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Garcia J, Oltean M, Rumbo C, Sharkey L, Kaufman SS, Ramos Boluda E, Gupte G, Martinez M, Moon J, Raghu V, Segovia MC, Sudan D, Talbotec C, Varkey J, Gondolesi GE, Mazariegos G, Venick R. Endoscopic Surveillance of the Intestinal Allograft: Recommendations From the Intestinal Rehabilitation and Transplant Association Working Group. Transplantation 2024; 108:827-835. [PMID: 37723639 DOI: 10.1097/tp.0000000000004785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Intestinal transplant (ITx) rejection lacks a reliable noninvasive biomarker and rejection surveillance relies on serial endoscopies and mucosal biopsies followed by histologic assessment. Endoscopic biopsies are also essential for identifying other ITx-related complications such as infectious, allergic, and inflammatory graft enteritis as well as post-transplant lymphoproliferative disease or graft versus host disease. In spite of its central role in ITx, published guidelines on endoscopy and biopsy are lacking and significant variability between centers in terms of timing and technical performance exists. Therefore, an international expert group convened and discussed several aspects related to the surveillance endoscopy after ITx with the aim to summarize and standardize its practice. This article summarizes these considerations on endoscopic ITx monitoring and highlights practices of surveillance and for-cause endoscopy, biopsy techniques, pathologic evaluation, potential risks and complications, outsourcing, and less-invasive monitoring techniques.
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Affiliation(s)
- Jennifer Garcia
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, FL
| | - Mihai Oltean
- Sahlgrenska Intestinal Failure and Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carolina Rumbo
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Lisa Sharkey
- Department of Gastroenterology, Intestinal Failure and Intestinal/Multivisceral Transplant, Cambridge University Hospital, Cambridge, United Kingdom
| | | | | | - Girish Gupte
- Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Mercedes Martinez
- Center for Liver Disease and Abdominal Organ Transplantation, Columbia University Medical Center, New York, NY
| | - Jang Moon
- Recanati Miller Transplantation Institute, New York, NY
| | - Vikram Raghu
- Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Cécile Talbotec
- Pediatric Gastroenterology-Hepatology-Nutrition, Hôpital Necker-Enfants Malades, Paris, France
| | - Jonas Varkey
- Sahlgrenska Intestinal Failure and Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - George Mazariegos
- Children's Hospital of Pittsburgh, Hillman Center for Pediatric Transplantation, University of Pittsburgh Medical Center, Pittsburgh, PA
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Couper MR, Valamparampil J, Thyagarajan M, Hartley J, Gupte G. Intestinal ultrasound may be a useful tool in monitoring acute rejection following intestinal transplantation. Pediatr Transplant 2023; 27:e14574. [PMID: 37458363 DOI: 10.1111/petr.14574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Acute rejection is the leading cause of mortality and morbidity for children following intestinal transplantation. Rapid detection and prompt treatment are critical; however, the only reliable method of diagnosis and monitoring is endoscopic graft biopsies. The required regular anesthetics are particularly problematic in children, and non-invasive strategies are needed. METHODS We describe the intestinal ultrasound findings of three children before and after treatment for rejection. Ultrasounds were performed within 24 h of endoscopically obtained biopsies which were used to establish a diagnosis of rejection and to define severity. A single sonographer performed the ultrasounds and was blinded to biopsy results at the time of the scanning. These findings are provided in the context of the ultrasound appearance of seven children who had no features of rejection on surveillance biopsies. RESULTS Intestinal ultrasound demonstrated increased bowel wall thickness, vascularity, and mesenteric inflammation during moderate to severe rejection episodes. The submucosal layer was particularly thickened, which may represent a finding more specific for rejection. All patients demonstrated improvement in all quantitative ultrasound features correlating with the resolution of acute cellular rejection on histology. Patients with no evidence of rejection on biopsy had a bowel wall thickness range of 0.9-2.8 mm, suggesting a normal upper limit of 3 mm. CONCLUSION Moderate and severe acute rejection may be detected and response to treatment can be monitored by intestinal ultrasound and, correlating with clinical improvement, can aid in follow-up.
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Affiliation(s)
- Michael R Couper
- Liver Unit (Including Small Bowel Transplantation), Birmingham Women's, and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Joseph Valamparampil
- Liver Unit (Including Small Bowel Transplantation), Birmingham Women's, and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Manigan Thyagarajan
- Radiology Department, Birmingham Women's, and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jane Hartley
- Liver Unit (Including Small Bowel Transplantation), Birmingham Women's, and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Girish Gupte
- Liver Unit (Including Small Bowel Transplantation), Birmingham Women's, and Children's Hospital NHS Foundation Trust, Birmingham, UK
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Thompson RJ, Artan R, Baumann U, Calvo PL, Czubkowski P, Dalgic B, D’Antiga L, Di Giorgio A, Durmaz Ö, Gonzalès E, Grammatikopoulos T, Gupte G, Hardikar W, Houwen RH, Kamath BM, Karpen SJ, Lacaille F, Lachaux A, Lainka E, Loomes KM, Mack CL, Mattsson JP, McKiernan P, Ni Q, Özen H, Rajwal SR, Roquelaure B, Shteyer E, Sokal E, Sokol RJ, Soufi N, Sturm E, Tessier ME, van der Woerd WL, Verkade HJ, Vittorio JM, Wallefors T, Warholic N, Yu Q, Horn P, Kjems L. Interim results from an ongoing, open-label, single-arm trial of odevixibat in progressive familial intrahepatic cholestasis. JHEP Rep 2023; 5:100782. [PMID: 37456676 PMCID: PMC10338319 DOI: 10.1016/j.jhepr.2023.100782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/28/2023] [Accepted: 04/16/2023] [Indexed: 07/18/2023] Open
Abstract
Background & Aims PEDFIC 2, an ongoing, open-label, 72-week study, evaluates odevixibat, an ileal bile acid transporter inhibitor, in patients with progressive familial intrahepatic cholestasis. Methods PEDFIC 2 enrolled and dosed 69 patients across two cohorts; all received odevixibat 120 μg/kg per day. Cohort 1 comprised children from PEDFIC 1, and cohort 2 comprised new patients (any age). We report data through 15 July 2020, with Week 24 of PEDFIC 2 the main time point analysed. This represents up to 48 weeks of cumulative exposure for patients treated with odevixibat from the 24-week PEDFIC 1 study (cohort 1A) and up to 24 weeks of treatment for those who initiated odevixibat in PEDFIC 2 (patients who received placebo in PEDFIC 1 [cohort 1B] or cohort 2 patients). Primary endpoints for this prespecified interim analysis were change from baseline to Weeks 22-24 in serum bile acids (sBAs) and proportion of positive pruritus assessments (≥1-point drop from PEDFIC 2 baseline in pruritus on a 0-4 scale or score ≤1) over the 24-week period. Safety monitoring included evaluating treatment-emergent adverse events (TEAEs). Results In cohort 1A, mean change from PEDFIC 1 baseline to Weeks 22-24 of PEDFIC 2 in sBAs was -201 μmol/L (p <0.0001). For cohort 1B and cohort 2, mean changes from odevixibat initiation to weeks 22-24 in sBAs were -144 and -104 μmol/L, respectively. The proportion of positive pruritus assessments in the first 24-week period of PEDFIC 2 was 33%, 56%, and 62% in cohorts 1A, 1B, and 2, respectively. Most TEAEs were mild or moderate. No drug-related serious TEAEs occurred. Conclusions Odevixibat in patients with progressive familial intrahepatic cholestasis was generally well tolerated and associated with sustained reductions in sBAs and pruritus. Clinical Trials Registration This study is registered at ClinicalTrials.gov (NCT03659916). Impact and Implications Disrupted bile flow is a hallmark feature of patients with progressive familial intrahepatic cholestasis and can result in build-up of bile constituents in the liver with spill over into the bloodstream; other effects that patients can experience include extremely itchy skin, and because not enough bile reaches the gut, patients can have problems digesting food, which may lead to poor growth. Odevixibat is an orally administered medication that shunts bile acids away from the liver. The current study, called PEDFIC 2, suggested that odevixibat can improve the problematic signs and symptoms of progressive familial intrahepatic cholestasis and was generally safe for patients.
