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Objective: Liver transplantation requires lifelong immunosuppression, which has significant psychological and physiological implications. While depression and anxiety are prevalent among transplant recipients, their potential relationship with immune tolerance remains unclear. This study aims to evaluate the association between depression, anxiety, and immune tolerance in liver transplant recipients., Methods: This cross-sectional study included 179 adult liver transplant recipients, categorized as tolerant (n=49) and non-tolerant (n=130) based on immunosuppressive status. Depression and anxiety levels were assessed using the Beck Depression Inventory (BDI-II) and Spielberger's State-Trait Anxiety Inventory (STAI-Y). Data were analyzed using appropriate statistical tests, with significance set at P<0.05., Results: A history of psychiatric disorders, including depression and anxiety, was observed in 19.0% and 53.1% of participants, respectively. No significant differences were found in BDI-II scores between tolerant (13.14±10.67) and non-tolerant (12.45±11.38) groups. Similarly, STAI-Y State and Trait anxiety scores did not differ significantly between groups (P=0.23 for both)., Conclusions: While depression and anxiety are common in liver transplant recipients, this study did not find a significant association with immune tolerance. Given the cross-sectional design and sample size limitations, further longitudinal research is needed to determine whether psychological factors influence transplant outcomes., Competing Interests: Source of Funding and Conflicts of Interest: This study was funded by the Shiraz University of Medical Sciences, Shiraz, Iran. The authors declare no conflict of interest regarding the publication of this manuscript., (Copyright © 2025 Society for Biopsychosocial Science and Medicine.)

Purpose: Transplant patients face a risk of developing incisional hernias. Establishing a reliable and secure incisional hernia repair method for this patient population remains a challenge., Methods: In this retrospective cohort study, we gathered data from patients who had undergone liver and kidney transplantations and subsequently had developed postoperative incisional hernias. Patient follow-up was extended for a minimum of 18 months. Primary outcomes focused on recurrence, hematoma, and infection rates, comparing the complication profiles of propylene mesh and Dual Mesh incisional hernia repair methods., Results: 122 transplant patients with incisional hernias were included. The incidence of recurrence and infection after incisional hernia repair surgery was 20.6% and 5.9% for Dual Mesh and 22.2% and 9.9% for polypropylene mesh (P = 0.721 and 1.000). In liver recipients, the Dual Mesh method showed a slightly lower incidence of recurrence (17.9% vs. 23.3%) and infection (3.6% vs. 10.0%) compared to polypropylene mesh (P = 0.782, 0.423). Kidney recipients exhibited insignificant higher recurrence (33.3% vs. 19%) and infection rates (16.7% vs. 9.5%) with Dual Mesh (P = 0.588, 0.545)., Conclusions: The results suggest that while trends indicate a lower recurrence and infection rate with Dual Mesh in liver transplant patients and a slightly higher recurrence and infection rate with Dual Mesh in kidney transplant patients, these differences were not statistically significant. Therefore, no definitive advantage of one mesh type over the other can be concluded from the data., Competing Interests: Declarations. Competing interests: The authors declare that there are no competing interests. Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and give their approval for this version to be published., (© 2025. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background and Aims: Frailty is a common complication in patients with liver cirrhosis, which is linked with augmented rates of morbidity and mortality. In this regard, timely nutritional assessment and intervention have gained scientific attention. L-carnitine may be a promising candidate with its potential to enhance energy metabolism, reduce inflammation, and act as an antioxidant. Therefore, we aimed to assess the impact of l-carnitine supplementation on frailty status and liver function in adults with liver cirrhosis., Methods: This double-blinded, randomized, controlled clinical trial study enrolled 77 patients with liver cirrhosis. Patients were randomly allocated into two groups: the control group ( n  = 42) and the l-carnitine group ( n  = 35). The l-carnitine group received 500 mg of l-carnitine orally three times a day for 8 weeks, while the control group did not receive any intervention., Results: L-carnitine administration resulted in a significant decrease in alanine transaminase levels ( p : 0.043) and partial thromboplastin time ( p : 0.036). Furthermore, compared to the control group, l-carnitine treatment led to improvements in prothrombin time ( p : 0.008) and international normalized ratio ( p : 0.024). However, no significant improvement in the Liver Frailty Index, Freid Frailty Index, and Karnofsky Performance Status Scale ( p  > 0.05) was observed in the carnitine group after the 8-week intervention period., Conclusion: In conclusion, the administration of l-carnitine exhibited hepatoprotective properties and was correlated with lowered alanine transaminase levels with improvement in coagulation status in liver cirrhosis patients. Nevertheless, our study indicated that the short-term use of l-carnitine might not significantly improve frailty in these patients., Competing Interests: The authors declare that they have no conflicts of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Metabolic syndrome (MetS) is a noncommunicable disease with a high burden, including the development of type 2 diabetes mellitus, cardiovascular events, and death. It is characterized by abdominal obesity, elevated blood pressure, increased fasting plasma glucose levels, hypertriglyceridemia, and reduced levels of high-density lipoprotein (HDL) cholesterol. MetS is preventable by modifying lifestyle and dietary patterns, which are major contributing factors. This research aimed to investigate the dietary patterns of the Shiraz Heart Study (SHS) and their associations with the occurrence of MetS and its components among middle-aged residents of Shiraz., Methods: Based on data from the Shiraz Heart Study (SHS), a prospective cohort study, the nutritional status of 1,675 participants was assessed using a food frequency questionnaire (FFQ). Three food patterns were extracted from the analysis named as vegan, western, and carbohydrate. Subjects were categorized into three levels for three major dietary patterns: low, moderate, and high, based on their adherence to each pattern. After adjusting the effect of co-founder variables, the relationship between dietary patterns, and the risk of developing MetS was analyzed., Results: Of the 1,675 participants, 728 (43.5%) of them were male. The prevalence of MetS was 47.2%. Multivariate logistic regression analysis showed that high adherence to the vegan pattern was negatively associated with the occurrence of MetS ( P value <0.001), while low adherence to the western pattern was also negatively associated ( P value <0.05)., Conclusion: Healthier diets, such as vegan diets, are significantly related to lower rates of MetS among the 40-70-year-old people in Shiraz, Iran., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Nasrin Motazedian et al.)

Background: Marital satisfaction is one of the important components of quality of life. Women's marital satisfaction is affected when they enter the middle age period, due to the mental and emotional tensions caused by the physical changes. In this regard, the present study aimed to investigate the association of quality of life with marital satisfaction, stress, and anxiety in middle-aged women referring to health centers of Ahvaz city, Iran., Methods: This cross-sectional descriptive-analytical study was conducted on 1,000 middle-aged married women (30-59 year of age) under the auspices of health centers of Ahvaz city, Iran in 2019. The subjects were selected by simple random sampling method, and were asked to complete demographic characteristics, quality of life questionnaire, Enrich marital satisfaction questionnaire, Holmes-Raheh stress questionnaire, and Spielberger state-trait anxiety inventory. The data were analyzed by using SPSS 0.22 software through mean, standard deviation, frequency, Pearson correlation and regression ( p  = 0.05)., Results: Based on the results, 42.4% of the participants were between 40 and 50 years of age, 35.6% had a high school diploma, and 50% of them were housewives. Also, the results of Pearson's correlation showed a positive and significant relationship between quality of life and marital satisfaction ( r  = 0.178) ( p  < 0.001). However, quality of life had a negative and significant relationship with anxiety ( r  = -0.552) ( r  < 0.001) and stress ( r  = -0.188) ( p  < 0.001)., Conclusion: Given the positive and significant relationship between quality of life and marital satisfaction, appropriate trainings are highly recommended for couples to increase the quality of life and marital satisfaction of middle-aged women and thus strengthen the health of family and society., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rakhshani, Amirsafavi, Motazedian, Harsini, Kamyab and Jeihooni.)

