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Intensive care unit readmission in adult Egyptian patients undergoing living donor liver transplant:A single-centre retrospective cohort study

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World Journal of Hepatology 2022年第6期14卷 1150-1161页

作者： Manar Salah Iman Fawzy Montasser Hanaa A El Gendy Alaa A Korraa Gamal M Elewa Hany Dabbous Hossam R Mahfouz Mostafa Abdelrahman Mohammed Hisham Goda Mohamed Mohamed Bahaa El-Din Mahmoud El-Meteini Heba A Labib Department of Tropical Medicine Ain Shams Center for Organ TransplantationAin Shams UniversityCairo 11566Egypt Department of Anaesthesia and Critical Care Ain Shams Centre for Organ TransplantationAin Shams UniversityCairo 11566Egypt Department of General Surgery and liver transplantation Ain Shams Centre for Organ TransplantationAin Shams UniversityCairo 11566Egypt

BACKGROUND Patients who undergo living donor liver transplantation(LDLT)may suffer complications that require intensive care unit(ICU)*** To identify the incidence,causes,and outcomes of ICU readmission after *** A retrospective cohort study was conducted on patients who underwent *** collected data included patient demographics,preoperative characteristics,intraoperative details;postoperative stay,complications,causes of ICU readmission,and *** were divided into two groups according to ICU readmission after hospital *** factors for ICU readmission were identified in univariate and multivariate *** The present study included 299 ***-one(10.4%)patients were readmitted to the ICU after *** who were readmitted to the ICU were older in age(53.0±5.1 vs 49.4±8.8,P=0.001)and had a significantly higher percentage of women(29%vs 13.4%,P=0.032),diabetics(41.9%vs 24.6%,P=0.039),hypertensives(22.6%vs 6.3%,P=0.006),and renal(6.5%vs 0%,P=0.010)patients as well as a significantly longer initial ICU stay(6 vs 4 d,respectively,P<0.001).Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age(OR=1.048,95%CI=1.005-1.094,P=0.030)and length of initial hospital stay(OR=0.836,95%CI=0.789-0.885,P<0.001).CONCLUSION The identification of high-risk patients(older age and shorter initial hospital stay)before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.

关键词： Intensive care units liver transplantation Patient readmission Risk factors

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Biliary cast syndrome:literature review and a single centre experience in liver transplant recipients

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Hepatobiliary & Pancreatic Diseases International 2008年第3期7卷 300-303页

作者： Narasimhaiah Srinivasaiah Mettu Srinivas Reddy Schlok Balupuri David Talbot Bryon Jaques Derek Manas Department of Hepatobiliary&transplant Surgery Freeman HospitalFreeman RoadHigh HeatonNewcastle- upon-TyneNE7 7DNUK

BACKGROUND:Biliary cast syndrome(BCS)is an unusual complication of orthotopic liver transplantation (OLTx),and its management is *** success using endoscopic retrograde cholangiopancreatography (ERCP)or open exploration to clear casts has been reported, but failure usually results in *** aimed to review our experience with BCS and highlight a novel combined percutaneous and endoscopic approach for duct clearance.A brief review of the literature is given. METHODS:We retrospectively reviewed our experience of managing BCS using case notes *** were also gathered from radiology,where interventional procedures were carried out. RESULTS:We had a total of three cases of BCS reported between 2002 and *** attempts were made to remove these *** three were treated in a variety of *** is discussed along with highlighting a novel combined percutaneous and endoscopic approach for duct clearance. CONCLUSIONS:BCS is a potential complication of OLTx. Surgical and endoscopic methods of removing casts are ***,in circumstances where these methods are technically difficult,a percutaneous endoscopic approach with serial dilatation of the cutaneous port and surgical removal of casts can be done.

