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Treatment modalities for hypersplenism in liver transplant recipients with recurrent hepatitis C

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World Journal of Gastroenterology 2009年第40期15卷 5010-5013页

作者： Lena Sibulesky Justin H Nguyen Ricardo Paz-Fumagalli C Burcin Taner Rolland C Dickson Division of transplant Surgery and transplant Hepatology Division of Interventional Radiology

Hepatitis C is the most common indication for orthotopic liver transplantation in the united States. Unfortunately, hepatitis C recurs universally in the transplanted liver and is the major cause of decreased graft and patient survival. The combination therapy of interferon and ribavirin has been shown to be the most effective therapy for recurrent hepatitis C. However, pre-and post-transplant hypersplenism often precludes patients from receiving the antiviral therapy. Splenectomy and partial splenic embolization are the two invasive modalities that can correct the cytopenia associated with hypersplenism. In this report we review the two treatment options, their associated outcomes and complications.

关键词： Hypersplenism Leukopenia Recurrenthepatitis C Thrombocytopenia Liver transplant

Changes of duplex parameters and splenic size in liver transplant recipients during a long period of observation

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World Journal of Gastroenterology 2005年第43期11卷 6787-6791页

作者： Bita Boozari Michael Gebel Mathias J Bahr Michael P Manns Christian P Strassburg Joerg S Bleck J Klempnauer Bjoern Nashan Department of Gastroenterology Department of Visceral and transplant Surgery Department of transplant Surgery

AIM: To assess the changes of portal and arterial velocities, resistance index, spleen and liver size during a long observation period (13.7 years) after orthotopic liver transplantation (OLT).METHODS: Two hundred and sixty patients were recruited retrospectively for this study and divided into groups with defined time intervals after OLT. The cross-sectional changes of portal and arterial velocities,resistance index, spleen and liver size between the defined time intervals were studied. The complications detected by ultrasound were compared to gold standard ***: The mean values for liver size were all within the normal range. The splenic size decreased between the time intervals 100 and 1 000 d after OLT (t;P＜0.01).While portal and arterial flow velocities decreased up to 5.5 years (t; portal velocity P＜0.01, maximal systolic velocity P=0.05, maximal end diastolic velocity P＜0.01),RI increased during this interval (t:P＜0.01). Higher RIvalues were found in older patients (r = 0.24, P＜0.001).CONCLUSION: The arterial and portal velocities show adaptation processes continuing over the course of many years after OLT and are reported for the first time. The vascular complications detected by ultrasound occur mostly up to 100 d after OLT.

关键词： Ultrasound Color Doppler Liver transplantation Monitoring

Management of bacterial infection in the liver transplant candidate

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World Journal of Hepatology 2018年第2期10卷 222-230页

作者： Alberto Ferrarese Alberto Zanetto Chiara Becchetti Salvatore Stefano Sciarrone Sarah Shalaby Giacomo Germani Martina Gambato Francesco Paolo Russo Patrizia Burra Marco Senzolo Multivisceral transplant unit Department of Surgery Oncology and Gastroenterology Padua University Hospital

Bacterial infection(BI) is a common cause of impairment of liver function in patients with cirrhosis, especially in the liver transplant candidates. These patients share an immunocompromised state and increased susceptibility to develop community and hospital-acquired infections. The changing epidemiology of BI, with an increase of multidrug resistant strains, especially in healthcareassociated settings, represents a critical issue both in the waiting list and in the post-operative management. This review focused on the role played by BI in patients awaiting liver transplantation, evaluating the risk of drop-out from the waiting list, the possibility to undergo liver transplantation after recovery from infection or during a controlled infection.

