BACKGROUND/AIMS: The relationship between patient survival and biopsy-proven acute rejection (BPAR) in liver transplant recipients with hepatitis C remains unclear. The aims of this study were to compare the characteristics of patients with and without BPAR and to identify risk factors for BPAR. METHODS: We retrospectively reviewed the records of 169 HCV-RNA-positive patients who underwent LT at three centers. RESULTS: BPAR occurred in 39 (23.1%) of the HCV-RNA-positive recipients after LT. The 1-, 3-, and 5-year survival rates were 92.1%, 90.3%, and 88.5%, respectively, in patients without BPAR, and 75.7%, 63.4%, and 58.9% in patients with BPAR (P<0.001). Multivariate analyses showed that BPAR was associated with the non-use of basiliximab and tacrolimus and the use of cyclosporin in LT recipients with HCV RNA-positive. CONCLUSION: The results of the present study suggest that the immunosuppression status of HCV-RNA-positive LT recipients should be carefully determined in order to prevent BPAR and to improve patient survival.
Antibodies, Monoclonal/therapeutic use ; Biopsy ; Cyclosporine/therapeutic use ; Drug Therapy, Combination ; Genotype ; Graft Rejection/mortality/*prevention & control ; Hepacivirus/genetics/isolation & purification ; Hepatitis C/drug therapy/*virology ; Humans ; Immunosuppressive Agents/*therapeutic use ; *Liver Transplantation/adverse effects ; Polymerase Chain Reaction ; RNA, Viral/blood ; Recombinant Fusion Proteins/therapeutic use ; Recurrence ; Retrospective Studies ; Survival Rate ; Tacrolimus/therapeutic use

OBJECTIVE: To evaluate the safety and clinical outcomes of chemoembolization in Child-Pugh class C patients with hepatocellular carcinomas (HCC). MATERIALS AND METHODS: The study comprised 55 patients with HCC who were classified as Child-Pugh class C and who underwent initial chemoembolization between January 2003 and December 2012. Selective chemoembolization was performed in all technically feasible cases to minimize procedure-related complications. All adverse events within 30 days were recorded using the Common Terminology Criteria for Adverse Events (CTCAE). The tumor response to chemoembolization was evaluated using the modified Response Evaluation Criteria In Solid Tumors. RESULTS: Thirty (54.5%) patients were within the Milan criteria, and 25 (45.5%) were beyond. The mortality of study subjects at 30 days was 5.5%. Major complications were observed in five (9.1%) patients who were all beyond the Milan criteria: two hepatic failures, one hepatic encephalopathy, and two CTCAE grade 3 increases in aspartate aminotransferase/alanine aminotransferase abnormality. The mean length of hospitalization was 6.3 ± 8.3 days (standard deviation), and 18 (32.7%) patients were discharged on the next day after chemoembolization. The tumor responses of the patients who met the Milan criteria were significantly higher (p = 0.014) than those of the patients who did not. The overall median survival was 7.1 months (95% confidence interval: 4.4-9.8 months). CONCLUSION: Even in patients with Child-Pugh class C, chemoembolization can be performed safely with a selective technique in selected cases with a small tumor burden.
Adult ; Aged ; Alanine Transaminase/metabolism ; Aspartate Aminotransferases/metabolism ; Carcinoma, Hepatocellular/mortality/*pathology/therapy ; Chemoembolization, Therapeutic/adverse effects ; Female ; Hepatic Encephalopathy/etiology ; Humans ; Length of Stay ; Liver Neoplasms/mortality/*pathology/therapy ; Liver Transplantation ; Male ; Middle Aged ; Proportional Hazards Models ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Tumor Burden

