1
|
Nejatollahi SMR, Mostafavi K, Ghorbani F. Abdominal pain in a young lady with inverted Meckel's diverticulum: a case report. Gastroenterol Hepatol Bed Bench 2024; 17:100-103. [PMID: 38737928 PMCID: PMC11080686 DOI: 10.22037/ghfbb.v17i1.2815] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/10/2023] [Indexed: 05/14/2024]
Abstract
Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract which is located in small bowel within 2 feet of the ileocecal valve. Nevertheless, an inverted Meckel's diverticulum is an uncommon condition believed to result from aberrant peristalsis in that specific area. This article showed signs, symptoms, and possible clinical presentations using CARE guidelines in a case of inverted Meckel's diverticulum and reviews other possible features lastly, definitive treatment, results, and case follow-up were shown to refresh, and raise surgeons' awareness of this rare disorder.
Collapse
Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keihan Mostafavi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Nejatollahi SMR, Abdolmohammadi Y, Ahmadi S, Hasanzade A, Hosseini F, Mohseni A, Shafaghi S, Dezfuli MM, Ghorbani F. Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study. Korean J Transplant 2023; 37:241-249. [PMID: 37997212 PMCID: PMC10772271 DOI: 10.4285/kjt.23.0049] [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] [Received: 09/04/2023] [Revised: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 11/25/2023] Open
Abstract
Background Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors. Methods In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals. Results A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals. Conclusions This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.
Collapse
Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yazdan Abdolmohammadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Ahmadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Hasanzade
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arshia Mohseni
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mokhber Dezfuli
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Nejatollahi SMR, Hasanzade A, Ghorbani F. Successful Surgical Management of Ruptured Hepatic Artery Pseudoaneurysm Post-Liver Retransplant: A Case Report. Int J Surg Case Rep 2023; 112:108989. [PMID: 37913669 PMCID: PMC10667863 DOI: 10.1016/j.ijscr.2023.108989] [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] [Received: 09/23/2023] [Revised: 10/14/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Hepatic Artery Pseudoaneurysm (HAP) is a rare and potentially fatal complication following liver transplantation, with unclear etiology. Various predisposing factors, including local infections, biliary-enteric anastomosis, particularly Roux-en-Y hepaticojejunostomy, vascular interventions, and iatrogenic injuries, have been identified. PRESENTATION OF CASE We report a case of HAP occurring after liver re-transplantation in a twenty-year-old male patient who had initially undergone liver transplantation for cirrhosis resulting from autoimmune hepatitis. Subsequently diagnosed with chronic ischemic liver disease accompanied by diffuse cholangiopathy and a liver abscess, the patient underwent a liver re-transplantation. Within the early days post-re-transplantation, the patient presented symptoms of gastrointestinal bleeding and sudden hypotension. A high clinical suspicion led to prompt laparotomy, ultimately successful preserving both the graft and the recipient's life. DISCUSSION HAP is an uncommon complication following liver transplantation. This condition may remain asymptomatic until the rupture of the HAP, which can result in gastrointestinal bleeding, hypotension, and, eventually, mortality. While there have been emerging non-surgical techniques proposed for HAP treatment, surgical intervention remains the definitive solution for preserving the graft and ensuring the recipient's survival. CONCLUSION HAP, while uncommon, represents a life-threatening complication post-transplantation. In the event of rupture, immediate intervention is imperative for the patient's survival. Hence, it is critical for surgeons to be cautious about this complication, recognize its symptoms, and be aware of associated risk factors.
