International Journal of Organ Transplantation Medicine
Volume:13 Issue: 4, Autumn 2022

Liver cirrhosis is an end stage liver damage. Biliary atresia (BA) and inherited syndromes of intrahepatic cholestasis are the most frequent causes of liver cirrhosis in children especially in the first year of life.

To compare the prognostic value of albumin-bilirubin grade (ALBI), an alternative predictor of mortality in cirrhotic adults, with Child-Pugh and Pediatric End-Stage Liver Disease (PELD) scores in cirrhotic children with variceal bleeding.

We analyzed the patients’ data using MedCalc software, and calculated area under the curves (AUC) of receiving-operator characteristic (ROC).

All scores were higher in expired compared to survived patients (p<0.001). The AUC values for predicting mortality in all patients were 0.879±0.04 for Child-Pugh and PELD scores and 0.733±0.06 for ALBI. The prognostic values in two subgroups of BA and those with other underlying diseases (non-BA) showed that in BA group, ALBI score with AUC of 0.607±0.102, p<0.29, had no significant difference between survived and non-survived patients. ALBI in non-BA group, with AUC of 0.863±0.063 showed closer value to other scores (0.954), and was differed between survived and non-survived groups (p<0.001).

Our results suggested that ALBI might be useful in predicting mortality in non-BA patients.

Decellularized livers could provide an environment for liver-specific cell migration. Synthetic glucocorticoids induce liver development and hepatocyte differentiation as well as limit immune cell migration, which can both promote or inhibit fibrogenesis in the engineered liver. Although decellularized scaffolds provide a promising approach for liver regeneration, the effect of the implant on the donor's liver remained clear.

This study investigated the impact of the transplanted decellularized liver with/without prednisolone preloading on liver histopathology and functions.

Decellularized rat liver scaffolds were prepared by the perfusion method. After scaffolds characterization, they were grafted to partially hepatectomized rats in prednisolone-free and -loaded groups. After 2 and 4 weeks, the liver and grafts were removed and evaluated by Periodic acid Schiff staining and immunohistochemistry. Serological assessments were also performed on blood sera and compared with untreated control. The data were analyzed by ANOVA and LSD.

Both grafts were invaded by hepatocytes. No histopathological symptom was detected in the recipient's liver; however, oval cells were observed within the epithelium of the bile duct and in the surrounding connective tissue. No significant variation was observed in the levels of alkaline phosphatase(ALP), but the levels of albumin and total protein were significantly reduced in both groups that received the grafts after two weeks; however, after four weeks, total protein and albumin reached the average level.

decellularized liver transplantation with/without the drug is safe enough for the recipient liver to be considered a promising technique in regenerative medicine.

Kidney transplantation is the most common solid organ transplantation. The aim of our research is to describe technical and surgical aspects of a porcine model of heterotopic kidney allotransplantation, using up-to-date techniques, utilized nowadays during human kidney transplantation.

We performed a total of 20 heterotopic kidney transplantations on a porcine animal model. The manipulation time, cold ischemia time and surgery time were measured and analyzed over time.

Over the course of the experiment manipulation time decreased by 32% from 28min to 19min, cold ischemia time decreased by 33% from 46min to 31min, and surgery time decreased by 28% from 180min to 130min. All animals had successful reperfusion of the grafts. We witnessed urination of all grafts before performing the ureteral anastomosis. Three grafts had an early graft failure due to an early arterial thrombosis; in the first two cases, the grafts had their artery anastomosed onto a thin external iliac artery, the third thrombosis occurred on a graft with complex arterial anatomy with implanted pole artery.

Our experimental model demonstrated that a pig laboratory model is a useful and valuable tool for surgical training. It can help to shorten the operation times and lower the complication rates. This specific model can also be extended to serve not only as a simple training tool for surgical techniques. Considering pig to human similarities in physiology, biochemistry, and immunology, it can also be used as a short- or long-term model in kidney transplantation.

Pancreas thrombosis is a significant complication after pancreas transplantation. Most centers use pharmacologic thromboprophylaxis with anticoagulants and antiplatelet drugs during and/or immediately after transplantation. Currently, there is no consensus on the best thromboprophylaxis in these patients.

A literature review of MEDLINE, SCOPUS, and Google Scholar was done. Studies administered pharmacologic thromboprophylaxis after pancreas transplantation and reported thrombosis and/or bleeding complications were recruited.

Aspirin, unfractionated or low-molecular-weight heparin (LMWH) were the most utilized options. Dextran, antithrombin III, and warfarin have been occasionally used. The reported rates of thrombosis and bleeding ranged from 4-43% and 0.3-58%, respectively.

Best regimen and duration of pharmacologic thromboprophylaxis in pancreas transplantation remain to be determined. Low-dose aspirin is a common part of antithrombotic regimens that usually continue after discharge. Intraoperative heparin has been administered in some centers and appears to decrease the risk of thrombosis without increasing the risk of bleeding. Adding post-operative, prophylactic doses of intravenous or subcutaneous heparin, starting while the patient is homeostatically stable, forms a part of the current thromboprophylaxis regimen. LMWH has sometimes been substituted for heparin; however, the dose adjustment according to renal function is challenging. Warfarin should be reserved only for patients with hypercoagulability or for thrombosis treatment.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory clinical syndrome of uncontrolled immune response which results in hypercytokinemia due to underlying primary or secondary immune defects. HLH can be classified into familial (primary) and acquired (secondary) forms according to the underlying defect. Hematopoietic stem cell transplantation (HSCT) is the only curative treatment option in primary HLH, and the outcome of HSCT for HLH patients has improved over the last decades. However, HSCT for HLH still carries significant morbidity and mortality. Herein, we described three patients with primary HLH, including a 4.5 years old girl with Chédiak-Higashi Syndrome (CHS- LYST gene mutation), a 5.5 years old boy with Griscelli syndrome type 2 (GS2- Rab27a gene mutation), and an 8.9 years old girl with Hemophagocytic lymphohistiocytosis Syndrome type 5 (HLH 5- STXBP2 gene mutation). All three patients received allogeneic HSCT with a reduced-intensity conditioning (RIC) regimen, including Fludarabine, Melphalan, Rabbit Anti-thymocyte globulin (r-ATG), and graft versus host disease (GvHD) prophylaxis by Methylprednisolone and Cyclosporine. The outcome of HSCT for HLH patients has improved, and HSCT can provide long-term survival for familial HLH. Ongoing challenges in various aspects of HSCT remain to be elucidated, including donor selection, the timing of HSCT, the conditioning regimen, and mixed chimerism after HSCT.

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.