关键词： Cirrhosis Portal hypertension Bacterial infection Liver transplantation

Thrombosis prophylaxis in pediatric liver transplantation: A systematic review

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World Journal of Hepatology 2018年第10期10卷 752-760页

作者： Mirco Nacoti Giulia Maria Ruggeri Giovanna Colombo Ezio Bonanomi Federico Lussana Department of Anesthesia and Intensive care Pediatric Intensive Care Unit Papa Giovanni Ⅹ Hospital Hematology and Bone Marrow transplant unit Papa Giovanni Ⅹ Hospital

AIM To review current literature of thrombosis prophylaxis in pediatric liver transplantation(PLT) as thrombosis remains a critical *** Studies were identified by electronic search of MEDLINE, EMBASE and Cochrane Library(CENTRAL) databases until March 2018. The search was supplemented by manually reviewing the references of included studies and the references of the main published systematic reviews on thrombosis and PLT. We excluded from this review case report, small case series, commentaries, conference abstracts, papers which describing less than 10 pediatric liver transplants/year and articles published before 1990. Two reviewers performed study selection independently, with disagreements solved through discussion and by the opinion of a third reviewer when *** Nine retrospective studies were included in this review. The overall quality of studies was poor. A pooled analysis of results from studies was not possible due to the retrospective design and heterogeneity of included studies. We found an incidence of portal vein thrombosis(PVT) ranging from 2% to 10% in pediatric living donorliver transplantation(LDLT) and from 4% to 33% in pediatric deceased donor liver transplantation(DDLT). Hepatic artery thrombosis(HAT) was observed mostly in mixed LDLT and DDLT pediatric population with an incidence ranging from 0% to 29%. In most of the studies Doppler ultrasonography was used as a first line diagnostic screening for thrombosis. Four different surgical techniques for portal vein anastomosis were reported with similar efficacy in terms of PVT reduction. Reduced size liver transplant was associated with a low risk of both PVT(incidence 4%) and HAT(incidence 0%, P < 0.05). Similarly, aortic arterial anastomosis without graft interposition and microsurgical hepatic arterial reconstruction were associated with a significant reduced HAT incidence(6% and 0%, respectively). According to our inclusion and exclusion criteria, we did not find

关键词： Pediatric liver transplantation Prophylaxis Hepatic artery thrombosis Surgical technique Portal vein thrombosis

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

Late complications of pancreas transplant

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World Journal of transplantation 2020年第12期10卷 404-414页

作者： Javier Maupoey Ibáñez Andrea BoscàRobledo Rafael López-Andujar Hepato-Pancreatico-Biliary Surgery and transplant unit La Fe University HospitalValencia 46026Spain

To summarize the long-term complications after pancreas transplantation that affect graft function,a literature search was carried out on the long-term complications of pancreatic transplantation,namely,complications from postoperative 3rd mo onwards,in terms of loss of graft function,late infection and vascular complications as *** most relevant reviews and studies were selected to obtain the current evidence on these *** definition of graft failure varies among different studies,so it is difficult to evaluate,a standardized definition is of utmost importance to know the magnitude of the problem in all worldwide *** rejection is the main cause of long-term graft failure,occurring in 10%of *** the 3rd mo of transplantation onwards,the main risk factor for late infections is immunosuppression,and patients have opportunistic infections like:Cytomegalovirus,hepatitis B and C viruses,Epstein-Barr virus and varicella-zoster virus;opportunistic bacteria,reactivation of latent infections as tuberculosis or fungal *** preoperative studies and serological tests should be made in all recipients to avoid these infections,adding perioperative prophylactic treatments when *** are uncommon,but one of the main causes of late bleeding,which can be *** treatment should be performed with radiological endovascular approaches or open surgery in case of *** all therapeutic options for the complications mentioned above,transplantectomy is a necessary option in approximately 50%of relaparotomies,especially in lifethreatening *** complications in pancreatic transplantation threatens long-term graft *** exhaustive follow-up as well as a correct immunosuppression protocol are necessary for prevention.