Collapse
Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arman Hasanzade
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Nejatollahi SMR, Nazari M, Mostafavi K, Ghorbani F. Reoperation etiologies in the initial hospital stay after liver transplantation: a single-center study from Iran. Korean J Transplant 2023; 37:103-108. [PMID: 37435148 PMCID: PMC10332282 DOI: 10.4285/kjt.23.0026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
Background Liver transplantation (LT) is widely recognized as a life-saving therapy for patients with end-stage liver disease. However, due to certain posttransplant complications, reoperations or endovascular interventions may be necessary to improve patient outcomes. This study was conducted to examine reasons for reoperation during the initial hospital stay following LT and to identify its predictive factors. Methods We evaluated the incidence and etiology of reoperation in 133 patients who underwent LT from brain-dead donors over a 9-year period based on our experiences. Results A total of 52 reoperations were performed for 29 patients, with 17 patients requiring one reoperation, seven requiring two, three requiring three, one requiring four, and one requiring eight. Four patients underwent liver retransplantation. The most common cause of reoperation was intra-abdominal bleeding. Hypofibrinogenemia was identified as the sole predisposing factor for bleeding. Frequencies of comorbidities such as diabetes mellitus and hypertension did not differ significantly between groups. Among patients who underwent reoperation due to bleeding, the mean plasma fibrinogen level was 180.33±68.21 mg/dL, while among reoperated patients without bleeding, it was 240.62±105.14 mg/dL (P=0.045; standard mean difference, 0.61; 95% confidence interval, 0.19-1.03). The initial hospital stay was significantly longer for the reoperated group (47.5±15.5 days) than for the non-reoperated group (22.5±5.5 days). Conclusions Meticulous pretransplant assessment and postoperative care are essential for the early identification of predisposing factors and posttransplant complications. In order to enhance graft and patient outcomes, any complications should be addressed without hesitation, and appropriate intervention or surgery should not be delayed.
Collapse
Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Nazari
- Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keihan Mostafavi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Nejatollahi SMR, Kazempour Dizaji M, Zare A, Abedini A, Varahram M, Kiani A, Marjani M, Alizedeh Kolahdozi N, Velayati AA. Investigating the Coronavirus Disease 2019 Process and its Related Occurrences during the Treatment Course. Tanaffos 2023; 22:332-336. [PMID: 38638390 PMCID: PMC11022195] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/09/2023] [Indexed: 04/20/2024]
Abstract
Background The disease process involves the occurrences happening during the disease and treatment course for the patient. Investigating this process is a significant and necessary issue for all diseases, including coronavirus disease 2019 (COVID-19). Materials and Methods Using the information of 4372 patients with COVID-19 referring to Dr. Masih Daneshvari Hospital in Tehran during the COVID-19 epidemic, being hospitalized, cared for, and home quarantined due to having mild symptoms, the COVID-19 process and its related occurrences were investigated during the treatment course. Results In the COVID-19 course, considering the disease severity, the likelihood of hospitalization in the general ward or the intensive care unit (ICU) ward, the likelihood of isolation or home quarantine, and the likelihood of occurrences such as recovery or death at the end of the disease course were taken into consideration. Based on the results of this study, the likelihood of hospitalization in the general ward, the ICU ward, and isolation or home quarantine was determined to be approximately 49.54%, 14.73%, and 35.73%, respectively. Also, for patients hospitalized in the general ward, the ICU ward, and isolated or home quarantined, the likelihood of recovery was estimated at approximately 64.79%, 10.82%, and 96.31%, respectively, and the likelihood of death was also estimated at about 35.21%, 89.18%, and 3.69% respectively. Conclusion Investigating the COVID-19 process and estimating the likelihood of incidence of its related occurrences during the treatment course both create an accurate prognosis and provide the possibility of achieving an efficient treatment for these patients.
