Effect of Chronic Rhinosinusitis on Liver Transplant Patients

Background The use of immunosuppressant after liver transplantation makes transplant recipients susceptible to infections. Most infections that can alter mortality after liver transplantation are wound infections, urinary infections, and pneumonias. There is no evidence, however, that chronic rhinosinusitis can alter mortality in patients awaiting liver transplantation. We have therefore assessed the association of rhinosinusitis with mortality and prognosis after liver transplantation. Methods The clinical records of 996 patients who received liver transplants between January 1995 and March 2005 were reviewed and the collected data were analyzed. Results Of the 996 patients who received liver transplants between January 1995 and March 2005, 28 (2.8%) had pretransplant rhinosinusitis. Of the latter, 5 patients were treated medically, 1 patient had endoscopic sinus surgery, and 22 patients had no treatment before liver transplantation. Untreated rhinosinusitis before liver transplantation was associated with aggravated rhinosinusitis after transplantation but did not contribute to an increase in infectious mortality or overall mortality rate. Conclusion Pretransplant chronic rhinosinusitis does not contribute to mortality in patients undergoing liver transplantation.

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Endoscopic Management of Biliary Complications following Liver Transplantation after Donation from Cardiac Death Donors

Canadian Journal of Gastroenterology ◽

10.1155/2012/346286 ◽

2012 ◽

Vol 26 (9) ◽

pp. 607-610 ◽

Cited By ~ 19

Author(s):

Kris P Croome ◽

Vivian McAlister ◽

Paul Adams ◽

Paul Marotta ◽

William Wall ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Cardiac Death ◽

Hepatic Duct ◽

Biliary Complications ◽

Endoscopic Management ◽

Transplant Recipients ◽

Biliary Strictures ◽

Liver Transplants ◽

Liver Transplant Recipients

BACKGROUND Previous studies have shown a higher incidence of biliary complications following donation after cardiac death (DCD) liver transplantation compared with donation after brain death (DBD) liver transplantation. The endoscopic management of ischemic type biliary strictures in patients who have undergone DCD liver transplants needs to be characterized further.METHODS: A retrospective institutional review of all patients who underwent DCD liver transplant from January 2006 to September 2011 was performed. These patients were compared with all patients who underwent DBD liver transplantation in the same time period. A descriptive analysis of all DCD patients who developed biliary complications and their subsequent endoscopic management was also performed.RESULTS: Of the 36 patients who received DCD liver transplants, 25% developed biliary complications compared with 13% of patients who received DBD liver transplants (P=0.062). All DCD allograft recipients who developed biliary complications became symptomatic within three months of transplantation. Ischemic type biliary strictures in DCD allograft recipients included disseminated biliary strictures in two patients, biliary strictures of the hepatic duct bifurcation in three patients and biliary strictures of the donor common hepatic duct in three patients.CONCLUSIONS: There was a trend toward increasing incidence of total biliary complications in recipients of DCD liver allografts compared with those receiving DBD livers, and the rate of diffuse ischemic cholangiopathy was significantly higher. Focal ischemic type biliary strictures can be treated effectively in DCD liver transplant recipients with favourable results. Diffuse ischemic type biliary strictures in DCD liver transplant recipients ultimately requires retransplantation.

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Squamous Metaplasia and Chronic Rhinosinusitis: A Clinicopathological Study

American Journal of Rhinology ◽

10.2500/ajr.2008.22.3236 ◽

2008 ◽

Vol 22 (6) ◽

pp. 602-605 ◽

Cited By ~ 11

Author(s):

Robert G. Mynatt ◽

Jennifer Do ◽

Christine Janney ◽

Raj Sindwani

Keyword(s):

