Post-Liver Transplant CMV Reactivation, Graft, and Patient Survival Rates in Iranian Population

Background: Human cytomegalovirus (CMV) is the major complication of viral infection in immunocompromised patients. This opportunistic infection is associated with high morbidity and mortality in transplanted recipients. Objectives: The present study aimed to determine CMV burden and assess the clinical outcome in the liver recipients with CMV reactivated infection at Nemazi Hospital, Shiraz, Iran. Methods: This retrospective study examined 657 patients who underwent liver transplantation during 2014 - 2017 to identify the CMV infection, morbidity, and mortality rates. To this end, the medical records of such patients were reviewed, and their rejection/survival rates were analyzed. Accordingly, the CMV infection was diagnosed by Taq-Man real-time PCR assays. Results: In this study, 151 (23%) had CMV reactivation at least one year after liver transplantation. Viremic patients had a viral burden between 300 - 738790 copies/mL. In this study, 41 persons (6.2%) died, and 58 LT patients (8.8%) had rejection experience up to one year after their operation. Among the 41 dead patients, 21 and 20 cases were with and without CMV-reactivation, respectively. The results demonstrated that the mortality rate was significantly higher in the CMV-infected patients than the non-CMV-infected counterparts. In contrast, the graft survival rate was not significantly different between the two groups (P ≤ 0.05). Conclusions: In the present study, CMV infection can serve as a significant mortality predictor in LT patients.

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Cardiovascular and Metabolic Consequences of Liver Transplantation: A Review

Medicina ◽

10.3390/medicina55080489 ◽

2019 ◽

Vol 55 (8) ◽

pp. 489

Author(s):

Plotogea ◽

Ilie ◽

Sandru ◽

Chiotoroiu ◽

Bratu ◽

...

Keyword(s):

Metabolic Syndrome ◽

Liver Transplantation ◽

De Novo ◽

Current Knowledge ◽

Morbidity And Mortality ◽

High Morbidity ◽

Term Survival ◽

The Metabolic Syndrome ◽

Acute Liver Disease

Liver transplantation (LT) is considered the curative treatment option for selected patients who suffer from end-stage or acute liver disease or hepatic malignancy (primary). After LT, patients should be carefully monitored for complications that may appear, partially due to immunosuppressive therapy, but not entirely. Cardiovascular diseases are frequently encountered in patients with LT, being responsible for high morbidity and mortality. Patients with underlying cardiovascular and metabolic pathologies are prone to complications after the transplant, but these complications can also appear de novo, mostly associated with immunosuppressants. Metabolic syndrome, defined by obesity, hypertension, dyslipidemia, and hyperglycemia, is diagnosed among LT recipients and is aggravated after LT, influencing the long-term survival. In this review, our purpose was to summarize the current knowledge regarding cardiovascular (CV) diseases and the metabolic syndrome associated with LT and to assess their impact on short and long-term morbidity and mortality.

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Bile leakage after liver transplantation

Open Medicine ◽

10.1515/med-2017-0062 ◽

2017 ◽

Vol 12 (1) ◽

pp. 424-429 ◽

Cited By ~ 1

Author(s):

Cheng Fang ◽

Sheng Yan ◽

Shusen Zheng

Keyword(s):

Liver Transplantation ◽

Survival Rate ◽

Patient Survival ◽

Survival Rates ◽

Operating Time ◽

Bile Leak ◽

Deceased Donor ◽

Donor Liver Transplantation ◽

One Year ◽

Patient Survival Rate

AbstractObjective To evaluate the risk factors and outcome of bile leak after liver transplantation.MethodsWe undertook a retrospective study of patients who underwent liver transplantation in our institution between January 2010 and January 2014. The characteristics and survival rate of patients with or without bile leak were compared.ResultsBile leak was observed in sixteen patients after liver transplantation (2.7% of the total number of patients transplanted). Total operating time and bile duct reconstruction technique (duct-to-duct anastomosis or Rouxen-Y cholangiojejunostomy) were found to differ significantly between patients with and without bile leak in univariate (p = 0.001 and 0.024, respectively) and multivariate analyses (p = 0.012 and 0.026, respectively). There was no difference in the one-year patient survival rate between the two groups. However, two-year patient survival rate was significantly lower in the bile leak group (p = 0.003). Both one-year and two-year graft survival rates were significantly lower in the bile leak group (p = 0.049 and <0.001, respectively).ConclusionsCholangiojejunostomy and prolonged total operating time are risk factors for bile leak after deceased donor liver transplantation. Bile leak reduces graft and patient survival rates after deceased donor liver transplantation.

