1,210 results on '"Liver Failure, Acute surgery"'
Search Results
152. Liver Transplantation for Acute Liver Failure Due to Dengue Fever.
- Author
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Galante A, Adeyi O, Lau L, Humar A, Galvin Z, Selzner N, Lilly L, Sapisochin G, and Bhat M
- Subjects
- Female, Humans, Middle Aged, Dengue complications, Liver Failure, Acute surgery, Liver Failure, Acute virology, Liver Transplantation
- Published
- 2019
- Full Text
- View/download PDF
153. Late allograft fibrosis in pediatric liver transplant recipients: Assessed by histology and transient elastography.
- Author
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Chanpong A, Angkathunyakul N, Sornmayura P, Tanpowpong P, Lertudomphonwanit C, Panpikoon T, and Treepongkaruna S
- Subjects
- Adolescent, Allografts, Autoimmune Diseases complications, Biliary Atresia surgery, Biopsy, Child, Child, Preschool, Cholangitis, Sclerosing surgery, Female, Graft Rejection, Humans, Liver Cirrhosis physiopathology, Liver Failure, Acute surgery, Liver Function Tests, Male, Multivariate Analysis, Pressure, Prevalence, Elasticity Imaging Techniques, Liver Cirrhosis diagnosis, Liver Transplantation
- Abstract
Late allograft fibrosis in LT recipients can cause graft dysfunction and may result in re-transplantation. TE is a non-invasive tool for the assessment of liver fibrosis. We aimed to evaluate the prevalence of allograft fibrosis in pediatric LT recipients, identify factors associated with allograft fibrosis, and determine the diagnostic value of TE, compared to histology. All children who underwent LT for ≥3 years were included. TE was performed for LSM in all patients. LSM of ≥7.5 kPa was considered as abnormal and suggestive of allograft fibrosis. Percutaneous liver biopsy was performed when patients had abnormal LSM and/or abnormal LFTs. Histological fibrosis was diagnosed when METAVIR score ≥F1 or LAF scores ≥1. TE was performed in 43 patients and 14 (32.5%) had abnormal LSM suggestive of allograft fibrosis. Histological fibrosis was identified in 10 of the 15 patients (66.7%) who underwent percutaneous liver biopsy and associated findings included chronic active HBV infection (n = 3), and late acute rejection (n = 3). Multivariate analysis showed that graft age was significantly associated with allograft fibrosis (OR = 1.22, 95% CI: 1.05-1.41, P = 0.01). In conclusion, late allograft fibrosis is common in children undergoing LT for ≥3 years and associated with graft age. HBV infection and late acute rejection are common associated findings. Abnormal TE and/or LFTs may guide physicians to consider liver biopsy for the detection of late allograft fibrosis in LT children., (© 2019 Wiley Periodicals, Inc.)
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- 2019
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154. In Situ Left Lateral Sectionectomy in Deceased Donor Liver Transplantation: Could This Be Another Solution for a Large-for-Size Graft? A Case Report.
- Author
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Kim YM, Kwak BJ, Shim DJ, Kwon YK, and Yoon YC
- Subjects
- Adult, Female, Humans, Liver Failure, Acute surgery, Male, Middle Aged, Hepatectomy methods, Liver Transplantation methods, Tissue and Organ Harvesting methods
- Abstract
Background: Large-for-size (LFS) graft should be avoided when performing an adult deceased donor liver transplantation (DDLT) as it is associated with abdominal compartment syndrome, severe graft injury, and primary graft nonfunction. When inadvertently facing with LFS graft intraoperatively, the most commonly reported approach has been a surgical reduction of the right lobe despite its technical difficulty in addition to ongoing coagulopathy after graft reperfusion. We report a case where we performed a left lateral sectionectomy instead of a right lobe modification., Case Report: A 44-year-old 58.4 kg female patient was admitted with drug-induced acute hepatic failure and underwent an emergency DDLT. The donor was a 51-year-old 60.0 kg man. At the time of procurement, the liver was noted to be hypertrophic. The estimated graft/recipient weight ratio was 3.49%. After completing the vascular and bile duct anastomosis, the abdomen could not be closed due to its large graft size. Because of the hypertrophic left lateral lobe and ongoing coagulopathy, we decided to perform an in situ left lateral sectionectomy rather than right posterior sectionectomy or right hemihepatectomy. The next day, the liver function failed to improve, and the patient's blood pressure began to decline gradually. Computed tomography showed severe inferior vena cava (IVC) compression by the graft, and the patient underwent transjugular IVC stent placement. Soon after, the patient's blood pressure improved and liver function gradually normalized. The patient was discharged uneventfully on postoperative day 45., Conclusion: Under specific conditions, in situ left lateral sectionectomy is a solution for unexpected LFS graft during DDLT., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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155. Black Adult Patients With Acute Liver Failure Are Sicker and More Likely to Undergo Liver Transplantation Than White Patients.
- Author
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Nephew L, Zia Z, Ghabril M, Orman E, Lammert C, and Chalasani N
- Subjects
- Acetaminophen poisoning, Adult, Black or African American statistics & numerical data, Asian statistics & numerical data, Female, Hepatitis, Autoimmune complications, Hepatitis, Autoimmune immunology, Hispanic or Latino statistics & numerical data, Humans, Kaplan-Meier Estimate, Liver Failure, Acute diagnosis, Liver Failure, Acute etiology, Liver Failure, Acute mortality, Male, Middle Aged, Registries statistics & numerical data, Retrospective Studies, Risk Factors, Severity of Illness Index, Survival Rate, Treatment Outcome, United States epidemiology, Waiting Lists mortality, White People statistics & numerical data, Health Status Disparities, Liver Failure, Acute surgery, Liver Transplantation statistics & numerical data
- Abstract
Racial and ethnic differences in the presentation and outcomes of patients wait-listed with acute liver failure (ALF) have not been explored. Adult patients with ALF wait-listed for liver transplantation (LT) from 2002 to 2016 were investigated using the United Network for Organ Sharing database. Clinical characteristics and causative etiologies were compared between white, black, Hispanic, and Asian patients with ALF who were wait-listed as status 1. A competing risk analysis was used to explore differences in LT and wait-list removal rates. Kaplan-Meier survival curves were used to explore differences in 1-year posttransplant survival. There were 8208 patients wait-listed with a primary diagnosis of ALF; 4501 were wait-listed as status 1 (55.3% of whites, 64.4% of blacks, 51.6% of Hispanics, 40.7% of Asians; P < 0.001). Black patients had higher bilirubin and Model for End-Stage Liver Disease at wait-listing than other groups. White patients were the most likely to have acetaminophen toxicity as a causative etiology, whereas black patients were the most likely to have autoimmune liver disease. Black patients were significantly more likely to undergo LT than white patients (hazard ratio, 1.20; 95% confidence interval, 1.08-1.30). There was no difference in wait-list removal because of death or clinical deterioration among racial/ethnic groups. The 1-year posttransplant survival was lowest in black patients (79.6%) versus white (82.8%), Hispanic (83.9%), and Asian (89.3%) patients (P = 0.02). In conclusion, etiologies of ALF vary by race and ethnicity. Black patients with ALF were more likely to be wait-listed as status 1 and undergo LT than white patients, but they were sicker at presentation. The 1-year posttransplant survival rate was lowest among black patients., (Copyright © 2019 by the American Association for the Study of Liver Diseases.)
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- 2019
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156. Outcomes of Liver Transplantation in Small Infants.
- Author
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Yamamoto H, Khorsandi SE, Cortes-Cerisuelo M, Kawano Y, Dhawan A, McCall J, Vilca-Melendez H, Rela M, and Heaton N
- Subjects
- Age Factors, Female, Humans, Incidence, Infant, Liver Failure, Acute mortality, Male, Postoperative Complications etiology, Prospective Studies, Survival Rate, Treatment Outcome, Graft Survival, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Postoperative Complications epidemiology
- Abstract
Liver transplantation (LT) for small infants remains challenging because of the demands related to graft selection, surgical technique, and perioperative management. The aim of this study was to evaluate the short-term and longterm outcomes of LT regarding vascular/biliary complications, renal function, growth, and patient/graft survival in infants ≤3 months compared with those of an age between >3 and 6 months at a single transplant center. A total of 64 infants ≤6 months underwent LT and were divided into 2 groups according to age at LT: those of age ≤3 months (range, 6-118 days; XS group, n = 37) and those of age >3 to ≤6 months (range, 124-179 days; S group, n = 27) between 1989 and 2014. Acute liver failure was the main indication for LT in the XS group (n = 31, 84%) versus S (n = 7, 26%). The overall incidence of hepatic artery thrombosis and portal vein thrombosis/stricture were 5.4% and 10.8% in the XS group and 7.4% and 11.1% in the S group, respectively (not significant). The overall incidence of biliary stricture and leakage were 5.4% and 2.7% in the XS group and 3.7% and 3.7% in the S group, respectively (not significant). There was no significant difference between the 2 groups in terms of renal function. No significant difference was found between the 2 groups for each year after LT in terms of height and weight z score. The 1-, 5-, and 10-year patient survival rates were 70.3%, 70.3%, and 70.3% in the XS group compared with 92.6%, 88.9%, and 88.9% in the S group, respectively (not significant). In conclusion, LT for smaller infants has acceptable outcomes despite the challenges of surgical technique, including vascular reconstruction and graft preparation, and perioperative management., (Copyright © 2019 The Authors. Liver Transplantation published by Wiley Periodicals, Inc., on behalf of American Association for the Study of Liver Diseases.)
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- 2019
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157. Whole Exome Sequencing Among 26 Patients With Indeterminate Acute Liver Failure: A Pilot Study.
- Author
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Rakela J, Rule J, Ganger D, Lau J, Cunningham J, Dehankar M, Baheti S, and Lee WM
- Subjects
- Adult, Aged, Aged, 80 and over, Biomarkers analysis, Computational Biology, Cytochrome P-450 CYP2D6 genetics, Cytochrome P-450 Enzyme System genetics, DNA Mutational Analysis, Female, Humans, Liver pathology, Liver Failure, Acute blood, Liver Failure, Acute mortality, Liver Failure, Acute surgery, Male, Middle Aged, Mutation, Missense, Pilot Projects, Polymorphism, Single Nucleotide, Prognosis, Serpins genetics, Exome Sequencing, Young Adult, Genetic Predisposition to Disease, Liver Failure, Acute genetics
- Abstract
Introduction: The etiology of acute liver failure (ALF) remains an important prognostic factor. The Acute Liver Failure Study Group recently reported that 150 of 2,718 adult patients with ALF (5.5%) had an indeterminate etiology. Our aim was to use whole exome sequencing to identify genetic variants associated with phenotypic, biochemical, and histologic features among patients with indeterminate ALF., Methods: This effort has defined a cohort of well-pedigreed patients with indeterminate ALF; DNA samples extracted from whole blood samples were obtained from 26 respective patients with indeterminate ALF. These samples were kept at the Acute Liver Failure Study Group repository at the NIDDK, Bethesda. Whole exome sequencing and bioinformatics analysis were performed at the Mayo Clinic Center of Individualized Medicine in Rochester, MN., Results: Of the 26 patients, 8 survived spontaneously, 6 died, and 12 underwent a liver transplantation; all those transplanted were alive at 21 days after enrollment in the study. Twenty-two of the 26 patients presented as ALF. We found 12 variants associated with 11 genes. The most common variant was rs4940595 in the SERPINB11 gene which was found in 23 of the 26 patients. This variant had a stop codon; no reports of disorders have been associated with this variant. The next most commonly found variant was rs1135840 in the CYP2D6 gene; this mutation is a missense_variant and has been reported to be associated with hepatotoxicity of antituberculous therapy. None of our patients were receiving this therapy. We also found a significant asymmetric distribution of rs1800754 of the CYP2D7 gene and rs1135840 of the CYP2D6 gene between patients who survived spontaneously (75%) and those who died or underwent liver transplantation (30.5% and 25%, respectively)., Discussion: We found 12 variants of 11 genes significantly associated with ALF among adults with indeterminate etiology. We also found a significant asymmetric distribution of 2 variants belonging to the CYP2D7 and CYP2D6 genes, respectively, between those who survived spontaneously and those who died or underwent liver transplantation. The 2 most common variants, rs4940595 and rs1135840, of the SERPINB11 and CYP2D6 genes, respectively, found in our patients with ALF have been described as potentially important in the adaptive response combating the emergence of infectious diseases and associated with hepatotoxicity of antituberculous therapy, respectively. Our findings need to be expanded to include more patients with indeterminate ALF as well as viral, drug toxicity, and autoimmune etiologies to determine whether our findings are associated with the specific etiology, indeterminate, or with the overall ALF syndrome itself.
