LIVER TRANSPLANT

Abstract
Variations in the anatomy of the intrahepatic bile ducts have long been recognized.
Serious consideration of the surgical anatomy of the liver began, however, with the advent of
minimally invasive therapeutic intervention for bile duct or hepatic resection, or partial liver
transplantation. Thus, accurate knowledge of the anatomy of IHDs is critical. 30 cases were
included in this study. Right lobe donation in 27 cases and left lobe donation in 3 cases. The
main indication for transplantation was end stage liver disease: hepatitis C end stage liver
cirrhosis in 29 cases, while hepatocellular carcinoma on top of liver cirrhosis was the remaining
case. Pretransplantation preparation of both donors and recipients was done.No mortality was
reported to either any of the donors or the recipients. Postoperative donor biliary complications
occurred in 1 case and conservative treatment was followed with complete resolution of the
condition .Postoperative recipient biliary complicatioins occurred in eleven cases in the form of
biloma, biliary leakage, biliary stricture, cholangitis and peritonitis, six of them with two ducts
anastomosis. They were managed and cured without residual pathology.

Cholangiocellular carcinoma (CCC) is a biliary malignancy that frequently presents in advanced unresectable stages. The role of liver transplantation (LT) as a surgical modality is unclear. The goal of this study is to evaluate outcomes of patients with CCC undergoing LT. A retrospective analysis of all patients undergoing LT was undertaken. Only those patients with the pathological diagnosis of CCC

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio=1.1; P<.05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

Deoxyguanosine kinase (DGUOK) deficiency is the commonest type of mitochondrial DNA depletion associated with a hepatocerebral phenotype. In this article, we evaluate predictors of survival and therapeutic options in patients with DGUOK deficiency. A systematic search of ...

Matrix metalloproteinases (MMPs) are known to play an important role in cell migration during cancer invasion by degrading extracellular matrix proteins. This study aimed to determine the role of MMP-9 in hepatocellular carcinoma (HCC) carcinogenesis. Eighty-nine cases who underwent liver transplantation for HCC in cirrhotic liver were selected for this study. The tumor characteristics such as nodule number, maximal diameter, portal vein invasion, and the preoperative alpha-fetoprotein levels were reviewed. The intensity of immunostaining and the percentage of immunoreactive cells with MMP-9 were evaluated. All patients were evaluated for HCC recurrence and/or death, and cause of death was noted. There was a lower survival and more recurrence risk among participants with 4 or more nodules exceeding 3 cm in diameter, with poorly differentiated tumor, and with large-vessel involvement. Eleven patients developed recurrent HCC (12.4%). Twelve patients died as a result of HCC (13.5%). Am...

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio=1.1; P<.05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio=1.1; P<.05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

BACKGROUND AND OBJECTIVE: Giant hemangiomas are less likely to be present at birth. This syndrome is caused by obstruction of the portal veins of the liver and requires surgical intervention. Treatment of hepatic hemangiomas varies depending on the symptoms, location and size. In this study, giant hepatic hemangioma in a patient with Budd-Chiari syndrome was reported.
CASE REPORT: The patient is a 57-year-old woman with a giant hemangioma in the liver who has referred to Montaserieh Hospital in Mashhad with symptoms of liver failure, anorexia and early satiety and obstruction of hepatic portal veins. She did not mention any specific drug or food allergies. Except for the heartbeat, all other vital signs were in the normal range. Initial examinations diagnosed giant liver hemangiomas and ascites. After performing the required diagnostic tests, the liver weighing about 10 kg was removed and a liver transplant was performed. After 13 days, the patient was discharged in good general condition.
CONCLUSION: One of the rare indications for liver transplantation is giant hepatic hemangioma, which causes liver dysfunction and Budd-Chiari syndrome. Liver transplantation in these patients improves their life and shows good results.

Objective: To determine the association between Doppler Parameters of average peak portal vein velocity and flow direction and Child Pugh classes of patients suffering from the chronic liver disease.
Study Design: It was a descriptive study.
Place and Duration of Study: The study was conducted from December 2013 to January 2015 at the Radiology Department of Holy Family Hospital, Rawalpindi, Pakistan.
Materials and Methods: Selected chronic liver disease (CLD) patients were examined with gray scale and Doppler USG for assessment of portal vein (PV). Average peak portal venous velocity (PVV) and direction of flow in the main portal vein were recorded. Doppler findings were correlated with clinical features and laboratory findings in three classes (A, B & C) of patients using Child Pugh criteria to establish any probable association between them (appendix: I).
Results: Out of total 115 CLD patients studied, 47.8% were in Child Pugh class C. The main portal vein average PVV (cm/sec) in 24.34% patients with Child Pugh class A was 18.75 + 1.88, in 27.82% patients with Child Pugh class B was 14.25 + 0.98 and in 47.82% patients with Child Pugh class C was 8.15 + 1.84. This showed a significant fall in portal vein average PVV with advancing Child Pugh class of cirrhosis. Only 10.4% patients showed continuous hepatofugal flow and 4.3% showed bidirectional flow. It was recorded only in Child Pugh class C patients.
Conclusion: Doppler findings of average peak velocity in the main portal vein fall progressively with worsening of the Child Pugh class. In addition, the direction of flow is also reversed in cases of the Child Pugh class C cirrhosis.

Oxidative stress is implicated in the pathogenesis of hepatic ischemia-reperfusion injury, a major determinant of initial poor graft function (IPGF) after orthotopic liver transplantation (OLT). We prospectively investigated the association between the recipient plasma preoperative oxidative stress and the occurrence of IPGF after deceased-donor OLT and indirectly studied the source-hepatic or extra-hepatic-of systemic oxidative stress in vivo in cirrhosis. We used a recently developed specific and sensitive mass spectrometry assay to measure 7beta-hydroxycholesterol and 7-ketocholesterol (oxysterols), markers of oxidative stress, in biological matrices. At univariate analysis, preoperative recipient 7beta-hydroxycholesterol plasma concentration was significantly higher in transplants with subsequent IPGF (n = 9) compared with those with initial good graft function (IGGF; n = 23) [mean +/- SD: 30.63 +/- 26.42 and 11.57 +/- 15.76 ng/mL, respectively] (P = 0.017). In a logistic regres...