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Prognosis of liver transplantation: Does postoperative ileus matter?

BMC Gastroenterology ◽

10.1186/s12876-021-02026-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruiping Bai ◽

Rui An ◽

Kunyu Han ◽

Mengwen Xue ◽

Simei Zhang ◽

...

Keyword(s):

Liver Transplantation ◽

Survival Data ◽

Postoperative Ileus ◽

Total Bilirubin ◽

Survival Rates ◽

Major Complication ◽

Meld Score ◽

Gastrointestinal Dysfunction ◽

End Stage ◽

Relative Factors

Abstract Background Nowadays, liver transplantation has become a main therapy for end-stage liver disease. However, studies show that there are high mortality and severe complications after liver transplantation. Although gastrointestinal dysfunction is a common and major complication after liver transplantation, there was rarely relative research. This study aims to elucidate the factors about ileus after liver transplantation and patients’ survival. Methods We collected and analyzed the data (n = 318, 2016–2019) from the First Affiliated Hospital of Xi’an Jiaotong University. After excluding cases, a total of 293 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. We reviewed 38 variables (including preoperative, operative and postoperative relative factors). Additionally, other complications after liver transplantation and survival data were compared between two groups. Results Of the 293 patients, 23.2% (n = 68) experienced postoperative ileus. Ileus patients were not different with non-ileus patients in preoperative, operative and postoperative factors. HBV-positive patients with ileus had a lower MELD score (P = 0.025), and lower postoperative total bilirubin was correlated with ileus (P = 0.049). Besides, Child–Pugh score of HCC patients with ileus was low (P = 0.029). The complications after liver transplantation were not different between two groups. Compared with the patients without ileus, the patients with ileus had a higher mortality rate. Conclusion According to our research, ileus-patients had a lower 1-year survival rates. The preoperative MELD score and postoperative total bilirubin of HBV-positive patients with ileus were lower, and Child–Pugh score of HCC patients with ileus was also lower.

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Cytomegalovirus Infection after Unrelated Cord Blood Transplantation (CBT) for Adults with Hematological Diseases.

Blood ◽

10.1182/blood.v104.11.5101.5101 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5101-5101

Author(s):

Tomohiro Myojo ◽

Tomoko Matsumura ◽

Hiroto Narimatsu ◽

Kazuhiro Masuoka ◽

Chiho Inokuchi ◽

...

Keyword(s):

Cord Blood ◽

Antiviral Treatment ◽

Cord Blood Transplantation ◽

Univariate Analysis ◽

Conditioning Regimen ◽

Major Complication ◽

Cmv Infection ◽

Blood Transplantation ◽

Cmv Reactivation ◽

Cmv Antigenemia

Abstract Backgrounds: Cytomegalovirus (CMV) infection is a major complication after allogeneic transplantation; however clinical significance of CMV reactivation after cord blood transplantation remains unclear. Objective: We retrospectively investigated the incidence of CMV antigenemia, and CMV diseases, and its prognosis in adult patients who underwent reduced-intensity cord blood transplantation (RI-CBT) Patients/ Methods: We reviewed medical records of 77 patients who received RICBT at Toranomon Hospital between January 2002 and March 2004. Median age of the patients was 55 years (range 17–79). Underlying diseases were chemorefractory hematologic diseases (n=76) and severe aplastic anemia (n=4). Conditioning regimen comprised fludarabine (125 mg/m2), melphalan (80 mg/m2), and TBI 4-8Gy. GVHD prophylaxis was cyclosporine (n=69) or tacrolimus (n=11). Median total nucleated cells and CD34+ cells was 2.4×106 cells/kg (0.39–4.3), and 0.81×105 cells/kg (0.05–5.7) respectively. HLA disparity was 6/6 (n=3), 5/6 (n=12), 4/6 (n=63), and 3/6 (n=2). All patients were monitored CMV-antigenemia weekly and received pre-emptive gancyclovir or foscarnet. Results CMV antigenemia tested positive in 47 patients on a median of day 32 (range, 12–55) after RICBT. The cumulative incidence of CMV reactivation at day 100 was 0.70. Seven and 29 patients were treated with preemptive ganciclovir and foscarnet, respectively. Adverse events of them were myelosuppression in 3 patients given ganciclovir, and mild hyponatremia in a patient given foscarnet. CMV diseases developed in 15 patients on a median of day 39 (range 15–92); enterocolitis (n=13), pneumonia (n=1), and encephalitis (n=1). Seven of 15 patients were resolved with antiviral treatment, and the other patients were fatal with CMV infection. Univariate analysis showed any risk factors for CMV reactivation. Discussion CMV reactivation and diseases develop early after cord blood transplantation. Opitimal strategy for preventing CMV disease should be established in RICBT.

