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Potentially fatal haemobilia due to inappropriate use of an expanding biliary stent

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World Journal of Gastroenterology 2003年第10期9卷 2377-2378页

作者： Rakesh Rai John Rose Derek Manas Hepatobiliary Surgery and Liver transplant unit Freeman HospitalNewcastleUK Department of Interventional Radiology Freeman HospitalNewcastleUK Hepatobiliary Surgery and Liver transplant unit.Freeman Hospital.Newcastle.UK

AIM: To highlight the fatal complication caused by expanding biliary stents and the importance of avoiding use of expanding stent in potentially curable ***: Arteriobiliary fistula is an uncommon cause of haemobilia. We describe a case of right hepatic artery pseudoaneurysm causing arteriobiliary fistula and presenting as severe malena and cholangitis, in a patient with a mesh metal biliary stent. The patient had lymphoma causing bile duct ***: Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolisation of the pseudo aneurysm successfully controlled the ***: Bleeding from the pseudo aneurysm of the hepatic artery can be fatal. Mesh metal stents in biliary tree can cause this complication as demonstrated in this *** mesh metal stent insertion should be avoided in potentially benign or in curable conditions. Difficulty in diagnosis and management is discussed along with the review of the literature.

关键词： Aneurysm, False Biliary Fistula Female Hemobilia Hemorrhage Humans Middle Aged Stents

Retransplantation for graft failure in chronic hepatitis C infection: A good use of a scarce resource?

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World Journal of Gastroenterology 2010年第40期16卷 5070-5076页

作者： Ian A Rowe Kerri M Barber Rhiannon Birch Elinor Curnow James M Neuberger Liver and Hepatobiliary unit University Hospital Birmingham NHS Trust Queen Elizabeth Hospital NHS Blood and transplant

AIM: To investigate the outcome of patients with hepatitis C virus (HCV) infection undergoing liver retransplantation. METHODS: Using the UK National Registry, patients undergoing liver transplantation for HCV-related liver disease were identified. Data on patient and graft characteristics, as well as transplant and graft survival were collected to determine the outcome of HCV patients undergoing retransplantation and in order to identify factors associated with transplant survival. RESULTS: Between March 1994 and December 2007, 944 adult patients were transplanted for HCV-related liver disease. At the end of follow-up, 617 of these patients were alive. In total, 194 (21%) patients had first graft failure and of these, 80 underwent liver retransplantation, including 34 patients where the first graft failed due to recurrent disease. For those transplanted for HCV-related disease, the 5-year graft survival in those retransplanted for recurrent HCV was 45% [95% confidence interval (CI): 24%-64%] compared with 80% (95% CI: 62%-90%) for those retransplanted for other indications (P = 0.01, log-rank test); the 5-year transplant survival after retransplantation was 43% (95% CI: 23%-62%) and 46% (95% CI: 31%-60%), respectively (P = 0.8, log-rank test). In univariate analysis of all patients retransplanted, no factor analyzed was significantly associated with transplant survival. CONCLUSION: Outcomes for retransplantation in patients with HCV infection approach agreed criteria for minimum transplant benefit. These data support selective liver retransplantation in patients with HCV infection.

关键词： Hepatitis C Liver Recurrence Retransplantation Outcome

Risk stratification of renal transplant recipients using routine parameters: Implication of learning from SARS-CoV-2 into transplant follow-up program

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World Journal of transplantation 2023年第6期13卷 344-356页

作者： Abbas Ghazanfar Madiha Abbas Md Walid Hussain Malik Kayal Renal and transplant unit St Georges University Hospitals NHS Foundation TrustLondon SW170QTUnited Kingdom Department of Anesthesia and Intensive care Medicine Epsom and St Helier University Hospitals NHS TrustLondon KT87EGUnited Kingdom Department of Renal and transplant Surgery St Georges University Hospitals NHS Foundation TrustLondon SW170QTUnited Kingdom

BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ *** the course of acute SARS-CoV-2 infection,various laboratory markers have been identified as predictors for high risk of *** To risk stratify renal transplant recipients(RTxR)using general demographic parameters,comorbidities and routine laboratory markers for the severity of the disease and its *** believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up *** This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February *** recorded the basic demographics,comorbidities and routine laboratory *** investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or *** From 505 RTxRs in our renal transplant follow-up program,29(7.75%)RTxRs had PCR-positive SARS-CoV-2 *** recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6%but a significant 27.6%mortality in SARS-CoV-2 positive *** more than 68 years,non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability;P≤0.001.<0.001 and<0.0001 respectively.87.5%of the deceased were diabetic;P≤*** glomerular filtration rate of less than 26 mL/min/1.73 m2,serum albumin less than 20 g/L,Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality;P=0.0128,<0.001,<0.0001 and 0.0061 *** This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and *** knowledge can be used in RTxR follow-up programs by addressing these parameters

关键词： SARS-CoV-2 mortality Renal transplant recipients Glomerular filtration rate Anemia Albumin Calcium Reducing morbidity and mortality Renal transplant follow-up program

Survivals after liver transplantation for hepatocellular carcinoma:Granular data for a better allocation process?