Collapse
Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Hepato-Pancreato-Biliary and Transplant Surgery,Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Kazempour Dizaji
- Mycobacteriology Research Center (MRC),National Research Institute of Tuberculosis and Lung Disease (NRITLD) , Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, NRITLD , Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Zare
- Department of Biostatistics, NRITLD , Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Varahram
- Mycobacteriology Research Center (MRC),National Research Institute of Tuberculosis and Lung Disease (NRITLD) , Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali Akbar Velayati
- Mycobacteriology Research Center (MRC),National Research Institute of Tuberculosis and Lung Disease (NRITLD) , Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Montazeri S, Eslami F, Dezfuli MM, Ghorbani F, Nejatollahi SMR, Mostafavi K, Mirbahaeddin SK. Smartening of organ donation process. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-3483] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sadra Montazeri
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Eslami
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mokhber Dezfuli
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Organ Donation Procurement Unit, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Nejatollahi
- Department of Transplantation Surgery, Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keihan Mostafavi
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Khashayar Mirbahaeddin
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Fashami MZ, Eslami F, Beigi EA, Dezfuli MM, Ghorbani F, Nejatollahi SMR, Mirbahaeddin SK. Spinal reflexes as a barrier for family consent. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-5263] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Maryam Zaman Fashami
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Eslami
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Ali Beigi
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mokhber Dezfuli
- Department of Transplantation Surgery, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Organ Donation Procurement Unit, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Nejatollahi
- Department of Transplantation Surgery, Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Khashayar Mirbahaeddin
- Organ Donation Procurement Unit, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Mokhber Dezfuli M, Eslami F, Mostafavi K, Khoshkholgh R, Reza Nejatollahi SM, Montazeri S, Abdolmohammadi Y, Ghorbani F. Organ Procurement From Donors After Brain Death During the COVID-19 Pandemic: Experience of a High Prevalence Country. EXP CLIN TRANSPLANT 2022; 20:420-424. [PMID: 35297335 DOI: 10.6002/ect.2021.0398] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our aim was to compare the donation process before and after the COVID-19 pandemic in an organ procurement unit in Iran and to discuss different strategies to address the impact of the pandemic on the donation process. MATERIALS AND METHODS All activities including donor detection, donor selection, family approach, donors characteristics, rate of organs per donor, and types of organs were compared between 2 intervals over 18 months (March 2020 to June 2021 [during the COVID19 pandemic] vs November 2018 to February 2020 [before the pandemic]). RESULTS Before and during the COVID-19 pandemic, there were 218 and 137 brain dead donors with mean age of 42.6 ± 14.5 and 42.8 ± 15.5 years, respectively (P = .82). The prevalence of tumors leading to brain death decreased by more than half during the COVID-19 pandemic (P = .04). There was a 52% increase in cardiac death before organ retrieval during the COVID-19 pandemic, reaching 38% from 25% before COVID-19. During the 2 intervals, the number of organs per donor was 2.3 ± 1.2 and 2.2 ± 1.2 (P = .52). The rate of actual to potential donors before and during the pandemic was significantly different, with 42.16 ± 7.8% before and 29.9 ± 4.8% during the pandemic, mostly as a result of unsuitable donors. The time to obtain family consent during the COVID-19 pandemic was 35.1 ± 8.5 hours, which was a significantly longer length of time than before the pandemic (21.3 ± 12.3 hours; P = .008). CONCLUSIONS In our organ procurement unit, which encompasses a population of 5.5 million in Tehran, Iran, the number of actual donors was reduced dramatically during the studied pandemic period. However, despite a high workload, all transplant centers and organ procurement units in Iran worked to identify and transplant the available organs to reduce wait list mortality.
Collapse
Affiliation(s)
- Mojtaba Mokhber Dezfuli
- From the Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Ahmadi ZH, Mirhosseini SM, Fakhri M, Mozaffary A, Lotfaliany M, Nejatollahi SMR, Marashi SA, Behzadnia N, Sharif-Kashani B. First successful combined heart and kidney transplant in Iran: a case report. EXP CLIN TRANSPLANT 2012; 11:361-3. [PMID: 23113666 DOI: 10.6002/ect.2012.0135] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Combined heart and kidney transplant has become an accepted therapy for patients with coexisting heart and kidney failure. This method, compared with single-organ transplant, has a better outcome. Here, we report the first successful combined heart and kidney transplant in Iran. The patient was a 36-year-old man with end-stage renal disease owing to IgA nephropathy, admitted to Masih Daneshvari Hospital in Tehran, Iran for progressive dyspnea and chest pain. In-patient evaluations revealed cardiomyopathy leading to end-stage heart failure. Owing to concurrent heart and kidney end-stage diseases, combined cardiorenal transplant was done. Eight months after his transplant, routine follow-ups have not shown any signs of acute rejection. He is now New York Heart Association functional class I. Both cardiac and renal functions are within normal ranges. Good outcome during follow-up for this case justifies simultaneous heart plus kidney transplants as an alternate treatment for patients with advanced disease of both organs.
