liver transplantation

Purpose: The purpose of the study is to access the prevalence of accessory right inferior hepatic veins and their relevant significance in liver transplantation. Materials and Methods: A retrospective study was done in which the CT of 82 potential liver transplant candidates between January 2012 and March 2013 were reviewed. The presence of the accessory right inferior hepatic vein was examined; the diameters of the accessory inferior hepatic veins and the distance between the point where they open into the inferior vena cava on the coronal plane and to the right hepatic vein-inferior vena cava junction was measured. Results: Out of 82 patients, 42 (51%) had accessory right inferior hepatic veins. Right accessory inferior hepatic veins larger than 3 mm were detected in 23 (28%) patients. The distance of these veins to the right hepatic vein-inferior vena cava junction was more than 4 cm in 13 (15%) patients. Conclusion: The precise preoperative knowledge of accessory right inferior hepatic veins is essential in living donor liver transplantation.

43-year-old lady presented with incidentally discovered liver lesions while she was being managed for her complaints of menorrhagia. CT and MRI showed hepatomegaly with multiple lesions in both lobes of the liver with vascular element in the background of diffuse fatty infiltration. Patient underwent laparoscopic core biopsy. Histopathology showed extensive steatosis, intracytoplasmic giant mitochondria and absence of portal tracts, features highly suggestive of hepatic adenomatosis. IHC staining showed membranous and cytoplasmic positivity in hepatocytes for B-catenin consistent with multiple hepatic adenomatosis. Hepatic adenomatosis is a new clinical entity in the hepatological practice characterized by the presence of 10 or more nodules in the liver known for its major complication of bleeding. Hepatic adenomatosis is managed by regular imaging and resection of large (> 5cm) superficial and painful adenomas along with liver function tests and tumor markers to rule out malignant transformation. However, the potential cure being the liver transplantation.

Acute liver failure (ALF) in children is a severe disease with a high mortality rate. The current treatment strategies are still defective, with many cases die when liver transplantation is unavailable. The current protocol of steroids therapy improved the survival rate of hepatitis A virus (HAV)-related ALF. However, there is still a high mortality for non-HAV cases. Stem cell therapy (SCT) has been tried in experimental animals with ALF and in few adult studies with acute-on-chronic liver failure. No previous trials of SCT have been tested in children with ALF. The absence of SCT application in ALF in children could be due to some issues. These could be related to safety, sources, administration route, optimum dosage, efficacy, and survival. It is proposed that could be the future therapy if these obstacles have been well studied and solved.

Morbidity and mortality of HIV-infected patients have been improved over the last decades with the advent of combined antiretroviral therapy. As a result, other comorbidities such as chronic kidney and chronic liver diseases have emerged in the HIV population. A considerable percentage of end-stage liver disease (ESLD) in HIV population is attributed to hepatitis C co-infection and reactivation, and a growing need for solid organ transplantation has emerged among those patients. On the other hand, several studies on liver transplantations of patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) have shown discouraging results both in patient and graft survival rates. As a result, HIV-HCV co-infection has been considered a relative contraindication for liver transplantation. Thankfully, new drugs for HCV treatment have been discovered, acting direct on viral replication of HCV and they have changed the whole clinical course of HCV/HIV co-infected liver transplant recipients. Our case illustrates the long-term efficacy and safety of the new combination of Sofosbuvir/Ledipasvir in HCV/HIV co-infected liver transplant recipients.

Liver Transplantation is fraught with thrombo-hemorrhagic complications, due to the precarious hemostasis of the recipient, anhepatic conditions, and the release of hemostatic factors from the allograft. Disseminated intravascular coagulation and its “flat-line” variant are common causes of hemorrhage and thrombosis, and frequently force the clinician along with a delicate balance between hemorrhage and thrombosis. We present a case that highlights some of the more challenging diagnostic and management decisions in liver transplantation and presents a safe and carefully structured approach to hyperfibrinolysis in liver transplantation.