Background: Chronic liver disease (CLD) in children, often leads to cirrhosis and end-stage liver disease (ESLD). CLD poses significant challenges in management and prognosis. Assessing body composition, including sarcopenia, is increasingly recognized as important in understanding outcomes in this population., Methods: We conducted a prospective observational study, involving children aged 2 to 18 years with ESLD awaiting liver transplantation. Socio-demographic, clinical, and laboratory data were collected, and body composition was assessed using Bioelectrical Impedance Analysis (BIA). Sarcopenia was defined using age-specific cut-off points for appendicular skeletal muscle mass (aSMM) and fat-free mass (FFM)., Results: The study included 57 children (42.1% girls, 57.9% boys; median age: 10.9 years) with liver cirrhosis. Of them 11 (19.3%) died during the study. The mean duration of living with end-stage liver disease prior to participation was 5.43 years [IQR: 3.32, 8.39]. The most common etiology was biliary atresia (24.6%), followed by cryptogenic (22.8%). Deceased children exhibited significantly higher sarcopenia prevalence, lower basal metabolic rate and growth scores compared to survivors (P < 0.05), (771.0 vs. 934.0, P = 0.166) (65.0 vs. 80.5, P = 0.005). Total body and limb-specified lean mass were lower in deceased children, although not statistically significant. Similarly, total mineral (90% normal) and bone mineral content were lower in deceased children, with a significant difference observed only in water-to-FFM percentage (72.5 vs. 73.1, P = 0.009)., Conclusion: This study highlights the high prevalence of sarcopenia among children with ESLD and its association with adverse outcomes, including mortality. Bioimpedance analysis emerges as a promising, non-invasive method for assessing body composition in pediatric ESLD, warranting further investigation and integration into clinical practice., (© 2024. The Author(s).)

Objectives: The recurrence of underlying diseases remains a major cause of graft failure after liver transplant. This study aimed to identify factors associated with the recurrence of underlying diseases and investigate the incidence of these factors and recurrence at the main liver transplant center in Iran., Materials and Methods: We included adult liver transplant recipients followed at Shiraz Transplant Center between 2011 and 2018 with a confirmed diagnosis of recurrence of underlying disease in our study. We reviewed medical records and extracted data on demographic characteristics, clinical and paraclinical features, medication use, and current status. We used a systematic random sampling method to select a control group of 95 transplant recipients who did not have recurrence. Of 3022 total transplant recipients, 76 recipients experienced a recurrence of their underlying disease., Results: Model for End-Stage Liver Disease score, underlying disease, recipient blood group, donor sex, donor blood group, and rejection frequency were significantly different between study groups with and without recurrence of underlying diseases. Liver transplant recipients with recurrence had lower mean Model for End-Stage Liver Disease score. Recipients with recurrence also had higher rate of drug consumption (eg, prednisolone, tacrolimus, mycophenolate mofetil, sirolimus). Regression analysis showed that donor sex and rejection frequency had an effect on disease recurrence. Death occurred more frequently in liver transplant recipients with recurrence than in the control group (39.5% vs 26.3%), butthe difference was not significant., Conclusions: Donor sex and acute rejection frequency are independent factors predictive of the recurrence of underlying disease. Modifying risk factors can help minimize the recurrence of underlying diseases after liver transplant.

Objectives: Identification of chronic rejection risk factors in liver transplant recipients is critical for early detection and prevention of further graft loss. We investigated characteristics of liver transplant recipients who had experienced chronic rejection and the associated risk factors versus patients without chronic rejection., Materials and Methods: Data from 3022 adult liver transplant recipients between 2011 and 2018 were analyzed; of these, 80 patients had experienced chronic rejection. The control group included 98 randomly selected liver transplant recipients who did not have chronic rejection., Results: The age of the recipients and the donors was significantly lower in the group with chronic rejection versus the group without chronic rejection.The results indicated that chronic rejection was significantly associated with the sex of the recipients (hazard ratio 3.2, 95% CI 1.77-6.08; P < .001) and with the sex concordance between the recipients and donors (hazard ratio 2.93, 95% CI 1.67-5.13; P < .001, respectively). Also, in the group without chronic rejection, there were no male donors; however, the group with chronic rejection had mostly male donors (P <.001). Cold ischemia time was longer in patients with chronic rejection versus that shown in the control group (P = .031), and there was a significant difference between the 2 groups in acute rejection frequency (P < .001)., Conclusions: Recipient sex and sex concordance were independent risk factors for chronic rejection. Most transplantrecipients with chronic rejection responded to medicaltreatment, and the rate of graftloss was low among our recipients.

Aim: The purpose of this retrospective single-center study was to determine the frequency of sarcopenia and its association with mortality and other morbidities in children with chronic liver disease who had undergone liver transplantation., Background: Sarcopenia, a muscle-wasting syndrome, is common in patients with advanced liver disease and is associated with increased morbidity and mortality. While sarcopenia in adults has been extensively studied, there is little information in this regard about children and adolescents with chronic liver diseases., Methods: The study included 108 children and adolescents who had undergone liver transplantation. Sarcopenia was measured using skeletal muscle index at the third lumbar vertebral level and assessed using abdominal computed tomography imaging., Results: The frequency of sarcopenia in the studied population was found to be 45.7%. Patients with sarcopenia were more likely to be male (P<0.0001), older (P<0.0001), and had lower height-for-age z-scores (P=0.012). Genetic/metabolic diseases were the most common underlying cause of sarcopenia in children. Except for a higher rate of transplant rejection in the sarcopenia group (P=0.035), there was no significant difference in mortality rates (P=0.688) or post-LT complications between the two groups. One year after LT, computed tomography-derived body composition parameters revealed no significant differences between children who survived and those who did not., Conclusion: Our findings indicated a high frequency of sarcopenia in children with chronic liver disease, implying that more research is needed to better understand its impact on clinical outcomes in this population., Competing Interests: The authors report no conflicts of interest in this work., (© 2024, Gastroenterology and Hepatology From Bed to Bench (GHFBB).)

Biliary atresia (BA) is the primary cause of neonatal jaundice with various pathological mechanisms. Many BA patients may experience progressive liver dysfunction and eventually need a liver transplant. Therefore, identifying potential non-invasive biomarkers for BA is crucial. miR-122, the most abundant microRNA in the liver, plays significant roles in different liver diseases. This study aimed to assess miR-122 levels in BA patients. Eighteen patients with biliary atresia were selected at random from the Shiraz Pediatric Liver Cirrhosis Cohort Study (SPLCCS), along with 18 healthy controls. Blood samples were collected, and biochemical parameters (such as liver function tests) were measured. Quantitative reverse-transcription PCR (RT-PCR) was conducted on serum samples from both the case and control groups to analyze miR-122 levels. The study results indicated that serum miR-122 expression in BA patients was elevated compared to the control group, although it did not reach statistical significance. Additionally, no correlation was found between miR-122 expression and serum levels of liver enzymes or other laboratory findings in BA cases. miR-122 could be a potential target for diagnosing BA; however, further research with a larger population is necessary to determine if miR-122 could serve as a useful biomarker for diagnosing BA., Competing Interests: The authors declare that there is no conflict of interest.