Collapse
Affiliation(s)
- Zargham-Hossein Ahmadi
- From the Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Kazemi K, Geramizadeh B, Nikeghbalian S, Salahi H, Bahador A, Reza Nejatollahi SM, Dehghani SM, Dehghani M, Kakaei F, Malek-Hosseini SA. Effect of D-penicillamine on liver fibrosis and inflammation in Wilson disease. Exp Clin Transplant 2009; 6:261-3. [PMID: 19338486 DOI: pmid/19338486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Wilson disease is a disorder of copper metabolism characterized by copper overload. A mutation in the ATP7B gene causes dysfunction of ATP7B protein and a reduction in copper excretion into the bile in hepatocytes. Excess copper accumulation leads to liver injury. D-penicillamine primarily can inhibit fibrogenesis and prevent the appearance of scar lesions in the liver. We studied this phenomenon in our patients. MATERIALS AND METHODS Pathology slides from the explanted livers of 26 patients diagnosed as having Wilson disease with hepatoneurologic manifestations between 2000 and 2008 who had undergone a liver transplant were investigated retrospectively. Patients were divided into 2 groups according to their history of D-penicillamine use before transplant. The degree of fibrosis and inflammation were classified as mild (1), moderate (2), and severe (3), and were reviewed by an impartial hepatopathologist. RESULTS Of 26 patients (20 male, 6 female) who had Wilson disease with a mean age of 17.6 -/+ 8.6 years, 69% (18/26) had a history of D-penicillamine use before liver transplant from 6 months to 9 years (mean, 3.4 -/+ 2.7 years). In the D-penicillamine group, 14 patients (77%) had grade 1 fibrosis. Grade 2 and 3 fibrosis was seen in 5.6% and 16% of patients, respectively. In the D-penicillamine group, inflammation was grade 3 in 44% (8/18), grade 2 in 44% (8/18), and grade 1 in 11% of the patients (2/18). In the non- D-penicillamine group (8 patients), grades of fibrosis were grade 3 (62%), grade 2 (25%), and grade 1 (12%); 87% of the patients had grade 2 and 3 inflammation. The degree of fibrosis was significantly lower in the D-penicillamine group than it was in the non-D-penicillamine group (P < .05). CONCLUSION D-penicillamine may reduce the rate of liver fibrogenesis in patients with Wilson disease.