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CD 44 as a Marker of Rejection in Patients with Post Liver Transplantation

QJM ◽

10.1093/qjmed/hcaa052.035 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

E M Bayomy ◽

T M Yousef ◽

M B Ahmed ◽

K A Zaki ◽

A M Elghandour ◽

...

Keyword(s):

Liver Transplantation ◽

Serum Level ◽

Liver Biopsy ◽

Survival Rates ◽

Normal Liver ◽

Liver Function Tests ◽

The United States ◽

Control Group ◽

A Value ◽

One Year

Abstract Background The first human orthotopic liver transplantation (LT) in Europe was performed by Sir Roy Calne in Cambridge in 1968, only one year after the first successful human liver transplantation reported by Thomas Starzl in the United States. Since then LT has evolved rapidly, becoming the standard therapy for acute and chronic liver failure of all aetiologies, with more than 80,000 procedures performed to date. Survival rates have improved significantly in the last 25 years, achieving rates of 96% and 71% at 1 and 10 years after LT respectively. Objective To assessment of value of serum level of CD44 as a marker of rejection in patients with post liver transplantation. Patients and Methods The study was conducted on patient all were recruited from ASCOT from May 2017 till December 2018. It included 20 adult patients with Post LDLT with elevated liver function tests and they were reviewed to determine if the serum level of CD44 had a value in diagnosis of acute rejection depending on proving the rejection by liver biopsy. They were distributed as 14 males and 6 females with age ranging 16 - 59 years. After obtaining the results of liver biopsy we had 14 patients with rejection, 4 patients with cholangitis with biliary obstruction and 2 patient with rejection with vascular insult. Results The control group was with irrelevant past medical history and normal liver functions, normal liver biopsy and underwent measurement of CD44 serum level. They were distributed as 14 males and 6 females with age ranging 26 – 41 years. Conclusion There was correlation between different pathological findings in liver biopsy and Serum level of CD44 that the low levels being with rejection and higher levels being with control group, that the CD44 may be used as a marker for rejection.

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Prognosis of Liver Transplantation: Does Postoperative Ileus Matter ?

10.21203/rs.3.rs-118170/v1 ◽

2020 ◽

Author(s):

Ruiping Bai ◽

Rui An ◽

Kunyu Han ◽

Xin Shen ◽

Zheng Shaohua

Keyword(s):

Liver Transplantation ◽

Survival Rate ◽

Survival Data ◽

Postoperative Ileus ◽

Total Bilirubin ◽

Survival Rates ◽

Major Complication ◽

Meld Score ◽

End Stage ◽

Relative Factors

Abstract Background: Nowadays, liver transplantation has become a main therapy for end-stage liver disease. However, studies show that there are high mortality and severe complications after liver transplantation. Although gastrointestinal dysfunction is a common and major complication among complications, there was rarely relative research. The study aims to elucidate the factors about ileus after liver transplantation and patients’ survival rate. Methods: We collected data (n=318, 2016–2019) from the First Affiliated Hospital of Xi’an Jiaotong University. After excluding cases, a total of 293 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. We reviewed 38 variables (including preoperative, operative and postoperative relative factors). In addition, other complications after liver transplantation and survival data were compared among groups. Results: Of the 293 patients, 23.2% (n=68) experienced postoperative ileus. Ileus patients were not different with non-ileus patients in preoperative, operative and postoperative factors. HBV-positive patients with ileus had a lower MELD score (P=0.025), and lower postoperative total bilirubin was correlated with ileus (P=0.049). Besides, Child-Pugh score of HCC patients with ileus was low (P=0.029). The complications after liver transplantation and survival rate were all not different among groups. Conclusions: According to our research, compared with non-ileus patients, we didn’t obtain the risk factors for patients with ileus. Ileus-patients didn’t increase complications after liver transplantation and didn’t decrease post-LT survival rates. But the preoperative MELD score and postoperative total bilirubin of HBV-positive patients with ileus were lower, and Child-Pugh score of HCC patients with ileus was also lower.

