathophysiology,clinical manifestations,and management strategies.

关键词： COVID-19 Liver Post-COVID-19 syndrome Long haulers Cholangiopathy Cholestasis

Pediatric metabolic liver diseases:Evolving role of liver transplantation

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World Journal of Transplantation 2021年第6期11卷 161-179页

作者： Jagadeesh Menon Mukul Vij Deepti Sachan ashwin rammohan Naresh Shanmugam Ilankumaran Kaliamoorthy Mohamed Rela Institute of Liver Disease and Transplantation Dr Rela Institute and Medical CenterChennai 600044Tamil NaduIndia Department of Pathology Dr Rela Institute and Medical CenterChennai 600044Tamil NaduIndia Department of Transfusion Medicine Dr Rela Institute and Medical CenterChennai 600044Tamil NaduIndia

Metabolic liver diseases(MLD)are the second most common indication for liver transplantation(LT)in *** is based on the fact that the majority of enzymes involved in various metabolic pathways are present within the liver and LT can cure or at least control the disease *** is also performed in metabolic disorders for end-stage liver disease,its sequelae including hepatocellular *** is also performed for preventing metabolic crisis’,arresting progression of neurological dysfunction with a potential to reverse symptoms in some cases and for preventing damage to end organs like kidneys as in the case of primary hyperoxalosis and methyl malonic *** findings in explant liver with patients with metabolic disease include unremarkable liver to steatosis,cholestasis,inflammation,variable amount of fibrosis,and *** outcome of LT in metabolic disorders is excellent except for patients with mitochondrial disorders where significant extrahepatic involvement leads to poor outcomes and hence considered a contraindication for LT.A major advantage of LT is that in the post-operative period most patients can discontinue the special formula which they were having prior to the transplant and this increases their well-being and improves growth *** partial orthotopic LT has been described for patients with noncirrhotic MLD where a segmental graft is implanted in an orthotopic position after partial resection of the native *** retained native liver can be the potential target for future gene therapy when it becomes a clinical reality.

关键词： Liver transplantation Metabolic liver disease Tyrosinemia Wilson disease Glycogen storage diseases Urea cycle disorders Pathology Auxiliary liver transplant

Incidental gall bladder cancers:Are they truly incidental?

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World Journal of Gastrointestinal Oncology 2014年第12期6卷 441-443页

作者： ashwin rammohan Sathya D Cherukuri Jeswanth Sathyanesan Ravichandran Palaniappan Manoharan Govindan The Institute of Surgical Gastroenterology and Liver Transplantation Centre for GI Bleed Division of HPB diseases Stanley Medical College Hospital Stanley Medical College Hospital

AIM: To seek and analyze features suggestive of gallbladder cancer(GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC(IGBC). METHODS: The study was conducted on 79 patients of IGBC managed in our department over a 10-year period(2003-2012). Review of preoperative imaging and operative notes was done to ascertain any suspicion of ***: Of the 79 patients, Ultrasound abdomen showed diffuse thickening, not suspicious of malignancy in 5 patients, and diffuse suspicious thickening was seen in 4 patients. Focal thickening suspicious of malignancy was present in 24 patients. Preoperative computed tomography/magnetic resonance imaging was done in 9 patients for suspicion of malignancy. In 5 patients, dif-ficult Cholecystectomy was encountered due to dense/inflammatory adhesions. Intraoperative findings showed focal thickening of the gallbladder and a gallbladder mass in 9 and 17 patients respectively. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. In 42(53.2%) patients, there was no evidence suggestive of malignancy and was an unanticipated ***: Our study highlights a potential and not-so-rare pitfall of Laparoscopic Cholecystectomy. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, especially in endemic areas may avert avoidable patient morbidity and mortality.

关键词： Incidental gallbladder cancer Preoperative detection Imaging