Collapse
Affiliation(s)
- Kourosh Kazemi
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Nikeghbalian S, Nejatollahi SMR, Salahi H, Bahador A, Sabet B, Jalaeian H, Geramizadeh B, Dehghani SM, Malek-Hosseini SA. Does donor's fatty liver change impact on early mortality and outcome of liver transplantation. Transplant Proc 2007; 39:1181-3. [PMID: 17524926 DOI: 10.1016/j.transproceed.2007.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The effect of donor fatty liver on graft survival is still uncertain. The aim of this study was to determine the influence of steatosis on the outcomes of OLT among our recipients. METHODS In this retrospective study, we evaluated the effect of donor liver steatosis on postoperative liver function and prognosis. Data obtained from liver transplantation data registry of our organ transplant center. Liver biopsies taken before transplantation were reviewed by two pathologists. Pathology reports were divided into four groups: normal pathology; mild fatty change (10%-30%); moderate (30%-60%); and severe steatosis (>60%). Livers with severe steatosis were excluded from transplantation. Factors determining transplantation outcome, such as early mortality, duration of intensive care unit (ICU) and hospital stay, clinical rejection episodes, and graft surgical complications, were compared between subjects who received donor liver, with various degrees of steatosis. RESULTS Three-month survival rates in recipients without donor liver fatty change, subjects with mild fatty change (10%-30%) and those with moderate (30%-60%) steatosis were 68%, 72%, and 76%, respectively, which were not significantly different (P>.05). Furthermore, short-term (hospital) mortality (20%, 14.3%, and 21.2%), hospital stay (30.89, 29.93, and 23.62 days), and length of ICU admission (5.06, 5.89, and 4.39 days) were not significantly different. In addition, Child score of recipients, pre- and postoperative liver function enzyme changes were similar. CONCLUSION Mild-to-moderate (up to 60%) liver fatty change was not found to be associated with a worse prognosis in OLT.
Collapse
Affiliation(s)
- S Nikeghbalian
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Nikeghbalian S, Kazemi K, Salahi H, Bahador A, Davari HR, Jalaeian H, Rasekhi AR, Nejatollahi SMR, Gholami S, Malek-Hosseini SA. Transplantation of a cadaveric liver allograft with right lobe cavernous hemangioma, without back-table resection: a case report. Transplant Proc 2007; 39:1691-2. [PMID: 17580222 DOI: 10.1016/j.transproceed.2006.12.040] [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] [Received: 09/09/2006] [Accepted: 12/13/2006] [Indexed: 12/16/2022]
Abstract
UNLABELLED The use of extended criteria liver donors has become a necessity in an era of organ scarcity for transplantation. We present here a case report of orthotopic liver transplantation using a liver with a giant right lobe hemangioma without backtable resection. CASE REPORT There were no data regarding the liver mass before organ procurement. The donor liver function tests and electrolyte profile were normal. During donor exploration a hemangioma was identified in segments V-VI, occupying approximately 20% of the total liver volume. It was prepared for transplantation on a sterile backtable without performing backtable hemangioma resection. A standard orthotropic liver transplant procedure was performed uneventfully, without veno-veno bypass. There was no bleeding from the hemangioma. The ischemic time was 9 hours and 20 minutes. Postoperative course was uneventful and the patient was discharged at 19 days after the operation. The hemangiomas showed evolution with some decrease in size upon later follow-ups. No clinically important complication was observed. CONCLUSION Our case and other previous reports show that even large hemangiomas should not be considered to be a contraindication to organ procurement. These benign lesions either could be left in situ and observed or resected.
Collapse
Affiliation(s)
- S Nikeghbalian
- Shiraz Organ Transplantation Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Nikeghbalian S, Kazemi K, Davari HR, Salahi H, Bahador A, Jalaeian H, Khosravi MB, Ghaffari S, Lahsaee M, Alizadeh M, Rasekhi AR, Nejatollahi SMR, Malek-Hosseini SA. Early Hepatic Artery Thrombosis After Liver Transplantation: Diagnosis and Treatment. Transplant Proc 2007; 39:1195-6. [PMID: 17524930 DOI: 10.1016/j.transproceed.2007.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [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: 11/15/2022]
Abstract
BACKGROUND Hepatic artery thrombosis (HAT) occurs in 3% to 9% of all liver transplantations with acute graft failure as a possible sequel. METHODS Eleven episodes of HAT were identified among 256 orthotropic liver transplantations (whole, LDCT, split) performed on 253 patients between April 1993 and July 2006. HAT was suspected clinically and confirmed by Doppler ultrasonography, magnetic resonance angiography, angiography, or reexploration. One patient was excluded due to poor follow-up. Treatment options included exploration with HA thrombectomy plus thrombolysis, retransplantation, or conservative treatment of hepatic and biliary complications. RESULTS Among 11 patients of mean age 29.98 +/- 17.14 years (range, 10 months to 56 years). 2 had split right lobe liver transplantations and 9 received whole organs. None of LDLTs were identified to have HAT. The causes of liver cirrhosis among HAT patients were autoimmune hepatitis (n=3), cryptogenic (n=3), Wilson (n=1), PBC (n=1), biliary atresia (n=1), and HBs (n=1). HAT was diagnosed at 5.9 +/- 4.43 (range, 2 to 16) days after operation. Most patients developed right upper quadrant (RUQ) pain at presentation. Two patients developed acidosis, fever, or SIRS and underwent retransplantation. Four underwent exploration of HA and 1 was treated conservatively. Three cases expired due to HAT complications. CONCLUSION We found RUQ pain to be the presenting sign of early HAT in majority of cases. RUQ pain has been reported to occur in late HAT. Whenever HAT is confirmed, liver transplanted patients should be revascularized or even retransplanted. Intra-arterial thrombolysis and thrombolytic therapy for HAT should be done cautiously due to the potential risk of hemorrhage.