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BRONKHOPNEUMONIA AS COMORBIDITIES OF CMV INFECTION : STUDY CASE ON 1 YEAR 9 MONTHS OLD BOY

DIPONEGORO MEDICAL JOURNAL (JURNAL KEDOKTERAN DIPONEGORO) ◽

10.14710/dmj.v10i1.28187 ◽

2021 ◽

Vol 10 (1) ◽

pp. 55-59

Author(s):

Wulan Widiasmaran ◽

Ayu Anggraini Kusumaningrum ◽

Fitri Amalia ◽

Dimas Tri Anantyo

Keyword(s):

Cytomegalovirus Infection ◽

Congenital Infection ◽

Lung Parenchyma ◽

Klebsiella Pneumonia ◽

High Morbidity ◽

High Avidity ◽

Cmv Infection ◽

History Of ◽

One Year ◽

Infection Study

Background. Pneumonia is an acute lung parenchyma inflammation, which includes the alveoli and tissues. According to RISKESDAS 2018, pneumonia prevalence of children under five years old in Indonesia has increased from 1.6% in 2013 to 2% in 2018. Cytomegalovirus infection (CMV) is the most common congenital infection and causes high morbidity in newborns. The purpose of this case is to report a case in Semarang and conduct a discussion of pneumonia cases and a history of CMV infection so that proper treatment can immediately start.Method. Anamnesis carried out on February 1, 2020, at Government Hospital in Semarang. Data obtained from allonamnesis with the patient's mother, physical examination, supporting examinations, and medical records of patients. Case. Patient of a boy aged one year nine months that come to the ER with a chief complaint of fever and cough.Discussion. A boy aged one year nine months with fever and cough complaints about five days before entering the hospital. Sputum culture examination revealed the presence of Klebsiella pneumonia, then treated with cefoperazone sulbactam. The patient had a history of cytomegalovirus infection but not optimally treated because of the high avidity value.Conclusion. Patient has diagnosed with bronchopneumonia et causa Klebsiella pneumonia.

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A prospective study of 20 cases of maternal outcome in morbidly adherent placenta in tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170384 ◽

2017 ◽

Vol 6 (2) ◽

pp. 571

Author(s):

Krishna Vora ◽

Pallavi Chandana ◽

Amrita Patel ◽

Mahima Jain

Keyword(s):

Prospective Study ◽

Maternal Outcome ◽

Placenta Praevia ◽

Morbidity And Mortality ◽

High Morbidity ◽

Care Hospital ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

One Year ◽

A Prospective Study

Background: Morbidly adherent placenta with its variants is one of the most feared complication causing high morbidity and mortality in obstetrics. Aim of this study is to help in identifying high risk pregnancies, planning line of management of morbidly adherent placenta. The objective of the study wad to evaluate the risk factors, different modes of management, maternal outcome in case of morbidly adherent placenta.Methods: A prospective study for one year was done to describe the incidence, causes, treatment, complications, and maternal morbidity and mortality associated with morbidly adherent placenta.Results: A total of 20 cases of morbidly adherent placenta were studied over one-year span at our Institute. Most of the women with morbidly adherent placenta were in the age group of 26-30years (55%).The most common aetiology of morbidly adherent placenta was previous caesarean scar with placenta praevia (85%). In majority, placenta accreta found. Total abdominal hysterectomy done in 12 patient and subtotal hysterectomy in 6 cases. Trial haemostasis with uterine sparing in 2 cases out of which one case underwent total hysterectomy due to massive haemorrhage on same day. Associated Bladder repair in adherent placenta with invasion of bladder was needed in 10% cases. There was 1 maternal death noted in this study.Conclusions: Leading cause of morbidly adherent placenta is previous caesarean section with placenta praevia, high index of suspicion, early antenatal diagnosis, planned surgery at high care centre with multi-disciplinary expertise, anticipation of blood volume transfusion, Delivery of foetus without manipulating placenta are key steps to reduce morbidity and mortality in morbidly adherent placenta. The decision to perform hysterectomy and conservative management to be individualized. Timely decision is the key to get success in morbidly adherent placenta as in other obstetric emergencies.