Background: MicroRNAs (miRNAs) are a group of small non-coding RNAs that bind to the target mRNA and regulate gene expression. Recently circulating microRNAs were investigated as markers of diseases and therapeutic targets. Although various studies analyze the miRNA expression in liver disease, these studies on PFIC are few. Progressive familial intrahepatic cholestasis (PFIC) is a rare liver disease with autosomal recessive inheritance. Most children with PFIC progress to cirrhosis and liver failure and consequently need to have a liver transplant. The aim of this study is the investigation of the miR-19b and miR-let7b expression levels in Iranian PFIC children., Methods: 25 PFIC patients, 25 healthy children and 25 Biliary Atresia patients were considered as case and two control groups respectively. Blood samples were obtained and Liver function tests (LFTs) were measured. After RNA extraction and cDNA synthesis, quantitative PCR was performed using specific primers for miR-19b and miR-let7b. The U6 gene is used as an internal control., Results: qPCR on PFIC patients' samples demonstrated that the miR-19b and the miR-let7b expression were significantly decreased in patients compared to the control groups, with a p-value<0.0001 and p-value=0.0006 receptively., Conclusion: In conclusion, circulating micro-RNA like miR-19b and miR-let7b have a potential opportunity to be a non-invasive diagnostic marker or therapeutic target for PFIC in the future., (Copyright © 2023 Elsevier España, S.L.U. All rights reserved.)

Objectives: Prolonged tracheal intubation and mechanical ventilation after liver transplant increase postoperative complications. Hence, timely extubation should be considered; however, a standard clinical criteria set or scoring system to select patients has not been established for early extubation after livertransplant.We investigated the factors that affect early extubation to design a predictive scoring system for early extubation., Materials and Methods: This study is a case-control study of adult liver transplant patients. Preoperative, intraoperative, and postoperative clinical data were collected. Early extubation was defined as tracheal extubation immediately or up to 6 hours posttransplant. The variables were compared between the early extubation group and the delayed extubation (>6 hours) group., Results: Our study enrolled 237 patients; among them, 57 patients (24%) were in the early extubation group, and 180 (76%) were in the delayed extubation group. Multiple logistic regression analysis showed that postoperative base excess level at admission to the intensive care unit, number of units of packed red blood cells transfused during surgery, urine volume, and excess base level 6 hours after surgery were the main predictors of successful early extubation., Conclusions: The initial base excess level at the entrance to the intensive care unit(postsurgery) and 6 hours after surgery, packed red blood cell volume transfused during surgery, and urine volume 6 hours after surgery are the main predictors for a successful early tracheal extubation.These factors are considered for the Shiraz Extubation Predictor formula.

Background: Metabolic syndrome (MetS) is a set of conditions that occur together and increase the risk of cardiovascular disease. Previous studies have linked a gluten-free diet (GFD) to obesity and MetS in some populations. However, others have suggested that weight gain is usually regulated only in underweight individuals with celiac disease (CD). Owing to the lack of sufficient data and the importance of GFD in controlling cardiovascular disease, we surveyed the prevalence of MetS and its components before and after a year of GFD in patients referred to the main celiac clinic in southern Iran. Methods: This was a repeated cross-sectional study conducted on 69 patients with a definite diagnosis of cardiovascular disease who were on follow-up and registered at the Shiraz Celiac Clinic. Demographic, anthropometric, and laboratory measurements at the time of diagnosis and one year after the GFD were extracted from their medical records. Results: The participants' mean age was 35.53, and 68.1% were women. The prevalence of MetS increased from 5.8% to 11.6% after a year of the GFD; however, this increase was not statistically significant. Waist circumference (WC) and serum triglyceride levels were significantly elevated during the study period. Conclusion: A GFD may contribute to the development of MetS in patients with cardiovascular disease; however, the rate of MetS is still lower than that in the general population. It is critical to educate patients about these potential risks and encourage them to have a healthy lifestyle that includes a balanced diet and physical activity., Competing Interests: Competing Interests The authors declare no conflict of interest related to this work., (© 2023 Middle East Journal of Digestive Diseases.)

Background: Children receive transplants at a younger age, and the period of immunosuppression therapy may extend over decades. However, immunosuppression seems to be responsible for long-term mortality and morbidity. Pediatric liver transplant recipients can benefit from achieving immune tolerance and the opportunity of freedom from lifelong immunosuppression. This study aimed to investigate the frequency of prope tolerance among pediatric liver transplant recipients and the characteristics of these patients., Methods: In this retrospective cohort study of pediatric liver transplant recipients, the medical records of transplant recipients treated at Shiraz Organ Transplant Center between 1994 and 2017 were reviewed. Prope tolerance was defined as normal laboratory values and stable clinical status on low-dose monotherapy. Children treated with low-dose monotherapy were categorized as the prope tolerant group. We compared the characteristics of prope tolerant recipients on low-dose monotherapy with patients on standard immunosuppression, i.e. full-dose tacrolimus plus steroids and mycophenolate mofetil. The data were analyzed with the t-test, chi-squared test, and a Cox proportional hazard model at a 5% significance level in SPSS software version 16., Results: A total of 585 children with a mean age of 8.32 ± 5.23 years were enrolled. 341 patients were categorized as prope tolerant and 244 comprised the full immunosuppression regimen group. Mean age at transplantation and rejection frequency were lower in the prope tolerant group (p < 0.001, p < 0.001). Based on the underlying diseases, metabolic/genetic, biliary tract, and cryptogenic liver diseases were significantly more prevalent in the prope tolerant group (p < 0.001). However, autoimmune liver disease was found to be more prevalent in the full immunosuppression regimen group. Also, those who received living organs (p = 0.001) and recipients of organs from female donors had a greater likelihood of achieving prope tolerant. According to the multiple Cox regression results, age at transplantation (p = 0.022), rejection frequency (p < 0.001), and autoimmune liver diseases (p = 0.028) had a prognostic effect on prope tolerance., Conclusion: Factors as underlying disease, age at transplantation, and rejection frequency were factors that were predictive of prope tolerance in this sample of children. However, the risk of rejection should be considered during the tapering period., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023. Published by Elsevier B.V.)