BACKGROUND/AIMS: Liver transplant patients are at high risk for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) colonization. We evaluated patients before and after liver transplant using active surveillance culture (ASC) to assess the prevalence of MRSA and VRE and to determine the effect of bacterial colonization on patient outcome. METHODS: We performed ASC on 162 liver transplant recipients at the time of transplantation and 7 days posttransplantation to monitor the prevalence of MRSA and VRE. RESULTS: A total of 142 patients had both nasal and rectal ASCs. Of these patients, MRSA was isolated from 12 (7.4%) at the time of transplantation (group 1a), 9 (6.9%) acquired MRSA posttransplantation (group 2a), and 121 did not test positive for MRSA at either time (group 3a). Among the three groups, group 1a patients had the highest frequency of developing a MRSA infection (p < 0.01); however, group 2a patients had the highest mortality rate associated with MRSA infection (p = 0.05). Of the 142 patients, VRE colonization was detected in 37 patients (22.8%) at the time of transplantation (group 1b), 21 patients (20%) acquired VRE posttransplantation (group 2b), and 84 patients did not test positive for VRE at either time (group 3b). Among these three groups, group 2b patients had the highest frequency of VRE infections (p < 0.01) and mortality (p = 0.04). CONCLUSIONS: Patients that acquired VRE or MRSA posttransplantation had higher mortality rates than did those who were colonized pre-transplantation or those who never acquired the pathogens. Our findings highlight the importance of preventing the acquisition of MRSA and VRE posttransplantation to reduce infections and mortality among liver transplant recipients.
Adult ; Enterococcus/*isolation & purification ; Female ; Gram-Positive Bacterial Infections/diagnosis/*microbiology/mortality/transmission ; Humans ; Liver Transplantation/*adverse effects/mortality ; Male ; Methicillin-Resistant Staphylococcus aureus/*isolation & purification ; Middle Aged ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors ; Staphylococcal Infections/diagnosis/*microbiology/mortality/transmission ; Time Factors ; Treatment Outcome ; *Vancomycin Resistance

OBJECTIVETo summarize the clinical characteristics, early diagnosis, comprehensive treatment and prognosis of 6 cases of children with post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation.

METHODData of 6 cases with PTLD seen between January 2011 and December 2013 were retrospectively analyzed. The anti-rejection drug dose adjustments, the effect of rituximab, antiviral therapy and comprehensive treatment program after surgery were explored.

RESULT(1) The diagnosis of PTLD was confirmed by histologic findings. Six cases of PTLD including 3 males and 3 females were diagnosed as congenital biliary atresia and underwent split liver transplantation. The occurrence rate of PTLD was 2.9%. (2) The median time to the development of PTLD was less than 6 months. The initial symptom of PTLD in all patients was fever and clinical manifestations of PTLD were non-specific, depending on the involving organs. Five cases of PTLD developed gastrointestinal symptoms, including diarrhea, abdominal pain, and abdominal distension. One case developed respiratory symptoms, including cough and tachypnea. Three cases had lymph node involvement. In 2 cases pathophysiology involved polymorphic lymphocyte proliferation and in 4 cases B lymphocyte proliferation. (3) Two cases died, in whom EBV DNA was not detected and were diagnosed as PTLD by surgical pathology before death. Four survived cases had high EBV-DNA load and then were diagnosed as PTLD by biopsy pathology. (4) Of the 6 cases of PTLD, 2 cases died and 4 cases survived. The overall mortality was 33%. The dead cases were only treated with laparotomy because of intestinal obstruction or perforation and the survived cases were treated with tacrolimus at reduced doses or discontinuation and rituximab. In 2 cases antiviral therapy (acyclovir) was continued, including 1 cases of intestinal obstruction treated with surgical repair. All the survived patients were followed up for 4 months to 1 year and no evidence has been found.

CONCLUSIONEBV infection is the high risk factor for PTLD after liver transplantation. Close clinical surveillance of EBV DNA for pediatric liver transplantation was important for the early diagnosis of PTLD. Reducing doses of immunosuppressive agents and rituximab is the initial therapy for PTLD. A reduction in the dose of tacrolimus is suggested. Operation therapy can also play a role in the management of local complications.

Antiviral Agents ; administration & dosage ; Biliary Atresia ; therapy ; DNA, Viral ; analysis ; Drug Therapy, Combination ; Early Diagnosis ; Epstein-Barr Virus Infections ; diagnosis ; therapy ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; adverse effects ; Infant ; Liver Transplantation ; adverse effects ; Lymphoproliferative Disorders ; diagnosis ; etiology ; mortality ; therapy ; Male ; Pediatrics ; Postoperative Complications ; Retrospective Studies ; Survival Rate ; Tacrolimus ; administration & dosage