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Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement

HPB Surgery ◽

10.1155/2008/839503 ◽

2008 ◽

Vol 2008 ◽

pp. 1-8 ◽

Cited By ~ 16

Author(s):

Olga N. Tucker ◽

Mohamed Rela

Keyword(s):

Pancreatic Adenocarcinoma ◽

Hepatic Artery ◽

Survival Rates ◽

High Volume ◽

Mortality Rates ◽

Morbidity And Mortality ◽

High Morbidity ◽

Borderline Resectable ◽

Term Survival ◽

Major Vessel

Synchronous major vessel resection during pancreaticoduodenectomy (PD) for borderline resectable pancreatic adenocarcinoma remains controversial. In the 1970s, regional pancreatectomy advocated by Fortner was associated with unacceptably high morbidity and mortality rates, with no impact on long-term survival. With the establishment of a multidisciplinary approach, improvements in preoperative staging techniques, surgical expertise, and perioperative care reduced mortality rates and improved 5-year-survival rates are now achieved following resection in high-volume centres. Perioperative morbidity and mortality following PD with portal vein resection are comparable to standard PD, with reported 5-year-survival rates of up to 17%. Segmental resection and reconstruction of the common hepatic artery/proper hepatic artery (CHA/PHA) can be performed to achieve an R0 resection in selected patients with limited involvement of the CHA/PHA at the origin of the gastroduodenal artery (GDA). PD with concomitant major vessel resection for borderline resectable tumours should be performed when a margin-negative resection is anticipated at high-volume centres with expertise in complex pancreatic surgery. Where an incomplete (R1 or R2) resection is likely neoadjuvant treatment with systemic chemotherapy followed by chemoradiation as part of a clinical trial should be offered to all patients.

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LIVER TRANSPLANTATION FOR CARCINOMA HEPATOCELLULAR IN SÃO PAULO: 414 CASES BY THE MILAN/BRAZIL CRITERIA

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600040007 ◽

2016 ◽

Vol 29 (4) ◽

pp. 240-245 ◽

Cited By ~ 8

Author(s):

Gustavo Pilotto D. SÁ ◽

◽

Fernando P. P. VICENTINE ◽

Alcides A. SALZEDAS-NETTO ◽

Carla Adriana Loureiro de MATOS ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Survival Rate ◽

Medical Records ◽

Vascular Invasion ◽

Statistical Difference ◽

Survival Rates ◽

Good Survival ◽

Number Of Patients ◽

Carcinoma Hepatocellular

ABSTRACT Background: The criterion of Milan (CM) has been used as standard for indication of liver transplantation (LTx) for hepatocellular carcinoma (HCC) worldwide for nearly 20 years. Several centers have adopted criteria expanded in order to increase the number of patients eligible to liver transplantation, while maintaining good survival rates. In Brazil, since 2006, the criterion of Milan/Brazil (CMB), which disregards nodules <2 cm, is adopted, including patients with a higher number of small nodules. Aim: To evaluate the outcome of liver transplantation within the CMB. Methods: The medical records of patients with HCC undergoing liver transplantation in relation to recurrence and survival by comparing CM and CMB, were analyzed. Results: 414 LTx for HCC, the survival at 1 and 5 years was 84.1 and 72.7%. Of these, 7% reached the CMB through downstaging, with survival at 1 and 5 years of 93.1 and 71.9%. The CMB patient group that exceeded the CM (8.6%) had a survival rate of 58.1% at five years. There was no statistical difference in survival between the groups CM, CMB and downstaging. Vascular invasion (p<0.001), higher nodule size (p=0.001) and number of nodules >2 cm (p=0.028) were associated with relapse. The age (p=0.001), female (p<0.001), real MELD (p<0.001), vascular invasion (p=0.045) and number of nodes >2 cm (p<0.014) were associated with worse survival. Conclusions: CMB increased by 8.6% indications of liver transplantation, and showed survival rates similar to CM.

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