Liver diseases in children and adolescents are a significant and arising public health issue and should be surveyed from different dimensions (clinical and para-clinical, psychological, socio-economic) and in diverse populations. Shiraz Liver Transplant Center, Shiraz, Iran is the only center for pediatric liver transplantation and its pre-operative evaluations. This provides a unique and valuable situation for studying this vulnerable population. The Shiraz Pediatric Liver Cirrhosis Cohort Study (SPLCCS) was established to assess cirrhotic children, the course of their disease, and treatment over time. This cohort study aimed to prospectively evaluate the natural course and factors that contributed to complications and death of children with chronic liver disease in the region. SPLCCS was launched in September 2018 after obtaining ethical approval; until August 2022, 370 children with end-stage liver disease were enrolled and followed every six months. Here, the cohort's features, the included population's baseline characteristics, and primary outcomes are reported., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Aim: This review sought to evaluate the significance of a functional assessment for liver transplant candidates, i.e., frailty, in the pre-transplant setting and its association with mortality and morbidities., Background: Liver transplantation (LT) remains the treatment of choice for patients with end-stage liver disease. Due to the shortage of organs for LT, a careful selection of suitable recipients is essential. Frailty, a measure of physiologic reserve and increased vulnerability to stressors, was initially used in geriatrics and then introduced to the field of transplantation for better patient selection., Methods: PubMed, Scopus, and Web of Science databases were reviewed up until January 2023. The search terms included: "frail*", "liver", and "transplant*". A Meta-analysis was conducted for the hazard ratios (HRs) obtained from the COX regression models. Fifty-five studies were included in this review; ten were included in the meta-analysis., Results: The prevalence of frailty varied from 2.82% to 70.09% in the studies. Meta-analysis showed that overall frailty had a significant association with mortality (pooled adjusted HR [95%CI]: 2.66 [1.96-3.63]). Subgroup analyses revealed that both the Liver Frailty Index and Fried Frailty Index were significantly associated with mortality. Furthermore, these studies have demonstrated that this population's frailty is associated with ascites, hepatic encephalopathy, and esophageal varices., Conclusion: According to emerging evidence, frailty is associated with increased morbidity and mortality of the patients on the LT waiting list. Further randomized trials are required to determine the efficacy and safety of variable interventions in the frail population., Competing Interests: The authors declare that there is no conflict of interest., (© 2023, Gastroenterology and Hepatology From Bed to Bench (GHFBB).)

Background: Liver transplantation (LT) is considered the only treatment for patients with end-stage liver disease and, despite its incredible impacts on the patients' health status, places them in an immunocompromised state in which opportunistic infection would find a way to present. Latent tuberculosis infection (LTBI) is the most common form of TB and can be diagnosed through tuberculin skin test (TST) or Interferon-Gamma Release Assays (IGRA). LT recipients are at significant risk of TB activation. There is no strict guideline to approaching these cases though, in most centers, Isoniazid (INH) would be prescribed prophylactically. INH is a hepatotoxic medication and can have adverse effects on the transplanted liver. There is no consensus on this issue; therefore, we aimed to survey the potential hepatotoxic effects of INH among LT recipients in Shiraz, Iran., Methods: A retrospective cohort study was conducted among LT candidates and recipients at Abu Ali Sina Organ Transplantation Center between 1993 and 2019. All the cases underwent TST and chest X-ray to detect LTBI. All the LTBI were treated with INH from 6-9 months and followed by the level of liver enzymes for quick detection of hepatotoxicity. A control group was selected among LT recipients and matched for age, gender, MELD score, and donor age., Results: Among 4895 medical records reviewed, 55 (1.12%) cases had LTBI. Neither INH-related hepatotoxicity, nor signs and symptoms that were suspicious to TB reactivation were reported. Overall, three deaths were reported, two because of myocardial infarction and one due to pneumonia. Ten patients (18.2%) experienced acute rejection as confirmed with pathology and responded to methylprednisolone. Aspartate aminotransferase (AST) was diminished from pre-LT time to the first time after transplantation; after that, it showed a steady pattern. Meanwhile, Alanine transaminase (ALT) was constant before and one stage later and decreased after that. Statistical analyses only showed significant changes in the total bilirubin titer between the case and control groups., Conclusion: This survey showed prophylactic management of LTBI with INH in LT candidates and recipients was associated with no hepatotoxicity or related death. It seems that INH prophylaxis is safe in LT settings and can efficiently prevent TB activation; however, careful monitoring for adverse effects and liver enzymes elevation is highly recommended., (© 2022 Wiley Periodicals LLC.)

Background: The liver transplant recipients are often subjected to excessive therapy by immunosuppressive drugs which produce several complications. Consequently, the minimization or even withdrawal of immunosuppression in selected patients is an attractive alternative. We investigated the frequency and characteristics of these near (or prope from Latin) tolerance in liver transplant recipients in Shiraz Organ Transplant Center., Material and Methods: We reviewed the medical records of over 3800 adult liver transplant recipients to select a group treated with a low-dose tacrolimus monotherapy (n = 90) between 1994 and 2017 in our transplant center. The patients with the best liver function parameters were selected; then, the clinician arbitrarily decided to withdraw steroids first and then mycophenolate mofetil and maintain each patient on a low dose tacrolimus. We compared the characteristics of prope tolerant recipients on a low-dose tacrolimus with those on standard immunosuppression, namely full-dose tacrolimus plus steroids and mycophenolate mofetil (n = 233). Data were analyzed by t-test, chi-square test using SPSS software version 16., Results: Out of over 3800 liver transplant patients, 90 (2.34%) recipients were treated with a minimum dose of tacrolimus monotherapy. These recipients were compared to a selected group of 233 (6.1%) recipients treated with full-dose tacrolimus plus steroids and mycophenolate mofetil. In a prope tolerant group, there were 55 males (61.1%) and 35 females (38.9%) recipients. Mean age at the time of transplant was 39.92 ± (SD = 13.40) years with an average time from the transplantation time to completed weaning from triple immunosuppression to low-dose monotherapy of 41.35 months (SD = 17.27). The most common etiology of liver disease among both groups was viral hepatitis., Conclusion: The achievement of prope (almost) immune tolerance was possible only in some liver transplant recipients with a relatively low risk of rejection. Our analysis suggests that there is a difference in the underlying diseases and recipients' age and the number of rejections between the two groups., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Tissue engineering is considered as a promising tool for remodeling the native cells microenvironment. In the present study, the effect of alginate hydrogel and collagen microspheres integrated with extracellular matrix components were evaluated in the decrement of apoptosis in human pancreatic islets., Materials/methods: For three-dimensional culture, the islets were encapsulated in collagen microspheres, containing laminin and collagen IV and embedded in alginate scaffold for one week. After that the islets were examined in terms of viability, apoptosis, genes and proteins expression including BAX, BCL2, active caspase-3, and insulin. Moreover, the islets function was evaluated through glucose-induced insulin and C-peptide secretion assay. In order to evaluate the structure of the scaffolds and the morphology of the pancreatic islets in three-dimensional microenvironments, we performed scanning electron microscopy., Results: Our findings showed that the designed hydrogel scaffolds significantly improved the islets viability using the reduction of activated caspase-3 and TUNEL positive cells., Conclusions: The reconstruction of the destructed matrix with alginate hydrogels and collagen microspheres might be an effective step to promote the culture of the islets., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Objectives: Liver transplant recipients are more susceptible to vancomycin-resistant enterococci colonization than healthy individuals. We investigated the prevalence of vancomycin-resistant enterococci colonization and its effect on the outcomes of liver transplant recipients., Materials and Methods: Patients who had undergone primary liver transplant at the Shiraz Organ Transplant Center from 2015 to 2017 were enrolled in this study. Demographic characteristics, laboratory test results, duration of stay in the intensive care unit, total duration of hospital stay, and clinical outcome data were extracted from the Shiraz Organ Transplant Center database. Posttransplant outcomes such as graft rejection, mortality, hospital stay, and kidney function tests were included for the first 90 days after transplant., Results: A total of 753 liver transplant recipients (470 males and 283 females) were included in this study. Vancomycin-resistant enterococci colonization was identified in 51 patients (6.8%) after transplant at the time of intensive care unit admission. Our study found no significant difference between outcomes for patients with vancomycin-resistant enterococci colonization and outcomes for patients without colonization, including graft rejection, mortality, hospital stay, and kidney function tests., Conclusions: Our study revealed that asymptomatic vancomycin-resistant enterococci colonization in liver transplant patients has no adverse effect on the duration of posttransplant hospital stay, early mortality rate, graft rejection rate, or kidney function compared with noncolonized patients.