Collapse
Affiliation(s)
- S Nikeghbalian
- Shiraz Transplant Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Davari HR, Malek-Hosseini SA, Salahi H, Bahador A, Nikeghbalian S, Jalaeian H, Salehipour M, Roozbeh J, Rais-Jalali G, Sagheb MM, Kazemi K, Nejatollahi SMR. Management of infrarenal duplicated inferior vena cava during living related kidney transplantation. Transpl Int 2007; 20:478-9. [PMID: 17263785 DOI: 10.1111/j.1432-2277.2007.00456.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
15
|
Khosravi MB, Jalaeian H, Lahsaee M, Ghaffaripour S, Salahi H, Bahador A, Nikeghbalian S, Davari HR, Salehipour M, Kazemi K, Nejatollahi SMR, Shokrizadeh S, Gholami S, Malek-Hosseini SA. The Effect of Clamping of Inferior Vena Cava and Portal Vein on Urine Output During Liver Transplantation. Transplant Proc 2007; 39:1197-8. [PMID: 17524931 DOI: 10.1016/j.transproceed.2007.02.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/13/2022]
Abstract
BACKGROUND Intraoperative hypotension, massive transfusion, liver disease, coexistent renal dysfunction, and decreased glomerular filtration rate during the anhepatic phase are major hazards for kidney function. We undertook this study to determine the change in urine output during clamping. METHOD Twenty-four patients without preexistent renal disease, who were undergoing liver transplantation using the piggyback method, were enrolled in this study. Patients with a serum creatinine level >1.2 mg/dL were excluded. Urine output was monitored over 30 minutes before inferior vena cava and portal vein clamping, during clamping, and for 30 minutes after declamping. None of the patients had a clamping time >70 minutes. Our goal was to maintain mean arterial blood pressure and heart rate just by fluid administration diuretics were avoided. RESULTS Participants had a mean age of 39.12 +/- 13.52 years (range, 15-67 years) with a male to female ratio of 1:4. Urine output 30 minutes before clamping was 3.64 +/- 3.58 (range, 1.25-15.18) mL/kg/h, decreased to 1.28 +/- 2.58 (range, 0-11.39) mL/kg/h during clamping (P=.00), and increased to 3.56 +/- 3.64 (range, 0.51-15.18) mL/kg/h 30 minutes after declamping (P=.00). CONCLUSION Urine output was significantly reduced in all patients after clamping of the IVC and portal veins. This observation may be explained by increased venous pressure leading to decreased renal perfusion pressure. It has been stated that one of the advantages of veno-veno bypass (VVB) is increased renal perfusion pressure. However, if the clamping time in the piggyback method is <70 minutes and patients have normal preoperative renal function, the decreased renal perfusion pressure will not cause postoperative kidney dysfunction.
Collapse
Affiliation(s)
- M B Khosravi
- Shiraz Organ Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|