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Affiliation(s)
| | - Reha Artan
- Department of Pediatric Gastroenterology, Akdeniz University, Antalya, Turkey
| | - Ulrich Baumann
- Pediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - Pier Luigi Calvo
- Pediatric Gastroenterology Unit, Regina Margherita Children’s Hospital, Azienda Ospedaliera-Città della Salute e della Scienza di Torino, Turin, Italy
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Nutritional Disorders, and Pediatrics, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Buket Dalgic
- Department of Pediatric Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Lorenzo D’Antiga
- Pediatric Hepatology, Gastroenterology, and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Angelo Di Giorgio
- Pediatric Hepatology, Gastroenterology, and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Özlem Durmaz
- Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Emmanuel Gonzalès
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de Référence de l’Atrésie des Voies Biliaires et des Cholestases Génétiques, FSMR FILFOIE, ERN RARE LIVER, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Hépatinov, Inserm U 1193, Paris, France
| | - Tassos Grammatikopoulos
- Institute of Liver Studies, King’s College London, London, UK
- Pediatric Liver, GI, and Nutrition Center and MowatLabs, King’s College Hospital NHS Trust, London, UK
| | - Girish Gupte
- Liver Unit and Small Bowel Transplantation, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Winita Hardikar
- Department of Gastroenterology, Royal Children's Hospital, Melbourne, Australia
| | - Roderick H.J. Houwen
- Department of Pediatric Gastroenterology at the Wilhelmina Children’s Hospital and University Medical Center, Utrecht, The Netherlands
| | - Binita M. Kamath
- Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada
| | - Saul J. Karpen
- Pediatrics Department, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Florence Lacaille
- Pediatric Gastroenterology-Hepatology-Nutrition Unit, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Alain Lachaux
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service D’hépatogastoentérologie et Nutrition Pédiatrique, Lyon, France
| | - Elke Lainka
- Department of Pediatric Gastroenterology, Hepatology, and Liver Transplantation, University Children’s Hospital, Essen, Germany
| | - Kathleen M. Loomes
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cara L. Mack
- Pediatric Gastroenterology, Hepatology, & Nutrition, Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Patrick McKiernan
- Liver Unit and Small Bowel Transplantation, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | | | - Hasan Özen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sanjay R. Rajwal
- Children’s Liver Unit, Leeds Teaching Hospitals NHS Trust, Leeds Children’s Hospital, Leeds, UK
| | | | - Eyal Shteyer
- Faculty of Medicine, Hebrew University of Jerusalem, Juliet Keidan Department of Pediatric Gastroenterology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Etienne Sokal
- Université Catholique de Louvain, Cliniques St Luc, Brussels, Belgium
| | - Ronald J. Sokol
- University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Nisreen Soufi
- Pediatrics Department, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ekkehard Sturm
- Pediatric Gastroenterology and Hepatology, University Children’s Hospital Tübingen, Tübingen, Germany
| | - Mary Elizabeth Tessier
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
| | - Wendy L. van der Woerd
- Department of Pediatric Gastroenterology at the Wilhelmina Children’s Hospital and University Medical Center, Utrecht, The Netherlands
| | - Henkjan J. Verkade
- Department of Pediatrics, University of Groningen, Beatrix Children’s Hospital/University Medical Center Groningen, Groningen, The Netherlands
| | - Jennifer M. Vittorio
- Department of Surgery, Center for Liver Disease and Transplantation, Columbia University Medical Center, New York, NY, USA
| | | | | | - Qifeng Yu
- Albireo Pharma, Inc., Boston, MA, USA
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Alfares BA, van der Doef HPJ, Wildhaber BE, Casswall T, Nowak G, Delle M, Aldrian D, Berchtold V, Vogel GF, Kaliciński P, Markiewicz-Kijewska M, Kolesnik A, Bernabeu JQ, Hally MM, Larrarte K M, Marra P, Bravi M, Pinelli D, Kasahara M, Sakamoto S, Uchida H, Mali V, Aw M, Franchi-Abella S, Gonzales E, Guérin F, Cervio G, Minetto J, Sierre S, de Santibañes M, Ardiles V, Uno JW, Evans H, Duncan D, McCall J, Hartleif S, Sturm E, Patel J, Mtegha M, Prasad R, Ferreira CT, Nader LS, Farina M, Jaramillo C, Rodriguez-Davalos MI, Feola P, Shah AA, Wood PM, Acord MR, Fischer RT, Mullapudi B, Hendrickson RJ, Khanna R, Pamecha V, Mukund A, Sharif K, Gupte G, McGuirk S, Porta G, Spada M, Alterio T, Maggiore G, Hardikar W, Beretta M, Dierckx R, de Kleine RHJ, Bokkers RPH. Prevalence, management and efficacy of treatment in portal vein obstruction after paediatric liver transplantation: protocol of the retrospective international multicentre PORTAL registry. BMJ Open 2023; 13:e066343. [PMID: 37500271 PMCID: PMC10387733 DOI: 10.1136/bmjopen-2022-066343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Portal vein obstruction (PVO) consists of anastomotic stenosis and thrombosis, which occurs due to a progression of the former. The aim of this large-scale international study is to assess the prevalence, current management practices and efficacy of treatment in patients with PVO. METHODS AND ANALYSIS The Portal vein Obstruction Revascularisation Therapy After Liver transplantation registry will facilitate an international, retrospective, multicentre, observational study, with 25 centres around the world already actively involved. Paediatric patients (aged <18 years) with a diagnosed PVO between 1 January 2001 and 1 January 2021 after liver transplantation will be eligible for inclusion. The primary endpoints are the prevalence of PVO, primary and secondary patency after PVO intervention and current management practices. Secondary endpoints are patient and graft survival, severe complications of PVO and technical success of revascularisation techniques. ETHICS AND DISSEMINATION Medical Ethics Review Board of the University Medical Center Groningen has approved the study (METc 2021/072). The results of this study will be disseminated via peer-reviewed publications and scientific presentations at national and international conferences. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL9261).
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Affiliation(s)
- Bader A Alfares
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hubert P J van der Doef
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Barbara E Wildhaber
- Swiss Paediatric Liver Centre, Division of Child and Adolescent Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Thomas Casswall
- Department Clinical Interventions and Technology Clintec, Division for Paediatrics, Karolinska Institute, Stockholm, Sweden
| | - Greg Nowak
- Department Clinical Interventions and Technology Clintec, Division for Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Martin Delle
- Department Clinical Science, Intervention and Technology Clintec, Division for Interventional Radiology, Karolinska Institute, Stockholm, Sweden
| | - Denise Aldrian
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Valeria Berchtold
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg F Vogel
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Piotr Kaliciński
- Department of Paediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Adam Kolesnik
- Cardiovascular Interventions Laboratory, The Children's Memorial Health Institute, Warsaw, Poland
| | - Jesús Q Bernabeu
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - María Mercadal Hally
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - Mauricio Larrarte K
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Vall d'Hebron Hospital (HVH), Barcelona, Spain
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Bravi
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mureo Kasahara
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Uchida
- Organ Transplantation Centre, National Center for Child Health and Development, Tokyo, Japan
| | - Vidyadhar Mali
- Department of Paediatric Surgery, National University Hospital, Singapore
| | - Marion Aw
- Department of Paediatrics, National University Hospital, Singapore
| | | | - Emmanuel Gonzales
- Paediatric Hepatology and Paediatric Liver Transplantation Unit, Hôpital Bicêtre, Paris, France
| | - Florent Guérin
- Paediatric Surgery and Paediatric Liver Transplantation Unit, Hôpital Bicêtre, Paris, France
| | - Guillermo Cervio
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Julia Minetto
- Division of Liver Transplant, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Sergio Sierre
- Division of Interventional Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Martin de Santibañes
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimmy Walker Uno
- HPB and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Helen Evans
- Department of Paediatric Gastroenterology, Starship Children's Health, Auckland, New Zealand
| | - David Duncan
- Department of Paediatric Radiology, Starship Children's Health, Auckland, New Zealand
| | - John McCall
- Liver Transplant Unit, Starship Children's Health, Auckland, New Zealand
| | - Steffen Hartleif
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Ekkehard Sturm
- Paediatric Gastroenterology and Hepatology, University Hospitals Tubingen, Tubingen, Germany
| | - Jai Patel
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marumbo Mtegha
- Department of Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Raj Prasad
- Department of Surgery and Transplantation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Luiza S Nader
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Marco Farina
- Department of Paediatrics, Hospital Santo Antonio, Porto Alegre, Brazil
| | - Catalina Jaramillo
- Department of Paediatrics, Division of Paediatric Gastroenterology, Hepatology and Nutrition, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Peter Feola
- Paediatric Interventional Radiology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amit A Shah
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Phoebe M Wood
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ryan T Fischer
- Division of Paediatric Gastroenterology and Hepatology, Department of Paediatrics, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Bhargava Mullapudi
- Department of Paediatric Surgery, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Richard J Hendrickson
- Department of Paediatric Surgery, Children's Mercy Hospital Kansas, Overland Park, Kansas, USA
| | - Rajeev Khanna
- Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Viniyendra Pamecha
- Department Hepatobiliary Surgery and Liver transplantation, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Amar Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
| | - Khalid Sharif
- Liver Unit, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Girish Gupte
- Liver Unit, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Simon McGuirk
- Department of Interventional Radiology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Gilda Porta
- Department of Paediatric Hepatology, Hospital Sírio-Libanês, Sao Paulo, Brazil
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Ospedale Pediatrico Bambino Gesu, Roma, Italy
| | - Tommaso Alterio
- Gastrointestinal, Liver, Nutrition Disorders Unit, IRCCS Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Giuseppe Maggiore
- Gastrointestinal, Liver, Nutrition Disorders Unit, IRCCS Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Winita Hardikar
- Department of Pediatrics, Royal Children's Hospital Research Institute, Parkville, Victoria, Australia
| | - Marisa Beretta
- Faculty of Health Sciences, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Rudi Dierckx
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ruben H J de Kleine
- Division of Hepatobiliary Surgery & Liver Transplantation, Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Centre Groningen, Groningen, The Netherlands
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5
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Couper MR, Brown RM, Gupte G, Perera MTPR, Kelgeri C. Liver Disease in GLIS3 Mutations: Transplant Considerations and Bile Duct Paucity on Explant Histology. J Pediatr Gastroenterol Nutr 2023; 77:110-114. [PMID: 36917836 DOI: 10.1097/mpg.0000000000003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
GLI-similar 3 (GLIS3) gene mutation heterozygosity is characterized by neonatal diabetes and hypothyroidism. It has wide phenotypic variability. Liver disease is prevalent, and its complications in some phenotypes are life-limiting. Transplantation and the pathogenesis of GLIS3 liver disease are not well explored in the literature. We report 2 cases of children with GLIS3 mutations with chronic liver disease who required liver transplantation and we present a literature review discussing the pathogenic mechanisms and liver histology. Histology demonstrated predominantly biliary cirrhosis consistent with abnormal bile duct development. Both patients were considered for multi-organ transplantation (liver, pancreas with or without kidney) before receiving a liver transplant alone. Postoperative management can be challenging due to infection, renal disease, and brittle diabetes. GLIS3 mutations need to be added to the list of non-syndromic causes of bile duct paucity in the liver. Liver transplantation should be considered in patients with life-limiting complications related to liver disease.
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Affiliation(s)
- Michael R Couper
- From the Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Rachel M Brown
- the Anatomical Pathology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Girish Gupte
- From the Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - M Thamara P R Perera
- From the Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Chayarani Kelgeri
- From the Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
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6
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Alnagar A, Mirza DF, Muiesan P, G P Ong E, Gupte G, Van Mourik I, Hartley J, Kelly D, Lloyd C, Perera TPR, Sharif K. Long-term outcomes of pediatric liver transplantation using organ donation after circulatory death: Comparison between full and reduced grafts. Pediatr Transplant 2022; 26:e14385. [PMID: 36087024 DOI: 10.1111/petr.14385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/02/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The shortage of donors' livers for pediatric recipients inspired the search for alternatives including donation after cardiac death (DCD). METHODS Retrospective review of pediatric liver transplant (PLT) using DCD grafts. Patients were divided into either FLG or RLG recipients. Pre-transplant recipient parameters, donor parameters, operative parameters, post-transplant recipient parameters, and outcomes were compared. RESULTS Overall, 14 PLTs from DCD donors between 2005 and 2018 were identified; 9 FLG and 5 RLG. All donors were Maastricht category III. Cold ischemia time was significantly longer in RLG (8.2 h vs. 6.2 h; p = .038). Recipients of FLG were significantly older (180 months vs. 7 months; p = .012) and waited significantly longer (168 days vs. 22 days; p = .012). Recipients of RLG tended to be sicker in the immediate pre-transplant period and this was reflected by the need for respiratory or renal support. There was no significant difference between groups regarding long-term complications. Three patients in each group survived more than 5 year post-transplant. One child was re-transplanted in the RLG due to portal vein thrombosis but failed to survive after re-transplant. One child from FLG also died from a non-graft-related cause. CONCLUSIONS Selected DCD grafts are an untapped source to widen the donor pool, especially for sick recipients. In absence of agreed criteria, graft and recipient selection for DCD grafts should be undertaken with caution.