Objectives: We aimed to determine outcomes and predictors of intraoperative-detected portal vein thrombosis in liver transplant recipients., Materials and Methods: We retrospectively analyzed 806 adult liver transplant recipients from Shiraz, Iran, to determine those with intraoperative-detected portal vein thrombosis. Patients with this complication were compared with age- and sex-matched patients without this complication. Background diseases, surgery parameters, hospital admission, reoperation, rethrombosis, acute rejection, and use of antico-agulants were assessed. Cox proportional hazards, logistic regression, and random classification forest and random survival forest plots were used for data analyses., Results: Mean age of patients was 44.7 ± 13.2 years. Patients with intraoperative-detected portal vein thrombosis (n = 91; 11.3%) had mortality ratio of 2.9 (range, 1.0-8.6) and 2-year survival of 78% versus 2-year survival rate of 92% in patients without this disease. Median time of survival in patients with this complication who died was 2 weeks versus 10 months in patients who died and did not have this complication. Random classification forest plots showed that high fasting blood sugar, autoimmune hepatitis, low prothrombin time, and cryptogenic cirrhosis were (in order) the main predictors of this complication. Random survival forest plots revealed that low prothrombin time, having intraoperative-detected portal vein thrombosis, Model for End Stage Liver Disease score, primary sclerosing cholangitis, diabetes mellitus, and hepatocellular carcinoma were (in order) the main predictors of death in liver transplant recipients. Low body mass index was associated with mortality in patients with intraoperative-detected portal vein thrombosis (by Cox proportional hazards)., Conclusions: One of every 9 liver transplant patients had intraoperative-detected portal vein thrombosis. Hazard of death was 2.9, and death occurred far earlier in patients with this complication. Improvements in diabetes mellitus care, prothrombin time, Model for End-Stage Liver Disease score, and body mass index may improve outcomes of these patients.

Aim: This study investigated the safety and efficacy of tenofovir disoproxil fumarate (TDF) compared with lamivudine (LAM) in the prevention of recurrent HBV infection after liver transplantation (LT)., Background: Although the recurrence of hepatitis B virus after liver transplantation (LT) is now very uncommon with both nucleoside and nucleotide analogs represented with lamivudine and tenofovir disoproxil fumarate, respectively, few studies have compared the two classes., Methods: A total of 302 HBV-related post-transplant patients who received liver transplants from deceased donors were enrolled in this retrospective study from 2011 to 2015 in the Shiraz Organ Transplant Center, Iran. The demographic data, kidney function, recurrence, resistance rate, and acute rejections at 1-, 6-, and 12-month intervals and after 12 months were compared on TDF (n=209) and lamivudine (n=93) groups., Results: During a median follow-up period of 42.9 months, mean creatinine level was not significantly different between the two groups. Hepatitis B virus recurrence rate as well as acute graft rejection episode had no statistical difference in either group over the study period., Conclusion: Kidney function, creatinine level, disease recurrence, and acute graft rejection were comparable between tenofovir disoproxil fumarate and lamivudine in patients who received follow-up periods., (©2021 RIGLD, Research Institute for Gastroenterology and Liver Diseases.)

Background: COVID-19 has been spreading worldwide with a significant death toll. Solid-organ transplantation (SOT) recipients are at higher risk due to their suppressed immune system. In this study, we aimed to conduct a systematic review on COVID-19 clinical manifestations and treatment strategies in SOT recipients., Methods: We searched three databases for relevant terms related to COVID-19 and transplantation. 50 studies, including 337 patients, were reviewed., Results: Two hundred thirty six patients were male, with a mean age of 49.9 years. The most prevalent group was the kidney 57.0%, followed by 17.2% heart and 13.6% liver. Fever and cough were the most reported clinical presentations. Infiltration (55.4%) in chest x-ray and ground-glass opacity (67.1%) in CT scans were the most radiological findings. It was found that 96.8% and 72.4% of patients present with CRP level and lymphocytopenia, respectively, and 70.6% of kidney recipients patients presented with high creatinine levels. The most common baseline immunosuppressants were calcineurin inhibitors (88.9%) and antimetabolites (73.2%). Antimetabolites (84.3%) and calcineurin inhibitors (54.3%) were discontinued/decreased 84.3% whereas glucocorticoids dosage almost has no change (77.9%) or even increased. 18.4% of cases had died, and 65.9% were discharged., Conclusions: Patients' demographics, signs, symptoms, and radiographic findings in SOT recipients are almost similar to the general population. However, gastrointestinal symptoms appear to be more common. There are different treatment strategies, but in most of them, antimetabolite and calcineurin inhibitors were decreased or discontinued, while corticosteroids were increased. Finally, COVID-19 seems to be more severe and has higher mortality in SOT recipients compared to the general population., (© 2020 Wiley Periodicals LLC.)

Background: Street children around the world are accompanying a wide range of risky behaviors. The most common ones include risky sexual behavior, substance and alcohol abuse, and violence. This study aimed to assess risk behaviors and HIV knowledge of street children in Shiraz. Methods: A total of 329 street children (7-18 years of age who spend days or nights on streets with or without their family for earning money) were interviewed through 2014-2016 in Shiraz. Data were collected through a structured interview about high-risk behaviors and HIV/AIDS Knowledge based on a form and questionnaire. Street children were asked to identify HIV/AIDS mode of transmission. All correct answers were scored as one (1), and incorrect, "don't know" responses and no responses scored as zero. The data were analyzed by SPSS software 16 (SPSS, Inc. Chicago, USA) using the Independent t-test and chi-square test, and Pearson's correlation test. P value< 0.05 was considered as statistically significant Results: The mean ± SD age was 13.46±3.09. A total of 86.6% of them were boys. A total of 97.6% of them reported staying with their parents. Street children reported sleeping place as follow: with their parents (n=312, 94.8%), sharing accommodation with other kids (n=13, %4), sleeping in parks (n=2, 7%), and one with relatives. The frequency of smoking, alcohol drinking, and drug abuse were 35 (10.6%), 47 (14. 3%), and 6 (1.8%) respectively. A total of 43 (13.1%) street children reported sexual activity, among them 30 (9.1%) had sexual activity without a condom. Mean ± SD HIV/AIDS knowledge scoring of street children was, 4.1±3.9. Conclusion: Special programs should be implemented in order to reduce high-risk behavior among street children. Intervention should include increasing awareness about alcohol and drug abuse, HIV/AIDS knowledge, sexual and verbal abuse through an organized system with the help of peer education., Competing Interests: Conflicts of Interest: None declared, (© 2020 Iran University of Medical Sciences.)