Chronic Rhinosinusitis ◽

Clinical Features ◽

Chronic Sinusitis ◽

Squamous Metaplasia ◽

Sinus Surgery ◽

Preoperative Ct ◽

Student’S T ◽

Pathology Reports ◽

Clinical Records ◽

Student’S T Test

Background The significance of squamous metaplasia (SM) in chronic rhinosinusitis (CRS) is unknown. The objectives of this study were to determine the prevalence of SM in histopathological specimens from patients with CRS and to correlate these histological findings with clinical features. Methods We reviewed the clinical records and pathological slides from 87 consecutive patients who underwent endoscopic sinus surgery for CRS. Demographic and clinical data, preoperative Chronic Sinusitis Survey (CSS) scores, and sinus CT stage were evaluated. Pathological slides were graded by a pathologist to characterize the degree of inflammation and SM, when present. CRS patients with and without SM were compared using student's t-test and χ2 test. Results Evaluation of the pathology slides revealed that 18.4% of specimens had SM present, whereas only 2.2% of pathology reports noted this. Histological grading of chronic inflammation showed significantly greater severity in specimens with SM (n = 16) when compared with the cohort without SM (n = 75; 100.0% versus 77.5%, respectively; p = 0.016). There was no difference in preoperative CT stage or the presence of hyperostosis on imaging, CSS scores, duration of CRS symptoms, or other clinical features between those with SM and those without SM (p > 0.05). Immunodeficiency was the only comorbidity more prevalent in the metaplastic group (12.5% versus 0%, respectively; p = 0.003). Conclusion SM is present in ∼18% of routine CRS specimens. It has a positive correlation with the severity of inflammation noted histologically in CRS but does not correlate with disease severity or chronicity, clinically.

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Management of COVID-19 in Liver Transplant Recipients with Immunosuppressant Therapy: Experiences of an Iranian Transplant Registry

10.21203/rs.3.rs-62369/v1 ◽

2020 ◽

Author(s):

Zahra Sheikhalipour ◽

Touraj Asvadi kermani ◽

Farzad Kakaei ◽

Azizeh Farshbaf Khalili ◽

Leila Vahedi

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Organ Transplant ◽

Immunosuppressive Drugs ◽

Personal Hygiene ◽

Transplant Recipients ◽

Liver Transplants ◽

Transplant Registry ◽

Use Of Medical Services ◽

Liver Transplant Recipients

Abstract Background: Following the pandemic of COVID-19 and the increased COVID-19 risk in transplant patient receptions, the authors assessed the prevalence, clinical course, and the outcome of the COVID-19 infection among liver transplant receptions. Methods: By designing and the use of researcher made questionnaire and the use of medical services, liver transplantation recipients under our center surveyed in terms of COVID-19 infection.Results: Seven patients infected with COVID-19 were identified from 265 liver transplantation recipients. The majority of patients were male and had COVID-19 despite being in-home quarantine. All patients received immunosuppressive drugs during infection with COVID-19 with no change in the routine immunosuppressive therapy. Among the identified patients, 5 recovered and 2 died. One of the dead patients, in addition to having a liver transplant, suffered brain cancer with metastasis to the lungs. Conclusion: It seems that the in liver transplants infected with COVID-19, the immunosuppressive drugs causes mild to moderate illness, and even recover from the disease.However, more evidence is needed to prove this hypothesis. It is also recommended that transplant recipients should be warned about personal hygiene and closely be monitored by organ transplant centers.

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Renal Safety of Tenofovir Disoproxil Fumarate and Entecavir in Liver Transplant Patients: A Nationwide Korean Registry Study

10.21203/rs.3.rs-1141515/v1 ◽

2021 ◽

Author(s):

Juhan Lee ◽

Jae Geun Lee ◽

Shin Hwang ◽

Kwang-Woong Lee ◽

Jong Man Kim ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Renal Dysfunction ◽