Background: Liver Transplantation (LT) is the definitive treatment for Autoimmune Hepatitis (AIH) in patients with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Outcomes of LT in AIH among black-Africans are not well-defined. We performed a single-center retrospective-review of adult LT patients. The study period was from 1st August 2004-31st August 2019. The primary aim was to document 1- & 5- year patient and graft survival. A secondary aim was to compare the survival of black-Africans to Caucasians. Data was analyzed using survival-analysis. Results: A total of 56 LT were performed for AIH. Sixty-seven percent (n = 38/56) had confirmed AIH on explant histology. Of these, the majority i.e., 79% (30/38) were female and 21% (8/38) were male. There were equal numbers of black-African 42% (n = 16/38) and Caucasian 42% (n = 16/38) patients. Rejection was four-times higher in black-Africans as compared to Caucasians. Forty-four percent (n = 17/38) had an acute rejection episode and 13% (5/38) had chronic rejection. Recurrence was found in four black-African females. Post-LT patient survival at 1- and 5- years was 86.5% and 80.7%, and graft survival was 94% and 70.8% respectively. The 5- year patient survival was insignificantly lower for black-Africans (73.9%) as compared to Caucasians (83.7%) (p - value 0.26, CI 6.3 - 12.2). Five-year graft survival was significantly lower among black-Africans (55%) as compared to Caucasians (84.8%) (p - value 0.003 CI 3.8 - 8.1)Conclusion: Black-Africans had a four-fold higher rate of rejection compared to Caucasians. Recurrent AIH was only found in patients of black ethnicity. Similar 1- & 5- year patient survival rates were observed between the two ethnicities. The 5-year graft survival among black-Africans was significantly lower than Caucasians.

Mesenchymal stem cell (MSC) transplantation may be an alternative to liver transplantation for patients with end-stage liver disease. A 24-year-old patient with Hepatic Encephalopathy due to alcoholic liver cirrhosis underwent UCMSC transplantation because there were no donors available for liver transplants involving adult deceased and living individuals. The patient was given allogeneic Umbilical cord-derived MSCs, which were then cultured following accepted practices. Subsequently, the UCMSCs were infused through the intravenous route 3 times at the interval of 30 days. Serum bilirubin, globulin, and ammonia levels were improved after the infusion and the morphology of the liver and spleen had also improved.

Background: The health professional appears to be concerned given the number of questions surrounding the patient’s post-transplant survival, patient selection method, and the continuous search for scores that reflect their reality and reconcile the results they desire with the patient’s expectations. It is from these considerations that the present work was born with the purpose of understanding the reality of patients hospitalized for hepatocellular carcinoma and what adherence to the Model For End-Stage Liver Disease (MELD) criteria meant in Brazil. Methods: This study is a discrete, univariate time series on emergency hospitalizations that occurred between 2000 and 2018, in the city of São Paulo, Brazil. Python version 3.11 was the software used for statistical treatment and analysis of the time series. Results: There were 6887 hospitalizations for malignant neoplasm of liver and intrahepatic bile ducts, in the period 2000-2006, of which 2898 were elective and 3915 (56.85%) were urgent in the period. There was an increase of 63.97% in the number of emergency hospitalizations in relation to the period 2000-2006 and 2007-2013. To highlight, in 2013 there were 1270 emergency admissions, which represented an increase of 109.22% in relation to the number of emergency admissions in 2006. The contingency correlation analysis demonstrated a significant association between the variables in which the chi-square value was 82.18, the p-value was 1.24 x 10-19, and the critical value was 3.84 with one degree of freedom. There was a 123.65% increase in the number of hospitalizations for chronic hepatitis, not elsewhere classified, between the periods 2000-2006 and 2007-2013. The chi-square value of the contingency association was 221.22, with a p-value of 4.90 x 10-50, a critical value of 9.488, with a significance level of 5% and one degree of freedom. The study showed an increase in hospitalizations of 21.88% for alcoholic liver disease between the periods 2000-2006 and 2007-2013. In the period 2000-2006, there were 21330 hospitalizations, 19224 of which were urgent (90.13%). In the period 2007-2013, there were 25997 hospitalizations, of which 22,802 (87.71%) occurred urgently. The chi-square value was 68.95, the p-value was 1 x 10-16, and the critical value was 3.84, with one degree of freedom. Conclusion: The MELD score, as it is sensitive to the patient’s severity, selects those who are at an advanced stage of the disease for liver transplantation. In this scenario, patients do not necessarily have access to outpatient services and begin to attend them regularly when MELD identifies the advanced stage of the disease, opening a gap between prevention, treatment, and rehabilitation.