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Isa HM, Alkharsi FA, Khamis JK, Hasan SA, Naser ZA, Mohamed ZN, Mohamed AM, Altamimi SA. Pediatric and adult liver transplantation in Bahrain: The experiences in a country with no available liver transplant facilities. World J Transplant 2024; 14:87752. [PMID: 38576753 PMCID: PMC10989476 DOI: 10.5500/wjt.v14.i1.87752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 03/15/2024] Open
Abstract
BACKGROUND Liver transplantation (LT) is a life-saving procedure for patients with end-stage liver disease and has become the standard and most effective treatment method for these patients. There are many indications for LT that vary between countries and settings. The outcome of LT depends on the available facilities and surgical expertise, as well as the types of liver graft donors available. AIM To assess the clinical characteristics of patients from Bahrain who underwent LT overseas, and analyze factors affecting their survival. METHODS In this retrospective cohort study, we reviewed the medical records and overseas committee registry information of all pediatric and adult patients who were sent overseas to undergo LT by the Pediatric and Medical Departments of Salmaniya Medical Complex and Bahrain Defence Force Hospital via the Overseas Treatment Office, Ministry of Health, Kingdom of Bahrain, between 1997 and 2023. Demo graphic data, LT indication, donor-recipient relationship, overseas LT center, graft type, post-LT medications, and LT complications, were collected. Outcomes measured included the overall and 5-year LT survival rate. Fisher's exact, Pearson χ2, and Mann-Whitney U tests were used to compare the pediatric and the adults' group in terms of clinical characteristics, donor-recipient relationship, medication, complications, and outcome. Survival analysis was estimated via the Kaplan-Meier's method. Univariate and multivariate analyses were used to detect predictors of survival. RESULTS Of the 208 eligible patients, 170 (81.7%) were sent overseas to undergo LT while 38 (18.3%) remained on the waiting list. Of the 170 patients, 167 (80.3%) underwent LT and were included in the study. The majority of the patients were Bahraini (91.0%), and most were males (57.5%). One-hundred-and-twenty (71.8%) were adults and 47 (28.3%) were children. The median age at transplant was 50.0 [interquartile range (IQR): 14.9-58.4] years. The main indication for pediatric LT was biliary atresia (31.9%), while that of adult LT was hepatitis C-related cirrhosis (35.0%). Six (3.6%) patients required re-transplantation. Most patients received a living-related liver graft (82%). Pediatric patients received more living and related grafts than adults (P = 0.038 and P = 0.041, respectively), while adult patients received more cadaveric and unrelated grafts. Most patients required long-term immunosuppressive therapy after LT (94.7%), of which tacrolimus was the most prescribed (84.0%), followed by prednisolone (50.7%), which was prescribed more frequently for pediatric patients (P = 0.001). Most patients developed complications (62.4%) with infectious episodes being the most common (38.9%), followed by biliary stricture (19.5%). Tonsilitis and sepsis (n = 12, 8.1% for each) were the most frequent infections. Pediatric patients experienced higher rates of infection, rejection, and early poor graft function than adult patients (P < 0.001, P = 0.003, and P = 0.025, respectively). The median follow-up time was 6.5 (IQR: 2.6-10.6) years. The overall survival rate was 84.4%, the 5-year survival rate, 86.2%, and the mortality rate, 15.6%. Younger patients had significantly better odds of survival (P = 0.019) and patients who survived had significantly longer follow-up periods (P < 0.001). CONCLUSION Patients with end-stage liver disease in Bahrain shared characteristics with those from other countries. Since LT facilities are not available, an overseas LT has offered them great hope.