Transplant Recipients ◽

Post Transplantation ◽

Transplant Patients ◽

Increased Risk ◽

B Virus ◽

Liver Transplant Recipients ◽

Renal Safety

Abstract Background and aims: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have been recommended after liver transplantation to prevent recurrence of hepatitis B virus infection. Despite its proven efficacy, the renal safety of TDF has not been established in liver transplant recipients. We aimed to compare the effects of TDF and ETV on renal function in liver transplant recipients and to evaluate risk factors for renal dysfunction after liver transplantation. Methods: This is a retrospective, observational multicenter study of data from the Korean Organ Transplantation Registry. We included adults who underwent liver transplantation for hepatitis B virus-related complications from April 2014 to December 2017 and received TDF or ETV post-transplantation. Renal dysfunction was defined as an estimated glomerular filtration rate decline by at least 20% from baseline (1 month post-transplantation). Median duration of follow-up was 29 months (interquartile range 19–42).Results: A total of 804 liver transplant patients were included. The cumulative probability of renal dysfunction was significantly higher in the TDF group than in the ETV group. Multivariable analysis confirmed that TDF was independently associated with an increased risk of renal dysfunction (hazard ratio = 1.47, 95% confidence interval 1.12-1.92; P = 0.005). Independent risk factors for renal dysfunction included older age, worse baseline renal function, and low body mass index. Renal dysfunction after liver transplantation was independently associated with increased mortality.Conclusions: In this nationwide study, use of TDF was associated with an increased risk of renal dysfunction, when compared with ETV.

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Single Center Analysis of Incidence and Outcome of COVID-19 Infection in Solid Organ Transplant Recipients

10.53350/pjmhs211551064 ◽

2021 ◽

Vol 15 (5) ◽

pp. 1064-1067

Author(s):

M Asim Rana ◽

M Ahad Qayyum ◽

Amer Latif ◽

M Afzal Bhatti ◽

Syed Arsalan Khalid ◽

...

Keyword(s):

Kidney Transplant ◽

Organ Transplant ◽

Solid Organ Transplant ◽

Interquartile Range ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Transplant Patients ◽

Solid Organ Transplant Recipients ◽

Overall Mortality

Aim: To determine overall mortality, outcome and mortality of COVID 19 infection in solid organ transplant pts. Study design: Retrospective study. Place and duration of study: Department of Medicine, Bahria International Hospital, Lahore, Pakistan15thApril 2020 to 31stDecember 2020. Methodology: Twenty-three patients 18 out of which were kidney transplant recipients while 5 were liver transplant recipients. All the solid organ transplant patients who were admitted with Sars CoV2 (Corona virus) infection were recorded. Their charts were reviewed regarding clinical course, management, and outcome of COVID-19 infection in recipients of solid organ (liver and kidney) transplant. Results: Mean age was 44.8±10.9 years. Median time lapsed from transplant surgery to admission was 2.88 years (interquartile range 2.25, 7.33). Median hospital stay was 15 days (interquartile range 13, 28). All 23 patients were admitted and managed, with 17 (73.91%) admitted in ICU. Over half of the cases (58.2%) presented with raised serum creatinine due to acute kidney injury. 80% received azithromycin, Tocilizumab and 50% received Remdesivir.Antimetabolites with or without calcineurin inhibitors were held or reduced. A total of 5 patients had died while the others 18 patients (78.26%) were discharged home. Conclusion: There is a theoretical high risk of getting Sars CoV-2 infection in post-transplant patients but we did not find any increase in overall mortality in solid organ transplant recipients receiving immunosuppressive therapy who acquired Sars CoV2 infection as compared with mortality in the general patients with SARS-CoV-2. We had favorable outcome in solid organ transplant COVID 19 patients in our center. Keywords: Incidence, Outcome, COVID-19, Infection

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AspergillusTracheobronchitis Causing Subtotal Tracheal Stenosis in a Liver Transplant Recipient

Case Reports in Transplantation ◽

10.1155/2013/928289 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Sonia Radunz ◽

Carmen Kirchner ◽

Jürgen Treckmann ◽

Andreas Paul ◽

Fuat H. Saner

Keyword(s):