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Affiliation(s)
- Amr Alnagar
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Darius F Mirza
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Paolo Muiesan
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Evelyn G P Ong
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Girish Gupte
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Indra Van Mourik
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jane Hartley
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Deirdre Kelly
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Carla Lloyd
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Thamara P R Perera
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Khalid Sharif
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
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7
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Painter SL, Rana M, Barua A, Abbott J, Gupte G, Shah S, Parulekar M. Outcomes following tacrolimus systemic immunosuppression for penetrating keratoplasty in infants and young children. Eye (Lond) 2022; 36:2286-2293. [PMID: 34839362 PMCID: PMC9674676 DOI: 10.1038/s41433-021-01855-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To report outcomes of tacrolimus immunosuppression after penetrating keratoplasty (PK) in very young children. METHODS Retrospective, consecutive, cohort study of children undergoing PK at a tertiary children's hospital between 2005 and 2016. Oral tacrolimus immunosuppression was given for 2 years, followed by topical tacrolimus. RESULTS Fourteen children (20 eyes) had 24 PKs; nineteen eyes had primary PKs, five eyes had repeat PKs. Mean age at primary graft was 95 days (3.1 months) for anterior segment dysgenesis (ASD), 430 days (14.3 months) for non-ASD children. Eleven children (15 eyes) had ASD. Three children (five eyes) had non-ASD: two children (three eyes) had glaucoma-related corneal opacity and one child (two eyes) had congenital hereditary endothelial dystrophy (CHED). One-year rejection-free survival rates following primary PK was 80% for ASD (n = 15) and 100% for non-ASD (n = 4). At final review, 5/15 of primary grafts for ASD were clear. 10/15 failed after a mean of 19 months, specifically attributable to infection (n = 2), rejection (n = 2) and glaucoma (n = 2). 4/4 primary non-ASD grafts are clear at final review (mean follow-up = 77 months). All repeat grafts (n = 5), failed after a mean of 38.25 months. Considering all grafts, 15/24 (62.5%) failed: 5/15 due to infection, 2/15 due to rejection, 8/15 due to glaucoma, phthisis, perforation or vascularised with no rejection. At last review (mean = 58.1 months, range 28-84), overall cohort survival is 37.5%. Final visual acuities range between 0.86 and 2.4 LogMAR. CONCLUSION We compare our results to published literature: 1-year graft survival was higher than previously reported, with lower failure due to rejection. Overall infection rates did not increase, however, proportionally, severe infections were higher. Overall graft survival is at least comparable to reported literature.
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Affiliation(s)
- Sally L Painter
- Department of Ophthalmology, Birmingham Children's Hospital, Birmingham, UK
| | - Mrinal Rana
- Department of Ophthalmology, North West Anglia Hospitals NHS Trust, Peterborough, UK
| | - Ankur Barua
- Department of Ophthalmology, Birmingham Midlands Eye Centre, Birmingham, UK
| | - Joseph Abbott
- Department of Ophthalmology, Birmingham Children's Hospital, Birmingham, UK
| | - Girish Gupte
- Department of Hepatology, Birmingham Children's Hospital, Birmingham, UK
| | - Sunil Shah
- Department of Ophthalmology, Birmingham Midlands Eye Centre, Birmingham, UK
| | - Manoj Parulekar
- Department of Ophthalmology, Birmingham Children's Hospital, Birmingham, UK.
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8
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Chan J, Gupte G. Fifteen-minute consultation: Child with an incidental finding of a fatty liver. Arch Dis Child Educ Pract Ed 2022; 107:246-252. [PMID: 33990372 DOI: 10.1136/archdischild-2020-321135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/03/2022]
Abstract
The incidental finding of a fatty liver on an abdominal ultrasound scan performed for an unrelated reason in an overweight child is an increasingly common phenomenon in paediatric practice. This article will explain the steps to be taken when receiving such an ultrasound report.
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Affiliation(s)
- Joseph Chan
- Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
| | - Girish Gupte
- Department of Paediatric Hepatology, Birmingham Children's Hospital, Birmingham, UK
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9
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Thompson RJ, Arnell H, Artan R, Baumann U, Calvo PL, Czubkowski P, Dalgic B, D'Antiga L, Durmaz Ö, Fischler B, Gonzalès E, Grammatikopoulos T, Gupte G, Hardikar W, Houwen RHJ, Kamath BM, Karpen SJ, Kjems L, Lacaille F, Lachaux A, Lainka E, Mack CL, Mattsson JP, McKiernan P, Özen H, Rajwal SR, Roquelaure B, Shagrani M, Shteyer E, Soufi N, Sturm E, Tessier ME, Verkade HJ, Horn P. Odevixibat treatment in progressive familial intrahepatic cholestasis: a randomised, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol 2022; 7:830-842. [DOI: 10.1016/s2468-1253(22)00093-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 12/12/2022]
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10
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Singh H, Kelgeri C, Passingham C, Johansen L, van Mourik I, Ong E, Perera MTPR, Mirza D, Sharif K, Hartley J, Gupte G. Response to Acute-on-Chronic Liver Failure: why children are not small adults. Acta Paediatr 2022; 111:1825-1826. [PMID: 35771191 DOI: 10.1111/apa.16471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Harveen Singh
- Clinical Liver Fellow, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - Chayarani Kelgeri
- Paediatric Hepatologist, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - Charlotte Passingham
- Research Co-ordinator, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - Lauren Johansen
- Paediatric Hepatologist, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - Indra van Mourik
- Paediatric Hepatologist, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - Evelyn Ong
- Paediatric Hepatobiliary and Transplant Surgeon, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - M Thamara P R Perera
- Hepatobiliary and Transplant Surgeon, University Hospitals Birmingham NHS Foundation Trust; Liver Unit, Women's Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Darius Mirza
- Hepatobiliary and Transplant Surgeon, University Hospitals Birmingham NHS Foundation Trust; Liver Unit, Women's Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Khalid Sharif
- Paediatric Hepatobiliary and Transplant Surgeon, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - Jane Hartley
- Paediatric Hepatologist, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
| | - Girish Gupte
- Paediatric Hepatologist, Liver Unit, Children's Hospital, Birmingham, Birmingham, UK
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11
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Singh H, Selvarajan L, Ong SY, Ali S, Sharif K, Mirza D, Gupte G. Late Bleeding Episodes Following Intestinal Transplantation: It Is Not Always Rejection or Infection. JPGN Rep 2022; 3:e174. [PMID: 37168923 PMCID: PMC10158307 DOI: 10.1097/pg9.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/23/2021] [Indexed: 05/13/2023]
Abstract
Ectopic varices have been reported in 5% of children presenting with variceal bleeding and are defined as portosystemic venous collaterals occurring anywhere in the abdomen except in the cardioesophageal region. The liver-intestinal transplant or isolated liver-intestinal transplant patient presenting several years post-transplant with ectopic variceal bleeding as a consequence of portal hypertension is a seldom reported complication. Etiologies such as rejection or infection are a more common source of bleeding, and only after excluding these can differentials such as portal hypertension secondary to a blocked portacaval shunt or native liver disease be considered.
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Affiliation(s)
- Harveen Singh
- From the Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Lakshmi Selvarajan
- From the Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Sik-Yong Ong
- From the Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Sajeed Ali
- University of Cambridge School of Medicine, Cambridge, United Kingdom
| | - Khalid Sharif
- From the Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - Darius Mirza
- From the Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Girish Gupte
- From the Liver Unit, Birmingham Children’s Hospital, Birmingham, United Kingdom
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12
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Zellos A, Debray D, Indolfi G, Czubkowski P, Samyn M, Hadzic N, Gupte G, Fischler B, Smets F, de Cléty SC, Grenda R, Mozer Y, Mancell S, Jahnel J, Auzinger G, Worth A, Lisman T, Staufner C, Baumann U, Dhawan A, Alonso E, Squires RH, Verkade HJ. Proceedings of ESPGHAN Monothematic Conference 2020: "Acute Liver Failure in Children": Diagnosis and Initial Management. J Pediatr Gastroenterol Nutr 2022; 74:e45-e56. [PMID: 35226643 DOI: 10.1097/mpg.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) aims to educate pediatric gastroenterologists, members of ESPGHAN and professionals from other specialties promoting an exchange of clinical expertise in the field of pediatric hepatology. Herewith we have concentrated on detailing the recent advances in acute liver failure in infants and children. METHODS The 2020 ESPGHAN monothematic three-day conference on pediatric hepatology disease, entitled "acute liver failure" (ALF), was organized in Athens, Greece. ALF is a devastating disease with high mortality and most cases remain undiagnosed. As knowledge in diagnosis and treatment of ALF in infants and children has increased in the past decades, the objective was to update physicians in the field with the latest research and developments in early recognition, curative therapies and intensive care management, imaging techniques and treatment paradigms in these age groups. RESULTS In the first session, the definition, epidemiology, various causes of ALF, in neonates and older children and recurrent ALF (RALF) were discussed. The second session was dedicated to new aspects of ALF management including hepatic encephalopathy (HE), coagulopathy, intensive care interventions, acute on chronic liver failure, and the role of imaging in treatment and prognosis. Oral presentations by experts in various fields are summarized highlighting key learning points. CONCLUSIONS The current report summarizes the major learning points from this meeting. It also identifies areas where there is gap of knowledge, thereby identifying the research agenda for the near future.