关键词： liver transplantation biliary cast syndrome endoscopic retrograde cholangiopancreatography

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Diuretic window hypothesis in cirrhosis: Changing the point of view

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World Journal of Gastroenterology 2019年第26期25卷 3283-3290页

作者： Anderson Brito-Azevedo liver transplant Unit S?o Lucas Hospital liver transplant Unit S?o Francisco na Providência de Deus Hospital liver transplant Unit Adventist Silvestre Hospital

Since the 1970s,non-selective beta-blockers(NSBB)have been used to prevent variceal upper bleeding in advanced cirrhotic ***,several recent studies have raised the doubt about the benefit of NSBB in end-stage cirrhotic *** fact,they suggested a detrimental effect in these patients that even reduced *** of these studies have been assembled to compose the“window therapy hypothesis”,in which NSBB would have traditional indication to be initiated to prevent variceal upper bleeding;however,treatment should be stopped(or not be initiated)in patients with end-stage *** would reduce the cardiac reserve of these patients,worsening systemic perfusion and ***,it should be emphasized that these studies present important bias issues,and their results also suggested that diuretic treatment may also be behind the effects *** this opinion review,we changed the point of view from NSBB to diuretic treatment,based on a physiopathogenic approach of circulatory parameters of cirrhotic patients studied,and based on diuretic effect in blood pressure lowering and in other hypervolemic disease,as heart *** suggest a“diuretic window hypothesis”,composed by an open window in hypervolemic phase,an attention window when patient present in a normal plasma volume phase,and a closed window during the plasma hypovolemic phase.

关键词： Cirrhosis Non-selective beta-blockers Diuretic Window hypothesis Baveno Cardiac output

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Complex liver retransplantation to treat graft loss due to long-term biliary tract complication after liver transplantation: A case report

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World Journal of Clinical Cases 2020年第3期8卷 568-576页

作者： Jiang Li Qing-Jun Guo Wen-Tao Jiang Hong Zheng Zhong-Yang Shen Department of liver transplant Tianjin First Central Hospital

BACKGROUND Loss of graft function after liver transplantation(LT) inevitably requires liver retransplant. Retransplantation of the liver(Re LT) remains controversial because of inferior outcomes compared with the primary orthotopic LT(OLT).Meanwhile, if accompanied by vascular complications such as arterial and portal vein(PV) stenosis or thrombosis, it will increase difficulties of surgery. We hereby introduce our center’s experience in Re LT through a complicated case of *** SUMMARY We report a patient who suffered from hepatitis B-associated cirrhosis and underwent LT in December 2012. Early postoperative recovery was *** months after LT, the patient’s bilirubin increased significantly and he was diagnosed with an ischemic-type biliary lesion caused by hepatic artery occlusion. The patient underwent percutaneous transhepatic cholangial drainage and repeatedly replaced intrahepatic biliary drainage tube regularly for 5 *** patient developed progressive deterioration of liver function and underwent liver re-transplant in January 2019. The operation was performed in a classic OLT manner without venous bypass. Both the hepatic artery and PV were occluded and could not be used for anastomosis. The donor PV was anastomosed with the recipient’s left renal vein. The donor hepatic artery was connected to the recipient’s abdominal aorta. The bile duct reconstruction was performed in an end-to-end manner. The postoperative process was very uneventful and the patient was discharged 1 mo after *** With the development of surgical techniques, portal thrombosis and arterial occlusion are no longer contraindications for ReLT.

关键词： liver retransplantation Biliary tract complication Ischemic type biliary lesion Portal vein thrombosis Arterial occlusion Graft liver failure Case report

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Radiologic-histological correlation of hepatocellular carcinoma treated via pre-liver transplant locoregional therapies

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Hepatobiliary & Pancreatic Diseases International 2013年第1期12卷 34-41页

作者： Galal El-Gazzaz Achuthan Sourianarayanane KV Narayanan Menon Juan Sanabria Koji Hashimoto Cristiano Quintini Dympna Kelly Bijan Eghtesad Charles Miller John Fung Federico Aucejo Hepatobiliary & liver transplant Surgery Cleveland Clinic Foundation