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Hepatobiliary & Pancreatic Diseases International 2018年第4期17卷 374-375页

作者： Quirino Lai Massimo Rossi Hepato-bilio-pancreatic and Liver transplant unit Department of SurgerySapienza University of Rome

To the Editor:A large international study has been recently published focusing on the combination of morphological aspects and alpha-fetoprotein(AFP)as predictors of survival in patients with hepatocellular cancer(HCC)treated with liver transplantation(LT)[1].As a matter of fact,morphology and biology represent the two sides of the same

关键词： AFP HCC Survivals after liver transplantation for hepatocellular carcinoma:Granular data for a better allocation process

Markers of acute rejection and graft acceptance in liver transplantation

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World Journal of Gastroenterology 2015年第4期21卷 1061-1068页

作者： Giacomo Germani Kryssia Rodriguez-Castro Francesco Paolo Russo Marco Senzolo Alberto Zanetto Alberto Ferrarese Patrizia Burra Multivisceral transplant unit Department of SurgeryOncology and GastroenterologyPaduaUniversity Hospital35128 PaduaItaly

The evaluation of the immunosuppression state in liver transplanted patients is crucial for a correct posttransplant management and a major step towards the personalisation of the immunosuppressive therapy. However, current immunological monitoring after liver transplantation relies mainly on clinical judgment and on immunosuppressive drug levels, without a proper assessment of the real suppression of theimmunological system. Various markers have been studied in an attempt to identify a specific indicator of graft rejection and graft acceptance after liver transplantation. Considering acute rejection, the most studied markers are pro-inflammatory and immunoregulatory cytokines and other proteins related to inflammation. However there is considerable overlap with other conditions, and only few of them have been validated. Standard liver tests cannot be used as markers of graft rejection due to their low sensitivity and specificity and the weak correlation with the severity of histopathological findings. Several studies have been performed to identify biomarkers of tolerance in liver transplanted patients. Most of them are based on the analysis of peripheral blood samples and on the use of transcriptional profiling techniques. Amongst these, NK cell-related molecules seem to be the most valid marker of graft acceptance, whereas the role CD4+CD25+Foxp3+ T cells has still to be properly defined.

关键词： Liver transplantation Acute cellular rejection Tol

Fulminant liver failure following a marathon: Five case reports and review of literature

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World Journal of Clinical Cases 2019年第12期7卷 1467-1474页

作者： Wojciech Figiel Marcin Morawski Michal Grat Oskar Kornasiewicz Grzegorz Niewiński Joanna Raszeja-Wyszomirska Maciej Krasnodebski Arkadiusz Kowalczyk Waclaw Holówko Waldemar Patkowski Krzysztof Zieniewicz Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw 02097 Poland Department of Anaesthesiology and Intensive care Medical University of Warsaw Warsaw 02097 Poland Liver and Internal Medicine unit Department of General Transplant and Liver Surgery Medical University of Warsaw Warsaw 02097 Poland

BACKGROUND The growing popularity of marathon and half-marathon runs has led to an increased number of patients presenting with exertion-induced heat stroke. Mild hepatic involvement is often observed in these patients;however, fulminant liver failure may occur in approximately 5% of all cases. Liver transplantation is a potentially curative approach for exertion-induced liver failure, although there is a lack of consensus regarding the criteria and optimal timing of this intervention. CASE SUMMARY This paper describes 5 patients (4 men and 1 woman) who were referred to the department where this study was performed with the diagnosis of exertioninduced acute liver failure. Three patients underwent liver transplantation, 1 recovered spontaneously, and 1 patient died on day 11 following the exertion. CONCLUSION Exertion-induced heat stroke may present as fulminant liver failure. These patients may recover with conservative treatment, may require liver transplantation, or may die. No definitive criteria are available to determine patient suitability for a conservative vs surgical approach.

关键词： Heat Stroke Hepatic insufficiency Liver transplantation Case report

Predictive factors of short term outcome after liver transplantation: A review

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World Journal of Gastroenterology 2016年第26期22卷 5936-5949页

作者： Giuliano Bolondi Federico Mocchegiani Roberto Montalti Daniele Nicolini Marco Vivarelli Lesley De Pietri Anaesthesiology Intensive Care and Pain Therapy Medical Residency University of Modena and Reggio Emilia Division of Hepatobiliary and transplant Surgery Department of Experimental Medicine Polytechnic University of Marche Division of Anaesthesiology and Intensive care unit Department of Cardiology Thoracic and Vascular Surgery Critical Care Medicine Arcispedale Santa Maria Nuova-IRCCS

