Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

Background: Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood. Methods: Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms. Results: Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS was present in 72.7% of the patients. Graft and patient survival at 1, 5, and 10 years was 97.1%, 91.2%, 91.2% and 100%, 94%, 94%, respectively Conclusions: Good outcomes after LT for BA in young patients can be achieved with careful donor selection and surgery to minimise the risk of complications. Identification of anatomical variants and shunting are helpful in guiding attitude at the time of transplant.

Therapeutic Applications of Resveratrol in Hepatic Encephalopathy through Its Regulation of the Microbiota, Brain Edema, and Inflammation

Hepatic encephalopathy is a common complication in patients with liver cirrhosis and portosystemic shunting. Patients with hepatic encephalopathy present a variety of clinical features, including neuropsychiatric manifestations, cognitive dysfunction, impaired gut barrier function, hyperammonemia, and chronic neuroinflammation. These pathogeneses have been linked to various factors, including ammonia-induced oxidative stress, neuronal cell death, alterations in the gut microbiome, astrocyte swelling, and blood-brain barrier disruptions. Many researchers have focused on identifying novel therapeutics and prebiotics in the hope of improving the treatment of these conditions. Resveratrol is a natural polyphenic compound and is known to exert several pharmacological effects, including antioxidant, anti-inflammatory, and neuroprotective activities. Recent studies suggest that resveratrol contributes to improving the neuropathogenic effects of liver failure. Here, we review the current evidence describing resveratrol’s effects in neuropathogenesis and its impact on the gut-liver axis relating to hepatic encephalopathy. We highlight the hypothesis that resveratrol exerts diverse effects in hepatic encephalopathy and suggest that these effects are likely mediated by changes to the gut microbiota, brain edema, and neuroinflammation.

Transjugular Portosystemic Shunting in Refractory Cirrhotic Ascites

Aim. Improvement of refractory ascites (RA) outcomes in underlying cirrhotic portal hypertension (PH) through optimising the transjugular intrahepatic portosystemic shunting (TIPS) procedure among therapy measures.Materials and methods. The survey included 107 patients with RA admitted to portal hypertension units of the Rostov State Medical University Surgical Clinic during 2007—2020. The patients were randomly assigned to two cohorts similar by gender, age, cirrhosis aetiology and condition severity. The control cohort had conventional paracentesis and albumin infusion. In cohort 2, 57 patients had minimally invasive endovascular TIPS surgery in a recommended setting.Results. TIPS eliminated PH in all 57 patients of cohort 2. Cohort 1 was reported with progressive esophagogastric varices (EGV), their enlargement in 37 and rupture in 11 patients during the first 12 months. Cohort 2 revealed the grade 3—2 and 2—1 EGV reduction in 24 (41.1%) patients with shunt surgery and in 39 (68.4%) patients in one year. Esophagogastric variceal bleeding (EGVB) developed in 9 patients in cohort 1, with 7 lethal outcomes. No variceal bleeding was observed in cohort 2, with 7 patients having the portosystemic shunt dysfunction.Conclusion. The TIPS procedure is justified in cirrhotic PH patients with RA for reducing the mortality rate in a one year follow-up.

Transjugular intrahepatic portosystemic shunting in combined treatment of a patient with decompensated liver cirrhosis and malignant neoplasm of the uterus (clinical case)

Nowadays the treatment of patients with malignant neoplasms of the abdominal organs against the background of decompensated liver cirrhosis is largely an unsolved problem. Complications of portal hypertension syndrome such as ascites, hypersplenism, recurrent bleeding from the veins of the esophagus prevent the implementation of radical surgical treatment. Low trauma of endovascular methods of treatment, low level of complications and mortality are the main advantages of interventional techniques that make it possible to prepare a patient with portal hypertension syndrome for further radical treatment of oncological disease. The presented clinical case describes the results of a combined approach to the treatment of a patient with complications of portal hypertension syndrome and a competing disease a giant tumor of the uterus. The patient was denied in surgical treatment for the neoplasm due to the presence of decompensated cirrhosis. Liver transplantation is not possible due to the presence of cancer. Transjugular intrahepatic portosystemic shunting led to relief of diuretic-resistant ascites, regression of the degree of esophageal varicose veins, which made it possible to remove the tumor with extirpation of the uterus with appendages. Up to now the observation period for the patient is more than 12 years (4 figs, bibliography: 7 refs).

