4
|
Menon J, Shanmugam N, Valamparampil J, Vij M, Kumar V, Munirathnam D, Hakeem A, Rammohan A, Rela M. Outcomes of liver transplantation in children with Langerhans cell histiocytosis: Experience from a quaternary care center. Pediatr Blood Cancer 2023; 70:e30024. [PMID: 36317422 DOI: 10.1002/pbc.30024] [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: 04/29/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare but important cause of end-stage liver disease in children. Conventional chemotherapeutic agents that are otherwise the standard-of-care in LCH may be counterproductive in patients with hepatic decompensation. Furthermore, the precise role of liver transplantation (LT) in the management of LCH remains unclear. METHODS Review of a prospectively collected database (January 2014 to December 2020) of children with liver disease was performed. All clinical details of patients with LCH managed at our center were collected and data analyzed. Based on the outcomes, a management algorithm was proposed. RESULTS Of the eight (five male) patients referred to our unit, six (75%) underwent LT (four and two for compensated and decompensated cirrhosis, respectively). Median age at diagnosis of LCH was 25 (range: 9-48) months. Two patients, who had previously completed LCH-specific chemotherapy, underwent upfront LT for compensated cirrhosis. Other two patients with compensated cirrhosis showed evidence of active disease. They underwent LT following completion of chemotherapy. Two children with decompensated cirrhosis also had evidence of active disease and were started on modified chemotherapy Both of them had progression of liver disease while on chemotherapy. Hence, an urgent LT was performed which was followed by completion of chemotherapy in these patients. On a median follow-up of 30.5 (10.5-50) months, all post-LT patients were alive with stable graft function and showed no disease recurrence. CONCLUSION We demonstrate that an algorithmic approach, along with newer chemotherapeutic agents, results in excellent outcomes in LCH patients with liver involvement. Larger multicentric studies on this rare disease are, however, needed to validate our findings.
Collapse
Affiliation(s)
- Jagadeesh Menon
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Naresh Shanmugam
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Joseph Valamparampil
- Department of Pediatric Gastroenterology & Hepatology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Mukul Vij
- Department of Histopathology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Vimal Kumar
- Department of Pediatric Hematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Deenadayalan Munirathnam
- Department of Pediatric Hematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Abdul Hakeem
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| |
Collapse
|
5
|
Kelgeri C, Couper M, Gupte GL, Brant A, Patel M, Johansen L, Valamparampil J, Ong E, Hartog H, Perera MTPR, Mirza D, van Mourik I, Sharif K, Hartley J. Clinical Spectrum of Children with Acute Hepatitis of Unknown Cause. N Engl J Med 2022; 387:611-619. [PMID: 35830627 DOI: 10.1056/nejmoa2206704] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [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: 01/05/2023]
Abstract
BACKGROUND Since January 2022, there has been an increase in reports of cases of acute hepatitis of unknown cause in children. Although cases have been reported across multiple continents, most have been reported in the United Kingdom. Investigations are ongoing to identify the causative agent or agents. METHODS We conducted a retrospective study involving children referred to a single pediatric liver-transplantation center in the United Kingdom between January 1 and April 11, 2022. These children were 10 years of age or younger and had hepatitis that met the case definition of the U.K. Health Security Agency for confirmed acute hepatitis that was not hepatitis A through E and did not have a metabolic, inherited or genetic, congenital, or mechanical cause, in the context of a serum aminotransferase level greater than 500 IU per liter. We reviewed medical records and documented demographic characteristics, clinical features, and results of liver biochemical, serologic, and molecular tests for hepatotropic and other viruses, as well as radiologic and clinical outcomes. The outcomes were classified as an improving condition, liver transplantation, or death. RESULTS A total of 44 children had hepatitis that met the confirmed case definition, and most were previously healthy. The median age was 4 years (range, 1 to 7). Common presenting features were jaundice (in 93% of the children), vomiting (in 54%), and diarrhea (in 32%). Among the 30 patients who underwent molecular testing for human adenovirus, 27 (90%) were positive. Fulminant liver failure developed in 6 patients (14%), all of whom received a liver transplant. None of the patients died. All the children, including the 6 who received liver transplants, were discharged home. CONCLUSIONS In this series involving 44 young children with acute hepatitis of uncertain cause, human adenovirus was isolated in most of the children, but its role in the pathogenesis of this illness has not been established.
Collapse
Affiliation(s)
- Chayarani Kelgeri
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Michael Couper
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Girish L Gupte
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Alexandra Brant
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Mitul Patel
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Lauren Johansen
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Joseph Valamparampil
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Evelyn Ong
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Hermien Hartog
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - M T P R Perera
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Darius Mirza
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Indra van Mourik
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Khalid Sharif
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| | - Jane Hartley
- From the Liver Unit, Birmingham Women's and Children's NHS Foundation Trust (C.K., M.C., G.L.G., A.B., L.J., J.V., E.O., H.H., M.T.P.R.P., D.M., I.V.M., K.S., J.H., M.P.), the Centre for Liver and Gastrointestinal Research, University of Birmingham (D.M.), and the Liver Unit, Queen Elizabeth Hospital (H.H., M.T.P.R.P., D.M.) - all in Birmingham, United Kingdom
| |
Collapse
|
9
|
Shankar S, Valamparampil J, Rammohan A, Thiruchunapalli D, Reddy MS, Shanmugam N, Rela M. Minimally Invasive Treatment of Metabolic Decompensation Due to Portal Steal in Auxiliary Liver Transplantation. Liver Transpl 2019; 25:960-963. [PMID: 30938922 DOI: 10.1002/lt.25463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/03/2019] [Accepted: 03/18/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Sadhana Shankar
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.,The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Joseph Valamparampil
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.,The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Ashwin Rammohan
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.,The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Deepashree Thiruchunapalli
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.,The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Mettu S Reddy
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.,The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India
| | - Naresh Shanmugam
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India
| | - Mohamed Rela
- The Institute of Liver Disease and Transplantation, Dr. Rela Institute and Medical Centre, Bharat Institute of Higher Education and Research, Chennai, India.,The Institute of Liver Disease and Transplantation, Global Hospitals and Health City, Chennai, India.,Institute of Liver Studies, King's College Hospital, London, United Kingdom
| |
Collapse
|