Journals

Decompensated hepatitis C virus-related cirrhosis delisted from liver transplantation after successful sofosbuvir-based treatment.

Decompensated hepatitis C virus-related cirrhosis delisted from liver transplantation after successful sofosbuvir-based treatment.

Liver Transpl. 2014 Nov 25;

Authors: Ruiz I, Feray C, Pawlotsky JM, Hezode C

PMID: 25420476 [PubMed - as supplied by publisher]

The safety and effectiveness of reno-portal by pass in patients with complete portal vein thrombosis: Our analysis on 10 patients.

The safety and effectiveness of reno-portal by pass in patients with complete portal vein thrombosis: Our analysis on 10 patients.

Liver Transpl. 2014 Nov 25;

Authors: Quintini C, Spaggiari M, Hashimoto K, Aucejo F, Diago T, Fujiki M, Winans C, D’Amico G, Trenti L, Kelly D, Eghtesad B, Miller C

Abstract

The presence of Portal Vein Thrombosis (PVT) is still considered by many transplant centers an absolute contraindication to liver transplantation (LT) due to the technical difficulties it can present and its association with a higher rate of patient morbidity and mortality. Reno-Portal Bypass (RPB) can help remove these barriers. This study describes our institution’s experience with RPB through the description of a new and successful simplified surgical strategy, the patient and graft outcome analysis, the intraoperative vascular flows measurements and the use of splenic artery embolization (SAE) as an effective adjunct to treat the sporadic cases of unrelieved portal hypertension. Between January 2004 and January 2013, ten patients with grade 4 PVT underwent RPB. At the last follow up (42.2 ± 21.1 months), patient and graft survival were 100%. Five patients (50%) experienced post-transplant ascites and two of those received proximal SAE to modulate liver inflow and overcome the ascites. Three patients (30%) experienced transient kidney injury in the early post-transplant period and were treated efficiently with medical therapy. The reno-portal flow, were close to the desirable 100ml per 100g of liver tissue in all cases. The experience and data support RPB as a feasible and easily reproducible technique without the risks and technical challenges associated with the tedious dissection of a cavernous hilum. This article is protected by copyright. All rights reserved.

PMID: 25420619 [PubMed - as supplied by publisher]

Selection of living donor liver grafts for patients weighing less than 6kg.

Selection of living donor liver grafts for patients weighing less than 6kg.

Liver Transpl. 2014 Nov 25;

Authors: Yamada N, Sanada Y, Hirata Y, Okada N, Wakiya T, Ihara Y, Miki A, Kaneda Y, Sasanuma H, Urahashi T, Sakuma Y, Yasuda Y, Mizuta K

Abstract

Background In the field of pediatric living donor liver transplantation (LDLT), physicians soetimes must reduce the volume of left lateral segment (LLS) grafts to prevent large-for-size syndrome. There are two established methods for decreasing the size of an LLS graft: the use of a segment 2 (S2) monosegment graft or that of a reduced-LLS graft. However, no procedure for selecting the proper graft type has been established. In this study, we conducted a retrospective investigation of LDLT and examined the strategy of graft selection for patients weighing <6kg. Patients and Methods Among 225 LDLTs conducted between May 2001 and December 2012, 15 were performed in patients weighing <6kg. We selected S2 monosegment grafts and reduced-LLS grafts if the preoperative computed tomography (CT)-volumetry value of the LLS graft was >5% and 4-5% of the graft recipient weight ratio, respectively. The mean follow-up period was 3.9 ± 2.2 years. Results We used LLS grafts in 7 recipients, S2 monosegment grafts in 5, reduced-S2 monosegment grafts in 2, and a reduced-LLS graft in 1. The reduction rate of S2 monosegment graft for use as an LLS graft was 48.3%. The overall recipient and graft survival rates were both 93.3%; and 1 patient died of a brain hemorrhage. Major surgical complications included hepatic artery thrombosis in 2 recipients, bilioenteric anastomotic stricture in 2, and portal vein thrombosis in 1. Conclusion Our graft selection strategy based on preoperative CT-volumetry is highly useful in patients weighing <6kg. S2 monosegment grafts are effective and safe in very small infants, particularly neonates. This article is protected by copyright. All rights reserved.

PMID: 25422258 [PubMed - as supplied by publisher]

The outcome of patients with cirrhosis and Type-1 hepatorenal sydrome treated with liver transplantation.