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Affiliation(s)
- Hasan M Isa
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
- Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
| | - Fatema A Alkharsi
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Jawad K Khamis
- Department of Medicine, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Sawsan A Hasan
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Zainab A Naser
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Zainab N Mohamed
- Department of Pediatrics, Salmaniya Medical Complex, Manama 26671, Bahrain
| | - Afaf M Mohamed
- Public Health Directorate, Ministry of Health, Manama 26671, Bahrain
| | - Shaikha A Altamimi
- The Overseas Office, Supreme Committee for Treatment Abroad, Ministry of Health, Manama 26671, Bahrain
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The Clinical Efficacy of Double Plasma Molecular Absorption System Combined with Plasma Exchange in the Treatment of Acute-on-Chronic Liver Failure: A Systematic Review and Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3139929. [PMID: 35368957 PMCID: PMC8975647 DOI: 10.1155/2022/3139929] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/17/2022] [Indexed: 11/17/2022]
Abstract
Objective This study aims to investigate the clinical efficacy of plasma exchange in treating acute-on-chronic liver failure (ACLF) through meta-analysis. Method PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched using a computer for all relevant Chinese and English literature from 2000 to 2021 in each database. At the same time, a large number of related papers and materials were manually consulted. Randomized controlled trials of plasma exchange (PE, control group) and combined double plasma molecular absorption system (DPMAS + PE, observation group) for the treatment of ACLF were collected. Meta-analysis was performed with Stata16.0 software. Result A total of 474 articles were retrieved, and 11 papers were finally included for research after screening. Meta-analysis results showed that the effective rate of treatment in the experimental group was significantly higher than that in the control group. At the same time, the observation group's prothrombin activity (PTA) level was better than that of the control group after treatment. After treatment, there was no significant difference in prothrombin time (PT) and international normalized ratio (INR) between the two groups. In addition, after treatment, the alanine aminotransferase (ALT) level of the observation group was significantly lower than that of the control group. However, TBIL levels and albumin (ALB) levels did not change significantly between the two groups. Regarding blood routine indexes, there were no significant changes in creatinine (Cr) levels and platelet counts (PLT) in the two groups after treatment, but hemoglobin (HGB) levels in the observation group were significantly lower than those in the control group. Conclusion DPMAS combined with plasma exchange therapy can improve liver function, coagulation function, and blood routine level of ACLF patients and increase the effective rate of treatment. It is an effective treatment for acute-on-chronic liver failure.
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Lei Y, Liang Y, Zhang X, Wang X, Zhang Y, Chan YM, Tang C, Zheng Z. Alternating therapeutic plasma exchange (TPE) with double plasma molecular adsorption system (DPMAS) for the treatment of fulminant hepatic failure (FHF). Clin Case Rep 2021; 9:e05220. [PMID: 34938567 PMCID: PMC8667290 DOI: 10.1002/ccr3.5220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 01/14/2023] Open
Abstract
Alternating therapeutic plasma exchange with double plasma molecular adsorption system can rapidly remove bilirubin and ammonia and supplement the essential substance from the blood, which could be used as an effective treatment for fulminant hepatic failure.
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Affiliation(s)
- Yan Lei
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yuling Liang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Xuemei Zhang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Xiaohua Wang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yu Zhang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yuk Ming Chan
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Chun Tang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Zhihua Zheng
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
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Kumar R, Anand U, Priyadarshi RN. Liver transplantation in acute liver failure: Dilemmas and challenges. World J Transplant 2021; 11:187-202. [PMID: 34164294 PMCID: PMC8218344 DOI: 10.5500/wjt.v11.i6.187] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/17/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Acute liver failure (ALF) refers to a state of severe hepatic injury that leads to altered coagulation and sensorium in the absence of pre-existing liver disease. ALF has different causes, but the clinical characteristics are strikingly similar. In clinical practice, however, inconsistency in the definition of ALF worldwide and confusion regarding the existence of pre-existing liver disease raise diagnostic dilemmas. ALF mortality rates used to be over 80% in the past; however, survival rates on medical treatment have significantly improved in recent years due to a greater understanding of pathophysiology and advances in critical care management. The survival rates in acetaminophen-associated ALF have become close to the post-transplant survival rates. Given that liver transplantation (LT) is an expensive treatment that involves a major surgical operation in critically ill patients and lifelong immunosuppression, it is very important to select accurate patients who may benefit from it. Still, emergency LT remains a lifesaving procedure for many ALF patients. However, there is a lack of consistency in current prognostic models that hampers the selection of transplant candidates in a timely and precise manner. The other problems associated with LT in ALF are the shortage of graft, development of contraindications on the waiting list, vaguely defined delisting criteria, time constraints for pre-transplant evaluation, ethical concerns, and comparatively poor post-transplant outcomes in ALF. Therefore, there is a desperate need to establish accurate prognostic models and explore the roles of evolving adjunctive and alternative therapies, such as liver support systems, plasma exchange, stem cells, auxiliary LT, and so on, to enhance transplant-free survival and to fill the void created by the graft shortage
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Affiliation(s)
- Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Utpal Anand
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
| | - Rajeev Nayan Priyadarshi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India
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Rovegno M, Vera M, Ruiz A, Benítez C. Current concepts in acute liver failure. Ann Hepatol 2020; 18:543-552. [PMID: 31126880 DOI: 10.1016/j.aohep.2019.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 02/04/2023]
Abstract
Acute liver failure (ALF) is a severe condition secondary to a myriad of causes associated with poor outcomes. The prompt diagnosis and identification of the aetiology allow the administration of specific treatments plus supportive strategies and to define the overall prognosis, the probability of developing complications and the need for liver transplantation. Pivotal issues are adequate monitoring and the institution of prophylactic strategies to reduce the risk of complications, such as progressive liver failure, cerebral oedema, renal failure, coagulopathies or infections. In this article, we review the main aspects of ALF, including the definition, diagnosis and complications. Also, we describe the standard-of-care strategies and recent advances in the treatment of ALF. Finally, we include our experience of care patients with ALF.
