جستجوی مقالات مرتبط با کلیدواژه « Liver transplantation » در نشریات گروه « پزشکی »

We evaluated the response to Trans-arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) patients according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. We determined the prognostic value of the neutrophil-to-lymphocyte ratio (NLR).

TACE is the most commonly used method to treat patients with large, unresectable tumors or as bridge therapy in patients with HCC before liver transplantation.

In this cross-sectional study, patients with a diagnosis of HCC who were referred for TACE were studied. The response rate to TACE treatment was assessed based on dynamic MRI 28 days after treatment according to mRECIST criteria. The NLR value was calculated, and its prognostic value was evaluated to predict the response to treatment.

Forty patients with HCC who underwent TACE were included. The response to TACE treatment included a complete response (CR) in 6 patients (15%), partial response (PR) in 16 patients (40%), and stable disease (SD) in 18 patients (45%). No progressive disease (PD) was found. Responders (CR and PR) were 22 patients (55%). The mean NLR after treatment in the non-responders was significantly higher than in the responders (4.2 vs. 2.4, P-value = 0.026). NLR values greater than 2.6 after treatment had a sensitivity of 70.6% and a specificity of 77.3% in diagnosing non-responders, with an Area Under the Curve (AUC) of 0.73 [95% confidence interval 0.58-0.89], P-value = 0.011.

Non-responders observed higher levels of NLR after treatment than responders. As a moderate prognostic factor, an NLR level of more than 2.6 after treatment could discriminate against non-responders.

The purpose of this retrospective single-center study was to determine the frequency of sarcopenia and its association with mortality and other morbidities in children with chronic liver disease who had undergone liver transplantation.

Sarcopenia, a muscle-wasting syndrome, is common in patients with advanced liver disease and is associated with increased morbidity and mortality. While sarcopenia in adults has been extensively studied, there is little information in this regard about children and adolescents with chronic liver diseases.

The study included 108 children and adolescents who had undergone liver transplantation. Sarcopenia was measured using skeletal muscle index at the third lumbar vertebral level and assessed using abdominal computed tomography imaging.

The frequency of sarcopenia in the studied population was found to be 45.7%. Patients with sarcopenia were more likely to be male (P<0.0001), older (P<0.0001), and had lower height-for-age z-scores (P=0.012). Genetic/metabolic diseases were the most common underlying cause of sarcopenia in children. Except for a higher rate of transplant rejection in the sarcopenia group (P=0.035), there was no significant difference in mortality rates (P=0.688) or post-LT complications between the two groups. One year after LT, computed tomography-derived body composition parameters revealed no significant differences between children who survived and those who did not.

Our findings indicated a high frequency of sarcopenia in children with chronic liver disease, implying that more research is needed to better understand its impact on clinical outcomes in this population.

Hepatocellular carcinoma (HCC) is the 4th leading cause of cancer-related deaths worldwide. Unlike other solid tumors, the underlying-cause of cirrhosis can affect the prognosis in HCC.

To assess the post-transplant survival factors in patients with hepatocellular carcinoma relative to the cirrhosis and alpha-fetoprotein levels in patients with liver transplantation in Abu-Ali Sina transplant hospital, Shiraz, 2010-2020.

In this retrospective study, demographic and clinical data affecting survival includes the underlying cause of cirrhosis and alpha-fetoprotein (AFP) levels were collected from all patients (n=160) who underwent transplantation in Shiraz between 2010 and 2020 with a definitive diagnosis of hepatocellular carcinoma. The one-, two-, three-, four- and five-years survival rates and the median survival time were calculated. Kaplan-Meier method was used to determine survival at different time intervals to determine the factors affecting survival.

The mean age of the study population was 51±14 years and most patients were men (82.5%). At the time of data collection, 109 patients were alive (68.1%), 22 patients died from recurrence hepatocellular carcinoma (13.8%) and 29 patients had deaths from underlying diseases (18.1%). The most common causes of cirrhosis were HBV (49.4%) and HCV (10%), respectively. 102 patients had liver cancer due to hepatitis-related factors (63.7%) and the prevalence of biliary and other diseases as the underlying cause of HCC was 5% and 31.3%, respectively. 55.6% of patients who died of hepatic impairment had AFP less than 500 ng / dl and 8 patients (44.4%) had AFP more than 500 ng / dl and blood AFP level was significantly associated with mortality (P=0.003). The prevalence of recurrence HCC death was also higher in people with AFP above 500 (29.6% vs. 9.17%). Survival rates of 1, 2, 3, 4 and 5 years were 0.86, 0.71, 0.61, 0.41 and 0.36, respectively. Survival in AFP <500 and AFP> 500 was almost the same until 40 months and after that survival time was significantly higher in individuals with AFP <500 (P-value = 0.06).