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Affiliation(s)
- Aglaia Zellos
- First Department of Pediatrics, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dominique Debray
- Pediatric Hepatology Unit, Hôpital Necker-Enfants Malades, Reference Center for Rare Pediatric Liver Diseases, ERN Rare Liver and Transplant Child, Paris, France
| | - Giuseppe Indolfi
- Department Neurofarba University of Florence, Meyer Children's University Hospital of Florence, Florence, Italy
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology and Nutritional Disorders and Pediatrics. The Children's Memorial Health Institute, Warsaw, Poland
| | - Marianne Samyn
- Paediatric Liver, GI & Nutrition Centre, King's College London School of Medicine at King's College Hospital
| | | | - Girish Gupte
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - Björn Fischler
- Department of Pediatrics, CLINTEC Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Françoise Smets
- Pediatrics, Cliniques universitaires Saint-Luc, Université Catholique de Louvain
| | - Stéphan Clément de Cléty
- Paediatric intensive care, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation & Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Yael Mozer
- Schneider Children's Medical Center, Israel
| | | | | | - Georg Auzinger
- King's College Hospital, Department Chair, Critical Care Cleveland Clinic
| | - Austen Worth
- Great Ormond Street Hospital for Children, London, UK
| | - Ton Lisman
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian Staufner
- Division of Neuropediatrics and Pediatric Metabolic Medicine, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Anil Dhawan
- Variety Children Hospital, Director Paediatric Liver GI and Nutrition and Mowat Labs, King's College Hospital, London, UK
| | - Estelle Alonso
- Siragusa Transplant Center, Ann and Robert H. Lurie Children' Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Robert H Squires
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Henkjan J Verkade
- Department of Paediatrics, University of Groningen, Beatrix Children's Hospital, University Medical Center, Groningen, The Netherlands
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13
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Zellos A, Debray D, Indolfi G, Czubkowski P, Samyn M, Hadzic N, Gupte G, Fischler B, Smets F, Clément de Cléty S, Grenda R, Mozer Y, Mancell S, Jahnel J, Auzinger G, Worth A, Lisman T, Staufner C, Baumann U, Dhawan A, Alonso E, Squires RH, Verkade HJ. Proceedings of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition Monothematic Conference, 2020: "Acute Liver Failure in Children": Treatment and Directions for Future Research. J Pediatr Gastroenterol Nutr 2022; 74:338-347. [PMID: 35226644 DOI: 10.1097/mpg.0000000000003345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) aims to educate pediatric gastroenterologists, members of ESPGHAN and professionals from other specialties promoting an exchange of clinical expertise in the field of pediatric hepatology. METHODS The 2020 single topic ESPGHAN monothematic 3-day conference on pediatric liver disease, was organized in Athens, Greece and was entitled " Acute Liver Failure" (ALF). ALF is a devastating disease with high mortality and in a considerable fraction of patients, the cause remains unresolved. As knowledge in diagnosis and treatment of ALF in infants and children has increased in the past decades, the objective was to update physicians in the field with developments in medical therapy and indications for liver transplantation (LT) and to identify areas for future research in clinical and neurocognitive outcomes in ALF. RESULTS We recently reported the epidemiology, diagnosis, and initial intensive care management issues in separate manuscript. Herewith we report on the medical treatment, clinical lessons arising from pediatric studies, nutritional and renal replacement therapy (RRT), indications and contraindications for LT, neurocognitive outcomes, new techniques used as bridging to LT, and areas for future research. Oral presentations by experts in various fields are summarized highlighting key learning points. CONCLUSIONS The current report summarizes the current insights in medical treatment of pediatric ALF and the directions for future research.
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Affiliation(s)
- Aglaia Zellos
- First Department of Pediatrics, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Greece
| | - Dominique Debray
- Pediatric Hepatology Unit, Hôpital Necker-Enfants Malades, Reference Center for Rare Pediatric Liver Diseases, ERN Rare Liver and Transplant Child, Paris, France
| | - Giuseppe Indolfi
- Department Neurofarba, University of Florence, Meyer Children's University Hospital of Florence, Florence, Italy
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology and Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Marianne Samyn
- Paediatric Liver, GI & Nutrition Centre, King's College London School of Medicine
| | | | - Girish Gupte
- Birmingham Children's Hospital NHS Trust, Birmingham, UK
| | - Björn Fischler
- Department of Pediatrics, CLINTEC Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Françoise Smets
- Department of Pediatrics, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | - Ryszard Grenda
- Department of Nephrology, Kidney Transplantation & Hypertension, The Children's Memorial Health Institute, Warsaw, Poland
| | - Yael Mozer
- Schneider Children's Medical Center, Israel
| | | | | | | | - Austen Worth
- Department of Immunology, Great Ormond Street Hospital for Children, London, UK
| | - Ton Lisman
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian Staufner
- Division of Neuropediatrics and Pediatric Metabolic Medicine, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg
| | | | - Anil Dhawan
- Paediatric Liver GI and Nutrition and Mowat Labs, King's College Hospital, London, UK
| | - Estelle Alonso
- Siragusa Transplant Center, Ann and Robert H. Lurie Children' Hospital, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Robert H Squires
- Division of Pediatric Gastronterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Henkjan J Verkade
- Department of Paediatrics, University of Groningen, Beatrix Children's Hospital/ University Medical Center, Groningen, The Netherlands
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14
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Yilmaz O, Daly A, Pinto A, Ashmore C, Evans S, Gupte G, Jackson R, Yabanci Ayhan N, MacDonald A. Physical Growth of Patients with Hereditary Tyrosinaemia Type I: A Single-Centre Retrospective Study. Nutrients 2021; 13:nu13093070. [PMID: 34578949 PMCID: PMC8472760 DOI: 10.3390/nu13093070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 12/23/2022] Open
Abstract
In a retrospective review, we aimed to assess long-term growth in 17 patients (n = 11 males) with hereditary tyrosinaemia type I (HTI). Median age at assessment was 15.6 years (5.7-26.6 years) and median age at diagnosis was 1 month (range: 0-16 months), with 35% (n = 6/17) symptomatic on presentation. From the age of 8 years, there was a noticeable change in median height, weight, and body-mass-index [BMI]-z-scores. Median height-for-age z-scores were consistently ≤ -1 (IQR -1.6, -0.5) during the first 8 years of life but increased with age. Weight-for-age z-scores ranged between -1 to 0 (IQR -1.2, 0.1) in the first 8 years; then increased to > 0.5 (IQR -0.3, 1.3) by age 16 years, and BMI-for-age z-scores ranged from 0 to 1 (IQR -0.7, 1.3) up to 8 years, and >1 (IQR -0.2, 1.9) until 16 years. The percentage of overweight and obesity was lowest in children aged < 5 years, and consistently > 40% in patients aged between 7 to 16 years. The prescribed total protein intake was associated with improved height growth (p < 0.01). Impaired growth in early life improved with age achieving normal population standards. Further studies are needed to investigate factors that influence growth outcome in HTI patients.
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Affiliation(s)
- Ozlem Yilmaz
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.)
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara Yildirim Beyazit University, Ankara 06760, Turkey
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara 06290, Turkey;
| | - Anne Daly
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.)
| | - Alex Pinto
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.)
| | - Catherine Ashmore
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.)
| | - Sharon Evans
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.)
| | - Girish Gupte
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.)
| | - Richard Jackson
- Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool L69 3GL, UK;
| | - Nurcan Yabanci Ayhan
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara 06290, Turkey;
| | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.)
- Correspondence: ; Tel.: +01213338024
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15
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Kyrana E, Rees D, Lacaille F, Fitzpatrick E, Davenport M, Heaton N, Height S, Samyn M, Mavilio F, Brousse V, Suddle A, Chakravorty S, Verma A, Gupte G, Velangi M, Inusa B, Drasar E, Hadzic N, Grammatikopoulos T, Hind J, Deheragoda M, Sellars M, Dhawan A. Clinical management of sickle cell liver disease in children and young adults. Arch Dis Child 2021; 106:315-320. [PMID: 33177052 PMCID: PMC7610372 DOI: 10.1136/archdischild-2020-319778] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/02/2020] [Accepted: 08/30/2020] [Indexed: 11/03/2022]
Abstract
Liver involvement in sickle cell disease (SCD) is often referred to as sickle cell hepatopathy (SCH) and is a complication of SCD which may be associated with significant mortality. This review is based on a round-table workshop between paediatric and adult hepatologists and haematologists and review of the literature. The discussion was prompted by the lack of substantial data and guidance in managing these sometimes very challenging cases. This review provides a structured approach for the diagnosis and management of SCH in children and young adults. The term SCH describes any hepatobiliary dysfunction in the context of SCD. Diagnosis and management of biliary complications, acute hepatic crisis, acute hepatic sequestration and other manifestations of SCH are discussed, as well as the role of liver transplantation and haemopoietic stem cell transplantation in the management of SCH.