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- 2019
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158. Feasibility of domino liver transplantation from hyperhomocsyteinemia.
- Author
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Qu W, Zhu ZJ, Wei L, Sun LY, Liu Y, and Zeng ZG
- Subjects
- Adult, Child, Feasibility Studies, Homocystinuria complications, Humans, Living Donors, Male, Hyperhomocysteinemia etiology, Liver Failure, Acute surgery, Liver Transplantation, Tissue and Organ Procurement
- Abstract
Hyperhomocysteinemia, resulting from a cystathionine beta synthase (CBS) deficiency, is an autosomal recessive disease associated with high levels of homocysteine. Such patients can present with severe mental retardation, ectopia lentis and osteoporosis and thromboembolic disease. To the best of our knowledge, only two cases of liver transplantation for CBS deficiency have been published. Here, we report a case of an 8-year-old male with a CBS deficiency that underwent living donor liver transplantation. The postoperative course was uneventful and homocysteine levels remained normal. The liver of this CBS deficiency patient was then successfully used in domino transplantation. The domino liver transplantation recipient was a 41-year-old male diagnosed with acute liver failure following hemi-liver resection due to cholangiocarcinoma. The domino recipient developed acquired hyperhomocysteinemia, which was controlled with a special regimen of medications. No complications relative to CBS deficiency were observed up to 11 months post-transplant. At this time, the patient expired as a result of cholangiocarcinoma recurrence. In conclusion, our data suggest that liver transplantation for CBS deficiency can be effective, safe and beneficial. It is possible to be both safe and beneficial to use a CBS deficiency patient as a domino donor for salvage liver transplantation in a selective category of recipients., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)
- Published
- 2019
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159. Liver Graft and Spleen Elastography After Living Liver Transplantation: Our First Results.
- Author
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Bayramov N, Yilmaz S, Salahova S, Bashkiran A, Zeynalov N, Isazade E, and Bayramova T
- Subjects
- Adult, End Stage Liver Disease complications, End Stage Liver Disease surgery, Female, Humans, Liver pathology, Liver Cirrhosis etiology, Liver Cirrhosis surgery, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Living Donors, Male, Middle Aged, Postoperative Period, Spleen pathology, Transplants pathology, Treatment Outcome, Elasticity Imaging Techniques methods, Liver diagnostic imaging, Liver Transplantation methods, Spleen diagnostic imaging, Transplants diagnostic imaging
- Abstract
Aim of the Study: Liver transplantation is widely applied as a standard and effective management of end-stage liver diseases, hepatocellular carcinoma, and acute liver failure. Investigation of morphologic and functional changes in the transplanted graft, gastrointestinal system, and spleen after transplantation is an important ground for assessment of post-transplantation results, early changes related to complications, and evaluation of response to treatment modalities. The aim of this study was to investigate the dynamics of changes in elastography of the liver graft and spleen after living-related liver transplantation., Material and Methods: The study included 14 cirrhotic patients after living-related liver graft transplantation. Stiffness of the spleen and liver was evaluated before transplantation and at 1, 3, and 6 months after transplantation with a Supersonic Aixplorer Multi Wave device. Each procedure consisted of measuring the density in 10 points (spots) of the organ. The final result was calculated as the mean value of successful measurements (must have been > 60% of all measurements) and expressed in kilopascals., Results: The mean value of the liver and spleen stiffness before transplantation was 27 kPa (14-31 kPa) and 51 kPa (38-92 kPa), respectively. The stiffness of the spleen gradually reduced after transplantation to 40.3, 35.4, and 24.1 kPa (P = .001) at 1, 3, and 6 months. The stiffness of the liver graft in patients without complications was stable at 4-5 kPa, whereas the same value in patients with complications was increased (≥ 7.5 kPa). In 5 patients, endoscopic investigation confirmed the significant reduction of varicose veins after surgery., Conclusion: Elastography of the liver graft and spleen after liver transplantation can be recommended as a useful-for-patient 1-off method of investigation., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
- Full Text
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160. Living Donor Liver Transplantation for Acute Liver Failure: Donor Safety and Recipient Outcome.
- Author
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Pamecha V, Vagadiya A, Sinha PK, Sandhyav R, Parthasarathy K, Sasturkar S, Mohapatra N, Choudhury A, Maiwal R, Khanna R, Alam S, Pandey CK, and Sarin SK
- Subjects
- Adult, Elective Surgical Procedures methods, Elective Surgical Procedures statistics & numerical data, Emergency Treatment methods, Emergency Treatment statistics & numerical data, Female, Follow-Up Studies, Hepatectomy methods, Hepatectomy statistics & numerical data, Humans, Liver Failure, Acute diagnosis, Liver Failure, Acute etiology, Liver Failure, Acute virology, Liver Transplantation methods, Male, Postoperative Complications etiology, Retrospective Studies, Severity of Illness Index, Time Factors, Time-to-Treatment, Tissue and Organ Procurement methods, Tissue and Organ Procurement statistics & numerical data, Treatment Outcome, Young Adult, Elective Surgical Procedures adverse effects, Emergency Treatment adverse effects, Hepatectomy adverse effects, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Living Donors statistics & numerical data, Postoperative Complications epidemiology
- Abstract
In countries where deceased organ donation is sparse, emergency living donor liver transplantation (LDLT) is the only lifesaving option in select patients with acute liver failure (ALF). The aim of the current study is living liver donor safety and recipient outcomes following LDLT for ALF. A total of 410 patients underwent LDLT between March 2011 and February 2018, out of which 61 (14.9%) were for ALF. All satisfied the King's College criteria (KCC). Median admission to transplant time was 48 hours (range, 24-80.5 hours), and median living donor evaluation time was 18 hours (14-20 hours). Median Model for End-Stage Liver Disease score was 37 (32-40) with more than two-thirds having grade 3 or 4 encephalopathy and 70% being on mechanical ventilation. The most common etiology was viral (37%). Median jaundice-to-encephalopathy time was 15 (9-29) days. Preoperative culture was positive in 47.5%. There was no difference in the complication rate among emergency and elective living liver donors (13.1% versus 21.2%; P = 0.19). There was no donor mortality. For patients who met the KCC but did not undergo LT, survival was 22.8% (29/127). The 5-year post-LT actuarial survival was 65.57% with a median follow-up of 35 months. On multivariate analysis, postoperative worsening of cerebral edema (CE; hazard ratio [HR], 2.53; 95% confidence interval [CI], 1.01-6.31), systemic inflammatory response syndrome (SIRS; HR, 16.7; 95% CI, 2.05-136.7), preoperative culture positivity (HR, 6.54; 95% CI, 2.24-19.07), and a longer anhepatic phase duration (HR, 1.01; 95% CI, 1.00-1.02) predicted poor outcomes. In conclusion, emergency LDLT is lifesaving in selected patients with ALF. Outcomes of emergency living liver donation were comparable to that of elective donors. Postoperative worsening of CE, preoperative SIRS, and sepsis predicted outcome after LDLT for ALF., (Copyright © 2019 by the American Association for the Study of Liver Diseases.)
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- 2019
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161. Analysis of the Liver Transplant Waiting List in Our Center.
- Author
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Emek E, Yesim Kara Z, Demircan FH, Serin A, Yazici P, Sahin T, Tokat Y, and Bozkurt B
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- Adult, Aged, End Stage Liver Disease surgery, Female, Humans, Liver Failure, Acute mortality, Liver Failure, Acute surgery, Liver Neoplasms surgery, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Turkey, Carcinoma, Hepatocellular mortality, End Stage Liver Disease mortality, Liver Neoplasms mortality, Liver Transplantation statistics & numerical data, Waiting Lists mortality
- Abstract
Background: Liver transplantation (LT) is an important treatment for acute liver failure and end-stage liver disease. Due to the limited supply of livers, there are still thousands of candidates waiting for transplantation in Turkey. We aimed to analyze LT waiting list access by demographics and etiology, particularly the diagnosis of hepatocellular carcinoma (HCC), which has been prioritized for LT in recent years., Materials and Methods: Between 2011 and 2018, all patients listed for LT in our center were retrospectively reviewed. Demographic features, etiology of liver disease, waiting time, Model for End-Stage Liver Disease (MELD) score, and survival data were recorded. Differences between the LT group and deceased patients on the waiting list were evaluated., Results: During this period, 266 patients were included in the LT waiting list. Only 119 patients (44.7%) underwent LT (men, 94; women, 25; mean age, 53 years), whereas 103 (38%) died (men, 60; women, 43; mean age, 53 years) in the waiting period. Seventeen patients were status 1A or 1B and of these, 7 patients died from fulminant hepatic failure. MELD score was significantly higher in deceased group (28 ± 7 vs 25 ± 6; P = .014). The frequency of HCC was significantly higher in LT group (29% vs 11%; P = .002). Overall survival of the patients in the waiting list with and without liver transplantation were 63% and 41%, respectively., Conclusions: HCC is one of the leading etiologies that is considered for cadaveric LT from the waiting list in our center. These patients had slightly lower MELD scores compared to deceased patients with shorter waiting times. We recommend early referral and close monitoring of the patients who are LT candidates., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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162. Characteristics, management and outcomes of patients with acute liver failure admitted to Australasian intensive care units.
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Warrillow S, Tibballs H, Bailey M, McArthur C, Lawson-Smith P, Prasad B, Anstey M, Venkatesh B, Dashwood G, Walsham J, Holt A, Wiersema U, Gattas D, Zoeller M, Garcia Alvarez M, and Bellomo R
- Subjects
- Adolescent, Adult, Australia epidemiology, Female, Humans, Intensive Care Units, Liver Failure, Acute epidemiology, Liver Failure, Acute etiology, Mental Disorders complications, Mental Disorders epidemiology, New Zealand epidemiology, Treatment Outcome, Young Adult, Acetaminophen administration & dosage, Acetaminophen toxicity, Analgesics, Non-Narcotic administration & dosage, Analgesics, Non-Narcotic toxicity, Drug Overdose epidemiology, Liver Failure, Acute chemically induced, Liver Failure, Acute surgery, Liver Transplantation methods
- Abstract
Objective: Acute liver failure (ALF) leads to severe illness and usually requires admission to the intensive care unit (ICU). Despite its importance, little is known about patients with ALF in Australia and New Zealand., Design: Binational observational study to evaluate the aetiology, baseline characteristics, patterns of illness, management, and outcomes for patients with ALF admitted to Australian and New Zealand ICUs., Setting: All six Australian and New Zealand ICUs in liver transplant centres submitted de-identified data for ten or more consecutive patients with ALF. Data were obtained from the clinical record and included baseline characteristics, aetiology, mode of presentation, illness severity, markers of liver failure, critical care interventions, utilisation of transplantation, and hospital outcome., Results: We studied 62 patients with ALF. Paracetamol overdose (POD) was the underlying cause of ALF in 53% of patients (33/62), with staggered ingestion in 42% of patients (14/33). Among patients with POD, 70% (23/33) were young women, most had psychiatric diagnoses, and most presented relatively early with overt liver failure. This group were transplanted in only 6% of cases (2/33) and had an overall mortality of 24% (8/33). The remaining patients with ALF had less common conditions, such as hepatitis B and non-paracetamol drug-induced ALF. These patients presented later and exhibited less extreme evidence of acute hepatic necrosis. Transplantation was performed in 38% of patients (11/29) in this subgroup. The mortality of nontransplanted non-POD patients was 56% (10/18). Illness severity at ICU admission, initial requirement for organ support therapies and length of hospital stay were similar between patients with POD and non-POD ALF., Conclusion: POD is the major cause of ALF in Australian and New Zealand liver transplant centres and is a unique and separate form of ALF. It has a much lower associated mortality and treatment with liver transplantation than non-POD ALF. Non-POD patients have a poor prognosis in the absence of transplantation.