The present study showed that gender and the underlying causes of cirrhosis do not have a significant effect on determining the patient’s survival rate and the only factor affecting was AFP which is a predictive and prognostic biomarker as a tumor antigen role in HCC.

Immune monitoring in transplant recipients, examining lymphocyte subsets and cytokine levels, is pivotal for advancing individualized medicine in transplantation. This study aims to assess T helper 1 and 2 cells in acute liver transplant rejection.

Thirty liver transplantation candidates were enrolled pre- and six months post-transplantation under stable condition. Additionally, fifteen recipients with acute rejection, matched for age and transplantation duration, were included. Flow cytometry and ELISA assessed TCD4+CXCR3+IFN-γ (T helper 1) and TCD4+CCR4+IL-4+ (Th2) cell frequencies, as well as serum IFN-γ and IL-10 levels.

Stable recipients showed significant decreases in Th1 and Th2 cell percentages six months post-transplant (both p < 0.0001), maintaining a comparable Th1/Th2 ratio. Serum IFN-γ levels also decreased. Conversely, the rejection group exhibited higher Th1 cell proportions and increased IFN-γ concentration compared to stable recipients (P = 0.03 and 0.001, respectively). IL-10 levels slightly decreased in both groups. Consequently, the IFN-γ/IL-10 ratio significantly increased during acute rejection (p < 0.0001). Th1 cell frequency and IFN-γ levels negatively correlated with allograft function.

Six months post-transplant, stable recipients experienced decreased Th1 and Th2 cell percentages, maintaining Th1/Th2 balance. The IFN-γ/IL-10 ratio significantly increased during acute rejection, indicating an immunological imbalance. Elevated Th1 frequency and IFN-γ levels were negatively correlated with allograft function, emphasizing their potential role in rejection dynamics.

 Colon inflammation may occur after solid and liquid organ transplantations at a rate higher than in the general population.

 This study aimed to investigate the incidence of de novo inflammatory bowel disease (IBD) and assess some risk factors after Orthotopic Liver Transplantation (OLT) in liver transplant patients in Shiraz, Iran.

 The sample study comprised patients (n = 1702) who had received liver transplants between 2001 and 2012 at the Shiraz liver transplant center. The data were obtained from patient records, which included information on their medical history, colonoscopy reports, family history of IBD, and other risk factors. The study evaluated the status of inflammatory bowel disease (IBD) among patients who had undergone liver transplantations due to Autoimmune Hepatitis (AIH) group, Primary Sclerosing Cholangitis (PSC), and other liver transplant patients. Additionally, case groups were formed, comprising AIH patients (n1 = 10) and other patients with IBD (n2 = 10), and were compared with transplant patients without IBD as the control group (n1 = 21, n2 = 21).

 Out of the total 1702 patients, 254 (14.92%) had AIH, 211 (12.40%) had PSC, and 1237 (72.68%) had other outcomes. The mean of leukocyte counts (P-value = 0.73), types of immunosuppressant medications, and serum levels of cyclosporine (P-value = 0.77) and tacrolimus (P-value = 0.27) did not show any significant differences between the case and control groups. However, it was observed that IBD developed earlier in patients with AIH compared to other patients (20.1 ± 2.23 vs 53.9 ± 4.42 months).

 The incidence of IBD after liver transplantation was higher compared to the general population, and it occurred earlier in patients who underwent transplantation for AIH and other groups.

The aim of the current research was to assess the clinical manifestations and diagnostic methods used in juvenile cases of Autoimmune Hepatitis (AIH).

This study employed a retrospective cross-sectional design to investigate pediatric patients diagnosed with AIH at Children’s Medical Center Hospital, which is affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. The study included patients who received routine examinations, treatments, and follow-ups during the period from 2018 to 2021. 

The present investigation encompassed the evaluation of 52 pediatric patients, mostly female, with a mean age of 7.76 years. The vast majority of patients have encountered the occurrence of acute AIH. Positive findings for the Anti-Smooth Muscle Antibodies (ASMA) test were seen in 50% of the patients. The mean score for fibrosis in the observed individuals was 2.56, whereas the mean value for the Hepatitis Activity Index (HAI) in a subset of 29 patients was found to be 7.34. One patient succumbed to the condition, one case underwent transplantation, and another individual was identified as a candidate for liver transplantation.