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Affiliation(s)
- Eirini Kyrana
- Children’s Live Unit, Leeds General Infirmary, Leeds, UK
| | - David Rees
- King’s College London, Department of Haematological Medicine, King’s College Hospital, Denmark Hill, London
| | - Florence Lacaille
- Gastroenterology-Hepatology-Nutrition Unit, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris
| | - Emer Fitzpatrick
- Institute of Liver Studies, King’s College London, Denmark Hill, London, UK
| | - Mark Davenport
- Department of Paediatric Surgery, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Nigel Heaton
- Hepatobiliary and Pancreatic Surgery/Liver Transplantation, King’s College Hospital NHS Trust, Denmark Hill, SE9 5RS, London, UK
| | - Sue Height
- Paediatric Haematology, King’s College Hospital NHS Trust, London
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition Centre, King’s College Hospital NHS Trust, London, UK
| | - Fulvio Mavilio
- Department of Life Sciences, University of Modena and Reggio Emilia Via Campi, 287; 41125 Modena – Italy
| | - Valentine Brousse
- Service de Pédiatrie Générale et Maladies Infectieuses, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris
| | - Abid Suddle
- Institute of Liver Studies, King’s College Hospital NHS Trust, Denmark Hill, SE9 5RS, London, UK
| | - Subarna Chakravorty
- Paediatric Haematology, King’s College Hospital NHS Trust, Denmark Hill, London, UK
| | - Anita Verma
- Institute of Liver Studies, Kings College Hospital, Denmark Hill, SE9 5RS, London UK
| | - Girish Gupte
- Liver Unit (including small bowel transplantation), Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH
| | - Mark Velangi
- Department of Haematology, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH
| | - Baba Inusa
- Children's sickle cell and thalassaemia centre at Evelina London Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH
| | - Emma Drasar
- Department of Clinical Haematology, University College London Hospitals, 250 Euston Roads Bloomsbury, London NW1 2PG
| | - Nedim Hadzic
- Paediatric Centre for Hepatology, Gastroenterology and Nutrition, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI & Nutrition Centre and MowatLabs King's College Hospital NHS Foundation Trust, London and Institute of Liver Studies, King’s College London, Denmark Hill, London, SE5 9RS
| | - Jonathan Hind
- Paediatric Liver, GI and Nutrition Centre, King’s College Hospital NHS Trust, London, UK
| | - Maesha Deheragoda
- Liver Histopathology Laboratory, Institute of Liver Studies, King’s College Hospital, London, UK
| | - Maria Sellars
- Department of Radiology, Kings College Hospital, Denmark Hill, London, UK
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre and MowatLabs, King's College Hospital NHS Foundation Trust, London, UK
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16
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Yilmaz O, Daly A, Pinto A, Ashmore C, Evans S, Gupte G, Santra S, Preece MA, Mckiernan P, Kitchen S, Yabanci Ayhan N, MacDonald A. Natural Protein Tolerance and Metabolic Control in Patients with Hereditary Tyrosinaemia Type 1. Nutrients 2020; 12:E1148. [PMID: 32325917 PMCID: PMC7230348 DOI: 10.3390/nu12041148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022] Open
Abstract
In a longitudinal retrospective study, we aimed to assess natural protein (NP) tolerance and metabolic control in a cohort of 20 Hereditary Tyrosinaemia type I (HTI) patients. Their median age was 12 years ([3.2-17.7 years], n = 11 female, n = 8 Caucasian, n = 8 Asian origin, n = 2 Arabic and n = 2 Indian). All were on nitisinone (NTBC) with a median dose of 0.7 g/kg/day (range 0.4-1.5 g/kg/day) and were prescribed a tyrosine (Tyr)/phenylalanine (Phe)-restricted diet supplemented with Tyr/Phe-free L-amino acids. Data were collected on clinical signs at presentation, medical history, annual dietary prescriptions, and blood Phe and Tyr levels from diagnosis until transition to the adult service (aged 16-18 years) or liver transplantation (if it preceded transition). The median age of diagnosis was 2 months (range: 0 to 24 months), with n = 1 diagnosed by newborn screening, n = 3 following phenylketonuria (PKU) screening and n = 7 by sibling screening. Five patients were transplanted (median age 6.3 years), and one died due to liver cancer. The median follow-up was 10 years (3-16 years), and daily prescribed NP intake increased from a median of 5 to 24 g/day. Lifetime median blood Tyr (370 µmol/L, range 280-420 µmol/L) and Phe (50 µmol/L, 45-70 µmol/L) were maintained within the target recommended ranges. This cohort of HTI patients were able to increase the daily NP intake with age while maintaining good metabolic control. Extra NP may improve lifelong adherence to the diet.
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Affiliation(s)
- Ozlem Yilmaz
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
- Department of Nutrition and Dietetics, Ankara Yildirim Beyazit University, 06760 Ankara, Turkey
| | - Anne Daly
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Alex Pinto
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Catherine Ashmore
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Sharon Evans
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Girish Gupte
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Saikat Santra
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Mary Anne Preece
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | - Patrick Mckiernan
- Gastroenterology/ Hepatic/Nutrition, UPMC, Children’s Hospital of Pittsburg, Pittsburg, PA 15224, USA;
| | - Steve Kitchen
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
| | | | - Anita MacDonald
- Birmingham Women’s and Children’s Hospital, Birmingham B4 6NH, UK; (O.Y.); (A.D.); (A.P.); (C.A.); (S.E.); (G.G.); (S.S.); (M.A.P.); (S.K.)
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17
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Abstract
Abstract
Background
Liver injury is known in patients on methotrexate (MTX). We retrospectively reviewed records of patients who had liver biopsy for suspected MTX induced liver injury and identify risk factors if any.
Methods
Children (≤ 16 years) referred to us from 2002 to 2015 with suspected MTX induced liver injury were identified and data related to their underlying diagnosis, biochemical parameters, Body Mass Index (BMI), dose and duration of MTX at the time of liver biopsy, use of concomitant drugs, duration and other causes for elevated transaminases, liver histology including clinical decisions to continue or stop MTX were extracted from the data base. All the liver biopsies were re-analysed for this study and scored using the Roenigk classification by a single histopathologist blinded to patient characteristics.
Results
Seventeen liver biopsies were performed in 14 children (3 had repeat biopsies) who were referred for frequent/persistent transaminitis (> 2 times upper limit normal).
The base line bilirubin, transaminases and synthetic liver function were normal in all prior to MTX therapy. All were on MTX at the time of biopsy except two who had been off the drug for 3 and 8 months following frequent transaminitis. They had liver biopsy to guide reintroduction of MTX in their treatment regime. None of the patients had renal impairment, diabetes or underlying liver disease.
Thirteen biopsies (82 %) had none (n = 6) to mild liver injury (n = 7) and were advised to continue MTX. Four biopsies (18%) showed significant liver injury (grade 3b and 4). Of these 3 patients were advised to stop MTX while one was advised to continue and repeat liver biopsy in 6 months. He however, stopped MTX soon thereafter. All biopsies of children (n = 3) with BMI ≥ 91st centile had liver damage. Two of thirteen biopsies with BMI < 91 centile had moderate-severe damage. No correlation was seen between the histologic findings or their severity with dose or duration of MTX, concomitant use of other drugs, severity/highest transaminase peak, total duration of transaminase abnormality, longest single episode of transaminase abnormality or frequency/number of peaks of abnormal transaminases. Of the 3 with repeat biopsies, fibrosis had progressed in 2, necessitating discontinuation of MTX in 1.
Conclusion
The finding of significant liver injury in our cohort is not entirely in keeping with previous paediatric studies which report non-significant fibrosis or cirrhosis. We could not identify any risk factors though children with BMI ≥ 91st centile seemed more likely to have liver injury. This finding is similar to adult studies implicating obesity as risk factor though it is difficult to draw definitive conclusions given the small size of our cohort. Other limitations include the retrospective nature of the study, bias as MTX dose modifications and referral were at the discretion of the rheumatologist and no information on alcohol intake in the teenagers.
This study emphasises the need for careful monitoring to prevent severe fibrosis and cirrhosis.
Conflicts of Interest
The authors declare no conflicts of interest.
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Affiliation(s)
- Chayarani Kelgeri
- Rheumatology, Birmingham Women’s and Children’s NHS Trust, Birmingham, United Kingdom
| | | | - Rachel Brown
- Rheumatology, Birmingham Women’s and Children’s NHS Trust, Birmingham, United Kingdom
- Pathology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Eslam Al-Abadi
- Rheumatology, Birmingham Women’s and Children’s NHS Trust, Birmingham, United Kingdom
| | - Girish Gupte
- Rheumatology, Birmingham Women’s and Children’s NHS Trust, Birmingham, United Kingdom
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Warner S, McKiernan PJ, Hartley J, Ong E, van Mourik ID, Gupte G, Abdel-Hady M, Muiesan P, Perera T, Mirza D, Sharif K, Kelly DA, Beath SV. Hepatopulmonary Syndrome in Children: A 20-Year Review of Presenting Symptoms, Clinical Progression, and Transplant Outcome. Liver Transpl 2018; 24:1271-1279. [PMID: 30066494 DOI: 10.1002/lt.25296] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023]
Abstract
Hepatopulmonary syndrome (HPS) in stable patients with cirrhosis can easily be overlooked. We report on the presenting symptoms, disease progression, and outcomes after liver transplantation (LT) in children with HPS. Twenty patients were diagnosed with HPS between 1996 and 2016. The etiologies were as follows: biliary atresia (n = 9); alpha-1-antitrypsin deficiency (n = 2); cryptogenic liver disease (n = 3); and others (n = 6). HPS presentations were as follows; dyspnea (n = 17) and pneumonia (n = 3). For diagnostic confirmation, the following techniques were used: technetium-99m-labeled macroaggregated albumin lung perfusion scan (n = 13) or contrast echocardiogram (n = 7). There were 16 patients listed for LT, with a median age at HPS diagnosis of 10 years and an average wait from listing to LT of 9 weeks. A marked rise in hemoglobin (Hb; median, 125-143.5 g/L) and modest decrease in oxygen saturation (SpO2 ; median 91% to 88% room air) were evident over this time. Patients' need for assisted ventilation (1 day), pediatric intensive care unit (PICU) stay (3 days), and total hospital stay (20 days) were similar to our general LT recipients-the key difference in the postoperative period was the duration of supplementary O2 requirement. Hb of ≥130 g/L on the day of LT correlated with a longer PICU stay (P value = 0.02), duration of supplementary O2 (P value = 0.005), and the need for the latter beyond 7 days after LT (P value = 0.01). Fifteen patients had resolution of their HPS after LT. The 5-, 10-, and 20-year survival rates were unchanged at 87.5%. None had a recurrence of HPS. In conclusion, HPS is a life-threatening complication of cirrhosis which usually develops insidiously. This combined with the often-stable nature of the liver disease leads to delays in diagnosis and listing for LT. Progressive polycythemia extends the need for supplementary O2 and PICU stay. We advocate screening for HPS with a combination of SpO2 and Hb monitoring to facilitate earlier recognition, timely LT, and shortened recovery periods.
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Affiliation(s)
- Suz Warner
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom.,Centre for Liver Research and National Institute for Health Research Biomedical Research Unit in Liver Disease, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Patrick J McKiernan
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Jane Hartley
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Evelyn Ong
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Indra D van Mourik
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Girish Gupte
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Mona Abdel-Hady
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Paolo Muiesan
- University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Thamera Perera
- University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Darius Mirza
- University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Khalid Sharif
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Deirdre A Kelly
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Susan V Beath
- The Liver Unit, Birmingham Women's and Children's Hospitals National Health Service Foundation Trust, Birmingham, United Kingdom
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19
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Norsa L, Gupte G, Ramos Boluda E, Joly F, Corcos O, Pirenne J, Herlenius G, Lacaille F. Life of patients 10 years after a successful pediatric intestinal transplantation in Europe. Am J Transplant 2018; 18:1489-1493. [PMID: 29316190 DOI: 10.1111/ajt.14654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 12/05/2017] [Accepted: 12/27/2017] [Indexed: 01/25/2023]
Abstract
A multicenter Europe-wide single-point study in intestinal transplantation (ITx) centers was conducted to identify and describe patients surviving for more than 10 years after ITx in childhood. The health and nutritional status, care requirements and psychosocial status were recorded. Among 120 transplanted before 2005, 38 patients with a functioning graft were included. Thirty (79%) had an exclusive oral diet, seven (18%) complimentary enteral nutrition for eating disorders, and one a combination of parenteral and enteral nutrition. They received a median of five drugs daily and five had a stoma. We did not observe any catch-up growth during the 10 years of follow-up. In the previous five years, 22 patients needed unplanned hospitalization with a median in-patient stay of six days. Eleven needed ongoing psychiatric follow-ups, and nine needed other specialist follow-ups. An increasing independency from parents was seen after the age of 18, with three having a stable employment and 31 pursuing education. Despite a good graft function, growth may not catch up. The burden of medical care remains high in the long term. This has to be closely followed in a multidisciplinary setting to improve long-term quality of life in these patients.