- Published
- 2019
163. Recurrent Idiopathic Liver Allograft Failure.
- Author
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Schiano TD, Florman S, and Fiel MI
- Subjects
- Adult, Allografts, Fatal Outcome, Female, Graft Rejection pathology, Humans, Recurrence, Graft Rejection immunology, Liver Failure, Acute surgery, Liver Transplantation
- Abstract
Objectives: Many transplant programs have had patients who develop idiopathic recurrent liver allograft failure, necessitating serial transplants, and are deemed to have refractory or recurrent rejection. The frequency and the etiology of this immunologic dysfunction have not been well characterized., Methods: Herein, we illustrate the case of a patient who required three retransplants over a period of 20 years for recurrent liver allograft failure. By extensively compiling the patient's many liver biopsy specimens and explants over time, we demonstrate that antibody-mediated rejection (AMR) was a major contributing factor from the outset. We conducted a review of the Scientific Registry for Transplant Recipients database to estimate the potential frequency of AMR., Results: As illustrated by this case, AMR has varied histologic findings in the setting of elevated donor-specific antibody titers., Conclusions: The cause of recurrent allograft failure in this patient was likely a combination of acute cellular rejection and AMR, manifestations of likely underlying immune dysregulation. Pathologists and transplant physicians should recognize the variable histologic presentations of AMR, which is imperative for its timely intervention. This case demonstrates how difficult the diagnosis of AMR can be to make, highlighting the need for strong clinical suspicion in patients having difficult-to-treat rejection and recurrent allograft failure., (© American Society for Clinical Pathology, 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2019
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164. Improved Survival Following Living Donor Liver Transplantation for Pediatric Acute Liver Failure: Analysis of 20 Years of US National Registry Data.
- Author
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Firl DJ, Sasaki K, McVey J, Hupertz V, Radhakrishnan K, Fujiki M, Eghtesad B, Miller CM, Quintini C, and Hashimoto K
- Subjects
- Adolescent, Age Factors, Allografts statistics & numerical data, Allografts supply & distribution, Child, Child, Preschool, Female, Follow-Up Studies, Graft Survival, Humans, Infant, Kaplan-Meier Estimate, Liver Failure, Acute diagnosis, Liver Failure, Acute mortality, Liver Transplantation statistics & numerical data, Liver Transplantation trends, Male, Prognosis, Registries statistics & numerical data, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Time-to-Treatment, Treatment Outcome, Liver Failure, Acute surgery, Liver Transplantation methods, Living Donors, Waiting Lists mortality
- Abstract
This study estimated the utility of technical variant grafts (TVGs), such as split/reduced liver transplantation (SRLT) and living donor liver transplantation (LDLT), in pediatric acute liver failure (PALF). PALF is a devastating condition portending a poor prognosis without liver transplantation (LT). Pediatric candidates have fewer suitable deceased donor liver transplantation (DDLT) donor organs, and the efficacy of TVG in this setting remains incompletely investigated. PALF patients from 1995 to 2015 (age <18 years) were identified using the Scientific Registry of Transplant Recipients (n = 2419). Cox proportional hazards model and Kaplan-Meier curves were used to assess outcomes. Although wait-list mortality decreased (19.1% to 9.7%) and successful transplantations increased (53.7% to 62.2%), patients <1 year of age had persistently higher wait-list mortality rates (>20%) compared with other age groups (P < 0.001). TVGs accounted for only 25.7% of LT for PALF. In the adjusted model for wait-list mortality, among other factors, increased age (subhazard ratio [SHR], 0.97 per year; P = 0.020) and access to TVG were associated with decreased risk (SHR, 0.37; P < 0.0001). LDLT recipients had shorter median waiting times compared with DDLT (LDLT versus DDLT versus SRLT, 3 versus 4 versus 5 days, respectively; P = 0.017). In the adjusted model for post-LT survival, LDLT was superior to DDLT using whole grafts (SHR, 0.41; P = 0.004). However, patient survival after SRLT was not statistically different from DDLT (SHR, 0.75; P = 0.165). In conclusion, despite clear advantages to reduce wait-list mortality, TVGs have been underutilized in PALF. Early access to TVG, especially from LDLT, should be sought to further improve outcomes., (Copyright © 2019 by the American Association for the Study of Liver Diseases.)
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- 2019
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165. A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A-Related Acute Liver Failure.
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Kim JD, Cho EJ, Ahn C, Park SK, Choi JY, Lee HC, Kim DY, Choi MS, Wang HJ, Kim IH, Yeon JE, Seo YS, Tak WY, Kim MY, Lee HJ, Kim YS, Jun DW, Sohn JH, Kwon SY, Park SH, Heo J, Jeong SH, Lee JH, Nakayama N, Mochida S, Ido A, Tsubouchi H, Takikawa H, Shalimar, Acharya SK, Bernal W, O'Grady J, and Kim YJ
- Subjects
- Adult, Female, Humans, Liver Failure, Acute mortality, Male, Middle Aged, Prognosis, Risk Assessment, Time Factors, Hepatitis A complications, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Liver Transplantation statistics & numerical data, Models, Statistical
- Abstract
Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A-related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk-prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c-statistic, 0.87; 95% confidence interval [CI], 0.84-0.92) versus King's College criteria (KCC; c-statistic, 0.56; 95% CI, 0.53-0.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV-ALFSG; c-statistic, 0.70; 95% CI, 0.65-0.76), the new ALFSG index (c-statistic, 0.79; 95% CI, 0.74-0.84), Model for End-Stage Liver Disease (MELD; c-statistic, 0.79; 95% CI, 0.74-0.84), and MELD including sodium (MELD-Na; c-statistic, 0.78; 95% CI, 0.73-0.84) in the derivation set (all P < 0.01). In the validation set, the performance of the ALFA score (c-statistic, 0.84; 95% CI, 0.74-0.94) was significantly better than that of KCC (c-statistic, 0.65; 95% CI, 0.52-0.79), MELD (c-statistic, 0.74; 95% CI, 0.61-0.87), and MELD-Na (c-statistic, 0.72; 95% CI, 0.58-0.85) (all P < 0.05), and better, but not statistically significant, than that of the HAV-ALFSG (c-statistic, 0.76; 95% CI, 0.61-0.90; P = 0.28) and new ALFSG indices (c-statistic, 0.79; 95% CI, 0.65-0.93; P = 0.41). The model was well-calibrated in both sets. Conclusion: Our disease-specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A., (© 2018 by the American Association for the Study of Liver Diseases.)
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- 2019
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166. Everolimus worsening chronic proteinuria in patient with diabetic nephropathy post liver transplantation.
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Hanna RM, Yanny B, Arman F, Barsoum M, Mikhail M, Al Baghdadi M, Rastogi A, Wallace W, and Saab S
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- Aged, Diabetic Nephropathies diagnosis, Diabetic Nephropathies urine, Disease Progression, Humans, Liver Failure, Acute complications, Liver Failure, Acute diagnosis, Male, Proteinuria diagnosis, Proteinuria urine, Risk Factors, Treatment Outcome, Diabetic Nephropathies complications, Everolimus adverse effects, Immunosuppressive Agents adverse effects, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Proteinuria etiology
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Mammalian target of rapamycin (mTOR) inhibitors are used in renal sparing protocols and transplant immunosuppression in patients with solid organ and stem cell transplants. They cause various side effects, including proteinuria, which is mediated by blockade of the vascular endothelial growth factor receptor pathway. There have been various reports of mTOR inhibitors causing proteinuria or worsening proteinuria form preexisting renal glomerulo-pathies. We report a 73-year old male with diabetic glomerulosclerosis, acute liver failure due to Budd-Chiari syndrome, chronic low platelets, and worsening proteinuria from 0.46 g protein/g creatinine to 2.2 g protein/g creatinine. Workup revealed no thrombotic microangiopathy through skin biopsy, and a renal biopsy confirmed only clinically suspected diabetic and hypertensive glomerulosclerosis and possible calcineurin inhibitors. On discontinuation of everolimus urine protein decreased back to 0.6 g/g creatinine. We review the mechanism of mTOR-induced proteinuria and how this may affect diabetic nephropathy secondarily. We also consider the clinical implications of this in transplant patients receiving these agents., Competing Interests: None
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- 2019
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167. Adult T-Cell Leukemia After Deceased Donor Liver Transplantation for Acute Liver Failure: A Case Report.
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Motomura T, Yoshizumi T, Kosai-Fujimoto Y, Mano Y, Toshima T, Takeishi K, Itoh S, Harada N, Ikegami T, Soejima Y, Yoshimoto G, Akashi K, and Mori M
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- Hepatitis B complications, Hepatitis B virology, Humans, Immunosuppression Therapy methods, Liver Failure, Acute virology, Liver Transplantation methods, Male, Middle Aged, Hepatitis B surgery, Human T-lymphotropic virus 1, Leukemia-Lymphoma, Adult T-Cell virology, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Postoperative Complications virology
- Abstract
Human T-cell leukemia virus type 1 (HTLV-1) causes adult T-cell leukemia (ATL); however, the mechanism of its development has yet to be uncovered. A few ATL cases have been reported in HTLV-1-positive recipients after living donor liver transplantation. A 57-year-old HTLV-1-positive Japanese male suffered acute liver failure due to hepatitis B infection. He was transferred to our department to undergo deceased donor liver transplantation (DDLT). Tacrolimus and mycophenolate mofetil were induced for immunosuppression. His clinical outcome was satisfactory. However, he visited his physician 3 years after DDLT reporting abdominal pain and fever. A computed tomography scan showed multiple lymph node enlargement. Lymph node biopsy and his blood sample led to a diagnosis of ATL. He was transferred to the Department of Hematology and Oncology and underwent chemotherapy. To our knowledge, this is the first report of ATL development after DDLT from an HTLV-1-positive recipient. As is the case with our previous report, the current patient had undergone liver transplant for acute liver failure. Unlike living donor liver transplantation, however, DDLT needs no hepatic growth factor for liver regeneration. This finding sheds light on the resolution of the mechanism for the development of ATL from the HTLV-1 carrier., (Copyright © 2019. Published by Elsevier Inc.)
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- 2019
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168. Exosome-derived galectin-9 may be a novel predictor of rejection and prognosis after liver transplantation.