The outcome of patients with cirrhosis and Type-1 hepatorenal sydrome treated with liver transplantation.

Liver Transpl. 2014 Nov 25;

Authors: Wong F, Leung W, Al Beshir M, Marquez M, Renner EL

Abstract

Hepatorenal syndrome type 1 (HRS-1) is acute renal failure in advanced cirrhosis, resulting from hemodynamic derangements, which should be fully reversible after liver transplantation. However, the rate of HRS reversal, and factors predicting renal outcome post-transplant have not been fully elucidated. Aim: To assess outcome of HRS-1 patients post-liver transplant and factors predicting HRS reversal.

METHODS: A chart review of all liver transplant patients with HRS-1 (International Ascites Club criteria) at Toronto General Hospital from 2001-2010 was conducted. Patient demographic, pre- and post-transplant laboratory data, as well as the presence of and time to post-transplant HRS reversal (serum creatinine <1.5mg/dL) were extracted from the centre’s transplant electronic database. Patients were followed until death or end of calendar year 2011.

RESULTS: 62 patients (mean age 54.7±1.2years, MELD score 35±1) with HRS-1 (serum creatinine 3.37±0.13mg/dL) at liver transplant were enrolled. 38 patients received midodrine, octreotide and albumin without success and subsequently received renal dialysis. One further patient received dialysis without pharmacotherapy. Post-liver transplant, HRS-1 resolved in 47/62 patients (76%) at a mean time of 13±2days. Patients without HRS reversal had significantly higher pre-transplant serum creatinine (3.81±0.34mg/dL vs. 3.23±0.14mg/dL, p=0.06), longer duration of HRS-1 (25 days (95% confidence interval or CI: 16:42) vs. 10 days (95%CI: 10:18), p=0.02), pre-transplant dialysis duration (27 days (95% CI: 13:41) vs. 10 days (95% CI: 6:14), p=0.01), associated with increased post-transplant mortality versus those with recovered renal function (p=0.045). The only predictor of HRS-1 non-reversal was the duration of pre-transplant dialysis with a 6% increased risk of non-reversal with each additional day of dialysis.

CONCLUSIONS: Our study suggests that patients with HRS-1 should receive a timely liver transplant to improve their outcome. This article is protected by copyright. All rights reserved.

PMID: 25422261 [PubMed - as supplied by publisher]

Raising Expectations For Subunit Vaccine.

Raising Expectations For Subunit Vaccine.

J Infect Dis. 2014 Nov 24;

Authors: Schiller JT, Lowy DR

Abstract

Multi-dose regimens are recommended for all prophylactic subunit vaccines. Recent findings from clinical trials of an HPV virus-like particle (VLP) vaccine suggest that it may be possible to develop effective single dose subunit vaccines. The broad implications of these findings are discussed and the importance of antigen structure and adjuvant in achieving this goal is considered. In conclusion, we argue for the inclusion of single dose arms in future trials of vaccines, especially if they are based on induction of antibodies by virus-like displayed antigens.

PMID: 25420478 [PubMed - as supplied by publisher]

Mound of butter: Antoine Vollon.

Mound of butter: Antoine Vollon.

JAMA. 2014 Nov 26;312(20):2076-7

Authors: Cole TB

PMID: 25423202 [PubMed - in process]

Antibiotics for children: when less is more.

Antibiotics for children: when less is more.

JAMA. 2014 Nov 26;312(20):2079-80

Authors: Slomski A

PMID: 25423203 [PubMed - in process]

High-tech care can save lives–but it also may create incentives that result in lives lost.

High-tech care can save lives–but it also may create incentives that result in lives lost.

JAMA. 2014 Nov 26;312(20):2081

Authors: Frakt A

PMID: 25423204 [PubMed - in process]

Ending the cycle of blame in US health care.

Ending the cycle of blame in US health care.

JAMA. 2014 Nov 26;312(20):2091-2

Authors: Powers BW, Cassel CK, Jain SH

PMID: 25423214 [PubMed - in process]

Accountable health communities: getting there from here.

Accountable health communities: getting there from here.

JAMA. 2014 Nov 26;312(20):2093-4

Authors: Fisher ES, Corrigan J

PMID: 25423215 [PubMed - in process]