Cavernous hemangioma is an encapsulated nodular mass composed of dilated, cavernous vascular space separated by connective tissue stroma. Flattened endothelial cells line the vascular spaces, which were filled with blood. Though hemangiomas are the mast common benign neoplasms seen in children, they rarely occur in adults. In the head and neck region, the masseter and trapezius muscles are most commonly involved. Herein, the case is a 64 years old male who presented with a round, painless mass in the right temporal fossa with extension to infratemporal fossa. The lesion was surgically excised and histopathology confirmed the diagnosis of cavernous hemangioma.

Background: Hepatocyte transplantation using isolated human hepatocytes is an alternative source that can be used for the treatment of metabolic diseases and acute liver failure as a time bridge to liver transplantation. These cells can also be used for bioartificial liver systems and in vitro study of drug toxicity., Objective: To determine which cold preservation solution is better maintain the liver function., Methods: We prepared 4 cold preservation solutions made of different combination of antioxidants, chelating, membrane protective, and anti-apoptotic agents as well as inhibitor of cyclophilin D. For hepatocyte isolation, we used livers obtained from unused deceased donor livers and the liver of patients with Crigler-Najjar syndrome who were candidates of partial liver transplantation. After culture and cold preservation, the level of albumin, and urea production were measured as indices of liver functionality., Results: We found that albumin production significantly decreased after cold preservation in solution 1. There was no significant difference in urea production after cold preservation in solution 1 compared with control 24 h. No significant differences in albumin production were found after cold storage in solution 2 and solution 4 compared with control 24 h. Urea production significantly decreased after cold storage in solutions 2 and 4 compared with control 24 h. As a whole albumin and urea production were significantly decreased after cold preservation. Although albumin and urea production were decreased after cold preservation, but the results of albumin production of two solutions were not significantly different from that of the control group (p=0.109 and 0.951)., Conclusion: Cold preservation of cultured human hepatocytes in solution 2 and solution 4 could maintain the function of albumin production better than other cold preservation solutions in our experiments; solution 1 was more effective on urea production of cultured human hepatocytes at 4 °C for 24 h. To determine if these hepatocytes are suitable candidates for transplantation, further studies should be performed.

Background: Probable effects of living donor liver transplantation on the wellbeing of the donor and psychological difficulties are necessary to be understood., Objective: To assess the quality of life of living donors after liver donation., Methods: 140 living donors who underwent hepatectomy between 2012 and July 2015 were enrolled in this study. Donors were asked to complete the Short Form 36-question Health Survey (SF-36) through face to face or by telephone interview., Results: The mean±SD age of donors at transplantation was 32.1±7.3 years; 83 (59.3%) of donors were female. 134 (95.7%) were married. The mean±SD BMI was 23.8±3.5 (kg/m 2 ). "Mother-to-child" was the most frequent relationship (n=79, 56.4%). 22 (15.7%) complications were reported by participants. The mean±SD score of Physical Component Summary and Mental Component Summary were 48.8±14.6 and 50.1±6.9, respectively., Conclusion: Most living donors sustain a near average quality of life post-donation. It seems that living donation does not negatively affect the quality of life.

HIV/AIDS not only affects the patients, but also their entire family. This study aimed to assess the impacts of the patients' and their spouses' anxiety and depression on their quality of life (QoL) at the dyadic level. A total of 120 serodiscordant husband-wife dyads from the voluntary counselling and testing center in Shiraz, Iran, were involved in this study from February to June 2015. The WHOQOL-BREEF, CESD-10, and Beck Anxiety Inventory instruments were used, respectively, to assess the QoL, depression, and anxiety scores of the participants. The actor-partner interdependence model (APIM) was used to estimate the effects of depression and anxiety of both the people living with HIV/AIDS (PLWHA) and their spouses on their own QoL (actor effect) as well as their partners' (partner effect). The APIM analysis revealed that both PLWHAs' and their spouses' depression and anxiety showed actor effects on their own QoL. Furthermore, spouses' depression showed a significant partner effect on PLWHAs' QoL and PLWHAs' anxiety had significant partner effects on spouses' QoL. Accordingly, this data can be used to develop targeted interventions aimed at guidance and assistance of PLWHAs and their spouses to find coping strategies that improve their own QoL as well as their partners'.

Minocycline functions as a therapeutic drug in different diseases because of its cytoprotective properties. In the present study, we examined the potential of minocycline to decrease the islet loss in pre-transplantation culture stage. Pancreatic islets were isolated from the deceased donors and treated by 0, 2, 10, and 20 μM minocycline for 24 and 72 h. After that, the incubated islets were evaluated for viability and function. Apoptosis markers including Bax, Bcl2, and caspase-3 were determined at gene and protein level. On the other hand, TUNEL assay was used to confirm apoptosis. The functionality of the islets was investigated using glucose-induced insulin and c-peptide secretion assay. After 72 h of incubation, the viability of human islet was drastically decreased, whereas supplementation with minocycline inhibited the cells death. In this regard, the expression of Bax and active Caspase-3 was downregulated, whereas the expression of Bcl2 was upregulated. These consequences suggest that pancreatic islets undergo apoptosis in vitro and minocycline can decelerate or inhibit this process. Our findings identified minocycline as a cytoprotective molecule for preventing human islets death in pre-transplantation culture., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Islets transplantation, as a treatment of type 1 diabetes, faces challenges, including the loss of islets in the process of isolation and pre-transplantation due to cellular stresses-induced apoptosis. Accordingly, the optimization of culture plays a decisive role in the transplantation success. In this study, we evaluated the effect of nobiletin on the cultured human islets. Isolated human islets were treated by different concentrations of nobiletin and cultured for 24 and 72 hours. Then, the islets viability, apoptosis, insulin and C-peptide secretion, and apoptosis markers were evaluated. Also, the production of reactive oxygen species (ROS), hypoxia inducible factor 1 alpha (HIF-1α), and its target genes in the islets were examined. Our findings showed that the islets were encountered with hypoxia and oxidative stress after isolation and during culture. These insults induced apoptosis and reduced viability during culture period. Moreover, the secretion of insulin and C-peptide decreased. Nobiletin treatments significantly improved the islets survival through reduction of HIF-1α and ROS production and suppression of apoptosis, along with increased islets function. Islet protective effect of nobiletin might be related to its anti-oxidant, anti-apoptotic and insulinotropic properties. Hence, in order to achieve viable and functional islets for clinical transplantation, the application of nobiletin during pre-transplantation period is useful.

Background and Purpose: Islet transplantation is considered as a promising approach in the treatment of diabetes type 1. In this regard, optimal culture of the pancreatic islets is promising in the success of transplantation. In the present study, the effect of olesoxime, as an antiapoptotic substance, was evaluated on human islet culture., Experimental Approach: The pancreatic islets were isolated by mechanical and enzymatic techniques. After overnight recovery, the islets were treated by different concentrations of olesoxime for 24 and 72 h. Then, they were examined in terms of viability, apoptosis, genes and proteins expression including BAX, BCL2, active caspase-3, and insulin. Moreover, the islets function was evaluated through the glucose-induced insulin and C-peptide secretion assay., Key Results: Our findings showed that the islets increased in apoptosis and the decreased in viability after 72 h; also, insulin and C-peptide secretion reduced. However, in the presence of olesoxime, BAX/BCL2 ratio and the activation of caspase-3 were decreased. Therefore, olesoxime could improve the viability of the islets with the decrease of apoptosis., Conclusion: The application of olesoxime can reduce the stressful condition for the islets in vitro and subsequently improve their viability and functionality., (Copyright © 2019 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

The use of marginal kidneys or kidneys with pathologic problems (such as renal artery aneurysms in a living or deceased donor) is on the rise due to organ shortages and improvements in surgical techniques. When renal vascular abnormalities are detected during a transplant, it puts the surgeon in a difficult position to decide what to do with the organ. In this study, we report a case of a kidney from a deceased donor who had 2 renal artery saccular aneurysms, which we were able to use for transplant. The recipient was a 61-year-old male patient with diabetic nephropathy and significant comorbidities. Kidney transplant was performed successfully with a good outcome. Recent advancements in surgical techniques have allowed the use of kidneys with renal artery aneurysms for kidney transplant, thus helping to overcome shortages of transplantable organs.