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Zhang AB, Peng YF, Jia JJ, Nie Y, Zhang SY, Xie HY, Zhou L, and Zheng SS
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- Adult, Biomarkers metabolism, Female, Galectins metabolism, Graft Rejection metabolism, Humans, Immunosuppressive Agents therapeutic use, Kaplan-Meier Estimate, Liver pathology, Liver Failure, Acute mortality, Male, Middle Aged, Prognosis, Proportional Hazards Models, Steroids therapeutic use, Tetraspanin 28 metabolism, Tetraspanin 30 metabolism, Tissue Array Analysis, Treatment Outcome, Exosomes metabolism, Galectins genetics, Graft Rejection genetics, Liver Failure, Acute surgery, Liver Transplantation
- Abstract
Acute cellular rejection (ACR) remains a major concern after liver transplantation. Predicting and monitoring acute rejection by non-invasive methods are very important for guiding the use of immunosuppressive drugs. Many studies have shown that exosomes and their contents are potential biomarkers for various liver diseases. Here, we identify and validate the role of exosomes and galectin-9 in ACR after liver transplantation. Exosomes were isolated from three sets of paired patients, with and without ACR, and the proteins within the exosomes were isolated and identified. Candidate proteins were then validated using a tissue microarray containing resected liver samples from 73 ACR and 63 non-rejection patients. Finally, protein expression and clinical manifestations were included in Kaplan-Meier survival and Cox regression analyses. Circulating exosomes were isolated from ACR and non-rejection patients and characterized using transmission electron microscopy and western blotting for CD63/CD81. Western blotting experiments revealed higher levels of galectin-9 protein in circulating exosomes from ACR recipients. Immunohistochemical analysis of the tissue microarray showed that the expression of galectin-9 in resected liver was significantly higher in the ACR group than in the non-rejection group (P<0.05). Higher levels of galectin-9 expression in resected livers were associated with poorer prognosis (P<0.05). Exosome-derived galectin-9 may be a novel predictor of rejection and prognosis after liver transplantation.
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- 2019
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169. Transjugular Portosystemic Shunt Reductions: A Retrospective Single-Center Experience.
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Joseph AS, Sandhu B, Khalil A, and Lopera J
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- Adult, Aged, Blood Vessel Prosthesis, Databases, Factual, Female, Hepatic Encephalopathy etiology, Hepatic Encephalopathy physiopathology, Humans, Hypertension, Pulmonary etiology, Hypertension, Pulmonary physiopathology, Liver Failure, Acute etiology, Liver Failure, Acute physiopathology, Male, Middle Aged, Reoperation, Retrospective Studies, Risk Factors, Stents, Texas, Time Factors, Treatment Outcome, Young Adult, Angioplasty, Balloon adverse effects, Angioplasty, Balloon instrumentation, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation instrumentation, Hepatic Encephalopathy surgery, Hypertension, Pulmonary surgery, Liver Failure, Acute surgery, Portasystemic Shunt, Transjugular Intrahepatic adverse effects
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Purpose: To report the results of transjugular intrahepatic portosystemic shunt (TIPS) reductions for hepatic encephalopathy (HE), acute liver failure (ALF), and pulmonary hypertension (PH)., Materials and Methods: A single-institution retrospective review analysis was performed between 2007 and 2017 on patients undergoing TIPS reduction at single tertiary liver transplant center. A total of 27 patients (14 males and 13 females) underwent TIPS reduction for refractory HE (n = 18), ALF (n = 7), and PH (n = 2). The average age at time of reduction was 59 years (range, 23-73; standard deviation [SD], 8). Mean prereduction Model of End-State Liver Disease-Na and portosystemic pressure gradient were 19 (range, 11-29; SD, 6) and 9.4 mm Hg (range, -2 to 19; SD, 4.8), respectively. Comparison between responders and nonresponders was performed for multiple variables using a 2-tailed t test. Methods of reduction were compared in cases of HE., Results: Technical success, defined as a decrease of at least 50% of the caliber of the shunt, was 100%. Clinical success rates in improving HE, ALF, and PH were calculated at 89%, 71%, and 100%, respectively. Eight patients had major and 10 had minor complications after the reductions. There were 3 shunt thrombosis. Pre- and postreduction Model of End-State Liver Disease-Na, portosystemic pressure gradient change, duration of indwelling TIPS, and reduction method were not significantly different between responders and nonresponders. Six-month survival rates were 80%, 20%, and 100% for HE, ALF, and PH, respectively., Conclusions: TIPS reduction is effective in reversing refractory HE, ALF, and PH after TIPS creation. TIPS reduction is associated with a high rate of complications and should be reserved for severe refractory overshunting complications., (Copyright © 2019 SIR. Published by Elsevier Inc. All rights reserved.)
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- 2019
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170. Urgent liver transplantation for acute liver failure due Wilson's disease.
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Estrada León I, Guiberteau Sánchez A, Vinagre Rodríguez G, Blanco Fernández G, Pérez Civantos D, Gaspar Blázquez MJ, and Narváez Rodríguez I
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- Adolescent, Biomarkers, Ceruloplasmin analysis, Copper analysis, Copper-Transporting ATPases genetics, Delayed Diagnosis, Emergencies, Female, Hemorrhagic Disorders etiology, Hepatolenticular Degeneration diagnosis, Hepatolenticular Degeneration genetics, Homozygote, Humans, Incidental Findings, Liver Failure, Acute etiology, Mutation, Missense, Severity of Illness Index, Hepatolenticular Degeneration complications, Liver Failure, Acute surgery, Liver Transplantation
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- 2019
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171. Outcome of Liver Transplant Patients With High Urgent Priority: Are We Doing the Right Thing?
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de Boer JD, Braat AE, Putter H, de Vries E, Strassburg CH, Máthé Z, van Hoek B, Braun F, van den Berg AP, Mikulic D, Michielsen P, Trotovsek B, Zoller H, de Boer J, van Rosmalen MD, Samuel U, Berlakovich G, and Guba M
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- Aged, Case-Control Studies, Clinical Decision-Making, Female, Health Services Needs and Demand, Health Status, Health Status Indicators, Humans, Liver Failure, Acute diagnosis, Liver Failure, Acute mortality, Male, Middle Aged, Reoperation, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Health Priorities, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Liver Transplantation mortality, Waiting Lists mortality
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Background: About 15% of liver transplantations (LTs) in Eurotransplant are currently performed in patients with a high-urgency (HU) status. Patients who have acute liver failure (ALF) or require an acute retransplantation can apply for this status. This study aims to evaluate the efficacy of this prioritization., Methods: Patients who were listed for LT with HU status from January 1, 2007, up to December 31, 2015, were included. Waiting list and posttransplantation outcomes were evaluated and compared with a reference group of patients with laboratory Model for End-Stage Liver Disease (MELD) score (labMELD) scores ≥40 (MELD 40+)., Results: In the study period, 2299 HU patients were listed for LT. Ten days after listing, 72% of all HU patients were transplanted and 14% of patients deceased. Patients with HU status for primary ALF showed better patient survival at 3 years (69%) when compared with patients in the MELD 40+ group (57%). HU patients with labMELD ≥45 and patients with HU status for acute retransplantation and labMELD ≥35 have significantly inferior survival at 3-year follow-up of 46% and 42%, respectively., Conclusions: Current prioritization for patients with ALF is highly effective in preventing mortality on the waiting list. Although patients with HU status for ALF have good outcomes, survival is significantly inferior for patients with a high MELD score or for retransplantations. With the current scarcity of livers in mind, we should discuss whether potential recipients for a second or even third retransplantation should still receive absolute priority, with HU status, over other recipients with an expected, substantially better prognosis after transplantation.
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- 2019
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172. Liver Transplantation for Acute Liver Failure due to Yellow Fever: A Case Report.
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Vieira V, Pacheco L, Demetrio L, Balbi E, Bellinha T, Toledo R, Auler L, Halpern M, Pinto L, Guaraldi B, Victor L, Bigi J, Carius L, and Roma J
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- Africa, Humans, Male, Middle Aged, Yellow fever virus, Liver Failure, Acute surgery, Liver Failure, Acute virology, Liver Transplantation, Yellow Fever complications
- Abstract
Yellow fever is a noncontagious disease caused by an arbovirus in the Flaviviridae family. It is an endemic disease in the tropical forests of Africa and South America, with the mosquito as a vector. Approximately half of those infected will be asymptomatic, while 15% will develop the severe/malignant form of the disease that includes renal and hepatic failure, bleeding, and neurological impairment as the principal symptoms. The lethality of the severe form reaches up to 70%. The objective of this study was to report on the case of a patient who was transferred to the hepatobiliary unit of our service due to acute liver failure due to yellow fever. He was treated with liver transplantation. The patient progressed satisfactorily, being discharged from the intensive care unit in 10 days and discharged from the hospital within 19 days after transplantation. Despite the encouraging result of our team, this has not been applied to other centers that have also performed this modality of treatment; therefore, the question remains as to whether and when to recommend liver transplantation for treatment of severe yellow fever., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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173. Abdominal Compartment Syndrome After Liver Transplant in Drug-Induced Acute Liver Failure: A Case Report.
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Nagy G, Görög D, Kóbori L, Mihály E, Piros L, Pőcze B, Sandil A, Szabó J, and Mathe Z
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- Female, Humans, Liver Failure, Acute surgery, Young Adult, Chemical and Drug Induced Liver Injury surgery, Compartment Syndromes etiology, Liver Transplantation adverse effects, Postoperative Complications etiology
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The incidence of drug-induced acute liver failure (ALF) has been increasing in recent years. Despite the complex intensive treatment, liver transplant should be performed in progressive cases. A systemic inflammatory response syndrome and the burden of surgical intervention promote abdominal compartment syndrome (ACS); observed preoperatively, they are significant negative prognostic factors. THE CASE: We demonstrate a young woman with liver transplant after ALF and a consecutive ACS. We presumed drug toxicity in the background of the rapidly progressive ALF, based on the preoperative hematologic examination and the histology of the removed liver. An ACS has occurred in the postoperative period that must have been resolved with mesh, and later, anatomic segment 2-3 resection had to be performed to further decrease the pressure. The patient left the hospital after 62 days with good graft function. DISCUSSION: A complex intensive care is mandatory in the case of orthotopic liver transplant for ALF. Outcomes are good after orthotopic liver transplant. An ACS might occur after surgery. In these rare cases a delayed abdominal closure or even a liver resection can be the only solution and sometimes an urgent need to resolve the life-threatening problem., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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174. Sequential transplantation and implications for clinical management: OLT followed by HCT and consequent RT in a pediatric patient.
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Hoogenboom L, Margolis D, Anderson L, and Phelan R
- Subjects
- Adenocarcinoma complications, Calcineurin Inhibitors therapeutic use, Colonic Neoplasms complications, Fatal Outcome, Graft Survival, Humans, Immunosuppression Therapy, Kidney Failure, Chronic complications, Liver Failure, Acute complications, Male, Tissue Donors, Treatment Outcome, Young Adult, Hematopoietic Stem Cell Transplantation methods, Kidney Failure, Chronic surgery, Kidney Transplantation methods, Liver Failure, Acute surgery, Liver Transplantation methods
- Abstract
We report a case of a pediatric patient who required three separate transplants: OLT at the age 5, HCT at age 13 (8 years post-OLT), and cadaveric RT at age 15 (10 years post-OLT). The child initially presented with fulminant liver failure without known cause, ultimately undergoing OLT from his mother. He then developed SAA, for which he required HCT. Unfortunately, he developed ESRD secondary to prolonged CNI exposure, for which he underwent cadaveric RT. These processes then resulted in 7 years largely free from complications, during which a multi-disciplinary team monitored the patient for complications. Regrettably, at the age of 21 he developed poorly differentiated mucinous adenocarcinoma of the colon which ultimately led to his demise. While there are case reports of patients requiring two sequential transplants, there is a paucity of reports of successfully completing three separate organ transplants in the same patient. Our case demonstrates progression of a pediatric patient through OLT, HCT, and RT with discussion of notable clinical implications. Secondarily, this case highlights the importance of coordination of care amongst various subspecialties to facilitate tandem transplantations and manage the complications of these processes. As pediatric patients have improved survival rates and may require multiple transplants, it remains important to highlight the feasibility as well as the complications of the tandem transplant process., (© 2019 Wiley Periodicals, Inc.)