Patients with AIH saw a decrease in long-term survival. There was no observed disparity in prognosis based on gender; nevertheless, it was noted that males had a shorter lifespan, perhaps attributable to an earlier beginning of the illness. The presence of cirrhosis at the time of diagnosis constituted a significant risk factor for unfavorable prognosis, as it was associated with an elevated overall risk of mortality owing to liver dysfunction.

Context: 

Liver transplant recipients are highly susceptible to infections, including those affecting the central nervous system (CNS), due to their compromised immune systems and underlying chronic comorbidities.

 Despite recent advancements in diagnostic and treatment modalities, post-transplant fungal infections continue to affect these patients. CNS fungal infections following liver transplantation pose a significant challenge in the diagnostic and therapeutic management of transplant recipients. Timely diagnosis and treatment are crucial because these infections are often identified late, leading to substantial morbidity and mortality in this patient population.

 This mini-review aims to explore the incidence of CNS fungal infections in liver transplant recipients, the key opportunistic pathogens involved, the associated risk factors, various clinical presentations, and the importance of preventive measures.

 Epidemiological studies on liver transplant (LT) patients can provide valuable information about the etiology and trends of cirrhosis. The present study aimed to investigate the prevalence and trend of different etiologies and survival rates of LT patients at the Namazi Transplant Center in Shiraz, Iran, between 2001 and 2018.

 In this single-center, retrospective cohort study, the demographic and clinical characteristics of 3751 patients who underwent LT and met the study inclusion criteria, including age, gender, blood group, body mass index, model for end-stage liver disease (MELD) score, cause of cirrhosis, and diabetes, were extracted from patients’ physical or electronic medical records between 2001 and 2018.

 The MELD scores of LT patients with primary sclerosing cholangitis (PSC), hepatitis B virus (HBV), and non-alcoholic steatohepatitis (NASH) cirrhosis significantly decreased over the study period (P<0.001). Among the LT patients, HBV infection had the highest frequency (21.09%), followed by cryptogenic (17.33%) and PSC (17.22%). The proportion of patients with PSC and NASH (both P<0.001) cirrhosis was significantly increased, so that PSC cirrhosis (2016: 19.4%, 2018: 18.8%) surpassed HBV (2016: 18.4%, 2018: 13.5%), autoimmune hepatitis (2016: 11.7%, 2018: 12.7%), and cryptogenic cirrhosis (2016: 16.1%, 2018:14%) as the leading indication for LT from 2016 to the end of the study period. Fortunately, these patients had a better survival rate than other common diseases (HR: 0.53, CI: 0.43‒0.66; P<0.001).

 The proportion of NASH and PSC cirrhosis significantly increased during the 18 years of study. However, these patients had an improved survival rate. Therefore, health organizations should pay more attention to non-communicable diseases, especially fatty liver disease and cholangitis.

Background:

 Partial liver transplantation is one of the standard methods for liver transplantation. This surgical procedure is performed from a living person to a sick person, which can lead to physical and mental challenges affecting the quality of life of donors. Objective: To compare the level of health anxiety and quality of life of liver donors before and after liver transplant surgery.

Methods:

 This descriptive cross-sectional study was performed on 45 liver donors referred to Shiraz Organ Transplant Hospital between 2019 and 2020. Standard questionnaires of demographic information, health anxiety and quality of life were used to collect data by convenience sampling. Descriptive and inferential statistics tests were used to analyses the data. A significance level was considered P<0.05.

Results: 

Patients' quality of life score (in comparison with the overall score and with the subgroups) decreased significantly (P= 0.001) after liver donation. Also, patients' health anxiety scores (in comparison with the overall score and with the subgroups) increased significantly after surgery (P= 0.001).

Conclusion: 

The implementation of awareness programs before and after surgery and purposeful and long-term follow-up, as well as the use of empowerment programs to increase the level of health and quality of life of these people can be a comprehensive and appropriate approach for hospital officials in order to improve health and quality of life after organ donation.

More and more children are undergoing liver transplantation and reaching adolescence, even though they must take immunosuppressant drugs for their entire lives.

This study aimed to determine the non-adherence rate in liver transplant recipients and identify its potential etiologies.

A cross-sectional survey was performed to assay medication adherence among pediatric liver transplant recipients in Shiraz, Iran. The patients’ demographic, socioeconomic, and clinical characteristics were collected via interviews. Medication adherence was assessed using a validated Morisky 8-item Medication Adherence Questionnaire (MMAS-8).

A total of 157 patients with a mean age of 12.73 ± 4.02 participated in this study. Based on the Morisky adherence scores, 12.1% (n = 19), 25.5% (n = 40), and 62.4% (n = 98) were categorized as low, moderate, and high adherence groups, respectively. Among all studied variables, cost, forgetfulness, the number of drugs used, and follow-up time after transplant were significantly associated with adherence among children after liver transplantation in Iran.

