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Protecting kidneys in liver transplant patients:A pathway to preventive interventions

world Journal of Hepatology 2018年第9期10卷 637-638页

作者： Lena Sibulesky scott w biggins Raimund Pichler Division of Transplant Surgery Department of SurgeryUniversity of WashingtonSeattle Division of Gastroenterology and Hepatology Department of MedicineUniversity of Washington Division of Nephrology Department of MedicineUniversity of WashingtonSeattle

Acute kidney injury(AKI) is a frequent postoperative complication after liver transplantation. The etiology is multifactorial,including perioperative renal status,surgery related events,and postoperative immunosuppression therapy. The role of renal hypoperfusion and hepatic ischemia-reperfusion injury as causes of early AKI are now being increasingly recognized. Further studies should focus on therapies that would attenuate this injury.

关键词： Acute kidney injury Liver transplantation Hepatic ischemia-reperfusion injury Marginal grafts Small interfering ribonucleic acid

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Acute liver failure secondary to acute antibody mediated rejection after compatible liver transplant: A case report

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world Journal of Hepatology 2022年第1期14卷 287-294页

作者： Todd J Robinson James B Hendele Idoia Gimferrer Nicolae Leca scott w biggins Jorge D Reyes Lena Sibulesky Department of Surgery Virginia MasonSeattleWA 98101United States Department of Surgery University of Washington Medical CenterSeattleWA 98195United States Bloodworks Northwest SeattleWA 98104United States Department of Nephrology University of Washington Medical CenterSeattleWA 98195United States Department of Gastroenterology and Hepatology University of Washington Medical CenterSeattleWA 98195United States

BACKGROUND The liver has traditionally been regarded as resistant to antibody-mediated rejection(AMR).AMR in liver transplants is a field in its infancy compared to kidney and lung *** our case we present a patient with alpha-1-antitrypsin disease who underwent ABO compatible liver transplant complicated by acute liver failure(ALF)with evidence of antibody mediated rejection on allograft biopsy and elevated serum donor-specific antibodies(DSA).This case highlights the need for further investigations and heightened awareness for timely *** SUMMARY A 56 year-old woman with alpha-1-antitrypsin disease underwent ABO compatible liver transplant from a deceased *** recipient MELD at the time of transplant was *** flow cytometric crossmatches were noted to be positive for T and B *** patient had an uneventful recovery *** on postoperative day 5 the patient developed fevers,elevated liver function tests,distributive shock,renal failure,and hepatic *** went into ALF with evidence of antibody mediated rejection with portal inflammation,bile duct injury,endothelitis,and extensive centrizonal necrosis,and C4d staining on allograft biopsy and elevated *** various interventions including plasmapheresis and immunomodulating therapy,she continued to *** was relisted and successfully underwent liver *** This very rare case highlights AMR as the cause of ALF following liver transplant requiring retransplantation.

关键词： Liver transplant Acute antibody mediated rejection Acute liver failure Donor specific antibody Liver rejection Case report

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