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- 2019
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175. Outcomes of renal dysfunction in patients with acute liver failure.
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Hadem J, Kielstein JT, Manns MP, Kümpers P, and Lukasz A
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- Acute Kidney Injury mortality, Adult, Bilirubin blood, Creatinine blood, Disease-Free Survival, Female, Follow-Up Studies, Hospitalization, Humans, Incidence, Intensive Care Units, Liver Failure, Acute surgery, Liver Transplantation, Male, Middle Aged, Retrospective Studies, Acute Kidney Injury epidemiology, Acute Kidney Injury etiology, Liver Failure, Acute complications
- Abstract
Background: Although acute kidney injury (AKI) often accompanies acute liver failure (ALF), its impact on long-term outcome is unknown., Objective: This study examines the incidence, severity and outcomes of AKI in patients with ALF., Methods: A total of 134 ALF patients treated at Hannover Medical School between 1995 and 2013 were retrospectively analyzed., Results: Fifty-four ALF patients (40.3%) demonstrated AKI, as defined by the acute kidney injury network (AKIN) classification, on intensive care unit (ICU) admission, and 85 patients (63.4%) developed AKI prior to ALF recovery, emergency liver transplantation (ELT) or death. AKI severity was closely associated with other end-organ damage ( p < 0.001). Follow-up creatinine levels in survivors were increased compared to baseline levels (76 versus 64 µmol/l, p = 0.003). One-hundred-and-three (76.9%) patients reached the combined endpoint of ELT or death, and 42 (31.3%) patients died within 28 days. AKIN stage 3 at ICU admission was the strongest independent predictor of 28-day overall mortality (hazard ratio 3.48, 95% confidence interval 1.75-6.93, p < 0.001) and ELT or death (hazard ratio 2.52, 95% confidence interval 1.60-3.96, p < 0.001)., Conclusions: AKI is a frequent complication in ALF that correlates with remote organ damage and long-term creatinine levels and independently predicts outcome.
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- 2019
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176. Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry.
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Mendizabal M, Tagliafichi V, Rubinstein F, Rojas P, Marciano S, Yantorno S, Cejas N, Barrabino M, Anders M, Cairo F, Villamil F, Blazquez L, Zerega A, Ferretti S, Fernández D, Paredes S, Aballay Soteras G, Gaite L, Bisigniano L, and Silva MO
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- Adult, Argentina epidemiology, Decision Support Techniques, Female, Graft Survival, Health Status, Health Status Indicators, Hepatitis, Autoimmune diagnosis, Hepatitis, Autoimmune mortality, Humans, Liver Failure, Acute diagnosis, Liver Failure, Acute mortality, Male, Middle Aged, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Tissue and Organ Procurement, Treatment Outcome, Young Adult, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Liver Transplantation mortality, Waiting Lists mortality
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Introduction and Aim: Liver transplantation (LT) for acute liver failure (ALF) still has a high early mortality. We aimed to evaluate changes occurring in recent years and identify risk factors for poor outcomes., Material and Methods: Data were retrospectively obtained from the Argentinean Transplant Registry from two time periods (1998-2005 and 2006-2016). We used survival analysis to evaluate risk of death., Results: A total of 561 patients were listed for LT (69% female, mean age 39.5±16.4 years). Between early and later periods there was a reduction in wait-list mortality from 27% to 19% (p<0.02) and 1-month post-LT survival rates improved from 70% to 82% (p<0.01). Overall, 61% of the patients underwent LT and 22% died on the waiting list. Among those undergoing LT, Cox regression analysis identified prolonged cold ischemia time (HR 1.18 [1.02-1.36] and serum creatinine (HR 1.31 [1.01-1.71]) as independent risk factors of death post-LT. Etiologies of ALF were only available in the later period (N=363) with indeterminate and autoimmune hepatitis accounting for 28% and 26% of the cases, respectively. After adjusting for age, gender, private/public hospital, INR, creatinine and bilirubin, and considering LT as the competing event, indeterminate etiology was significantly associated with death (SHR 1.63 [1.06-2.51] and autoimmune hepatitis presented a trend to improved survival (SHR 0.61 [0.36-1.05])., Conclusions: Survival of patients with ALF on the waiting list and after LT has significantly improved in recent years. Indeterminate cause and autoimmune hepatitis were the most frequent etiologies of ALF in Argentina and were associated with mortality., (Copyright © 2019 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2019
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177. Auxiliary partial orthotopic liver transplantation for acute liver failure.
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Shrivastav M, Rammohan A, Reddy MS, and Rela M
- Subjects
- Aspartate Aminotransferases blood, Bilirubin blood, Female, Humans, Infant, Liver Cirrhosis complications, Liver Cirrhosis surgery, Liver Failure, Acute etiology, Liver Transplantation adverse effects, Patient Selection, Postoperative Complications blood, Postoperative Complications etiology, Treatment Outcome, Liver Cirrhosis congenital, Liver Failure, Acute surgery, Liver Transplantation methods
- Abstract
Introduction: Auxiliary partial orthotopic liver transplantation (APOLT) in acute liver failure acts as a bridge to native liver regeneration with potential for immunosuppression free survival. While technical concerns limit its universal acceptance, the indications in acute liver failure also need to be examined for this procedure to ultimately succeed., Case History: We present the case of an eight-month-old girl with cryptogenic acute liver failure who underwent APOLT. She developed postoperative liver dysfunction, most likely owing to the persistence of the diseased native liver, ultimately leading to an orthotopic retransplantation. She remains well on follow-up review., Conclusions: A tempered approach to selecting patients for APOLT (especially with regard to aetiology of acute liver failure) makes it a safe and effective alternative to orthotopic liver transplantation.
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- 2019
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178. Liver Transplantation for Wilson's Disease in Non-adult Patients: A Systematic Review.
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Garoufalia Z, Prodromidou A, Machairas N, Kostakis ID, Stamopoulos P, Zavras N, Fouzas I, and Sotiropoulos GC
- Subjects
- Adolescent, Child, End Stage Liver Disease etiology, End Stage Liver Disease surgery, Female, Hepatolenticular Degeneration complications, Humans, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Liver Transplantation mortality, Male, Quality of Life, Retrospective Studies, Survival Rate, Treatment Outcome, Hepatolenticular Degeneration surgery, Liver Transplantation methods
- Abstract
Introduction: Wilson's disease (WD) is a rare autosomal recessive disorder transmitted through a gene located on chromosome 13. Liver transplantation (LT) provides a therapeutic option for patients with WD presenting fulminant liver failure or drug resistance. LT in patients with WD has a twofold aim: to save the patient's life when the disorder has progressed to hepatic (or other organ) failure and to cure the underlying metabolic defect. The aim of our study was to investigate the indications, aspects and post-operative outcomes in pediatric patients (< 18 years old) with WD who underwent LT., Methods: A meticulous search of the literature since 1971 was performed. A retrospective analysis of all the studies, presenting cases of LT in children due to WD, was conducted. Studies that did not report patients' characteristics, transplantation indications, post-operative outcomes, and complications, as well as those with small study populations (< 10 patients), were excluded., Results: Six studies were included in the present review, which involved 290 children. The main indications for LT included chronic liver failure and fulminant liver failure. The average 1-year survival rate was 91.9%, while the average 5-year survival rate was 88.2%. Retransplantation was performed in 16 patients due to transplant rejection. In general, patients transplanted for WD displayed an excellent quality of life after LT., Conclusion: LT is a safe and efficient procedure in selected pediatric patients with WD, demonstrating excellent long-term outcomes and quality of life., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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179. Cerebral autoregulation in a fulminant hepatic failure patient who underwent liver transplantation.
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Paschoal-Jr FM, Nogueira RC, de-Lima-Oliveira M, Paschoal EH, Teixeira MJ, D'Albuquerque LA, and Bor-Seng-Shu E
- Subjects
- Female, Hepatic Encephalopathy diagnostic imaging, Hepatic Encephalopathy physiopathology, Homeostasis, Humans, Liver Failure, Acute diagnosis, Liver Failure, Acute physiopathology, Middle Aged, Recovery of Function, Reoperation, Time Factors, Treatment Outcome, Ultrasonography, Doppler, Transcranial, Cerebrovascular Circulation, Hepatic Encephalopathy surgery, Liver Failure, Acute surgery, Liver Transplantation
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- 2019
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180. Effect of Stem Cell Treatment on Acute Liver Failure Model Using Scaffold.
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Kang HT, Jun DW, Jang K, Hoh JK, Lee JS, Saeed WK, Chae YJ, and Lee JH
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- Animals, Biomarkers metabolism, Cell Differentiation, Cell Movement, Cell Proliferation, Cells, Cultured, Chemical and Drug Induced Liver Injury etiology, Chemical and Drug Induced Liver Injury metabolism, Chemical and Drug Induced Liver Injury pathology, Cytochrome P-450 CYP2E1 metabolism, Disease Models, Animal, Humans, Liver pathology, Liver Failure, Acute chemically induced, Liver Failure, Acute metabolism, Liver Failure, Acute pathology, Mice, Inbred C57BL, Necrosis, Paracrine Communication, Phenotype, Thioacetamide, Chemical and Drug Induced Liver Injury surgery, Liver metabolism, Liver Failure, Acute surgery, Liver Regeneration, Mesenchymal Stem Cell Transplantation methods, Mesenchymal Stem Cells metabolism, Polylactic Acid-Polyglycolic Acid Copolymer chemistry, Tissue Scaffolds chemistry
- Abstract
Background: Injecting MSCs via blood vessel is most commonly used method, which has a major drawback of safety. The aim of our study was to evaluate efficacy using scaffold-loaded MSCs in acute liver failure model., Method: Acute liver failure was induced in mice using thioacetamide (TAA) (200 mg/kg, i.p) once a day for two consecutive days. The animals were divided in four acute liver failure groups: (1) TAA; (2) empty scaffold; (3) MSCs injected through tail vein; (4) MSC + Scaffold, scaffold loaded with MSCs, to evaluate the mortality and changes in liver function. Polylactic-co-glycolic acid scaffold alone and loaded with human MSCs was implanted on mice dorsum., Results: TAA dose was titrated until one-third mortality rate was achieved. TAA (200 mg/kg) once daily for two consecutive days was injected to establish the acute liver failure model. The mortality of TAA and scaffold groups was 55.9% and 63.2%, respectively. Although, mortality of MSC-TV group decreased 14.7% as compared to TAA group (p = 0.200), MSC + Scaffold group had the lowest mortality (31.4%) (p = 0.013). Cells implanted in PLGA biomaterial were survived until 3 weeks, and their function was increased. Area of hepatic inflammation and necrosis was significantly reduced in MSC-TV and MSC + Scaffold groups; but there was no difference between the two groups. Gene expressions related to inflammation were significantly decreased in MSC-TV and MSC + Scaffold groups compared to TAA group. In MSC + Scaffold group, no migration of stem cells to liver tissue was observed. Although, not all cells in scaffold were stained, some of them were differentiated into hepatocyte-like cells which stained positive for PAS and CYP2E1 antibody., Conclusion: Scaffold loaded with MSCs showed protective effects via paracrine signaling on acute liver failure model.
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- 2019
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181. Liver transplantation in patients with liver failure related to exertional heatstroke.