The rate and reported causes of non-adherence are similar to those found in previous studies, which is quite remarkable. Proper instruction, financial aid, and recruitment of new technologies are among the strategies to overcome non-adherence.

Solid organ transplantation from the same donor is an established procedure for end-stage organ failure that developed after a previous hematopoietic stem cell transplantation (HSCT); however, it is rarely done in patients transplanted with unmanipulated haplo-HSCT. There are no pediatric reports regarding the long-term performance of organ transplantation after haplo-HSCT with post-transplant cyclophosphamide (PTCY). A juvenile myelomonocytic leukemia patient, who underwent unmanipulated haplo-HSCT with PTCY from her mother at the age of 3 years, developed chronic liver graft versus host disease (GvHD) which was refractory to specific GvHD treatment. Liver transplantation (LT) from her mother (the donor of her haplo-HSCT) was decided as the next line of treatment. LT was performed on day 540 post-HSCT, and the donor's left lateral segment was appropriately removed and attached to the recipient. The symptoms of GvHD completely regressed in a month. The patient died on day 121 after LT, because of a possible hepato-pulmonary syndrome. Organ failure can develop after allo-HSCT secondary to GvHD and therefore performing HSCT from a haplo-donor may be superior to a matched unrelated donor in terms of subsequent organ transplantation for organ failure.

Liver diseases in children and adolescents are a significant and arising public health issue and should be surveyed from different dimensions (clinical and para-clinical, psychological, socio-economic) and in diverse populations. Shiraz Liver Transplant Center, Shiraz, Iran is the only center for pediatric liver transplantation and its pre-operative evaluations. This provides a unique and valuable situation for studying this vulnerable population. The Shiraz Pediatric Liver Cirrhosis Cohort Study (SPLCCS) was established to assess cirrhotic children, the course of their disease, and treatment over time. This cohort study aimed to prospectively evaluate the natural course and factors that contributed to complications and death of children with chronic liver disease in the region. SPLCCS was launched in September 2018 after obtaining ethical approval; until August 2022, 370 children with end-stage liver disease were enrolled and followed every six months. Here, the cohort’s features, the included population’s baseline characteristics, and primary outcomes are reported.

Primary Sclerosing Cholangitis (PSC)is a chronic cholestatic liver disease which is associated with Inflammatory Bowel Disease (IBD)in 70% of cases. It seems PSC/IBD is a distinct phenotype that is different from PSC, and IBD alone. Hence, we review the epidemiology, pathogenesis, natural course and management of PSC/IBD before and after LT for PSC. Extensive colitis, rectal sparing, backwash ileitis, and mild symptomsare the characteristics of IBD coexisting with PSC. Moreover, PSC patients with concurrent IBD have higher risk of cholangiocarcinoma, and colorectal neoplasia predominantly in right colon and at younger age. Therefore, it is essential to monitor these individuals continuously. It is interesting to note that the course of IBD (ulcerative colitis) after liver transplantation (LT)for PSC varies greatly, and some patients may develop worsening colitis after LT despite immunosuppressive regimens. As well, management of these patients was discussed in this review.

We launched this study to compare subjective global assessment (SGA) and nutrition risk index (NRI) as malnutrition screening tools for nurses to use in the care of End-stage Liver Disease (ESLD) patients.  This pilot study was conducted on liver transplant patients in two hospitals in Iran from May to September 2021. Sensitivity, specificity, and predictive values of NRI were evaluated compared with SGA in ESLD patients.  Sixty-five cirrhotic patients were assessed. The sensitivity, specificity, positive and negative predictive values for NRI in detecting malnutrition based on SGA were 97.67%, 31.82%, 77.68%, and 87.5%, respectively. However, the agreement between NRI and SGA was low (k=0.349). Changing the NRI cut-off value to 83.7 could yield acceptable sensitivity (72.7%) and specificity (58.1%).  NRI can be used as a screening tool in ESLD patients, but a different cut-off might be required to improve its validity against SGA in ESLD patients.

Anomalous portal vein branching poses a technical challenge by means of venous reconstruction in live donor liver transplantation. However, given the scarcity of deceased donor organ pool, liver transplantation surgeons should be familiar with the management of this issue. This study, represents the first case of living donor liver transplantation with type 2 anomalous portal vein branching, which was managed utilizing a Y shaped tubular graft constructed from porcine pericardium.

Liver transplantation is the ultimate treatment for end-stage liver failure. As organ donation systems improve, more reproductive-age women are expected to undergo liver transplantation. Current studies indicate increased risk of some perinatal and maternal complications; however, the available data is still scarce. Therefore, we aimed to evaluate the maternal and fetal outcomes of pregnancies in liver transplant recipients.