BACKGROUND:Locoregional therapies(LRTs) are treatments to achieve local control of hepatocellular carcinoma(HCC).Correlation between radiologic response to LRT and degree of induced tumor necrosis is not well *** aim of this study was to evaluate different levels of radiologic response after pre-liver transplant(LT) LRT and its correlation with percentage of tumor necrosis on explanted ***:Institutional Review Board approved LT database was queried for treated HCC in patients undergoing *** response was evaluated to predict tumor necrosis in the explanted *** response was evaluated 1 to 3 months after LRT with computed tomography or MRI via Response Evaluation Criteria in Solid Tumors(RECIST),and European Association for the Study of the liver(EASL) *** was repeated as needed until time of *** tumor necrosis was graded as complete(100%),partial(50%-99%),or poor(<50%).RESULTS:Between 2002 and 2011,128 patients(97 men and 31 women) received pre-LT LRT including transarterial therapy(93),radiofrequency ablation(20),or combination of both(15).The mean age of the patients was 58±9 *** mean follow-up was 35±27 *** median waitlist time was 55 *** hundred(78%) patients had HCC within the Milan criteria at the initial radiologic ***(15%) of the patients had complete tumor necrosis on histopathology ***(39%) of the patients exhibited partial necrosis,52(41%) showed poor or no necrosis and 7(5%) showed progressive *** overall pre-LT radiologic staging was correlated with explant pathology in 73(57%) of the *** tumor stage was noted in 49(38%) patients,and overestimated tumor stage in 6(5%) *** post-LT 3-year overall survival and disease free survival were 82% and 80%,and the rates for complete and partial tumor necrosis were 100% vs 78%(P=0.02) and 100% vs 75%(P=0.03),***:In the current era,interpretat

关键词： locoregional therapy radiologic response hepatocellular carcinoma

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Serious drug-induced liver disease secondary to ezetimibe

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World Journal of Gastroenterology 2008年第32期14卷 5098-5099页

作者： José Castellote Javier Ariza Rosa Rota Anna Girbau Xavier Xiol Hepatology and liver transplant Unit IdibellHospital Universitario de Bellvitge

Ezetimibe is the f irst member of a new family of lipid- lowering drugs that inhibits uptake of dietary and bili- ary cholesterol. It was approved by the FDA in 2002 for hypercholesterolemia alone or in combination with statins. Its use has been spreading over the last years. Ezetimibe was considered a safe drug. We report a case of a woman who developed a serious hepatocellular drug-induced liver disease after 4 mo therapy with 10 mg daily of ezetimibe. After withdrawal of the drug, the patient recovered slowly. Ezetimibe may produce seri- ous toxic hepatitis and prompt withdrawal is mandatory in case of a signif icant abnormality in liver testing after beginning or during treatment with ezetimibe.

关键词： Ezetimibe Hepatitis Drug-induced liverdisease

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liver decompensation after rapid weight loss from semaglutide in a patient with non-alcoholic steatohepatitis -associated cirrhosis

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World Journal of Gastroenterology 2023年第47期29卷 6165-6167页

作者： Matthew Peverelle Jonathan Ng James Peverelle Ryan D.Hirsch Adam Testro liver transplant unit Austin HealthMelbourne 3084Australia liver transplant unit Austin HealthHeidelberg 3084VictoriaAustralia

There is rapidly increasing uptake of GLP-1 (glucagon-like peptide-1) agonistssuch as semaglutide worldwide for weight loss and management of non-alcoholicsteatohepatitis (NASH). remains a paucity of safety data in the vulnerable NASHcirrhotic population. We report herein the first documented case of liver decompensationand need for liver transplant waitlisting in a patient with NASHcirrhosistreated with semaglutide. Rapid weight loss led to the development ofascites and hepatic encephalopathy and an increase in the patients Model forEndstage liver Disease-Na (MELD-Na) score from 11 to 22. Aggressive nutritionalsupplementation was commenced and the semaglutide was stopped. Overthe following months she regained her weight and her liver recompensated andher MELD-Na decreased to 13, allowing her to be delisted from the transplantwaitlist. This case serves as a cautionary tale to clinicians using semaglutide in thecirrhotic population and highlights the need for more safety data in this patientgroup.