Liver Transplantation ◽

Liver Transplant ◽

Invasive Aspergillosis ◽

Tracheal Stenosis ◽

Unusual Case ◽

Opportunistic Infections ◽

Optimal Strategies ◽

Transplant Recipients ◽

Transplant Patients ◽

Optimal Approach

Invasive aspergillosis is recognized as one of the most significant opportunistic infections after liver transplantation. Diagnosis of invasive aspergillosis in transplant recipients has been proven to be challenging, and optimal approach to the treatment of invasive aspergillosis is still controversial. We here present an unusual case ofAspergillustracheobronchitis in the setting of liver transplantation. A 47-year-old female patient with persistent dry cough after liver transplantation developed respiratory insufficiency and was readmitted to the intensive care unit 55 days after liver transplantation. A CT scan revealed subtotal tracheal stenosis; bronchoscopy was performed, and extended white mucus coverings causative of the tracheal stenosis were removed. Microbiological assessment isolatedAspergillus fumigatus. The diagnosis was obstructiveAspergillustracheobronchitis. The patient was started on a treatment of voriconazole 200 mg orally twice daily, adjusted to a trough level of 1–4 mg/L. For further airway management, a tracheal stent had to be implanted. The patient is alive and well 28 months after liver transplantation. Invasive aspergillosis should be considered a possible etiology in liver transplant patients presenting with unspecific symptoms such as persistent dry cough. Optimal strategies for improved and early diagnosis as well as prophylaxis need to be defined.

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Assessment of Pulmonary Function before and after Sinus Surgery in Lung Transplant Recipients

International Archives of Otorhinolaryngology ◽

10.1055/s-0037-1606600 ◽

2017 ◽

Vol 22 (02) ◽

pp. 157-160

Author(s):

Bernardo Ramos ◽

Fábio Pinna ◽

Silvia Campos ◽

José Afonso Júnior ◽

Ricardo Teixeira ◽

...

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Pulmonary Function ◽

Chronic Rhinosinusitis ◽

Lower Respiratory Tract ◽

Lung Transplant ◽

Sinus Surgery ◽

Transplant Recipients ◽

Inpatient Hospitalization ◽

Lung Transplant Recipients

Introduction The association between sinus and lung diseases is well known. However, there are scarce studies regarding the effects of sinus surgery on pulmonary function in lung transplant recipients. The present study describes our experience with sinus surgery in lung transplant recipients with chronic rhinosinusitis. Objectives To assess the impact of sinus surgery for chronic rhinosinusitis on pulmonary function and on inpatient hospitalization days due to lower respiratory tract infection in lung transplant recipients. Methods A retrospective study conducted between 2006 and 2012 on a sample of lung transplant recipients undergoing sinus surgery for chronic rhinosinusitis. Pulmonary function, measured by forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), as well as inpatient hospitalization days due to lower respiratory tract infection, were compared 6 months before and 6 months after sinus surgery. Results The FEV1 values increased significantly, and the inpatient hospitalization days due to bronchopneumonia decreased significantly 6 months after sinus surgery. The preoperative and postoperative median FEV1 values were 2.35 and 2.68 respectively (p = 0.0056). The median number of inpatient hospitalization days due to bronchopneumonia 6 months before and 6 months after surgery were 32.82 and 5.41 respectively (p = 0.0013). Conclusion In this sample of lung transplant recipients with chronic rhinosinusitis, sinus surgery led to an improvement in pulmonary function and a decrease in inpatient hospitalization days due to bronchopneumonia.

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Using Hepatocellular Carcinoma Tumor Burden Score to Stratify Prognosis after Liver Transplantation

Cancers ◽

10.3390/cancers12113372 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3372

Author(s):