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20
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Mieli-Vergani G, Vergani D, Baumann U, Czubkowski P, Debray D, Dezsofi A, Fischler B, Gupte G, Hierro L, Indolfi G, Jahnel J, Smets F, Verkade HJ, Hadžić N. Diagnosis and Management of Pediatric Autoimmune Liver Disease: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr 2018; 66:345-360. [PMID: 29356770 DOI: 10.1097/mpg.0000000000001801] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Paediatric autoimmune liver disease is characterized by inflammatory liver histology, circulating autoantibodies, and increased levels of IgG, in the absence of a known etiology. Three conditions have a likely autoimmune pathogenesis: autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis, and de novo AIH after liver transplantation. Two types of pediatric AIH are recognized according to seropositivity for smooth muscle and/or antinuclear antibody (AIH-1) or liver kidney microsomal type 1 and/or anti-liver cytosol type 1 antibodies (AIH-2).Pertinent issues addressing the diagnosis, treatment, and long-term follow-up were formulated by a core group of ESPGHAN members. They have commissioned the first authors with execution of this project. Initially, they have performed a systematic literature search on MEDLINE, ResearchGate, and Mendeley databases during the last 30 years and produced a document focusing on prospective and retrospective studies in children. The ESPGHAN core group and ESPGHAN Hepatology Committee members voted on each recommendation, using a formal voting technique.
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Affiliation(s)
| | - Diego Vergani
- MowatLabs, Paediatric Liver, GI & Nutrition Centre, King's College Hospital, London, UK
| | - Ulrich Baumann
- Pädiatrische Gastroenterologie und Hepatologie, Medizinische Hochschule, Hannover, Germany
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Nutrition Disturbances and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dominique Debray
- Pediatric Hepatology Unit, AP-HP-Hôpital Necker Enfants Malades, Paris, France
| | - Antal Dezsofi
- First Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Björn Fischler
- Department of Pediatrics, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Girish Gupte
- Liver Unit (Including Small Bowel Transplantation), Department of Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
| | - Loreto Hierro
- Hospital Infantil Universitario La Paz, Madrid, Spain
| | - Giuseppe Indolfi
- Paediatric and Liver Unit, Meyer Children's University Hospital of Florence, Firenze, Italy
| | - Jörg Jahnel
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Françoise Smets
- UCL, Cliniques Universitaires Saint-Luc, Pediatric Gastroenterology and Hepatology, Brussels, Belgium
| | - Henkjan J Verkade
- Dept of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases, University Medical Center Groningen, Groningen, the Netherlands
| | - Nedim Hadžić
- MowatLabs, Paediatric Liver, GI & Nutrition Centre, King's College Hospital, London, UK
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21
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Srivastava A, Gupte G. Editorial: Striving for Excellence in Pediatric Gastroenterology Care - A Continuous Effort. Indian J Pediatr 2016; 83:1426-1427. [PMID: 27578308 DOI: 10.1007/s12098-016-2214-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India.
| | - Girish Gupte
- Liver Unit (Including Small Bowel Transplantation), Department of Gastroenterology and Nutrition, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK
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22
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Abstract
Children with intestinal failure have had improved survival, particularly those with extreme short bowel syndrome, over the last 10-15 y. This has been attributed to better understanding of the pathophysiology of intestinal failure, improvement in line care, recognition of the importance of a team approach as well as the progress of intestinal transplant as a viable option. Parenteral nutrition remains the cornerstone for the continual survival of these patients. This review will cover contemporary approaches to intestinal failure including post surgical approaches, non-transplant surgery, dietetic and medication approaches during the adaptation process, considerations for home parenteral nutrition and latest in intestinal transplantation.
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Affiliation(s)
- Theodoric Wong
- Department of Gastroenterology and Nutrition, Birmingham Children's Hospital, Birmingham, UK
| | - Girish Gupte
- Liver Unit (Including Small Bowel Transplantation), Department of Gastroenterology and Nutrition, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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23
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Gupte G, Srivastava A. Editorial: Advancements in Pediatric Hepatology - Approach Based Diagnosis and Management. Indian J Pediatr 2016; 83:1289-1290. [PMID: 27704324 DOI: 10.1007/s12098-016-2213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Girish Gupte
- Liver Unit (Including Small Bowel Transplantation), Department of Gastroenterology and Nutrition, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B46NH, UK.
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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Santra S, Cameron JM, Shyr C, Zhang L, Drögemöller B, Ross CJ, Wasserman WW, Wevers RA, Rodenburg RJ, Gupte G, Preece MA, van Karnebeek CD. Cytosolic phosphoenolpyruvate carboxykinase deficiency presenting with acute liver failure following gastroenteritis. Mol Genet Metab 2016; 118:21-7. [PMID: 26971250 DOI: 10.1016/j.ymgme.2016.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/03/2016] [Accepted: 03/03/2016] [Indexed: 11/25/2022]
Abstract
We report a patient from a consanguineous family who presented with transient acute liver failure and biochemical patterns suggestive of disturbed urea cycle and mitochondrial function, for whom conventional genetic and metabolic investigations for acute liver failure failed to yield a diagnosis. Whole exome sequencing revealed a homozygous 12-bp deletion in PCK1 (MIM 614168) encoding cytosolic phosphoenolpyruvate carboxykinase (PEPCK); enzymatic studies subsequently confirmed its pathogenic nature. We propose that PEPCK deficiency should be considered in the young child with unexplained liver failure, especially where there are marked, accumulations of TCA cycle metabolites on urine organic acid analysis and/or an amino acid profile with hyperammonaemia suggestive of a proximal urea cycle defect during the acute episode. If suspected, intravenous administration of dextrose should be initiated. Long-term management comprising avoidance of fasting with the provision of a glucose polymer emergency regimen for illness management may be sufficient to prevent future episodes of liver failure. This case report provides further insights into the (patho-)physiology of energy metabolism, confirming the power of genomic analysis of unexplained biochemical phenotypes.
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Affiliation(s)
| | - Jessie M Cameron
- Genetics and Genome Biology Program, Peter Gilgan Centre for Research and Learning, Toronto, Canada
| | - Casper Shyr
- Centre for Molecular Medicine, Child & Family Research Institute, Vancouver, Canada
| | - Linhua Zhang
- Centre for Molecular Medicine, Child & Family Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Canada
| | - Britt Drögemöller
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Colin J Ross
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada; Centre for Molecular Medicine, Child & Family Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Canada
| | - Wyeth W Wasserman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada; Centre for Molecular Medicine, Child & Family Research Institute, Vancouver, Canada
| | - Ron A Wevers
- Department of Laboratory Medicine - Translational Metabolic Laboratory, Radboudumc, Nijmegen, The Netherlands
| | - Richard J Rodenburg
- Nijmegen Center for Mitochondrial Disorders, Department of Pediatrics, Translational Metabolic Laboratory, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | | | - Clara D van Karnebeek
- Centre for Molecular Medicine, Child & Family Research Institute, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Canada.
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25
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Craggs HM, Jackson P, Gupte G, Hartley J, Abdel-Hady M, Morton R, Beath S, Hogg L. Factors Affecting the Development of an Antibody Response to Hepatitis B Immunization in Children With Intestinal Failure: Before and After Small Bowel Transplantation (With and Without Liver Graft). JPEN J Parenter Enteral Nutr 2016; 41:1030-1036. [PMID: 26962060 DOI: 10.1177/0148607116637933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Small bowel transplant with or without a liver graft (SBTx ± LTx) for children with intestinal failure involves checking their immunity to a range of microorganisms, including hepatitis B virus (HBV), at the time of assessment. HBV vaccination in the United Kingdom is recommended for transplant candidates. The aim of this audit was to find out how many SBTx ± LTx candidates received HBV vaccination before transplantation and how the timing of vaccination influenced the development of immunity. MATERIALS AND METHODS Retrospective review of case notes and hospital microbiology database formed the basis of the study. Vaccination history and serology were available in 56 of 87 subjects who had SBTx ± LTx. RESULTS All patients were seronegative for HBV when assessed for transplant. HBV vaccination was started before transplant in 25 children and after transplant in 31. Eight children died posttransplant before their immunity could be checked, but of the 48 survivors, 20 children developed immunity, of whom 13 (65%) received at least 1 vaccination before SBTx ± LTx ( P = .008). Lack of response to HBV vaccine was significantly associated with isolated bowel transplantation and intensification of immune suppression. Of 11 children, 5 lost hepatitis B surface antibody (HbsAb), and 28 never made HBsAb, despite repeated vaccinations. CONCLUSION Our study clearly shows that HBV vaccine before transplant is more effective. In line with renal failure patients, we suggest that children with chronic intestinal failure receive HBV vaccine when clinically stable, before referral for transplant. Higher-dose vaccines, accelerated schedules, and more frequent booster vaccinations are also strategies that may improve HBsAb levels after transplant.