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Affiliation(s)
- Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Magdalena Vera
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Alex Ruiz
- Unidad de Gastroenterología, Instituto de Medicina, Escuela de Medicina, Universidad Austral de Chile, Chile
| | - Carlos Benítez
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile.
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The Effect of Modified Sini Decoction on Survival Rates of Patients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2501847. [PMID: 30915144 PMCID: PMC6409021 DOI: 10.1155/2019/2501847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 12/18/2022]
Abstract
Aim of the Study. To verify the effect of modified sini decoction on patients with hepatitis B virus related acute-on-chronic liver failure. Materials and Methods. A retrospective cohort study was conducted. Patients who had been treated with modified sini decoction and standard comprehensive internal medicine were assigned to an observation group, and patients who had been treated with standard comprehensive internal medicine were selected as a control group. The total bilirubin (TBIL), albumin (ALB), alanine aminotransferase (ALT), prothrombin activity (PTA), CTP, and MELD scores were analyzed at weeks 4, 8, and 12 after treatment, respectively. Meanwhile, the 12-week survival rate was analyzed. Results. The levels of TBIL and ALT were remarkably decreased, while the levels of ALB and PTA were remarkably increased in both groups at weeks 4, 8, and 12 after treatment, respectively, but the effects in the observation group were greater (P < 0.05). The CTP and MELD scores at 8-week and 12-week were lower in the observation group than in the control group (P < 0.05). At 12 weeks, the mean survival times of the observation group and the control group were 66.7 and 45.5 d, respectively. Significant improvement of 12-week survival rate [39/62 (62.9%) versus 18/50 (36.0%), P = 0.001] was observed in the observation group after treatment. Conclusions. Modified sini decoction could protect the liver function and improve the survival rates of patients with hepatitis B virus related acute-on-chronic liver failure.
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Yao J, Li S, Zhou L, Luo L, Yuan L, Duan Z, Xu J, Chen Y. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure. J Clin Apher 2019; 34:392-398. [PMID: 30758886 PMCID: PMC6767528 DOI: 10.1002/jca.21690] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
Objective The artificial liver support system (ALSS) is used frequently as a first‐line treatment for hepatitis B virus‐associated acute‐on‐chronic liver failure (HBV‐ACLF). This study aims to compare the therapeutic efficacy of double plasma molecular adsorption system (DPMAS) with sequential half‐dose plasma exchange (PE) (DPMAS+PE) and full‐dose PE in patients with HBV‐ACLF. Methods A total of 131 hospitalized patients who were diagnosed with HBV‐ACLF and underwent DPMAS+PE or PE were retrospectively analyzed. According to the treatment methods used, they were divided into PE group (n = 77) and DPMAS+PE group (n = 54). The main evaluation indexes included the change of liver function and the 28‐days liver transplant‐free survival rates after the different treatments. Results There were no significant differences on severity of illness between PE group and DPMAS+PE group (P > 0.05). The total bilirubin (TBIL) levels immediately after treatment, and at 24 and 72 hours after treatment were markedly decreased in DPMAS+PE group than that in PE group (52.3 ± 9.4% vs 42.3 ± 7.2%, P < 0.05; 24.2 ± 10.0% vs 13.5 ± 13.0%, P < 0.05; 24.8 ± 13.1% vs 14.9 ± 14.9%, P < 0.05; respectively). The 28‐days survival rates was 62.3% and 72.2% in PE and DPMAS+PE groups (P = 0.146). Furthermore, the 28‐days survival rates were significantly higher in DPMAS+PE group than that in PE group (57.4% vs 41.7%, P = 0.043) in the intermediate‐advanced stage patients. Conclusion Compared with PE alone, DPMAS+PE might more effectively improve temporary TBIL in ACLF patients, and improve the 28‐days survival rates in HBV‐ACLF patients with intermediate‐advanced stage. Therefore, DPMAS+PE may be an available ALSS treatment for HBV‐ACLF patients.