关键词： Pancreas transplantation Pancreas allograft failure Pancreas transplant rejection Pseudoaneurysm Allograft pancreatectomy

Perioperative thrombotic complications in liver transplantation

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World Journal of Gastroenterology 2015年第26期21卷 8004-8013页

作者： Paolo Feltracco Stefania Barbieri Umberto Cillo Giacomo Zanus Marco Senzolo Carlo Ori Department of Medicine UO Anaesthesia and Intensive CarePadua University Hospital Hepatobiliary Surgery and Liver transplant unit Department of SurgeryOncology and GastroenterologyUniversity Hospital of Padua Multivisceral transplant unit Department of SurgeryOncology and GastroenterologyUniversity Hospital of Padua

Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation(OLT),the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft *** during OLT is characterized not only by a complex aetiology,but also by unpredictable onset and evolution of the *** initiation of a procoagulant process may be triggered by various factors,such as inflammation,venous stasis,ischemia-reperfusion injury,vascular clamping,anatomical and technical abnormalities,genetic factors,deficiency of profibrinolytic activity,and platelet *** involvement of the arterial system,intracardiac thrombosis,pulmonary emboli,portal vein thrombosis,and deep vein thrombosis,are among the most serious thrombotic events in the perioperative *** rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis,particularly when these events occur intraoperatively or early after *** of the lack of studies and guidelines on anticoagulant prophylaxis in this setting,many institutions recommend such an approach especially in the subset of patients at high ***,the decision of when,how and in what doses to use the various chemical anticoagulants is still a difficult task,since there is no common consensus,even for highrisk *** risk of postoperative thromboembolism causing severe hemodynamic events,or even loss of graft function,must be weighed and compared with the risk of an important *** this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurringin the perioperative period,as well as their incidence and clinical ***,the indications to pharmacological prophylaxis and the current treatment strategies are also summarized.

关键词： Vascular complications Thromboembolicphenomena Liver transplantation Hepatic arteryocclusion Postoperative complications Pulmonaryemboli

Diverse Roles of Immune Cells in transplant Rejection and Immune Tolerance

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Engineering 2022年第3期8卷 44-56页

作者： Xiaojie Gan Jian Gu Zheng Ju Ling Lu Hepatobiliary Center The First Affiliated Hospital of Nanjing Medical University&Research Unit of Liver Transplantation and Transplant ImmunologyChinese Academy of Medical SciencesNanjing 210029China

Organ transplant rejection(OTR)is a complex immune reaction involving multiple cells,and it determines graft survival and patient *** present,most transplant recipients are administered a combination of immunosuppressive and biological agents to protect them from ***,immunosuppressive agents negatively impact the immune system of the patients,causing them to suffer from serious complications,such as chronic infection and malignant ***,a thorough understanding of the mechanisms involved in immune tolerance and immune rejection with regard to organ transplant(OT)is essential for developing better treatment options and improving patient *** article reviews the role of immune cells in OTR and organ transplant tolerance(OTT),including the novel cell therapies that are currently under clinical trials for transplant recipients.

关键词： Immune cells Innate immune cells Adaptive immune cells Organ transplant Immune tolerance

Risk factors, surgical complications and graft survival in liver transplant recipients with early allograft dysfunction

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Hepatobiliary & Pancreatic Diseases International 2019年第5期18卷 423-429页

作者： Douglas Bastos-Neves Paolo Rogerio de Oliveira Salvalaggio Marcio Dias de Almeida Digestive and Hepatobiliary Surgery Hospital Sao Vicente de PauloRio de JaneiroBrazil Liver transplant unit Hospital Israelita Albert EinsteinSao PauloBrazil

Background: Early allograft dysfunction (EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America. Methods: Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceaseddonor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following:(i) bilirubin ≥10 mg/dL on postoperative day 7;(ii) international normalized ratio ≥1.6 on postoperative day 7, and (iii) alanine aminotransferase or aspartate aminotransferase > 2000 IU/L within the first seven days after transplant. Results: A total of 602 patients were included;of these 34.2% developed EAD. Donor risk factors were male ( P = 0.007), age between 50 and 59 years ( P = 0.034), overweight ( P = 0.028) or grade I obesity ( P = 0.012), sodium > 157 mmol/L ( P = 0.002) and grade IV ischemia/reperfusion injury ( P = 0.002). Cold ischemia time ≥10 h ( P = 0.008) and warm ischemia time ≥40 min ( P = 0.013) were the surgical factors. Male ( P 157 mmol/L and grade Ⅳ ischemia/reperfusion injury. Cold ischemia time ≥10 h and warm ischemia time ≥40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates.

关键词： Graft survival Liver transplantation Primary graft dysfunction Donor evaluation