We retrospectively evaluated liver transplantations performed between 2011 and 2020 in a tertiary center. Perinatal, maternal, fetal outcomes and transplant status were assessed among pregnancies conceived after liver transplantation.

Among 1137 patients, 82 (7.2%) were reproductive-age females. Ten pregnancies in nine patients were identified after liver transplantation. The mean age of patients was 29.3±6.1 at transplantation, and 32.5±5.4 at conception. The mean interval between conception and transplantation was 30.3±11.7 months. There were eight live births (80%), one miscarriage (10%) and one termination (10%). Three patients delivered<37th gestational week (37.5%). The median gestational age at birth was 38.5 (IQR: 5.21) weeks. The mean birth weight of infants was 2669.3±831 g. Two patients were diagnosed with preeclampsia (25%) and acute graft rejection episode was observed in one patient (10%) during pregnancy.

Although the incidence of some perinatal complications, such as hypertensive disorders and preterm delivery, is increased in liver transplant recipients, pregnancy after liver transplantation appears to have favorable outcomes for the mother, fetus and transplant with close monitoring by a multidisciplinary team.

In patients with chronic liver disease, the presence of hepatocellular failure and/or portosystemic shunting lead to structural and functional brain changes. These changes are due to an increase in substances that are efficiently metabolized by the liver under normal circumstances. These abnormalities can be detected by MRI and magnetic resonance spectroscopy (MRS).

This study aims to evaluate changes in MR brain imaging, manganese, and ammonia levels in patients with chronic liver disease. Additionally, to assess the reversibility of these changes post-living donor liver transplantation.

The study included 10 adult male patients with CLD who underwent LDLT and 10 age and sexmatched healthy control subjects. All patients were subjected to clinical examination, routine labs, MR and MRS examinations of the brain. Follow-up MRI and MRS brain examination, as well as ammonia and manganese levels, were performed 6 to 9 months post-liver transplantation.

The CHILD score ranged from 7 to 13 with a mean of 10.4±1.8, whereas the MELD score ranged from 12 to 22 with a mean of 17.5±3.4. Ammonia levels pre-transplantation (mean 60±7.8) decreased significantly post-transplantation (mean 45.8±7.0) (P<0.001). Also, manganese levels pre-transplantation (mean 2.2±0.16 decreased significantly post-transplantation (mean 1.18±0.09) (P<0.001). Pallidal T1 hyperintense signal was detected in 8 out of 10 patients and regressed in 6 of them post-transplant. Eight patients demonstrated hyperintense whiter matter lesions (WMLs) in FLIAR WI that regressed in all patients after LT (P= 0.011). MRS findings demonstrated lower Cho/Cr and MI/Cr, and higher Glx/Cr compared to controls (P<0.05). The abnormal brain metabolites returned to normal levels post-transplant. Blood levels of ammonia and manganese significantly decreased post-transplant compared to their pre-transplant levels (P<0.01).

MRI and MRS findings can be used to detect metabolic brain abnormalities in chronic liver disease patients with a correlation with ammonia and manganese levels. Moreover, they can be used to monitor the patients post-transplant.

Estimation of graft weight for live donor liver transplant using portal vein diameter has not been validated widely.

To observe the accuracy of portal vein diameter based formula in predicting graft weight.

Graft weight was estimated using standard liver volume (SLV) multiplied by the ratio of portal vein branch diameter (Lee’s formula). SLV was calculated using different formulae described in the literature. The most accurate formula was compared with three dimensional computed tomography volumetry in terms of accuracy of prediction of actual graft weight. Factors which predicted percentage error of more than 15 in computed tomography were analyzed.

In 307 right hemiliver grafts, SLV calculation by Urata’s method in Lee’s formula was the most accurate (P=0.60 in Analysis of Variance) among all SLV methods. Lee’s formula with Urata and computed tomography volumetry had a good correlation with actual graft weight (r=0.77 vs. r=0.8) which was confirmed by Bland Altman analysis. On volumetry 45 patients had a percent error of more than 15. On logistic regression analysis, an estimated graft volume of greater than 800cc was a significant factor ( p=0.008, odds ratio 2.99) and, in these patients Lee’s formula was better(mean error 9.2 ±7.8 vs. 20.2±4.5, p<0.001).

Lee's formula with SLV by Urata’s method was accurate and can act as the second checkpoint after three dimensional computed tomography volumetry. Computed tomography estimate of graft weight more than 800 is associated with higher inaccuracy and in those patients portal vein diameter based formulae fared better.