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Affiliation(s)
- Jia Yao
- Gastroenterology Department,General Surgery Department, Shanxi Dayi Hospital, Taiyuan, China
| | - Shuang Li
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Li Zhou
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Lei Luo
- The First Clinical Medical School, Lanzhou University, Lanzhou, China
| | - Lili Yuan
- Gastroenterology Department,General Surgery Department, Shanxi Dayi Hospital, Taiyuan, China
| | - Zhongping Duan
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
| | - Jun Xu
- Gastroenterology Department,General Surgery Department, Shanxi Dayi Hospital, Taiyuan, China
| | - Yu Chen
- Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
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Mainardi V, Rando K, Valverde M, Olivari D, Castelli J, Rey G, Gerona S. Acute Liver Failure due to Wilson Disease: Eight Years of the National Liver Transplant Program in Uruguay. Ann Hepatol 2019; 18:187-192. [PMID: 31113589 DOI: 10.5604/01.3001.0012.7911] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/04/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Wilson's disease (WD) is an uncommon cause of acute liver failure (ALF). Our aim was to describe clinical features, diagnostic findings, treatments, and outcomes of patients with ALF due to WD. MATERIAL AND METHODS Retrospective medical record reviews of all patients with ALF due to WD in eight years in Uruguay. RESULTS WD was the cause of six (15%) of thirty-nine ALF cases. All patients were females, with a mean age of 18 years. Four patients presented with hyperacute liver failure and two with acute failure. Jaundice was the main complaint of all patients. Mean total bilirubin (TB), alkaline phosphatase (AP), AST, and ALT were 27.5 mg/dL, 45.5 lU/l, 156 IU/L, and 51 IU/L, respectively. Ceruloplasmin levels were low in four patients, urinary cooper was high in four, and two had Kayser-Fleischer rings. All patients had Coombs-negative hemolytic anemia, acute kidney injury, histochemical identifiable copper, and advanced fibrosis on liver histology. The average MELD score was 36. All patients were treated with d-penicillamine and listed for urgent liver transplantation (LT). Prometheus® was performed in one patient. Three patients died: two without LT and one after LT. Three patients survived: one without LT (New Wilson Index<11) and two with LT. The referral time to the program and the total time (referral plus waiting list time) were longer for non-survivors than for survivors (14 vs. 3 days and 23 vs. 8 respectively). CONCLUSION All cases had typical clinical, analytical and histopathology characteristics. Early referral was determinant of prognosis.
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Affiliation(s)
- Victoria Mainardi
- Hepatic Biliary and Pancreatic National Center - Teaching and Assistance Unit (UDA) and Bi-Intuitional Unit of Liver Transplantation, Military Hospital, Montevideo, Uruguay.
| | - Karina Rando
- Hepatic Biliary and Pancreatic National Center - Teaching and Assistance Unit (UDA) and Bi-Intuitional Unit of Liver Transplantation, Military Hospital, Montevideo, Uruguay
| | - Marcelo Valverde
- Hepatic Biliary and Pancreatic National Center - Teaching and Assistance Unit (UDA) and Bi-Intuitional Unit of Liver Transplantation, Military Hospital, Montevideo, Uruguay
| | - Daniela Olivari
- Hepatic Biliary and Pancreatic National Center - Teaching and Assistance Unit (UDA) and Bi-Intuitional Unit of Liver Transplantation, Military Hospital, Montevideo, Uruguay
| | - Jorge Castelli
- Hepatic Biliary and Pancreatic National Center - Teaching and Assistance Unit (UDA) and Bi-Intuitional Unit of Liver Transplantation, Military Hospital, Montevideo, Uruguay
| | - Gabriela Rey
- Hepatic Biliary and Pancreatic National Center - Teaching and Assistance Unit (UDA) and Bi-Intuitional Unit of Liver Transplantation, Military Hospital, Montevideo, Uruguay
| | - Solange Gerona
- Hepatic Biliary and Pancreatic National Center - Teaching and Assistance Unit (UDA) and Bi-Intuitional Unit of Liver Transplantation, Military Hospital, Montevideo, Uruguay
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Mainardi V, Rando K, Olivari D, Rey G, Castelli J, Grecco G, Leites A, Harguindeguy M, Gerona S. Mortality Analysis of Acute Liver Failure in Uruguay. Transplant Proc 2018; 50:465-471. [PMID: 29579829 DOI: 10.1016/j.transproceed.2017.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Acute liver failure (ALF) is a syndrome with high mortality. OBJECTIVE Describe characteristics and outcomes of patients with ALF in Uruguay, and identify factors associated with mortality. METHODS A retrospective analysis of 33 patients with ALF was performed between 2009 and 2017. RESULTS The patients' median age was 43 years, and 64% were women. Average Model for End-Stage Liver Disease (MELD) score at admission was 33. The median referral time to the liver transplant (LT) center was 7 days. The most common etiologies were viral hepatitis (27%), indeterminate (21%), autoimmune (18%), and Wilson disease (15%). Overall mortality was 52% (71% of transplanted and 46% of nontransplanted patients). Dead patients had higher referral time (10 vs 4 days, P = .008), higher MELD scores at admission (37 vs 28) and highest achieved MELD scores (42 