One of the X chromosome-linked disorders is ornithine transcarbamylase deficiency in the urea cycle. This disorder results in increased ammonia and glutamine in the blood. Accumulation of these metabolites without treatment causes brain edema, which often progresses to coma and death. This study describes a 5-year-old girl with ornithine transcarbamylase deficiency who presented with hyperammonemic encephalopathy that was successfully treated with an orthotropic liver transplant. Recently, liver transplant has been introduced as an alternative treatment for patients with ornithine transcarbamylase deficiency.

Background: Medication adherence is a dynamic and complex behavioral process, which is strongly influenced by personal, social and environmental factors., Objectives: To determine the prevalence and factors affecting non-adherence to medication among HIV-infected patients., Design: A cross-sectional study., Setting: Voluntary Counseling and Testing Center (VCT), Shiraz, Fars province, in the South of Iran., Patients: Among HIV-positive patients who received anti-retroviral therapy, 214 adult patients were selected through convenience sampling. Their medication adherence was checked by interview and counting the pills on visits during two months. Clinical and laboratory data were obtained from the patients' records., Results: Non-adherence and adherence groups included 30.4% (65) and 69.6% (149) of the patients, respectively. The mean age of patients was 40.80±7.77 years, and ranged from 20 to 65 years. Majority of cases (65%) were male. A significant relationship was found between non-adherence to medications and the variables of transmission method, marital status, housing status, and CD4, but there was no significant relationship with gender., Conclusion: The prevalence of medication adherence was similar to other regions with limited financial resources. To increase patient's medication adherence, they should be exposed to motivational interventions to promote their drug consumption, social and occupational support.

Introduction: HIV infection remains as a major challenge facing medical sciences in the world today. Mucocutaneous manifestation was first observed in patients with HIV/AIDS in the early 1980s. The aim of this study was to identify various skin manifestations based on making careful clinical observations and performing the necessary tests., Materials and Methods: A total of 240 patients whose disease was diagnosed using WB and ELISA tests, with dermatologic manifestations and were older than 18 years, participated in this study. These patients had referred to the voluntary counseling and testing center in Shiraz for routine examinations., Results: From the total of 240 participants, 158 were males (65.8%) and 82 were females (34.2%). The mean age was 40.87 ± 8.04 years. Dermatologic manifestations were of infectious origin in 79 (33%) of the participants. As the most common viral skin infections, herpes simplex was seen in 16 patients (6.7%), with herpes zoster ranking second with 15 patients (6.3%). No relationship was found between CD4 cell count and infectious or noninfectious dermatologic manifestations ( P = 0.274)., Conclusion: No association was found between CD4 cell counts and dermatologic manifestations. Many skin disorders may appear in HIV/AIDS patients with normal CD4 cell counts., Competing Interests: There are no conflicts of interest.

The use of anti-retroviral therapy has been effective in controlling the spread of HIV-1, and has prolonged life expectancy, but this success can be affected by the emergence of drug resistance. The main goal of this study was to investigate drug resistance in the reverse transcriptase (RT), and protease (PR) genes among HIV-1 infected individuals. We systematically selected 59 HIV-1 infected individuals from Shiraz Voluntary Counseling and Testing Center (29 treatment- naïve and 30 treated). In this study intravenous drug users older than 18 were included in this study. Using specific primers, nested RT-PCR was performed on RNA extracted from patient samples. The genes targeted for RT and PCR were successfully amplified and sequenced. The sequences of these two genes were compared with mutations related to drug resistance against nucleotide reverse transcriptase inhibitors (NRTI), non-nucleotide reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) using the latest database from the International AIDS society - USA, Stanford University, and the patterns were recorded. Among treatment-naïve, the detected NRTI and NNRTI resistance mutations were V179T, V75 M and E138A. V179T causes high level resistance to Efavirenze and Nevirapin. V75 M causes intermediate resistance to Stavudine. Regarding NRTI and NNRTI resistance mutations among treated patients, the most frequent mutation (7%) was M184 V, which causes high level resistance to zidovudin and emtricitabine. The interesting result from this study was the detection of NRTI and NNRTI resistance mutations before the initiation of treatment, which signifies the transmission of resistant strains of virus between individuals. This mutation highlights the importance of drug resistance HIV-1 genotyping before commencing treatment.

Introduction: Roux-en-Y choledochojejunostomy and duct-to-duct (D-D) anastomosis are biliary reconstruction methods for liver transplantation. However, there is a controversy over which method produces better results. We have compared the outcome of D-D anastomosis vs. Roux-en-Y hepaticojejunostomy in patients with primary sclerosing cholangitis who had undergone liver transplant in Shiraz Organ Transplant Center., Materials: The medical records of 405 patients with primary sclerosing cholangitis (PSC) who had undergone liver transplant from 1996 to 2015 were reviewed. Patients were divided into two groups: Roux-en-Y group and D-D group. Morbidity, disease recurrence, and graft and patient survival rates were compared between the two groups., Results: Total of 143 patients underwent a D-D biliary reconstruction, and 260 patients had a Roux-en-Y loop. Biliary complication involved 4.2% of patients from the D-D group, and 3.9% from the Roux-en-Y group (P=. 863). Actuarial 1-, 3-, and 5-year patient survival for D-D and Roux-en-Y group was 92%, 85%, and 74%; and 87%, 83%, and 79%, respectively (P=.384). The corresponding 1-, 3-, and 5-year probability of biliary complication was 97%, 95%, and 92%; and 98%, 97%, and 94%, respectively (P=.61)., Conclusion: Duct-to-duct biliary reconstruction in liver transplantation for selected patients with PSC is a good alternative instead of Roux-en-Y biliary reconstruction., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Although patient and graft survival rate has increased in recent years, biliary complications after liver transplantation are associated with significant morbidity and mortality., Methods and Materials: We reviewed the database of 1930 patients who underwent deceased donor liver transplantation between 2000 and 2013. The patients had abnormal results in liver tests, as well as fever and jaundice. Abdominal sonography was performed, and if complication was identified, the patient underwent an interventional procedure by endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography. If the complication was not resolved by the mentioned procedures, exploration of common bile duct and Roux-en-Y choledochojejunostomy or revision of Roux-en-Y choledochojejunostomy was done., Results: Our study group comprised 105 patients including 66 (63%) men and 39 (37.1%) women with a mean age of 36.7 ± 12.5 years (range: 15-66 years). Among 1930 patients, 105 (5.4%) cases presented with biliary complication after liver transplantation, of which 97 (5%) and 8 (0.4%) cases presented with biliary stricture and bile leak/biloma, respectively., Conclusion: In our study, most patients with biliary complications after liver transplantation responded to interventional procedures, with 37.1% requiring surgical exploration.