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Affiliation(s)
- Helen M Craggs
- 1 Faculty of Medicine, Manchester University, Manchester, UK
| | - Phoebe Jackson
- 1 Faculty of Medicine, Manchester University, Manchester, UK
| | - Girish Gupte
- 2 The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK
| | - Jane Hartley
- 2 The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK
| | - Mona Abdel-Hady
- 2 The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK
| | - Rachael Morton
- 2 The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK
| | - Sue Beath
- 2 The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK
| | - Lindsay Hogg
- 2 The Liver Unit (inc Small Bowel Transplantation), Birmingham Children's Hospital, Birmingham, UK
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26
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Mazurenko O, Gupte G, Shan G. A comparison of the education and work experiences of immigrant and the United States of America-trained nurses. Int Nurs Rev 2014; 61:472-8. [DOI: 10.1111/inr.12124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- O. Mazurenko
- Health Care Administration and Policy; School of Community Health Sciences; University of Nevada; Las Vegas NV USA
| | - G. Gupte
- Health Policy and Management; School of Public Health; Boston University; Boston MA USA
| | - G. Shan
- Environmental and Occupational Health; School of Community Health Sciences; University of Nevada; Las Vegas NV USA
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27
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Beath S, Lanchbury E, Alton H, Mahandru R, Toy M, van Mouirk I, McKiernan P, Hartley J, Kelly D, Sharif K, Gupte G. Selenium Homocholic Acid Taurocholate Scanning, Selenium-75-Labeled Bile Acid, a Novel Method for Testing the Function of the Terminal Ileum in Small Bowel Transplant Recipients: A Pilot Study. Transplant Proc 2014; 46:2119-21. [DOI: 10.1016/j.transproceed.2014.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Hartog H, Brown R, Dopazo C, Sadiq J, Ong E, Hartley J, Perera T, Muiesan P, Sharif K, Gupte G, Mirza D. Sequelae of Ischaemia-Reperfusion Injury in Intestinal Transplantation. Transplantation 2014. [DOI: 10.1097/00007890-201407151-02966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zamvar V, Puntis JWL, Gupte G, Lazonby G, Holden C, Sexton E, Bunford C, Protheroe S, Beath SV. Social circumstances and medical complications in children with intestinal failure. Arch Dis Child 2014; 99:336-41. [PMID: 24395645 DOI: 10.1136/archdischild-2013-304482] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED Although most children discharged on home parenteral nutrition (HPN) will achieve enteral autonomy, some remain parenteral nutrition dependent; those who develop life-threatening complications may undergo small bowel transplantation (SBTx). The aim of this study was to investigate the relationship between social circumstances, compliance and complications. SUBJECTS AND METHODS An observational study in 2008-2012 on 64 children (34 HPN, 30 SBTx) from three units (two regional gastroenterology; one transplant). Social circumstances were assessed routinely as part of discharge planning; adherence by families to home care management was scored, and episodes of catheter-related blood stream infection and graft rejection were recorded for 2 years and related to compliance and social circumstances. RESULTS A quarter of families had a disadvantaged parent: non-English speaking (n=11), unable to read (n=5), physical disability (n=3), mental health problems disclosed (n=10); 20% children were cared for by a lone parent. Discharge home was delayed by social factors (n=9) and need for rehousing (n=17, 27%). 17/34 (50%) of HPN and 12/30 (40%) of transplant families were assessed as fully adherent. 10 families were assessed as non-adherent, eight were subject to child protection review and care was taken over by another family member (n=3) or foster parents (n=2). The risk of catheter-related blood stream infection was increased by parental disadvantage and age <3 years (p<0.05). Poor compliance was associated with complications in HPN and SBTx recipients. CONCLUSIONS Children receiving complex home care may be socially isolated and measures to support improved compliance such as increased community support, social care involvement and respite care may improve outcomes.
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Affiliation(s)
- Veena Zamvar
- Department of Paediatric Gastroenterology, Leeds Children's Hospital, The General Infirmary at Leeds, , Leeds, UK
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Sheth J, Sharif K, Lloyd C, Gupte G, Kelly D, de Ville de Goyet J, Millar AJ, Mirza DF, Chardot C. Staged abdominal closure after small bowel or multivisceral transplantation. Pediatr Transplant 2012; 16:36-40. [PMID: 21981601 DOI: 10.1111/j.1399-3046.2011.01597.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Following paediatric SBMT, size discrepancy between the recipient's abdomen and the graft may lead to ACS, graft dysfunction, and death. We report our experience with SAC in these patients. Between 04/1993 and 03/2009, 57 children underwent 62 SBMTs. When abdominal wall tension seemed excessive for safe PAC, SAC was performed, using a Silastic® sheet and a vacuum occlusive dressing. Transplantations with SAC (23 combined liver and small bowel [CLB]) were compared with those with PAC [14 ISB and 25 CLB]. Indications for transplantation, preoperative status (after stratification for ISB/CLB transplants), age at transplantation, donor-to-recipient weight ratio, reduction in bowel and/or liver, and incidence of wound complications were not different in both groups. Post-operative intubation, stay in intensive care unit, and hospital stay were prolonged after SAC. Two deaths were related to ACS after PAC, none after SAC. Since 2000, one-yr patient survival is 73% after ISB transplantation and 57% vs. 75% after CLB transplantation with PAC vs. SAC, respectively (NS). SAC safely reduces severe ACS after paediatric SBMT and can be combined with graft reduction for transplantation of small recipients.
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Affiliation(s)
- J Sheth
- Liver Unit (including small bowel transplantation), Birmingham Children's Hospital, Birmingham, UK
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31
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Abstract
Four children who underwent ABO-compatible combined liver and small bowel transplantation developed severe immune-mediated hemolytic anemia. The main management strategies were early and aggressive treatment with steroids, the introduction of rituximab (an anti-CD20 monoclonal antibody), and the use of plasma exchange together with compatible but minimal blood transfusions. Three of the 4 children developed thrombi in the major vessels. In small bowel transplant patients, the early recognition of hemolytic anemia and intensified management with anticoagulation are necessary for the prevention of this complication.
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Affiliation(s)
- Piotr Czubkowski
- Liver Unit, Birmingham Children's Hospital, National Health Service Foundation Trust, Birmingham, United Kingdom
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32
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Sheth J, Sharif K, Gupte G, Lloyd C, Hartley J, Kelly D, Buckels J, De Ville De Goyet J, Millar A, Muiesan P, Mirza D, Mayer D, Chardot C. P259 - Fermeture pariétale différée après transplantation intestinale ou multiviscérale. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70657-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, Marcus R, Parameshwar J, Ramsay A, Newstead C. Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol 2010. [PMID: 20408847 DOI: 10.1111/j.1365-2141.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Transplantation Society (BTS) has reviewed the available literature and made recommendations for the diagnosis and management of post-transplant lymphoproliferative disorder (PTLD) in adult recipients of solid organ transplants. This review details the risk factors predisposing to development, initial features and diagnosis. It is important that the risk of developing PTLD is considered when using post transplant immunosuppression and that the appropriate investigations are carried out when there are suspicions of the diagnosis. These must include tissue for histology and computed tomography scan to assess the extent of disease. These recommendations have been made primarily for adult patients, there have been some comments made with regard to paediatric practice.
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Affiliation(s)
- Anne Parker
- The Beatson, West of Scotland Cancer Centre, Glasgow, UK.
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34
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Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, Marcus R, Parameshwar J, Ramsay A, Newstead C. Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol 2010; 149:675-92. [PMID: 20408847 DOI: 10.1111/j.1365-2141.2010.08161.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Transplantation Society (BTS) has reviewed the available literature and made recommendations for the diagnosis and management of post-transplant lymphoproliferative disorder (PTLD) in adult recipients of solid organ transplants. This review details the risk factors predisposing to development, initial features and diagnosis. It is important that the risk of developing PTLD is considered when using post transplant immunosuppression and that the appropriate investigations are carried out when there are suspicions of the diagnosis. These must include tissue for histology and computed tomography scan to assess the extent of disease. These recommendations have been made primarily for adult patients, there have been some comments made with regard to paediatric practice.
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Affiliation(s)
- Anne Parker
- The Beatson, West of Scotland Cancer Centre, Glasgow, UK.
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35
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Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, Marcus R, Parameshwar J, Ramsay A, Newstead C. Management of post-transplant lymphoproliferative disorder in adult solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol 2010; 149:693-705. [PMID: 20408848 DOI: 10.1111/j.1365-2141.2010.08160.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Transplantation Society (BTS) has reviewed the available literature and made recommendations for the diagnosis and management of post-transplant lymphoproliferative disorder in adult recipients of solid organ transplants. This review details the therapeutic options recommended including reduction in immunosuppression (RIS), transplant organ resection, radiotherapy and chemotherapy. Effective therapy should be instituted before progressive disease results in declining performance status and multi-organ dysfunction. The goal of treatment should be a durable complete remission with retention of transplanted organ function with minimal toxicity.
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Affiliation(s)
- Anne Parker
- The Beatson, West of Scotland Cancer Centre, Glasgow, UK.
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36
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Thøstesen LM, Lassen LB, Qvist N, Gupte G, Husby S. [The first Danish child with small bowel transplantation]. Ugeskr Laeger 2010; 172:886-887. [PMID: 20403273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A girl with extensive Hirschsprung's disease was operated, leaving her with a 35 cm short bowel. She received long-term parenteral nutrition through a central catheter. Progressive liver failure and intravenous access problems developed and at the age of 5.5 years she was transplanted in Birmingham with 270 cm small bowel, a reduced liver and pancreas. After the transplantation she received immunosuppressive medication, ursodeoxycholic acid and antibiotic prophylaxis. She is now well and on enteral nutrition, 32 months after the transplantation.
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37
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Abstract
Intestinal transplantation (ITx) has now become an accepted form of replacement therapy for intestinal failure (IF) and its complications. Disorders of bowel motility may represent up to 25% of patients on waiting lists for ITx. Some patients with short bowel as a cause for IF may also have dysmotile bowel. Underlying pathology of the intestine is heterogeneous and may be due to abnormalities in the nerve supply, intestinal smooth muscle, or may be regarded as idiopathic (chronic intestinal pseudo-obstruction). Outcome after ITx for dysmotility has previously been guarded, but providing the appropriate graft is used and taking into account the functional motility of residual bowel, it should not be different from other indications. The subject is reviewed emphasizing the potential pitfalls in case selection and management. The results of the ITx unit in Birmingham, UK are briefly reviewed.
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Affiliation(s)
- Alastair J W Millar
- University of Cape Town and Red Cross Children's Hospital, Cape Town, South Africa.
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38
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39
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40
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Brown RM, Gray G, Poulton K, Wassmer E, Gupte G. Ground glass hepatocellular inclusions caused by disturbed glycogen metabolism in three children on parenteral nutrition. Pediatr Dev Pathol 2009; 12:79-80. [PMID: 19006417 DOI: 10.2350/08-09-0523.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 10/19/2008] [Indexed: 11/20/2022]
Affiliation(s)
- Rachel Mary Brown
- Department of Histopathology, Birmingham Childrens, Hospital, Birmingham, United Kingdom
| | - George Gray
- Department of Clinical Chemistry, Birmingham Childrens, Hospital, Birmingham, United Kingdom
| | - Kelvin Poulton
- Muscle Biopsy Service, University Hospital, Birmingham, United Kingdom
| | - Evangaline Wassmer
- Department of Neurology, Birmingham Childrens Hospital, University Hospital, Birmingham, United Kingdom
| | - Girish Gupte
- Department of Hepatology, Birmingham Childrens Hospital, University Hospital, Birmingham, United Kingdom
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41
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Abell L, Press B, Hartt D, Gupte G, Gupta G. Intestinal transplantation in children: a new challenge for nursing. Paediatr Nurs 2007; 19:20-2. [PMID: 17425125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Small bowel transplantation is a recent innovation and thus a relatively new area of nursing practice. There is a lack of literature on the nursing care of children whose only hope of long-term survival is small bowel transplantation. The aim of this article is to raise awareness about intestinal transplantation in children using a case study to highlight the main nursing implications including: multidisciplinary team working, monitoring fluid balance, caring for immunosuppressed patients, monitoring for acute rejection and discharge preparation of the child and family.