vs 29; P < .001), and higher encephalopathy grade III to IV (94% vs 25%, P < .001) than survivors. Patients without LT criteria (n = 4) had lower MELD score at admission (25 vs 34, P = .001) and highest achieved MELD score (27 vs 37, P = .008) compared with the others. Patients with LT criteria but contraindications (n = 7) had higher MELD scores at admission (38 vs 31, P = .02), highest achieved MELD scores (41 vs 34, P = .03), and longer referral time (10 days) than those without contraindications (3.5 days) or those without LT criteria (7.5 days, P = .02). Twenty-two patients were listed; LT was performed in 7, with a median time on waiting list of 6 days. CONCLUSIONS ALF in Uruguay has high mortality associated with delayed referral to the LT center, MELD score, and encephalopathy. The long waiting times to transplantation might influence mortality.
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Affiliation(s)
- V Mainardi
- Hepatic Biliary and Pancreatic National Center-Teaching and Assistance Unit (UDA) from Uruguay University (UDELAR), Montevideo, Uruguay; National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay.
| | - K Rando
- Hepatic Biliary and Pancreatic National Center-Teaching and Assistance Unit (UDA) from Uruguay University (UDELAR), Montevideo, Uruguay; National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - D Olivari
- Hepatic Biliary and Pancreatic National Center-Teaching and Assistance Unit (UDA) from Uruguay University (UDELAR), Montevideo, Uruguay; National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - G Rey
- Hepatic Biliary and Pancreatic National Center-Teaching and Assistance Unit (UDA) from Uruguay University (UDELAR), Montevideo, Uruguay
| | - J Castelli
- National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - G Grecco
- National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - A Leites
- Hepatic Biliary and Pancreatic National Center-Teaching and Assistance Unit (UDA) from Uruguay University (UDELAR), Montevideo, Uruguay; National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - M Harguindeguy
- Hepatic Biliary and Pancreatic National Center-Teaching and Assistance Unit (UDA) from Uruguay University (UDELAR), Montevideo, Uruguay; National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
| | - S Gerona
- Hepatic Biliary and Pancreatic National Center-Teaching and Assistance Unit (UDA) from Uruguay University (UDELAR), Montevideo, Uruguay; National Liver Transplant Program, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
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Live donor liver transplantation for acute liver failure: A single center experience. Indian J Gastroenterol 2018; 37:25-30. [PMID: 29455437 DOI: 10.1007/s12664-017-0812-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/22/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Acute liver failure (ALF) is an indication for emergency liver transplantation (LT). Although centers performing only deceased donor liver transplants (DDLT) have shown improved outcomes in this situation, they still have relatively long waiting lists. An alternative would be living donor liver transplantation (LDLT), which has shown equivalent outcomes in the elective situation but there is limited evidence of its results in ALF. AIM The purpose of this study was to assess the outcomes in patients with ALF undergoing emergency LDLT in our center in Delhi, India. METHODS We prospectively collected data on 479 patients who underwent LT in our hospital between January 2009 and December 2015 to evaluate the outcomes of those with ALF. The ALF patients were listed for transplantation after they met the Kings' College criteria and rapid evaluation was done following a protocol consisting of three phases. Patients with grade III/IV encephalopathy were put on mechanical ventilation. Data regarding their postoperative course, morbidity, and mortality were analyzed. RESULTS Thirty-six (7.5%) out of the 479 patients underwent emergency LT for ALF. Their mean age was 27.5 years (range 4-59 years) and the male to female ratio of 2:3. Preoperative intubation was required in 15 of 25 patients who had encephalopathy. Wilson's disease was the most common cause of ALF in children while in adults, it was acute viral hepatitis. The time interval between listing and transplantation was a mean of 36 ± 12.4 h. The mean graft to recipient weight ratio (GRWR) was 1.06 ± 0.3. The recipients were extubated postoperatively after a mean period of 2.6 days and their mean ICU stay was 6.3 days. Postoperative infection was the most common complication and required upgradation of antifungal and antibiotic treatments. Neurological complications occurred in five patients. Thirty-one of 36 (86.1%) patients survived and progressive cerebral edema and sepsis were the most common causes of mortality. Patients who died had higher model for end-stage liver disease scores, longer cold ischemia time (CIT), and higher grades of encephalopathy (though 80% patients with encephalopathy survived). There was no donor mortality. At long-term follow up of a median of 56 months, 29 (80.5%) of 36 patients were still alive. CONCLUSIONS In our experience, LDLT is an alternative procedure to DDLT in patients with ALF and is associated with good outcomes even in patients with high grades of encephalopathy.