Dimitrios Moris ◽

Brian I. Shaw ◽

Lisa McElroy ◽

Andrew S. Barbas

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Continuous Variable ◽

Tumor Burden ◽

Milan Criteria ◽

Transplant Recipients ◽

Liver Transplants ◽

Free Survival ◽

Promising Tool ◽

Tumor Number

Liver transplantation (LT) remains a mainstay of treatment for hepatocellular carcinoma (HCC). Tumor factors such as size and number of tumors define eligibility for LT using the Milan criteria. The tumor burden score (TBS) incorporates both tumor number and size into a single continuous variable and has been used to differentiate prognosis among patients undergoing resection for HCC. The objective of the present study was to evaluate the ability of the TBS to predict overall and recurrence-free survival in patients undergoing LT for HCC. The Scientific Registry of Transplant Recipients (SRTR) was used to analyze all liver transplants for HCC, with initial tumor size data from 2004 to 2018. There were 12,486 patients in the study period. In the unadjusted analyses, patients with a high TBS had worse overall (p < 0.0001) and recurrence-free (p < 0.0001) survival. In the adjusted analyses, a high TBS was associated with a greater hazard ratio (HR) of death (HR = 1.21; 95%CI, [1.13–1.30]; p < 0.001) and recurrence (HR = 1.49; 95%CI [1.3–1.7]; p < 0.001). When we superimposed the TBS on the Milan criteria, we saw that a higher TBS was associated with a higher hazard of recurrence at values that were either all within (HR = 1.20; 95%CI, [1.04–1.37]; p = 0.011) or variably within (HR = 1.53; 95%CI, [1.16–2.01]; p = 0.002) the Milan criteria. In conclusion, the TBS is a promising tool in predicting outcomes in patients with HCC after LT.

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Rehabilitation of patients with chronic rhinosinusitis after functional endoscopic sinus surgery

Balneo and PRM Research Journal ◽

10.12680/balneo.2021.421 ◽

2021 ◽

Vol 12 (Vol.12, no.1) ◽

pp. 65-72

Author(s):

Ionuț Isaia JEICAN ◽

Veronica TROMBITAS ◽

Carmen CRIVII ◽

Mihai DUMITRU ◽

ALUAȘ Maria ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Facial Pain ◽

Family Doctor ◽

Young Patients ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Clinical Records

Introduction. In the case of many patients with chronic rhinosinusitis (CRS), antibiotic and steroid therapies fail, and surgery is required. The recovery of patients after surgery equally depends on the postoperative behavior of each individual patient. The paper presents the outcomes of recovery after functional endoscopic sinus surgery (FESS) in a group of 74 patients. Methods. The study was conducted in patients undergoing surgical treatment by FESS, performed by the same surgeon. For the development of the statistical database, the clinical records were collected by the same investigator. Results. On the day of surgery and on the first postoperative day, 72.9% of patients reported facial pain, 41.8% nausea, 9.4% nasal bleeding, 8.8% vomiting. At 6 months postoperatively, 71.6% of patients estimated that they had a better quality of life than before surgery, 64.8% mentioned an improvement of olfaction as an effect, and 6.7% developed septal turbinate synechiae. Conclusions. No major complications were identified in the recovery of CRS patients after FESS. Postoperative facial pain was less well tolerated by young patients (18-35 years old). The improvement of smell and the increase of disease-specific quality of life are the most relevant results of recovery after FESS mentioned by the patients included in our study. The otorhinolaryngologist and the family doctor play an important role in the education of patients regarding the importance of treatment with mineral and thermal waters in post-FESS recovery. Keywords: chronic rhinosinusitis, endoscopic sinus surgery, FESS, rehabilitation, ERAS protocols,

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Surgical Site Infections After Liver Transplantation: Prospective Surveillance and Evaluation of 250 Transplant Recipients in Canada

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.131 ◽

2017 ◽

Vol 38 (9) ◽

pp. 1084-1090 ◽

Cited By ~ 7

Author(s):

Yoichiro Natori ◽

Rawan Kassar ◽

Aled Iaboni ◽

Seyed M. Hosseini-Moghaddam ◽

James Vu ◽

...

Keyword(s):

Risk Factors ◽

Liver Transplantation ◽

Liver Transplant ◽

Surgical Site Infections ◽

Transplant Recipients ◽

Transplant Patients ◽

Transplant Center ◽

Observational Cohort ◽

Independent Risk Factors ◽

Liver Transplant Recipients

OBJECTIVETo evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections.DESIGNProspective observational cohort study.SETTINGSingle transplant center in Canada.PATIENTSPatients who underwent liver transplantation between February 2011 and August 2014.METHODSMultivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients.RESULTSWe enrolled 250 liver transplant recipients. The recipients’ median age at the time of transplantation was 56 years (range, 19–70 years), and 166 patients (66.4%) were male. Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85–8.13; P<.001) and dialysis (OR, 3.57; 95% CI, 1.02–12.50; P=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin.CONCLUSIONSOrgan-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted.Infect Control Hosp Epidemiol 2017;38:1084–1090

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