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42
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Olio DD, Gupte G, Sharif K, Murphy MS, Lloyd C, McKiernan PJ, Kelly DA, Beath SV. Immunosuppression in infants with short bowel syndrome undergoing isolated liver transplantation. Pediatr Transplant 2006; 10:677-81. [PMID: 16911490 DOI: 10.1111/j.1399-3046.2006.00504.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little data exist on immunosuppressive drug absorption in children with short bowel syndrome and intestinal failure associated liver disease (SBS-IFALD). AIM To evaluate the absorption of immunosuppressive medications in children with SBS-IFALD undergoing isolated liver transplantation (iLTx). METHODS A retrospective review was performed in children with SBS-IFALD undergoing LTx and comparison made with weight, age-matched children undergoing iLTX (extra-hepatic biliary atresia (EHBA) and normal intestinal length and function). RESULTS Seven children with SBS-IFALD undergoing iLTx (median residual bowel length, 60 cm, range 40-80) were compared with 15 children undergoing LTx for EHBA. SBS-IFALD children had significantly lower trough tacrolimus levels at three months (5.8 vs. 7.9 ng/mL, p<0.05) and six months (5.0 vs. 8.0 ng/mL, p<0.05), but equivalent levels at 12 months after iLTx. The median calculated dose-normalized concentrations indicated that systemic availability of tacrolimus was comparable in two groups at 3, 6, 12 months (33.1 vs. 23.3; 42.4 vs. 36; 51 vs. 52.9) despite the differences in enteral function. The incidence of acute rejection was 1/7 (SBS-IFALD) and 10/15 (EHBA) group (p = 0.06). CONCLUSION Children with SBS-IFALD demonstrated adequate absorption of oral tacrolimus without significant acute rejection rate after iLTx suggesting that modification of immunosuppression is not necessary.
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Affiliation(s)
- Dominic Dell Olio
- The Liver Unit, Birmingham Children's Hospital (BCH), Birmingham, UK.
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43
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Haghighi KS, Sharif K, Gupte G, Mirza DF, Mayer AD, Carroll D, Brown RM, Lloyd C, McKiernan PJ, Baumann U, van Mourik IDM, Kelly DA, Beath SV, Millar AJW. Is Serum Gentamicin Level a Good Predictor of Graft Injury in Intestinal Transplantation? Transplant Proc 2006; 38:1733-4. [PMID: 16908265 DOI: 10.1016/j.transproceed.2006.05.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Following intestinal transplant (SBT), the early diagnosis and treatment of rejection is a major management aim. The diagnosis of rejection is based on histology of stomal biopsies. Oral gentamycin (2.5 mg/kg) was used for selective decontamination of the digestive system. Our hypothesis was that gentamycin might be absorbed in the presence of graft dysfunction. AIM Our goal was to assess the correlation between serum gentamycin level and the health of the intestinal graft. SUBJECTS AND METHODS Among 33 SBT performed from 1993 to 2005, serum gentamycin levels were performed once weekly or more often when there was a suspicion of rejection. All data were analyzed retrospectively. RESULTS Adequate trough levels were achieved for only 23 patients, six of whom had histologically proven rejection and only one did not have a raised gentamycin content. Five patients with raised levels but no rejection included two with severe intestinal ischemia and three with bowel obstruction/ileus. Four of the five patients required laparotomies. CONCLUSION We concluded that in our study raised serum gentamycin levels were a good predictor of rejection or significant injury to the graft.
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Affiliation(s)
- K S Haghighi
- Liver Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom
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45
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Abstract
OBJECTIVE Acute disseminated encephalomyelitis (ADEM) is a treatable inflammatory demyelinating disorder seen more commonly in children than in adults. It typically presents to general paediatricians, often, like encephalitis, with non-specific cerebrospinal fluid findings. The brain computerized tomography scan is usually normal, so is falsely reassuring and delays the diagnosis, which might result in considerable morbidity. The present study was initiated to report on the various modes of presentation and raise the awareness of the diagnosis of ADEM among general paediatricians. METHODS A retrospective review of the case notes of 18 children with a diagnosis of ADEM established in a tertiary referral centre from 1995 to 2000 was undertaken with particular reference to clinical features, investigations and treatment. RESULTS The most common presenting features were ataxia (10 cases), followed by headache (eight cases) and weakness (five cases). Magnetic resonance imaging (MRI) of the brain was needed to confirm the diagnosis in all 18 children. Treatment usually included a course of intravenous methylprednisolone followed by a tapering dose of oral prednisolone over several weeks. Although the outcome for most of the children was generally good, two relapsed after cessation of steroids and five children had ongoing disabilities. CONCLUSIONS The investigation of choice for establishing the diagnosis of ADEM was MRI of the brain. Other investigations were seldom helpful in reaching the diagnosis. Early diagnosis and prompt treatment of ADEM will probably reduce morbidity.
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Affiliation(s)
- G Gupte
- Department of Paediatrics Walsgrave Hospitals NHS Trust, Clifford, Bridge Road, Coventry, Nottingham, UK
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46
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Abstract
Acute disseminated encephalomyelitis will often present to the general paediatrician as an acute polysymptomatic encephalopathy, and initially the diagnosis may not be clear. A brain MRI scan is essential in establishing the diagnosis and so enabling appropriate advice and treatment to be given. Multicentre clinical audit of outcome and controlled therapeutic trials are needed to secure an evidence base for current practice.
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Affiliation(s)
- M Stonehouse
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
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47
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Mercuri E, Cowan F, Gupte G, Manning R, Laffan M, Rutherford M, Edwards AD, Dubowitz L, Roberts I. Prothrombotic disorders and abnormal neurodevelopmental outcome in infants with neonatal cerebral infarction. Pediatrics 2001; 107:1400-4. [PMID: 11389264 DOI: 10.1542/peds.107.6.1400] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate the occurrence of prothrombotic disorders in a well-characterized cohort of infants with neonatal stroke and to document any association of prothrombotic disorders with the type of infarct seen on magnetic resonance imaging (MRI) and clinical outcome. METHODS Twenty-four infants with perinatal cerebral infarction confirmed by neonatal MRI were enrolled in the study. All the infants and, when possible, both parents were tested to identify inherited and acquired prothrombotic disorders. RESULTS None of the infants had a significant bleeding diathesis, but 10 (42%) had at least 1 prothrombotic risk factor. Five children showed heterozygosity for factor V Leiden, and 6 had high factor VIIIc concentrations. There was a striking association between the occurrence of these abnormalities and both the presence of cerebral hemorrhage on MRI and poor neurologic outcome. Eight of the 11 patients (73%) with hemiplegia or global developmental delay had factor V Leiden and/or raised factor VIIIc, whereas only 1 of the 13 patients (8%) with normal outcome had any prothrombotic risk factors. In particular, all 5 infants with factor V Leiden had hemiplegia, compared with only 4 of the 19 infants without factor V Leiden (21%). CONCLUSIONS These data suggest that the presence of prothrombotic risk factors and, in particular, of the factor V Leiden mutation, is significantly associated with poor outcome after perinatal cerebral infarction.
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Affiliation(s)
- E Mercuri
- Departments of Paediatrics, Imperial College, Hammersmith Campus, London, United Kingdom.
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48
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Abstract
Regulation of colanic acid polysaccharide capsule synthesis in Escherichia coli requires the proteins RcsC and RcsB, in addition to several other proteins. By sequence similarity, these two proteins appear to be members of the two-component sensor-effector regulatory family found in bacteria. The present study characterizes the functional domains of RcsB. We have isolated mutations in rcsB that are able to suppress an rcsC "up" mutation (i.e., leading to increase in cps transcription) that normally results in constitutive expression of the capsule. In addition, constitutive capsule mutations in rcsB have been isolated. From the characterization of the mutants and by analogy to the three-dimensional structure of CheY, we have begun to define different domains of RcsB and to assign functions to them. A few of the constitutive capsule mutations were localized in an acidic pocket that has been proposed to play a crucial role in phosphorylation of RcsB. As seen in other two-component systems, an aspartate-to-glutamate substitution at the presumed site of phosphorylation of RcsB resulted in constitutive capsule expression. Lastly, several of our rcsB mutants were found to be allele specific (rcsC137 specific) for rcsC, suggesting a physical as well as functional interaction between RcsC and RcsB proteins.
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Affiliation(s)
- G Gupte
- Department of Microbiology and Molecular and Cellular Biology Graduate Program, Arizona State University, Tempe 85287-2701, USA
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49
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Khungar A, Mahajan P, Gupte G, Vasundhara M, Kher A, Bharucha BA. Pseudoachondroplastic dysplasia. J Postgrad Med 1993; 39:91-3. [PMID: 8169872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Pseudoachondroplasia is a heterogeneous inherited skeletal dysplasia in which dwarfism is a major feature. We report here a case of a 7 year old girl misdiagnosed as rickets, who presented with short stature, lordosis, genu varum and flexion deformities at both the elbows. Skeletal survey revealed epiphyseal and metaphyseal irregularities. A review of literature is also presented.
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Affiliation(s)
- A Khungar
- Dept of Pediatrics, Seth GS Medical College, Bombay, Maharashtra
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50
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Gupte G, Mahajan P, Shreenivas VK, Kher A, Bharucha BA. Wildervanck syndrome (cervico-oculo-acoustic syndrome). J Postgrad Med 1992; 38:180-2. [PMID: 1307589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Wildervanck syndrome i.e. cervico (Klippel-Feil anomalad) -oculo (Duane-Stilling-Turk phenomenon with bilateral abducens palsy)-acoustic (deafness) is a rare syndrome. We report here 4 cases diagnosed as Wildervanck syndrome and analyse their findings. One patient had an an atrial septal defect. Such association of congenital heart disease with Wildervanck syndrome has not been reported previously.
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Affiliation(s)
- G Gupte
- Dept of Paediatrics, Seth GS Medical College, Parel, Bombay, Maharashtra
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