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Chen G, Sun J, Wei S, Chen Y, Tang G, Xie Z, Xu H, Chen J, Zhao H, Yuan Z, Wang W, Liu G, Wang B, Niu B. Simultaneous ABO-incompatible living-donor liver transplantation and splenectomy without plasma exchange in China: Two case reports. J Int Med Res 2017. [PMID: 28635356 PMCID: PMC5805207 DOI: 10.1177/0300060517710407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
ABO-incompatible (ABO-i) living-donor liver transplantation (LDLT) is performed
if an ABO-compatible graft cannot be obtained. However, a perfect
desensitization protocol has not been established worldwide, especially for
simultaneous ABO-i LDLT and splenectomy. We herein report two cases of ABO-i
LDLT. To the best of our knowledge, this is the first case report of ABO-i LDLT
in an adult patient in China. Splenectomy and T-cell-targeted immunosuppression
(basiliximab) was used to overcome the blood group barrier in these recipients.
The patients had good graft function without signs of antibody-mediated
rejection throughout the 12-month follow-up. Thus, ABO-i LDLT with splenectomy
is undoubtedly life-saving when an ABO-compatible graft cannot be obtained for
patients in critical condition.
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Affiliation(s)
- Guoyong Chen
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Janjun Sun
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Sidong Wei
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China.,2 Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou People's Hospital, Southern Medical University, Zhengzhou, China
| | - Yongfeng Chen
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Gaofeng Tang
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Zhantao Xie
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Huaen Xu
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Janbin Chen
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Huibo Zhao
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Zhenhua Yuan
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Weiwei Wang
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Guangbo Liu
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Bing Wang
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Biao Niu
- 1 Department of Hepatobiliary and Pancreatic Surgery, People's Hospital, Zhengzhou University, Zhengzhou, China
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12
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Goldaracena N, Spetzler VN, Marquez M, Selzner N, Cattral MS, Greig PD, Lilly L, McGilvray ID, Levy GA, Ghanekar A, Renner EL, Grant DR, Selzner M. Live donor liver transplantation: a valid alternative for critically ill patients suffering from acute liver failure. Am J Transplant 2015; 15:1591-7. [PMID: 25799890 DOI: 10.1111/ajt.13203] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/19/2014] [Accepted: 10/07/2014] [Indexed: 01/25/2023]
Abstract
We report the outcome of live donor liver transplantation (LDLT) for patients suffering from acute liver failure (ALF). From 2006 to 2013, all patients with ALF who received a LDLT (n = 7) at our institution were compared to all ALF patients receiving a deceased donor liver transplantation (DDLT = 26). Groups were comparable regarding pretransplant ICU stay (DDLT: 1 [0-7] vs. LDLT: 1 days [0-10]; p = 0.38), mechanical ventilation support (DDLT: 69% vs. LDLT: 57%; p = 0.66), inotropic drug requirement (DDLT: 27% vs. LDLT: 43%; p = 0.64) and dialysis (DDLT: 2 vs. LDLT: 0 patients; p = 1). Median evaluation time for live donors was 24 h (18-72 h). LDLT versus DDLT had similar incidence of overall postoperative complications (31% vs. 43%; p = 0.66). No difference was detected between LDLT and DDLT patients regarding 1- (DDLT: 92% vs. LDLT: 86%), 3- (DDLT: 92% vs. LDLT: 86%), and 5- (DDLT: 92% vs. LDLT: 86%) year graft and patient survival (p = 0.63). No severe donor complication (Dindo-Clavien ≥3 b) occurred after live liver donation. ALF is a severe disease with high mortality on liver transplant waiting lists worldwide. Therefore, LDLT is an attractive option since live donor work-up can be expedited and liver transplantation can be performed within 24 h with excellent short- and long-term outcomes.
