Staged biliary reconstruction after liver transplantation: A novel surgical strategy for high acuity pediatric transplant recipients

Background: Chronic kidney disease following liver transplantation is a major long-term complication. Most liver transplant recipients with kidney failure will be treated with dialysis instead of kidney transplantation due to noneligibility and shortage in organ availability. In this population, the role of peritoneal dialysis (PD) as a modality of kidney replacement therapy (KRT) remains unclear. Objective: To determine the feasibility regarding safety, technique survival, and dialysis efficiency of PD in liver transplant recipients requiring KRT for maintenance dialysis. Design: Systematic review. Setting: Interventional and observational studies reporting the use of PD after liver transplantation. Patients: Adult liver transplant recipients with kidney failure treated with maintenance KRT. Measurements: Extracted data included eligibility criteria, study design, demographics, and PD modality. The following outcomes of interest were extracted: rate of peritonitis and microorganisms involved, noninfectious peritoneal complications, technique survival, and kidney transplantation-censored technique survival. Non-PD complications included overall survival, liver graft dysfunction, and hospitalization rate. Methods: The following databases were searched until July 2020: MedLine/PubMed, EMBASE, CINAHL, and Cochrane Library. Two reviewers independently screening all titles and abstracts of all identified articles. Due to the limited sample size, observational designs and study heterogeneity expected, no meta-analysis was pre-planned. Descriptive statistics were used to report all results. Results: From the 5263 identified studies, 4 were included in the analysis as they reported at least 1 outcome of interest on a total of 21 liver transplant recipients, with an overall follow-up duration on PD of 19.0 (Interquartile range [IQR]: 9.5-29.5) months. Fifteen episodes of peritonitis occurred in a total cumulative PD follow-up of 514 patient-months, representing an incidence rate of 0.35 per year. These episodes did not result in PD technique failure, mortality, or impairment of liver graft function. Limitations: Limitations include the paucity of studies in the field and the small number of patients included in each report, a risk of publication bias and the impossibility to directly compare hemodialysis to PD in this population. These results, therefore, must be interpreted with caution. Conclusions: Based on limited data reporting the feasibility of PD in liver transplant recipients with kidney failure, no signal was associated with an increased risk of infectious complications. Long-term studies evaluating this modality need to be performed. Registration (PROSPERO): CRD42020218374.

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Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽

10.1093/qjmed/hcaa052.005 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M G Abdelrahman ◽

H A Mahmoud ◽

M K Mohsen ◽

M O Ali ◽

A M N Mohamed

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Liver Transplant ◽

Organ Transplantation ◽

Chronic Rejection ◽

Cytomegalovirus Infection ◽

Transplant Recipients ◽

Cmv Infection ◽

Donor Liver Transplantation ◽

Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

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HEALTH-RELATED QUALITY OF LIFE IN ADULT TRANSPLANT RECIPIENTS MORE THAN 15 YEARS AFTER ORTHOTOPIC LIVER TRANSPLANTATION.

Transplantation Journal ◽

10.1097/01.tp.0000332086.22260.e3 ◽

2008 ◽

Vol 86 (Supplement) ◽

pp. 247

Author(s):

T Becker ◽

L Kousoulas ◽

R Bastian ◽

T Becker ◽

M Neipp ◽

...

Keyword(s):

Quality Of Life ◽

Liver Transplantation ◽

Orthotopic Liver Transplantation ◽

Health Related Quality ◽

Transplant Recipients ◽

Related Quality ◽

Health Related

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Biliary Reconstruction in Pediatric Liver Transplantation: A Case Report of Biliary Complications and Review of the Literature

Journal of Liver ◽

10.4172/2167-0889.1000179 ◽

2015 ◽

Vol 04 (02) ◽

Cited By ~ 1

Author(s):

Thao T Nguyen N

Keyword(s):

Liver Transplantation ◽

Case Report ◽

Biliary Complications ◽

Biliary Reconstruction ◽

Pediatric Liver Transplantation ◽

Review Of The Literature ◽

Pediatric Liver

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Spontaneous Clearance of Hepatitis C after Liver and Renal Transplantation

Canadian Journal of Gastroenterology ◽

10.1155/2009/912848 ◽

2009 ◽

Vol 23 (4) ◽

pp. 265-267 ◽

Cited By ~ 14

Author(s):

CH Dale ◽

P Burns ◽

M McCutcheon ◽

R Hernandez-Alejandro ◽

PJ Marotta

Keyword(s):

Liver Transplantation ◽

Hepatitis C ◽

Common Factor ◽

Organ Transplant ◽

Hcv Rna ◽

Spontaneous Clearance ◽

Previous Exposure ◽

Transplant Recipients ◽

Liver And Kidney ◽

Solitary Liver

Spontaneous clearance of hepatitis C virus (HCV) is rare in immunocompromised patients, such as those who have undergone organ transplantation. It has been recognized that patients receiving liver transplantation for HCV-related disease have decreased graft and patient survival compared with those transplanted for other etiologies. There is a growing trend toward treating HCV recurrence aggressively after liver transplantation. For other organ transplant recipients with concurrent HCV, treatment is not often an option, given the high rates of graft rejection and loss secondary to interferon and its immunomodulatory effects. Although spontaneous clearance of HCV has been reported in recipients of solitary liver and renal transplants, a common factor arising in these cases has been previous exposure to interferon. To date, no reports of spontaneous clearance of HCV RNA have been reported in a multiorgan transplant recipient. A case of spontaneous clearance of HCV RNA in an immunocompromised patient, within five months of simultaneous liver and kidney retransplantation is described. Importantly, this patient had no previous exposure to interferon.

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