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Ichai P, Laurent-Bellue A, Camus C, Moreau D, Boutonnet M, Saliba F, Peron JM, Ichai C, Gregoire E, Aigle L, Cousty J, Quinart A, Pons B, Boudon M, André S, Coilly A, Antonini T, Guettier C, and Samuel D
- Subjects
- Adult, France, Humans, Male, Multiple Organ Failure diagnosis, Multiple Organ Failure etiology, Multiple Organ Failure therapy, Organ Dysfunction Scores, Outcome Assessment, Health Care, Patient Selection, Physical Exertion, Retrospective Studies, Heat Stroke complications, Heat Stroke physiopathology, Liver pathology, Liver physiopathology, Liver Failure, Acute blood, Liver Failure, Acute etiology, Liver Failure, Acute physiopathology, Liver Failure, Acute surgery, Liver Transplantation methods, Prothrombin Time methods
- Abstract
Background & Aims: Severe acute liver injury is a grave complication of exertional heatstroke. Liver transplantation (LT) may be a therapeutic option, but the criteria for LT and the optimal timing of LT have not been clearly established. The aim of this study was to define the profile of patients who require transplantation in this context., Methods: This was a multicentre, retrospective study of patients admitted with a diagnosis of exertional heatstroke-related severe acute liver injury with a prothrombin time (PT) of less than 50%. A total of 24 male patients were studied., Results: Fifteen of the 24 patients (median nadir PT: 35% [29.5-40.5]) improved under medical therapy alone and survived. Nine of the 24 were listed for emergency LT. At the time of registration, the median PT was 10% (5-12) and all had numerous dysfunctional organs. Five patients (nadir PT: 12% [9-12]) were withdrawn from the list because of an elevation of PT values that mainly occurred between day 2 and day 3. Ultimately, 4 patients underwent transplantation as their PT persisted at <10%, 3 days (2.75-3.25) after the onset of exertional heatstroke, and they had more than 3 organ dysfunctions. Of these 4 patients, 3 were still alive 1 year later. Histological analysis of the 4 explanted livers demonstrated massive or sub-massive necrosis, and little potential for effective mitoses, characterised by a "mitonecrotic" appearance., Conclusion: The first-line treatment for exertional heatstroke-related severe acute liver injury is medical therapy. LT is only a rare alternative and such a decision should not be taken too hastily. A persistence of PT <10%, without any signs of elevation after a median period of 3 days following the onset of heatstroke, was the trigger that prompted LT, was the trigger adopted in order to decide upon LT., Lay Summary: Acute liver injury due to heatstroke can progress to acute liver failure with organ dysfunction despite medical treatment; in such situations, liver transplantation (LT) may offer a therapeutic option. The classic criteria for LT appear to be poorly adapted to heatstroke-related acute liver failure. We confirmed thatmedication is the first-line therapy acute liver injury caused by heatstroke, with LT only rarely necessary. A decision to perform LT should not be made hastily. Fluctuations in prothrombin time and the patient's clinical status should be considered even in the event of severe liver failure., (Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
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- 2019
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182. Neurological Complications Occurring After Liver Transplantation: Role of Risk Factors, Hepatic Encephalopathy, and Acute (on Chronic) Brain Injury.
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Weiss N and Thabut D
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- Brain Damage, Chronic etiology, Hepatic Encephalopathy etiology, Humans, Liver Cirrhosis complications, Liver Failure, Acute complications, Postoperative Cognitive Complications etiology, Postoperative Cognitive Complications prevention & control, Risk Factors, Brain Damage, Chronic epidemiology, Hepatic Encephalopathy epidemiology, Liver Cirrhosis surgery, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Postoperative Cognitive Complications epidemiology
- Abstract
Orthotopic liver transplantation (LT) remains the only way to definitively cure patients with the most severe liver diseases. Because the survival rate is now fairly high, important questions about neurological sequelae or quality of life after LT have emerged. Indeed, LT represents a peculiar situation because up to 30% of patients present with neurological symptoms after LT compared with only 4% after cardiac transplant and 0.5% after renal transplant. These postoperative neurological symptoms have long been interpreted as sequelae of hepatic encephalopathy (HE). However, postoperative decompensation of an unknown cerebral condition due to the pathophysiology of cirrhosis or undiagnosed neurodegenerative disorders or aging constitute other possibilities that are underrecognized. Some patients who undergo LT for acute liver failure and patients with cirrhosis without episodes of HE and without any previous cerebral alteration also display post-LT neurological symptoms. This latter situation speaks in favor of a direct adverse effect of either general anesthesia, the surgical procedure, or factors related to the postoperative intensive care unit (ICU) environment. The role of inflammation, which has been described in the ICU setting, could also be a crucial determinant. In this review, we will discuss the neurological complications associated with LT, the neurocognitive complications after LT, and how to assess the LT-related neurological or neurocognitive complications. Furthermore, we will review the various hypotheses surrounding post-LT neurocognitive impairment and will conclude with recommendations for future directions., (Copyright © 2018 by the American Association for the Study of Liver Diseases.)
- Published
- 2019
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183. Mutation in ITCH Gene Can Cause Syndromic Multisystem Autoimmune Disease With Acute Liver Failure.
- Author
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Kleine-Eggebrecht N, Staufner C, Kathemann S, Elgizouli M, Kopajtich R, Prokisch H, and Lainka E
- Subjects
- Base Sequence, Child, Preschool, Fatal Outcome, Female, Hepatitis, Autoimmune diagnosis, Hepatitis, Autoimmune surgery, Humans, Infant, Liver Failure, Acute diagnosis, Liver Failure, Acute surgery, Hepatitis, Autoimmune genetics, Liver Failure, Acute genetics, Liver Transplantation trends, Mutation genetics, Repressor Proteins genetics, Ubiquitin-Protein Ligases genetics
- Abstract
Pediatric intractable autoimmune hepatitis is rare and may be responsible for acute liver failure. Mutations in the itchy E3 ubiquitin protein ligase ( ITCH ) gene (located on chromosome 20q11.22) can lead to a deficiency of the encoded protein, resulting in increased T-cell activity with lack of immune tolerance and manifestation of a complex systemic autoimmune disease. A 1-year-old girl of consanguineous parents received a liver transplant (LT) because of acute liver failure attributed to a drug-induced hypereosinophilic syndrome with positive liver-kidney-mikrosome-2 antibodies. Notable findings were syndromic features, dystrophy, short stature, psychomotor retardation, and muscular hypotonia. Later, we saw corticosteroid-sensitive rejections as well as a systemic autoimmune disease with detection of specific antibodies (de novo autoimmune hepatitis, thyroiditis with exophthalmos, diabetes mellitus type 1, and immune neutropenia). Histologically, liver cirrhosis with lobular inflammatory infiltrates, giant-cell hepatitis, and ductopenia was verified in chronic cholestasis. Shortly after a second LT, a comparable liver histology could be detected, and viral, bacterial, and mycotic infections deteriorated the general health condition. Because of refractory pancytopenia related to portal hypertension and hypersplenism, a posttransplant lymphoproliferative disorder was excluded. One year after the second LT, epidural and subdural bleeding occurred. Three months afterward, the girl died of sepsis. Postmortem, whole-exome sequencing revealed a homozygous mutation in the ITCH gene. A biallelic mutation in ITCH can cause a severe syndromic multisystem autoimmune disease with the above phenotypic characteristics and acute liver failure because of autoimmune hepatitis. This case reveals the importance of ubiquitin pathways for regulation of the immune system., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)
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- 2019
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184. Liver Transplant in a Patient With Hemophagocytic Lymphohistiocytosis.
- Author
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Ayvazoğlu Soy EH, Alam H, Olcay L, Barış Z, Yıldırım S, Torgay A, and Haberal M
- Subjects
- Bone Marrow Examination, Child, Preschool, Female, Hepatic Encephalopathy diagnosis, Hepatic Encephalopathy etiology, Humans, Liver Failure, Acute diagnosis, Liver Failure, Acute etiology, Liver Function Tests, Living Donors, Lymphohistiocytosis, Hemophagocytic complications, Lymphohistiocytosis, Hemophagocytic diagnosis, Treatment Outcome, Bone Marrow Transplantation methods, Hepatic Encephalopathy surgery, Liver Failure, Acute surgery, Liver Transplantation methods, Lymphohistiocytosis, Hemophagocytic surgery
- Abstract
Hemophagocytic lymphohistiocytosis is a rare and life-threatening systemic disease that can cause hepatic infiltration and present as acute liver failure. Here, we report a case of a 3-year-old pediatric patient who presented with acute liver failure and hepatic encephalopathy secondary to hemophagocytic lymphohistiocytosis. She had left lateral segment liver transplant from her father. After 27 months, she had bone marrow transplant from her sister. At the time of reporting (36 months after liver transplant), she showed normal liver function and blood peripheral counts. We found that liver transplant can be a curative treatment for this type of rare disorder, not only to improve the quality of life but also to prolong survival.
- Published
- 2019
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185. Acute Liver Failure due to Wilson Disease: Eight Years of the National Liver Transplant Program in Uruguay.
- Author
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Mainardi V, Rando K, Valverde M, Olivari D, Castelli J, Rey G, and Gerona S
- Subjects
- Adolescent, Child, Female, Follow-Up Studies, Hepatolenticular Degeneration mortality, Humans, Liver Failure, Acute mortality, Liver Failure, Acute surgery, Male, Prognosis, Retrospective Studies, Survival Rate trends, Time Factors, Uruguay epidemiology, Young Adult, Hepatolenticular Degeneration chemically induced, Liver Failure, Acute etiology, Liver Transplantation, Waiting Lists mortality
- Abstract
Introduction and Aim: Wilson's disease (WD) is an uncommon cause of acute liver failure (ALF). Our aim was to describe clinical features, diagnostic findings, treatments, and outcomes of patients with ALF due to WD., Material and Methods: Retrospective medical record reviews of all patients with ALF due to WD in eight years in Uruguay., Results: WD was the cause of six (15%) of thirty-nine ALF cases. All patients were females, with a mean age of 18 years. Four patients presented with hyperacute liver failure and two with acute failure. Jaundice was the main complaint of all patients. Mean total bilirubin (TB), alkaline phosphatase (AP), AST, and ALT were 27.5 mg/dL, 45.5 lU/l, 156 IU/L, and 51 IU/L, respectively. Ceruloplasmin levels were low in four patients, urinary cooper was high in four, and two had Kayser-Fleischer rings. All patients had Coombs-negative hemolytic anemia, acute kidney injury, histochemical identifiable copper, and advanced fibrosis on liver histology. The average MELD score was 36. All patients were treated with d-penicillamine and listed for urgent liver transplantation (LT). Prometheus® was performed in one patient. Three patients died: two without LT and one after LT. Three patients survived: one without LT (New Wilson Index<11) and two with LT. The referral time to the program and the total time (referral plus waiting list time) were longer for non-survivors than for survivors (14 vs. 3 days and 23 vs. 8 respectively)., Conclusion: All cases had typical clinical, analytical and histopathology characteristics. Early referral was determinant of prognosis., (Copyright © 2019 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2019
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186. When to Refer for Liver Transplantation.
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Carrion AF and Martin P
- Subjects
- Humans, Practice Guidelines as Topic, Liver Cirrhosis surgery, Liver Failure, Acute surgery, Liver Transplantation, Referral and Consultation
- Published
- 2019
- Full Text
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187. Extracorporeal Devices.