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Affiliation(s)
- N Goldaracena
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - V N Spetzler
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - M Marquez
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - N Selzner
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - M S Cattral
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - P D Greig
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - L Lilly
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - I D McGilvray
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - G A Levy
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - A Ghanekar
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - E L Renner
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - D R Grant
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - M Selzner
- Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada
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13
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Zhang Y, Hu XY, Zhong S, Yang F, Zhou TY, Chen G, Wang YY, Luo JX. Entecavir vs lamivudine therapy for naïve patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure. World J Gastroenterol 2014; 20:4745-4752. [PMID: 24782628 PMCID: PMC4000512 DOI: 10.3748/wjg.v20.i16.4745] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/13/2014] [Accepted: 02/27/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the short-term and long-term efficacy of entecavir versus lamivudine in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure (ACLF).
METHODS: This was a single center, prospective cohort study. Eligible, consecutive hospitalized patients received either entecavir 0.5 mg/d or lamivudine 100 mg/d. All patients were given standard comprehensive internal medicine. The primary endpoint was survival rate at day 60, and secondary endpoints were reduction in hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels, and improvement in Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores at day 60 and survival rate at week 52.
RESULTS: One hundred and nineteen eligible subjects were recruited from 176 patients with severe acute exacerbation of chronic hepatitis B: 65 were included in the entecavir group and 54 in the lamivudine group (full analysis set). No significant differences were found in patient baseline clinical parameters. At day 60, entecavir did not improve the probability of survival (P = 0.066), despite resulting in faster virological suppression (P < 0.001), higher rates of virological response (P < 0.05) and greater reductions in the CTP and MELD scores (all P < 0.05) than lamivudine. Intriguingly, at week 52, the probability of survival was higher in the entecavir group than in the lamivudine group [42/65 (64.6%) vs 26/54 (48.1%), respectively; P = 0.038]. The pretreatment MELD score (B, 1.357; 95%Cl: 2.138-7.062; P = 0.000) and virological response at day 30 (B, 1.556; 95%Cl: 1.811-12.411; P =0.002), were found to be good predictors for 52-wk survival.
CONCLUSION: Entecavir significantly reduced HBV DNA levels, decreased the CTP and MELD scores, and thereby improved the long-term survival rate in patients with spontaneous reactivation of hepatitis B presenting as ACLF.
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14
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Shukla A, Vadeyar H, Rela M, Shah S. Liver Transplantation: East versus West. J Clin Exp Hepatol 2013; 3:243-53. [PMID: 25755506 PMCID: PMC3940244 DOI: 10.1016/j.jceh.2013.08.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/11/2013] [Indexed: 02/07/2023] Open
Abstract
Liver transplantation (LT) has evolved rapidly since the first successful liver transplant performed in1967. Despite a humble beginning, this procedure gained widespread acceptance in the western world as a suitable option for patients with end stage liver disease (ESLD) by the beginning of the 1980s. At present, approximately 25,000 liver transplants are being performed worldwide every year with approximately 90% one year survival. The techniques of living donor liver transplantation (LDLT) developed in East Asia in the 1990s to overcome the shortage of suitable grafts for children and scarcity of deceased donors. While deceased donor liver transplantation (DDLT) constitutes more than 90% of LT in the western world, in India and other Asian countries, most transplants are LDLT. Despite the initial disparity, outcomes following LDLT in eastern countries have been quite satisfactory when compared to the western programs. The etiologies of liver failure requiring LT vary in different parts of the world. The commonest etiology for acute liver failure (ALF) leading to LT is drugs in the west and acute viral hepatitis in Asia. The most common indication for LT due to ESLD in west is alcoholic cirrhosis and hepatitis C virus (HCV), while hepatitis B virus (HBV) predominates in the east. There is a variation in prognostic models for assessing candidature and prioritizing organ allocation across the world. Model for end-stage liver disease (MELD) is followed in United States and some European centers. Other European countries rely on the Child-Turcotte-Pugh (CTP) score. Some parts of Asia still follow chronological order of listing. The debate regarding the best model for organ allocation is far from over.