Hepatopulmonary Syndrome in an Adolescent With Insidious Hypoxia and Small Intrahepatic Portal Venous Shunts: Posttransplant Benefit From Sildenafil

We report a patient without known preexisting liver disease who presented with hepatopulmonary syndrome (HPS) due to aberrant intrahepatic portal venous development leading to portosystemic shunting. Liver transplantation resulted in resolution of portal hypertension and HPS and sildenafil was safely tolerated in the treatment of persistent fatigue and hypoxemia. Twelve months later, patient has normal allograft function and has returned to normal activity.

Surgical intervention for portal hypertension caused by oxaliplatin-based chemotherapy: a case report and a review of literature regarding radiological and/or surgical interventions for oxaliplatin-associated portal hypertension

A 63-year-old man showed massive ascites, massive pleural effusion, severe lower-extremity edema, and repeated esophageal variceal bleeding. Two-year previously, he received 13-courses of oxaliplatin-based chemotherapy (OBC) followed by associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for multiple colorectal cancer liver metastases but developed a solitary remaining liver metastasis and multiple lung metastases 2 months after the ALPPS, for which multiple regimens of chemotherapy were conducted. The symptoms were considered attributable to the OBC-associated portal-hypertension. Water-retention symptoms were mitigated by the use of tolvaptan but the variceal bleeding necessitated frequent endoscopic treatments and disallowed restarting antineoplastic treatment. Transjugular intrahepatic portosystemic shunt (TIPS) was considered undesirable because TIPS in this patient might have prohibited future repeat hepatectomy. Thus, the patient underwent splenectomy and surgical portosystemic shunting. Since then, the portal-hypertension symptoms were completely resolved. Thereafter, chemotherapy was able to be recommenced. Moreover, repeat hepatectomy was performed. A literature review demonstrated that radiological and/or surgical interventions for the OBC-associated portal-hypertension have been reported in 31 cases to date. However, this report is the first to show a case of successful treatment of the OBC-associated portal-hypertension with splenectomy and surgical portosystemic shunting, which allowed subsequent chemotherapy followed by repeat hepatectomy.

Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Refractory Transudative Chylothorax due to Liver Cirrhosis

Chylothorax is an infrequent type of pleural effusion, typically exudative, caused by obstruction or laceration of the thoracic duct by malignancy, trauma, or thoracic surgery. Transudative chylous pleural effusions are extremely rare. We report a case of a 63-year-old male with recurrent transudative chylothorax secondary to cirrhosis that completely resolved with transjugular intrahepatic portosystemic shunting (TIPS). Transudative chylous pleural effusion is an extremely rare entity with only a few cases reported in the literature to date. Transudative chylothorax can occur in patients with liver cirrhosis. Recognizing this association will prevent unnecessary testing and procedures. Timely diagnosis and early initiation of treatment are pivotal in preventing complications from malnutrition and infection by preventing loss of electrolytes, immunoglobulins, and T-lymphocytes.

Serum melatonin in dogs with congenital portosystemic shunting, with and without hepatic encephalopathy

BackgroundMelatonin is a hormone produced and secreted primarily by the pineal gland and mainly metabolised in the liver. Increased melatonin concentrations have been reported in human cirrhosis and hepatic encephalopathy (HE), a syndrome of neurological dysfunction. The pathogenesis of canine HE is incompletely understood. Melatonin has been hypothesised as a contributor to the development of HE. The aim of this study was to investigate whether serum melatonin concentrations are increased in canine congenital portosystemic shunting (cPSS), with and without HE.MethodsMedical records were retrospectively reviewed, for which archived (−80°C) serum samples were available. A canine competitive ELISA was used to measure melatonin in two cohorts: dogs with a final diagnosis of cPSS (n=23) with and without clinical signs of HE, and healthy dogs (n=15).ResultsMelatonin concentrations were not significantly different (P=0.81) between healthy controls (median 27.2 pg/mL, range 19.8–161.5 pg/mL) and dogs with cPSS (median 25.7 pg/mL, range 18.5–244.9 pg/mL). Serum melatonin did not differ between cPSS patients with and without clinical signs of HE (P>0.99). No correlation was found between serum melatonin and blood ammonia (Spearman rank correlation coefficient, rs=−0.41, P=0.08).ConclusionSerum melatonin is not increased in canine cPSS with and without HE. We found no evidence that altered melatonin metabolism plays a role in the pathogenesis of cPSS-associated HE.