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Kandiah PA and Subramanian RM
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Critical Care Nursing standards, Liver Failure, Acute surgery, Liver Transplantation instrumentation, Liver, Artificial, Perioperative Care instrumentation, Perioperative Care standards, Practice Guidelines as Topic
- Abstract
Extracorporeal liver support (ECLS) emerged from the need stabilize high-acuity liver failure patients with the highest risk of death. The goal is to optimize the hemodynamic, neurologic, and biochemical parameters in preparation for transplantation or to facilitate spontaneous recovery. Patients with acute liver failure and acute-on-chronic liver failure stand to benefit from these devices, especially because they have lost many of the primary functions of the liver, including detoxifying the blood of various endogenous and exogenous substances, manufacturing circulating proteins, secreting bile, and storing energy. Existing ECLS devices are designed to mimic some of these functions., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
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188. Beating the Odds: A Full-Term Delivery After Liver Transplantation of a Pregnant Hyperthyroid Patient at 19 Weeks' Gestation for Propylthiouracil-Induced Acute Liver Failure.
- Author
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Bartnik CM, Maheshwari RN, and Subramanian RM
- Subjects
- Adult, Female, Humans, Live Birth, Liver Failure, Acute chemically induced, Liver Failure, Acute surgery, Pregnancy, Pregnancy Complications surgery, Antithyroid Agents adverse effects, Graves Disease complications, Graves Disease drug therapy, Liver Transplantation methods, Pregnancy Complications chemically induced, Propylthiouracil adverse effects
- Abstract
Liver transplantation (LT) for acute liver failure is an uncommon occurrence in the setting of pregnancy given the risk of fetal demise, and rarely is it undertaken with a viable fetus. Maternal hyperthyroidism increases fetal risk in the setting of LT, particularly in the setting of thyrotoxicosis. We report the first case of propylthiouracil-induced acute liver failure in a hyperthyroid patient in her second trimester resulting in LT. The multidisciplinary management led to a favorable outcome for the patient and the subsequent delivery of a healthy infant at 38-weeks' gestation., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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189. Long-term outcome in patients with acute liver failure.
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Putignano A, Figorilli F, Alabsawy E, Agarwal B, and Jalan R
- Subjects
- Adult, Drug Overdose physiopathology, Female, Humans, Liver Failure, Acute chemically induced, London epidemiology, Male, Middle Aged, Prognosis, Retrospective Studies, Survival Analysis, Time Factors, Treatment Outcome, Acetaminophen adverse effects, Liver Failure, Acute mortality, Liver Failure, Acute surgery, Liver Transplantation adverse effects
- Abstract
Background & Aims: Acute liver failure patients who meet poor prognostic criteria have high early mortality without emergency liver transplantation. A recent study however, reported that patients that survive spontaneously have a poorer outcome compared with patients undergoing transplantation. In this single centre study, we aimed to confirm or refute this observation., Methods: Early survivors (acute liver failure patients who survived 90 days after the ICU admission) were assessed for long-term outcomes in four distinctive cohorts, incorporating aetiology (Acetaminophen overdose or non-Acetaminophen overdose), and management strategy (conservative or liver transplantation). Chi Squared or Fisher test were used to compare outcomes among the four cohorts (P < 0.05) and Kaplan-Meier curve (Log Rank test) to represent cumulative survival., Results: Two hundred consecutive acute liver failure patients between 1990 and 2014 were included; mean age 38.3, ±12.8, male 70, 35%. 124/200 (62%) early survivors were identified; 13/124 (10.5%) acetaminophen patients underwent transplantation and 48/124 (38.7%) survived spontaneously; 36/124 (29.0%) non-acetaminophen underwent transplantation and 27/124 (21.8%) survived spontaneously. A total of 11/124 (8.9%) died subsequently (median survival 5.3± IQR 9.1), three spontaneous survivors and eight transplanted patients (P = 0.025); of the eight transplanted patients, six died of transplant related complications and two of suicide., Conclusion: The results of this study suggest that although liver transplantation is a life-saving procedure for acute liver failure patients, they have a worse long-term outcome compared with spontaneous survivors. Novel therapies to increase the percentage of spontaneous survivors are urgently needed., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2018
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190. Molecular Adsorbent Recirculating System Support Followed by Liver Transplantation for Multiorgan Failure From Heatstroke.
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LaMattina JC, Akbar H, Sultan S, Hanish SI, Bruno DA, Hutson WR, Stein DM, Bartlett ST, Scalea TM, and Barth RN
- Subjects
- Adult, Fluid Therapy instrumentation, Humans, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Male, Multiple Organ Failure surgery, Retrospective Studies, Young Adult, Fluid Therapy methods, Heat Stroke complications, Liver Transplantation methods, Multiple Organ Failure etiology
- Abstract
Background: Exertional heatstroke is an extremely rare cause of fulminant hepatic failure. Maximal supportive care has failed to provide adequate survival in earlier studies. This is particularly true in cases accompanied by multiorgan failure., Methods and Materials: Our prospectively collected transplant database was retrospectively reviewed to identify patients undergoing liver transplantation for heatstroke between January 1, 2012, and December 31, 2016. We report 3 consecutive cases of male patients with fulminant hepatic failure from exertional heatstroke., Results: All patients developed multiorgan failure and required intubation, vasopressor support, and renal replacement therapy. All patients were listed urgently for liver transplantation and were supported with the molecular adsorbent recirculating system while awaiting transplantation. All patients underwent liver transplantation alone and are alive and well, with recovered renal function, normal liver allograft function, and no chronic sequelae of their multiorgan failure at more than one year., Conclusion: Extreme heatstroke leading to whole-body organ dysfunction and fulminant liver failure is a complex entity that may benefit from therapy using the Molecular Adsorbent Recirculating System while waiting for liver transplantation as a component of a multidisciplinary, multiorgan system approach., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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191. Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis.
- Author
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Haffar S, Shalimar, Kaur RJ, Wang Z, Prokop LJ, Murad MH, and Bazerbachi F
- Subjects
- Genotype, Hepatitis Antibodies analysis, Hepatitis E virology, Humans, Liver Failure, Acute surgery, Liver Transplantation, RNA, Viral genetics, Risk Factors, Viral Load, Hepatitis E complications, Hepatitis E virus genetics, Liver Failure, Acute mortality, Liver Failure, Acute virology
- Abstract
Background & Aims: Acute liver failure caused by hepatitis E virus genotype 3 and 4 has been rarely described. Because of the presence of a short golden therapeutic window in patients with viral acute liver failure from other causes, it is possible that early recognition and treatment might reduce the morbidity and mortality. We performed a systematic review and pooled analysis of acute liver failure caused by hepatitis E virus genotype 3 and 4., Methods: Two reviewers appraised studies after searching multiple databases on June 12th, 2017. Appropriate tests were used to compare hepatitis E virus genotype 3 vs 4, suspected vs confirmed genotypes, hepatitis E virus-RNA positive vs negative, and to discern important mortality risk factors., Results: We identified 65 patients, with median age 58 years (range: 3-79), and a male to female ratio of 1.2:1. The median bilirubin, ALT, AST and alkaline phosphatase (expressed by multiplication of the upper limit of normal) levels were 14.8, 45.3, 34.8 and 1.63 respectively. Antihepatitis E virus IgG, antihepatitis E virus IgM and hepatitis E virus-RNA were positive in 84%, 91% and 86% of patients respectively. The median interval from symptoms onset to acute liver failure was 23 days, and 16 patients underwent liver transplantation. Final outcome was reported in 58 patients and mortality was 46%. Age was a predictor of poor prognosis in multivariate analysis. No important differences were found between patients infected with genotype 3 vs 4, patients with confirmed vs suspected genotypes, or patients with positive vs negative RNA., Conclusion: Acute liver failure caused by hepatitis E virus genotype 3 and 4 is rare, similar between genotypes, occurs commonly in middle-aged/elderly patients and has a very high mortality. Age is predictive of poor prognosis in multivariate analysis., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2018
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192. Central ECMO for circulatory failure following pediatric liver transplantation.
- Author
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Scott JP, Hong JC, Thompson NE, Woods RK, and Hoffman GM
- Subjects
- Child, Preschool, Humans, Male, Time Factors, Extracorporeal Membrane Oxygenation, Liver Failure, Acute surgery, Liver Transplantation, Nephrotic Syndrome surgery, Shock surgery, Short Bowel Syndrome surgery
- Abstract
We describe the case of a 4-year-old male with a past medical history significant for nephrotic syndrome, short-bowel syndrome and fulminant hepatic failure status post (s/p) liver transplant (LT) who developed early post-transplant allograft dysfunction (hyperbilirubinemia, coagulopathy) and septic shock requiring central extracorporeal membrane oxygenation (ECMO). He remained on ECMO for 85 hours before he was decannulated without event and later underwent repeat LT. This case highlights the potential of central ECMO to provide the circulatory output necessary to reverse distributive shock physiology in patients with sepsis and hepatic dysfunction following LT. Furthermore, this is the first documented example of central ECMO as a bridge to recovery for repeat LT.
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- 2018
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193. Management of Amanita phalloides poisoning: A literature review and update.
- Author
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Ye Y and Liu Z
- Subjects
- Acetylcysteine therapeutic use, Antidotes therapeutic use, Bile Ducts drug effects, Charcoal therapeutic use, Diuresis, Gastric Lavage, Humans, Liver Failure, Acute surgery, Liver Transplantation, Mushroom Poisoning epidemiology, Penicillin G therapeutic use, Silymarin therapeutic use, Amanita, Amanitins adverse effects, Liver drug effects, Liver Failure, Acute chemically induced, Mushroom Poisoning therapy
- Abstract
Amanita phalloides poisoning with a high mortality is a serious health problem in the world. The typical clinical manifestations are usually characterized by the absence of any symptoms followed by severe gastrointestinal disorders and acute liver failure. Inhibition of RNA polymeraseII (RNAP II) activity, apoptosis, and oxidative stress are considered as the major mechanism of amatoxins intoxication. The current treatment measures mainly include prevention of amatoxins absorption, elimination of absorbed amatoxins, potential antidotes therapy, and liver transplantation. Nevertheless, there are no widely accepted treatment criteria for Amanita phalloides poisoning. This paper will focus on the treatment measures based on the previous studies and provide the currently available information for clinicians., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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194. Liver transplantation for acute liver failure due to antitubercular drugs - a single-center experience.
- Author
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Martino RB, Abdala E, Villegas FC, D'Albuquerque LAC, and Song ATW
- Subjects
- Adolescent, Adult, Brain Diseases etiology, Female, Humans, Jaundice etiology, Liver Failure, Acute mortality, Liver Transplantation mortality, Middle Aged, Prospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, Tuberculosis complications, Young Adult, Antitubercular Agents adverse effects, Liver Failure, Acute chemically induced, Liver Failure, Acute surgery, Liver Transplantation methods, Tuberculosis drug therapy
- Abstract
Objectives: Patients receiving treatment for tuberculosis are at risk of developing acute liver failure due to the hepatotoxicity of antitubercular drugs. We aimed to describe our experience with liver transplantation from deceased donors in this situation., Methods: We identified patients undergoing transplantation for acute liver failure due to antitubercular drugs in our prospectively maintained database., Results: Of 81 patients undergoing transplantation for acute liver failure, 8 cases were attributed to antitubercular drugs during the period of 2006-2016. Regarding the time of tuberculosis treatment until the onset of jaundice, patients were on antitubercular drugs for a mean of 64.7 days (21-155 days). The model for end-stage liver disease (MELD) score of patients ranged from 32 to 47 (median 38), and seven patients underwent transplantation under vasopressors. The 1-year survival was 50%. Three patients died during the week following transplantation due to septic shock (including a patient with acute liver failure due to hepatic/disseminated tuberculosis), and the remaining patient died 2 months after transplantation due to pulmonary infection. There were 2 cases of mild rejection and 1 case of moderate rejection. Of the surviving patients, all were considered cured of tuberculosis after alternative drugs were given., Conclusion: Patients arrived very sick and displayed poor survival after deceased donor transplantation.