Liver transplantation (LT) has been the key therapy for end stage liver diseases. However, LT in infancy is still understudied. From 1992 to 2010, 152 children had undergone LT in Seoul National University Hospital. Operations were performed on 43 patients aged less than 12 months (Group A) and 109 patients aged over 12 months (Group B). The mean age of the recipients was 7 months in Group A and 74 months in Group B. The patients' survival rates and post-LT complications were analyzed. The mean Pediatric End-stage Liver Disease score was higher in Group A (21.8) than in Group B (13.4) (P = 0.049). Fulminant hepatitis was less common in Group A (4.8%) than in Group B (13.8%) (P = 0.021). The post-transplant lymphoproliferative disorder and portal vein complication were more common in Group A (14.0%, 18.6%) than in Group B (1.8%, 3.7%) (P = 0.005). However, the 1, 5, and 10 yr patient survival rates were 93%, 93%, and 93%, in Group A and 92%, 90%, and 88% in Group B (P = 0.212). The survival outcome of pediatric LT is excellent and similar regardless of age. LTs in infancy are not riskier than those of children.
Adolescent ; Age Factors ; Child ; Child, Preschool ; End Stage Liver Disease/mortality/*surgery ; Female ; Graft Rejection/epidemiology ; Graft Survival ; Herpesviridae Infections/etiology ; Humans ; Infant ; Liver Transplantation/*adverse effects/*statistics & numerical data ; Lymphoproliferative Disorders/*etiology ; Male ; Proportional Hazards Models ; Risk Factors ; Severity of Illness Index ; Survival Rate ; Treatment Outcome ; Vascular Diseases/etiology

OBJECTIVE: To investigate the possible risk factors for death among liver or kidney recipients with bloodstream infections (BSIs). METHODS: A retrospective study of 138 episodes of bloodstream infections documented in 103 patients was conducted to assess potential risk factors for mortality. The risk factors were identified by logistic regression analysis. RESULTS: The mean age of the patients was 12-66 (42.3±12.7) years. The majority of infections were nosocomial (78.6%). The BSIs-related mortality rate was 39.8% (41/103). The following variables were identified as risk factors for BSIs-related mortality by univariate analysis: intraabdominal/ biliary focus (P=0.003), polymicrobial infection (P<0.001), liver transplant (P<0.001), platelet count <50000/mm3 (P<0.001), and septic shock (P<0.001). Platelet count < 50000/mm3 (P=0.002) and septic shock (P<0.001) showed significantly difference between the mortality group and the survival groups in the multivariate logistic regression analysis. CONCLUSION Decreased platelet count and septic shock are risk factors for increased
Adolescent ; Adult ; Aged ; Bacteremia ; epidemiology ; etiology ; mortality ; Cause of Death ; Child ; China ; epidemiology ; Female ; Gram-Negative Bacterial Infections ; epidemiology ; etiology ; mortality ; Humans ; Kidney Transplantation ; adverse effects ; Liver Transplantation ; adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Shock, Septic ; epidemiology ; Thrombocytopenia ; epidemiology ; Young Adult

BACKGROUNDHepatic alveolar echinococcosis (AE) is a parasitic disease in humans and caused by the Echinococcus multilocularis (Em). Orthotopic liver transplantation (OLT) may be the only effective treatment for end-stage hepatic AE. However, in some AE patients, extrahepatic Em can not be completely eliminated after OLT. We aimed to study whether the immunological changes caused by Em evasion may influence the rejective response.

METHODSRat modles of AE were established by injecting the Em suspension into abdomen of Brown Norway (BN) rats. Three months later, in the experimental group, the liver was transplanted from Lewis (LEW) rats to Em-infected BN rats. In the control group, transplantation was from LEW rats to healthy BN rats. Liver tissue and peripheral blood (PB) samples were collected on days 1, 3, 5, and 7 after OLT. Liver tissue was analyzed after hematoxylin and eosin (H&E) staining; numbers of CD4, CD8, and CD28 on peripheral blood cells were detected by flow cytometry; and expression of the chemokine fractalkine (Fkn) was detected by reverse transcription PCR (RT-PCR). Interleukin-10 (IL-10) was measured in the serum by enzyme-linked immunosorbent assay (ELISA). In every group, eight BN rats were retained for observing survival time.

RESULTSThe survival times of recipients in the experimental group were prolonged compared with those in the control group. The rejective response occurred later and was milder in the experimental group. percentage of CD4, CD8, CD28 T-cells and Fkn mRNA expression were lower in the experimental group. While the serum IL-10 levels were higher in the experimental group than those in the control group.

CONCLUSIONSAcute rejective response after OLT was attenuated in the rats with Em infection, and the recipients` survival time was prolonged. Em may play a role in this process by elevating IL-10 secretion, decreasing the effector T cells, inhibiting the expression of Fkn, which lead to reduce the inflammatory cells infiltration into the liver.