We retrospectively compared induction therapy utilizing alemtuzumab and antithymoglobulin (ATG) in high-risk kidney transplant recipients in our center. Two hundred and fifty-one patients underwent kidney transplantation between 2009 and 2012. The high-risk patients were defined as those who had two or more times kidney transplantation and/or more than 30% panel reactive antibody. We studied 130 high-risk kidney transplant candidate; 58 (44.6%) patients received induction immunosuppressive therapy with alemtuzumab, and 72 (55.4%) with ATG. Delayed graft function developed in 11 patients receiving alemtuzumab, against the 27 patients who receiving ATG (P = 0.021). Acute cellular rejection episodes were observed in five patients in the alemtuzumab group and 19 patients in the ATG group (P = 0.009). There were three graft failures in the alemtuzumab group and eight graft failures in the ATG group due to rejection episodes. We found immunosuppressive induction therapy with alemtuzumab a significantly less incidence of acute rejection and delayed graft function than induction therapy with ATG in the high-risk kidney transplant recipients.

Background and Objectives: Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. It is usually a self-limited disease but may leads to the deaths of about 20% of pregnant women in developing countries. This study was conducted to determine the prevalence of HEV infection among HIV individuals ., Materials and Methods: This is a cross-sectional survey of HIV positive individuals in voluntary counselling and testing center of Shiraz in 2013 Using the systematic random sampling method, 158 patients enrolled for the research. They were asked about their age, gender, area of residence, marital status, number of children, education level, occupation, history of imprisonment, mode of HIV transmission, and viral hepatitis co-infection Three ml venous blood sample was drawn from each subject and transferred to the laboratory of voluntary counselling and testing center., Results: The overall seroprevalence of hepatitis E was 26 (16.4%), where it increased significantly with age ranging from zero in subjects less than 30 years of age to 47.4% in those aged 50 years or older., Conclusion: Co-infection of HIV positive individuals with HEV is an issue that should be of concern to health care providers.

Objectives: To identify the predictors of overall survival and tumor-free survival of 88 hepatocellular carcinoma patients who were treated with orthotopic liver transplant at Shiraz Organ Transplant Center., Materials and Methods: We performed this retrospective study after reviewing the transplant database of all patients who underwent orthotopic liver transplant secondary to hepatocellular carcinoma and liver cirrhosis. Hepatocellular carcinoma was diagnosed in 70 patients before liver transplant and 18 patients on histologic examination of the explanted livers. Cox regression identified independent factors that affected posttransplant survival., Results: The overall survival rate was 83% and the tumor-free survival rate was 79.5%. Independent factors for tumor recurrence were Milan criteria, alpha-fetoprotein level before operation ≥ 400 ng/mL, tumor grade, vascular invasion, and age. Vascular invasion (odds ratio, 5; 95% confidence interval, 1.1 to 25.496; P = .049) and tumor grade (odds ratio, 14.42; 95% confidence interval, 3.652 to 56.95; P < .001 were statistically significant., Conclusions: Vascular invasion and tumor grade were predictive factors for tumor-free survival.

Objectives: This study sought to investigate discarded organs at the Shiraz University of Medical Sciences, Shiraz, Iran., Materials and Methods: We performed a retrospective analysis of Shiraz Transplant Center database regarding discarded organ during May 2010 and December 2013. Our study investigated 80 unused liver donors' characteristics. The data included age, sex, cause of discard, cause of brain death, hypotension during hospitalization of donors, and result of liver biopsy., Results: Among 780 grafts, 80 livers (10.25%), between May 2010 and December 2013, were unsuitable for transplant. Among the donors whose livers were discarded, 36 were women (45%) and 44 were men (55%) (mean age, 43.7 ± 14 years; range, 1-67 y). The most common causes of brain death were cerebrovascular accidents 27 (33.8%), trauma 27 (33.8%), aneurysm, and subarachnoid hemorrhage 13 (16.3%). The most common cause of unused organ were fatty liver 50 (62.5%) and necrosis 25 (31%) (steatosis more than 40%)., Conclusions: Old age, cerebrovascular accidents, and severe steatosis ≥ 40 were the most common associated factors in organ discard in this study.

As a concentrated epidemic, human immunodeficiency virus (HIV) is spreading rapidly in one or more groups in Iran, but in the general population its prevalence is relatively low. Female sex workers (FSWs) and their partners are at greater risk for HIV infection. To determine the prevalence of HIV and sexually transmitted infections (STIs) including gonorrhoea, Chlamydia, herpes simplex type 2 and syphilis among FSWs. We conducted a cross-sectional study of 278 FSWs in Shiraz, by using respondent-driven sampling, from June to March 2010. The recruitment chain started with 14 seeds, and FSWs were tested for HIV, syphilis, herpes simplex type 2, gonorrhoea and Chlamydia. HIV prevalence was 4.7% (13/278); the most prevalent STI was herpes simplex type 2, 9.7% (27/278), followed by Chlamydia 9% (25/278), gonorrhoea 1.4% (4/278) and syphilis (0/278). The FSWs reported drug use (69.9%) of which 16.4% had history of injecting drug use. Unprotected sex in the past month was reported by 24.4% of FSWs. Urgent education and risk reduction programmes are needed in this population.

This quasi-experimental, before-after study was designed to assess the effect of an educational intervention on knowledge and attitudes about sexually transmitted infections, HIV and preventive behaviours among female sex workers in Shiraz, Iran. A single-group pre-post test design was used and the study was done between August and December 2009. The participants were 80 female sex workers recruited from three drop-in centers in Shiraz, with stratified random sampling. Pre-intervention knowledge was assessed by interview with a standard questionnaire. The educational intervention consisted of a lecture, face-to-face education, printed information, an educational movie, role playing and a contest. After 2 months, the effect of the intervention was evaluated (post-test). The average age of the participants was 32.6 ± 9.1 years. After the intervention, the mean score for general knowledge about HIV and sexually transmitted infections increased from 13.7 ± 0.95 (pre-test) to 19.47 ± 11.62 (post-test, p<0.001). There were significant improvements in attitude and the number of participants who self-reported preventive behaviours such as using a condom consistently (from 45 to 63) (p<0.001). The results show that the educational programme was successful in increasing the participants' HIV- and AIDS-related knowledge and attitudes, and in decreasing their risk behaviours.

Clinical laboratories are significant generators of infectious waste, including microbiological materials, contaminated sharps, and pathologic wastes such as blood specimens and blood products. Most waste produced in laboratories can be disposed of in the general solid waste stream. However, improper management of infectious waste, including mixing general wastes with infectious wastes and improper handling or storage, could lead to disease transmission. The aim of this study was to assess waste management processes used at clinical laboratories in Shiraz, Iran. One hundred and nine clinical laboratories participated In this cross sectional study, Data collection was by questionnaire and direct observation. Of the total amount of waste generated, 52% (by weight) was noninfectious domestic waste, 43% was non-sharps infectious waste and 5% consisted of sharps. There was no significant relationship between laboratory staff or manager education and the score for quality of waste collection and disposal at clinical laboratories. Improvements in infectious waste management processes should involve clearer, more uniformly accepted definitions of infectious waste and increased staff training.