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Key Words
- ALF, acute liver failure
- CTP, Child–Turcotte–Pugh
- DCD, donation after cardiac death
- DDLT, deceased donor liver transplantation
- DIALF, drug-induced acute liver failure
- EDC, extended criteria
- ELTR, European Liver Transplant Registry
- ESLD, end stage liver disease
- ETV, Entecavir
- GRWR, Graft weight to recipient's body weight ratio
- HBIG, Hepatitis B Immunoglobulin
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- ITR, Indian Transplant Registry
- LAM, Lamivudine
- LDLT, living donor liver transplantation
- LLS, left lateral segment
- LT, liver transplantation
- MELD, model for end-stage liver disease
- MHV, middle hepatic vein
- MOHAN, Multi Organ Harvesting Aid Network
- NASH, nonalcoholic steatohepatitis
- NGOs, non-governmental organizations
- NOTA, National Organ Transplant Act
- OPO, Organ Procurement Organization
- OPTN, Organ Procurement and Transplantation Network
- PBC, primary biliary cirrhosis
- PSC, primary sclerosing cholangitis
- RLT, reduced LT
- SLT, split LT
- UCSF, University of California in San Francisco
- UNOS, United Network of Organ Sharing
- acute liver failure
- hepatitis B virus
- hepatitis C virus
- liver transplantation
- pmp, per million population
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Affiliation(s)
| | | | | | - Samir Shah
- Institute of Liver Diseases, HPB Surgery and Transplantation, Global Hospital – Superspeciality and Multiorgan Transplant Centre, 35, Dr. E. Borges Road, Hospital Avenue, Mumbai 400012, Maharashtra, India
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15
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Akamatsu N, Sugawara Y, Kokudo N. Acute liver failure and liver transplantation. Intractable Rare Dis Res 2013; 2:77-87. [PMID: 25343108 PMCID: PMC4204547 DOI: 10.5582/irdr.2013.v2.3.77] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/18/2013] [Indexed: 12/19/2022] Open
Abstract
Acute liver failure (ALF) is defined by the presence of coagulopathy (International Normalized Ratio ≥ 1.5) and hepatic encephalopathy due to severe liver damage in patients without pre-existing liver disease. Although the mortality due to ALF without liver transplantation is over 80%, the survival rates of patients have considerably improved with the advent of liver transplantation, up to 60% to 90% in the last two decades. Recent large studies in Western countries reported 1, 5, and 10-year patient survival rates after liver transplantation for ALF of approximately 80%, 70%, and 65%, respectively. Living donor liver transplantation (LDLT), which has mainly evolved in Asian countries where organ availability from deceased donors is extremely scarce, has also improved the survival rate of ALF patients in these regions. According to recent reports, the overall survival rate of adult ALF patients who underwent LDLT ranges from 60% to 90%. Although there is still controversy regarding the graft type, optimal graft volume, and ethical issues, LDLT has become an established treatment option for ALF in areas where the use of deceased donor organs is severely restricted.
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Affiliation(s)
- Nobuhisa Akamatsu
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yasuhiko Sugawara
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Address correspondence to: Dr. Yasuhiko Sugawara, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail:
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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16
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Zhang ZY. Efficacy of lamivudine combined with adefovir dipivoxil in management of chronic hepatitis B with acute or sub-acute liver failure. Shijie Huaren Xiaohua Zazhi 2013; 21:1020-1023. [DOI: 10.11569/wcjd.v21.i11.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Too investigate the efficacy of lamivudine combined with adefovir dipivoxil in the management of chronic hepatitis B with acute or sub-acute liver failure.
METHODS: Thirty-four chronic hepatitis B patients with acute or sub-acute liver failure were treated with a combination of lamivudine and adefovir, apart from traditional internal therapy. Fifty-four patients who were treated with traditional internal therapy only during the same period were used as controls. The results were compared between the two groups.
RESULTS: Significantly lower levels of serum total bilirubin, alanine aminotransferase and HBV DNA were detected in the combination group compared with the control group (242.7 μmol/L ± 72.5 μmol/L vs 347.4 μmol/L ± 97.6 μmol/L, 140.2 U/L ± 59.0 U/L vs 244.1 U/L ± 65.1 U/L, 4.22 copies/L ± 1.02 copies/L vs 6.37 copies/L ± 1.35 copies/L). Prothrombin activity was significantly higher at weeks 4, 8 and 12 in the treatment group than in the control group (55.2% ± 11.2% vs 30.9% ± 11.7%, 78.3% ± 27.8% vs 53.6% ± 17.1%, 96.4% ± 20.1% vs 72.7% ± 28.3%). The mortality at weeks 24 and 48 in the treatment group was significantly lower than that in the control group (14.7% vs 33.3%, 14.7% vs 35.2%).
CONCLUSION: Lamivudine combined with adefovir is more effective than the traditional internal therapy in the management of acute or sub-acute liver failure associated with chronic hepatitis B.
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