Animals ; CD28 Antigens ; metabolism ; CD4-Positive T-Lymphocytes ; metabolism ; CD8-Positive T-Lymphocytes ; metabolism ; Echinococcosis, Hepatic ; mortality ; surgery ; therapy ; Echinococcus multilocularis ; pathogenicity ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Graft Rejection ; immunology ; Interleukin-10 ; blood ; Liver Transplantation ; adverse effects ; Rats ; Reverse Transcriptase Polymerase Chain Reaction

BACKGROUNDSimultaneous liver and kidney transplantation (SLKT) has been proven to be a favorable treatment for combined renal and hepatic end-stage disease. However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders. This study aimed to explore the indications, surgical techniques, therapeutic experience, prevention and treatment of postoperative complications of SLKT.

METHODSThe clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied. Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed.

RESULTSAll operations were successfully performed. Postoperative complications occurred in 13 cases (59.1%), including pleural effusions (7), intra-abdominal bleeding (2), biliary complications (2), repeated upper gastrointestinal bleeding (1), and acute liver graft rejection (1). All complications were treated conservatively. In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions. Mortality at 3 months was 13.6%. The one and three year patient survival rate was 81.3% and 73.9% respectively.

CONCLUSIONSSLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function. It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications. The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases. It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postoperative infections, to improve the long-term patient survival after SLKT.

Adolescent ; Adult ; Child ; Female ; Humans ; Kaplan-Meier Estimate ; Kidney Transplantation ; adverse effects ; methods ; mortality ; Liver Transplantation ; adverse effects ; methods ; mortality ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Young Adult

The aim of this study was to evaluate the infectious complications after living donor liver transplantation (LDLT) in children. We enrolled 95 children (38 boys and 57 girls) who underwent LDLT from 1994 to 2004. The median age was 22 months (range, 6 months to 15 yr). We retrospectively investigated the proven episodes of bacterial, viral, and fungal infection. There occurred 150 infections in 67 (70%) of 95 patients (1.49 infections/patient); 74 in 43 patients were bacterial, 2 in 2 were fungal, and 74 in 42 were viral. The most common sites of bacterial infection were the bloodstream (33%) and abdomen (25%). Most of the bacterial infections occurred within the first month after LDLT. Bacterial and fungal infections did not result in any deaths. The most common causes of viral infection were Epstein-Barr virus in 37 patients and cytomegalovirus in 18. Seven of the 14 deaths after LDLT were associated with viral infection. Our study suggests that infection is one of the important causes of morbidity and mortality after LDLT. Especially careful monitoring and management of viral infections is crucial for improving the outcome of LDLT in children.
Adult ; Child ; Communicable Diseases/*etiology/microbiology/mortality/virology ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Infection/*etiology/microbiology/mortality/virology ; Liver Transplantation/*adverse effects/mortality ; *Living Donors ; Male ; *Postoperative Complications/microbiology/mortality/virology ; Retrospective Studies

OBJECTIVETo analyze the preoperative risk factors on liver transplant recipients with acute renal failure(ARF), and to evaluate renal replacement therapy (RRT) as a transitonary therapy before liver transplantation.

METHODSLiver transplant recipients with acute renal failure treated with renal replacement therapy between January 1st, 2001 and January 1st, 2008 in our center were retrospected. Clinical characteristics, the kinds of RRT and prognosis were analyzed; Logistic regression was applied to analyze the parameters that can forecast the motality of the liver transplant recipients with acute renal failure.

RESULTSOf the patients who received RRT, 30% survived to liver transplantation, 67.5% died while waiting for liver transplantation. The dead had a higher multiple organ dysfunction score (MODS), and lower mean arterial pressure than those survived to liver transplantation. There was no significant difference in the duration of RRT between continuous renal replacement therapy (CRRT) patients and hemodialysis patients. CRRT patients had a higher MODS, lower mean arterial pressure, lower serum creatinine than hemodialysis patients. Lower mean arterial pressure was statistically associated with higher risk of mortality.

CONCLUSIONThough mortality was high, RRT helps part (30%) of patients survive to liver transplantation. Therefore, considering the high mortality without transplantation, RRT is acceptable for liver transplant recipients with ARF.

Acute Kidney Injury ; etiology ; mortality ; therapy ; Adult ; Blood Pressure ; Female ; Humans ; Liver Transplantation ; adverse effects ; Liver, Artificial ; Male ; Middle Aged ; Prognosis ; Regression Analysis ; Renal Dialysis ; methods ; Renal Replacement Therapy ; mortality ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Analysis