关键词： Semaglutide Non-alcoholic steatohepatitis Cirrhosis Non-alcoholic steatohepatitis cirrhosis Glucagon-like peptide 1 agonists Weight loss

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Solid,non-skin,post-liver transplant tumors:Key role oflifestyle and immunosuppression management

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World Journal of Gastroenterology 2016年第1期22卷 427-434页

作者： Christophe Carenco Stéphanie Faure JoséUrsic-Bedoya Astrid Herrero Georges Philippe Pageaux liver transplant Unit CHRU Montpellier34090 MontpellierFrance

liver transplantation has been the treatment of choice for end-stage liver disease since *** has emerged as a major long-term cause of death for liver transplant *** retrospective studies that have explored standardized incidence ratio have reported increased rates of solid organ cancers postliver transplantation;some have also studied risk *** transplantation results in a two to five-fold mean increase in the rate of solid organ *** of head and neck,lung,esophageal,cervical cancers and Kaposi’s sarcoma is high,but risk of colorectal cancer is not clearly *** appears to be no excess risk of developing breast or prostate *** risk factors such as viral infection and tobacco consumption,and personal risk factors such as obesity play a key role,but recent data also implicate the role of calcineurin inhibitors,whose cumulative and dose-dependent effects on cell metabolism might play a direct role in *** this paper,we review the results of studies assessing the incidence of non-skin solid tumors in order to understand the mechanisms underlying solid cancers in post-liver transplant patients and,ultimately,discuss how to prevent these *** protocol changes,including a calcineurin inhibitor-free regimen,combined with dietary guidelines and smoking cessation,are theoretically the best preventive measures.

关键词： liver transplantation Tumors Calcineurininhibitors Immunosuppression Risk factors Tacrolimus Review Incidence

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Outflow reconstruction with arterial patch in domino liver transplantation: a new technical option

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Hepatobiliary & Pancreatic Diseases International 2014年第5期13卷 551-554页

作者： Laura Lladó Emilio Ramos Sofia De LaSerna Joan Fabregat liver transplant Unit Hospital Universitari de Bellvitge

Domino liver transplantation（LT）, using livers from familial amyloidotic polyneuropathy（FAP） patients, is a well described technique useful to expand donor pool. One of the main difficulties of this type of LT arises from the necessity to share the vascular pedicles between the graft and the donor. The most important challenge resides in restoring a proper hepatic venous outflow in the FAP-liver *** is specially challenging when using the piggy-back technique, because the hepatic stumps may be too short. To overcome this issue, surgeons explored several techniques using different types of venous grafts. We describe a new technical option by using an arterial graft from the deceased donor. By using both iliac arteries a long graft is created and sutured as needed to the hepatic vein stump. We describe herein this new technique employed in a domino liver recipient who underwent retransplantation for ischemic cholangitis. The procedure was performed using the piggy-back technique; the venous stump of the FAP liver was reconstructed with the arterial graft. The patient had uneventful postoperative and mid-term hepatic function, and anastomosis was patent 24 months after LT.

关键词： liver transplantation technique graft hepatic vein iliac artery

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Risk factors for postoperative bile leakage:a retrospective single-center analysis of 411 hepatectomies

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Hepatobiliary & Pancreatic Diseases International 2016年第1期15卷 81-86页

作者： Fabrizio Panaro Lisa Hacina Hassan Bouyabrine Al-Warith Al-Hashmi Astrid Herrero Francis Navarro Department of General and liver transplant Surgery Montpellier University HospitalCollege of Medicine

BACKGROUND： The primary focus of the study was to ana- lyze the risk factors for bile leakage after hepatectomy for be- nign or malignant tumors. METHODS： A total of 411 patients who had undergone hepa- tectomy between December 2006 and December 2011 were ret- rospectively analyzed. The severity of bile leakage was graded according to the ISGLS classification. Twenty-eight pre- and postoperative parameters were analyzed. RESULTS： The overall bile leakage incidence was 10.2% （42/411）. The severity of the leakage was classified according to the IS- GLS classification. Bile leakage was detected early in case of abdominal drainage （11.4% vs 1.9%, P=0.034）. It prolonged the time of hospitalization （16 vs 9 days, P=0.001）. In all patients, wedge resection was associated with a higher incidence of bile leakage in contrast to anatomical resections （25.6% vs 4.1%, P〈0.0001） regardless of the underlying liver disease. Furthermore, total vascular exclusion increased risk of bile leakage （P=0.008）. CONCLUSIONS： Bile leakage as a major issue after hepatic resection is related to the postoperative morbidity and the hospitalization time. It is associated with non-anatomical re- section and a total vascular exclusion.

关键词： liver resection bile leakage wedge total vascular exclusion

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