Liver transplantation represents a fundamental therapeutic solution to end-stage liver disease. The need for liver allografts has extended the set of criteria for organ acceptability, increasing the risk of adverse outcomes. Little is known about the early postoperative parameters that can be used as valid predictive indices for early graft function, retransplantation or surgical reintervention, secondary complications, long intensive care unit stay or death. In this review, we present state-of-the-art knowledge regarding the early post-transplantation tests and scores that can be applied during the first postoperative week to predict liver allograft function and patient outcome, thereby guiding the therapeutic and surgical decisions of the medical staff. Post-transplant clinical and biochemical assessment of patients through laboratory tests (platelet count, transaminase and bilirubin levels, INR, factor V, lactates, and Insulin Growth Factor 1) and scores (model for end-stage liver disease, acute physiology and chronic health evaluation, sequential organ failure assessment and model of early allograft function) have been reported to have good performance, but they only allow late evaluation of patient status and graft function, requiring days to be quantified. The indocyanine green plasma disappearance rate has long been used as a liver function assessment technique and has produced interesting, although not univocal, results when performed between the 1th and the 5th day after transplantation. The liver maximal function capacity test is a promising method of metabolic liver activity assessment, but its use is limited by economic cost and extrahepatic factors. To date, a consensual definition of early allograft dysfunction and the integration and validation of the above-mentioned techniques, through the development of numerically consistent multicentric prospective randomised trials, are necessary. The medical and surgical management of trans

关键词： Liver transplant Liver failure Early allograft dysfunction Primary non-function Initial poor function Outcome predictors Post operative Scoring system Indocyanine green Liver maximal functional capacity

Challenges and opportunities in the application of artificial intelligence in gastroenterology and hepatology

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World Journal of Gastroenterology 2021年第37期27卷 6191-6223页

作者： Chrysanthos D Christou Georgios Tsoulfas Organ transplant unit Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54622Greece

Artificial intelligence(AI)is an umbrella term used to describe a cluster of interrelated *** learning(ML)refers to a model that learns from past data to predict future *** and particularly gastroenterology and hepatology,are data-rich fields with extensive data repositories,and therefore fruitful ground for AI/ML-based software *** this study,we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their ***,we refer to the applications of AI/ML-based models in prevention,diagnosis,management,and prognosis of gastrointestinal bleeding,inflammatory bowel diseases,gastrointestinal premalignant and malignant lesions,other nonmalignant gastrointestinal lesions and diseases,hepatitis B and C infection,chronic liver diseases,hepatocellular carcinoma,cholangiocarcinoma,and primary sclerosing *** the same time,we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome ***,we elaborate on the concerns regarding intrinsic biases,data protection,cybersecurity,intellectual property,liability,ethical challenges,and *** at a slower pace than anticipated,AI is infiltrating the healthcare *** in healthcare will become a reality,and every physician will have to engage with it by necessity.

关键词： Artificial intelligence Machine learning Gastroenterology Hepatology Artificial neural networks Support vector machine

Hepatitis C virus related cirrhosis decreased as indication to liver transplantation since the introduction of direct-acting antivirals: A single-center study

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World Journal of Gastroenterology 2018年第38期24卷 4403-4411页

作者： Alberto Ferrarese Giacomo Germani Martina Gambato Francesco Paolo Russo Marco Senzolo Alberto Zanetto Sarah Shalaby Umberto Cillo Giacomo Zanus Paolo Angeli Patrizia Burra Multivisceral transplant unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Hepatobiliary Surgery and Liver transplant unit Department of Surgery Oncology and Gastroenterology Padua University Hospital Internal Medicine Department of Medicine Padua University Hospital

AIM To evaluate waiting list(WL) registration and liver transplantation(LT) rates in patients with hepatitis C virus(HCV)-related cirrhosis since the introduction of direct-acting antivirals(DAAs).METHODS All adult patients with cirrhosis listed for LT at Padua University Hospital between 2006-2017 were retrospectively collected using a prospectivelyupdated database; patients with HCV-related cirrhosis were divided by indication for LT [dec-HCV vs HCV/hepatocellular carcinoma(HCC)] and into two interval times(2006-2013 and 2014-2017) according to the introduction of DAAs. For each patient, indications to LT, severity of liver dysfunction and the outcome in the WL were assessed and compared between the two different time periods. For patients receiving DAA-based regimens, the achievement of viral eradication and the outcome were also evaluated. RESULTS One thousand one hundred and ninty-four [male(M)/female(F): 925/269] patients were included. Considering the whole cohort, HCV-related cirrhosis was the main etiology at the time of WL registration(490/1194 patients, 41%). HCV-related cirrhosis significantly decreased as indication to WL registration after DAA introduction(from 43.3% in 2006-2013 to 37.2% in 2014-2017, P = 0.05), especially amongst decHCV(from 24.2% in 2006-2013 to 15.9% in 2014-2017, P = 0.007). Even HCV remained the most common indication to LT over time(289/666, 43.4%), there was a trend towards a decrease after DAAs introduction(from 46.3% in 2006-2013 to 39% in 2014-2017, P = 0.06). HCV patients(M/F: 43/11, mean age: 57.7 ± 8 years) who achieved viral eradication in the WL had better transplant-free survival(log-rank test P = 0.02) and delisting rate(P = 0.002) than untreated HCV patients. CONCLUSION Introduction of DAAs significantly reduced WL registrations for HCV related cirrhosis, especially in the setting of decompensated cirrhosis.

关键词： Liver transplantation Hepatitis C Cirrhosis Sustained virological response