- Published
- 2018
- Full Text
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195. Domino Hepatocyte Transplantation: A Therapeutic Alternative for the Treatment of Acute Liver Failure.
- Author
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Cardoso LMDF, Moreira LFP, Pinto MA, Henriques-Pons A, and Alves LA
- Subjects
- Humans, Liver Failure, Acute etiology, Allografts supply & distribution, Cell- and Tissue-Based Therapy, Hepatocytes transplantation, Liver Failure, Acute surgery, Liver Transplantation methods
- Abstract
Background and Aims: Acute liver failure (ALF) is a severe syndrome with an elevated mortality rate, ranging from 40 to 80 %. Currently, liver transplantation is the only definitive treatment for these patients and new therapies aiming to treat ALF include artificial organs implant and stem cells therapy, for example. However, a major limitation of liver donors exists. Living donor liver transplantation (LDLT), split liver transplantation (SLT), and domino liver transplantation (DLT) are some of the available alternatives to treat ALF patients, but these do not reduce the number of patients on waiting lists. Herein, we discuss domino hepatocyte transplantation (DHT) using livers that would not meet transplantation criteria., Methods: We conducted a literature search on PubMed/Medline using acute liver failure, liver transplantation, hepatocyte transplantation, and domino liver transplantation as key words., Results: New sources of biochemically functional hepatocytes and therapeutic treatments, in parallel to organ transplantation, may improve liver injury recovery and decrease mortality rates. Moreover, the literature reports hepatocyte transplantation as a therapeutic alternative for organ shortage. However, a major challenge remains for a wide clinical application of hepatocytes therapy, i.e., the availability of sufficient amounts of cells for transplantation. Ideally, hepatocytes isolated from livers rejected for transplantation may be a promising alternative for this problem., Conclusion: Our review suggests that DHT may be an excellent strategy to increase cell supplies for hepatocyte transplantation.
- Published
- 2018
- Full Text
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196. The recovery of the PT-INR to less than 1.3 predicts survival in patients with severe acute liver injury.
- Author
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Mawatari S, Moriuchi A, Ohba F, Kawano T, Oda K, Takikawa Y, Takikawa H, Ido A, and Tsubouchi H
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Child, Clinical Decision-Making, Female, Hepatitis complications, Hepatitis surgery, Hospitals, University, Humans, Japan, Kaplan-Meier Estimate, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Male, Middle Aged, Prognosis, ROC Curve, Survival Rate, Young Adult, Hepatitis mortality, International Normalized Ratio, Liver Failure, Acute mortality, Liver Transplantation, Prothrombin Time
- Abstract
Background: Acute liver failure is a potentially fatal disease of various etiologies for which liver transplantation is the only known curative treatment. Although the decision-making on transplantation is largely dependent on the severity of liver injury (based on predicting a fatal outcome), a statistical analysis to predict "survival" has not been extensively conducted. In this study, we investigate the medical history of patients in two distinct areas of Japan with the aim of identifying the predictors of survival in patients with acute liver injury (ALI)., Methods: Datasets of 301 patients with ALI in two distinct areas (93 in southern Kyushu and 208 in northern Tohoku) of Japan, who were treated from 2004 to 2014, were included in the analysis., Results: Among the enrolled 301 cases, 263 patients survived without transplantation. A PT-INR of ≥ 1.3 during the clinical course was found to be adequate for predicting a poor prognosis, because all of the fatal cases emerged from this population (hazard ratios: southern Kyushu, 0.2827; northern Tohoku, 0.1862). All surviving patients showed a reduction in their PT-INR during treatment, whereas the PT-INR did not decrease in the patients with a poor prognosis. A PT-INR of < 1.3 on days 7 and 8 efficiently predicted transplant-free survival (log-rank test: southern Kyushu, P = 0.0030; northern Tohoku, P = 0.0022)., Conclusions: A PT-INR of ≥ 1.3 during the clinical course might identify cases with a poor prognosis, while the recovery of the PT-INR to < 1.3 predicts transplant-free survival.
- Published
- 2018
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197. Significance and outcome of living-donor liver transplantation in acute mushroom intoxication.
- Author
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Baskiran A, Dirican A, Ozgor D, Kement M, Koc S, Sahin TT, Ates M, and Yilmaz S
- Subjects
- Adolescent, Adult, Aged, Bilirubin, Child, Child, Preschool, Female, Humans, Liver Failure, Acute mortality, Liver Failure, Acute therapy, Male, Middle Aged, Mushroom Poisoning mortality, Platelet Count, Postoperative Complications epidemiology, Postoperative Period, Prognosis, Tertiary Care Centers, Time Factors, Treatment Outcome, Turkey epidemiology, Young Adult, Liver Failure, Acute etiology, Liver Failure, Acute surgery, Liver Transplantation mortality, Living Donors, Mushroom Poisoning surgery
- Abstract
Introduction: Mushroom intoxication (MT) can lead to acute liver injury which may result in Mushroom intoxication-related liver failure (M-ALF) requiring liver transplantation (LT). In the present study, we want to share the experience of our institute regarding living-donor LT (LDLT) due to mushroom poisoning., Aim: The aim of this study is to identify the predictors of poor prognosis in patients with ALF secondary to mushroom intoxication requiring LDLT., Materials and Methods: All patients with MT between 2008 and 2016 were evaluated. Demographics, symptoms, interval between symptoms and admission to our institute, laboratory data, model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) scores, clinical course, and outcomes of supportive therapy and LT were evaluated. There were two groups in the study: Group A = responsive to supportive therapy (n = 9) versus Group B = unresponsive to supportive therapy (n = 9)., Results: During the study, a total of 18 patients were admitted with M-ALF. Twelve (66.7%) of them were female, and the mean age was 39.9 ± 18.2 years. All of the nine patients in Group A fully recovered with supportive therapy. In Group B, one patient died during waiting period for LT and 8 patients received LDLT LDLT. Three of the eight patients who were transplanted died in the postoperative early period within postoperative 5 days. The patients in Group B had significantly higher MELD/PELD scores and encephalopathy rate than in Group A (P < 0.05). International normalized ratio (INR), bilirubin, ammonium levels, and platelet count were significantly different between groups (P < 0.05). The patients in Group B had significantly longer interval before admission to our institute (P < 0.05)., Conclusion: The presence of encephalopathy, higher MELD/PELD, INR, bilirubin, ammonium levels, and lower platelet count was related to poor prognosis in MT. LDLT provides a good therapeutic option in patients with M-ALF. The time is a crucial factor in successful treatment of MT. Early admission to a tertiary referral center with expertise in LT results in a better prognosis and increased survival following M-ALF., Competing Interests: There are no conflicts of interest
- Published
- 2018
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198. Is Fulminant Hepatic Failure the Nemesis for Liver Transplant Centers? A Two Decade Psychosocial and Long-Term Outcome Study.
- Author
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Alsina A, Alsina A, Athienitis A, Buggs J, Aslam S, and Kemmer N
- Subjects
- Follow-Up Studies, Humans, Kaplan-Meier Estimate, Liver Failure, Acute mortality, Retrospective Studies, Treatment Outcome, Liver Failure, Acute surgery, Liver Transplantation methods, Liver Transplantation mortality
- Abstract
Long-term outcomes in liver transplantation for acute liver failure (ALF) are poorly studied. The aim of the study was to identify psychosocial variables that affect adherence and late survival. Retrospective review of ALF liver transplant (LTx) patients between 1997 and 2017 (n = 47) was conducted. Psychosocial history, life stressors, and ability to participate in transplant were recorded. Survival was calculated using Kaplan-Meier and logistic regression. Eleven patients (31.5%) had poor adherence, four died, all from graft failure. Of 13 with fair and 12 with good adherence, two died, no adherence related. Poor adherence was associated with higher mortality (P = 0.04), but by Kaplan-Meier, their five- and 10-year survival was 78 and 54 per cent, versus fair and good adherence (five years, 83% P = 0.3). Participating in transplant decision improved survival (five years, 80%) versus not participating (five years, 61%; P = 0.03). Of 10 early deaths, three were neurologic and five of sepsis. Overall, one- and five-year survival was 78 and 69 per cent. ALF represents the nemesis of LTx programs. Psychosocial aspects pre-LTx, stressors, and poor adherence affected survival in this series. No improvement over two decades of ALF LTxs was observed. The ethics of transplanting these high-risk patients will be the subject of our future research.
- Published
- 2018
199. Viral activity and outcome of hepatitis B surface antigen-positive grafts in deceased liver transplantation.
- Author
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Lee WC, Chou HS, Lee CS, Wu TH, Wang YC, Cheng CH, Lee CF, Wu TJ, and Chan KM
- Subjects
- Adult, Aged, Carcinoma, Hepatocellular surgery, DNA, Viral blood, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Liver Failure, Acute surgery, Male, Middle Aged, Treatment Outcome, Antiviral Agents therapeutic use, Hepatitis B Surface Antigens blood, Hepatitis B, Chronic drug therapy, Liver Transplantation, Nucleosides therapeutic use, Nucleotides therapeutic use, Transplant Recipients
- Abstract
Indications of liver transplantation are extensive, but deceased donation does not meet the demand. Hepatitis B surface antigen (HBsAg)-positive grafts used to be discarded in the past. The aim of this study was to examine viral activity and outcome of HBsAg-positive deceased grafts transplanted to HBsAg-positive recipients. Eleven HBsAg-positive deceased grafts were transplanted to HBsAg-positive patients with acute liver failure (3 patients), hepatocellular carcinoma (6 patients) and repeatedly bleeding varices (2 patients). Postoperatively, hepatitis B virus (HBV) infection was treated by a combination of antiviral nucleoside and nucleotide analogues. HBV DNA and HBsAg were measured periodically. The median (interquartile) model of end-stage liver disease score for the recipients was 19 (16-32) with a range from 11 to 40. HBV DNA was detected in 6 patients with a range from 61 to 1083 IU/mL before transplantation. After transplantation, HBV DNA was detected in 4 patients in the first month and 2 patients in the 6th month and became undetectable for all patients at end of the first year. The quantitative HBsAg ranged from 0.86 to 241.1 IU/mL at 6 months and 0.34 to 238.5 IU/mL at 24 months (P = .135). Three of the patients died in the early phase, and the other patients were followed up for 40.0 ± 19.2 months with normal liver function. In conclusion, HBsAg-positive deceased liver grafts function well with minimal viral activity under treatment of combined antiviral nucleoside and nucleotide analogues. Use of HBsAg-positive deceased grafts is feasible and increases the donor pool to rescue dying patients., (© 2018 John Wiley & Sons Ltd.)
- Published
- 2018
- Full Text
- View/download PDF
200. Successful DAA-Based Treatment of Hcv-Related Fibrosing Cholestatic Hepatitis After Liver Transplantation Due to a Fulminant Liver Failure.
- Author
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Krawczyk M, Gawęda B, Kośnik A, Rejowski S, Remiszewski P, Krawczyk M, Milkiewicz P, and Raszeja-Wyszomirska J
- Subjects
- Adult, Antiviral Agents administration & dosage, Benzimidazoles administration & dosage, Benzimidazoles therapeutic use, Diagnosis, Differential, Drug Therapy, Combination, Fluorenes administration & dosage, Fluorenes therapeutic use, Hepatitis C, Chronic drug therapy, Humans, Jaundice, Obstructive drug therapy, Liver Failure, Acute surgery, Liver Transplantation adverse effects, Male, Postoperative Complications diagnosis, Postoperative Complications drug therapy, Sofosbuvir administration & dosage, Sofosbuvir therapeutic use, Antiviral Agents therapeutic use, Hepatitis C, Chronic diagnosis, Jaundice, Obstructive diagnosis
- Published
- 2018
- Full Text
- View/download PDF
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