Browsing by Author "Khalaf, Hatem"

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    Liver Transplant for Hepatocellular Carcinoma: Experience in a Saudi Population
    (Başkent Üniversitesi, 2008-03) Allam, Naglaa; Khalaf, Hatem; Fagih, Mosa; Al-Sebayel, Mohamed
    Objectives: We present our experience with deceased-donor liver transplant and living-donor liver transplant for hepatocellular carcinoma. Between 2001 and 2007, we transplanted 133 organs (84 deceased-donor liver transplants, 49 living-donor liver transplants) in 126 patients (4 retransplants). Twenty-three patients had hepatocellular carcinoma (14 deceased-donor liver transplants and 9 living-donor liver transplants). Materials and Methods: The medical records of these patients were reviewed for recipient clinical, biochemical, and imaging characteristics. Slides of explants were assessed. Overall survival and tumor recurrence states were determined. All characteristics were tested for their prognostic significance. Results: The median age of the patients was 55 years and the median Mayo End-stage Liver Disease score was 16. The alpha-fetoprotein was ≥400 ng/mL in 4 patients. Histopathology revealed incidental cholan­giocarcinoma in 2 patients and a hepatoblastoma in 1. The mean tumor size was 4 cm; the mean number of lesions was 2. Most tumors were graded as well or moderately differentiated; 4 were poorly differentiated. Gross macrovascular invasion was seen in 2 patients, while microvascular invasion was seen in 9. After a mean follow-up of 736 days, overall patient and graft survival rates were 80.9% and 76.2%; overall disease-free patient and graft survival rates were 76.2% and 71.4%. Two patients died of primary graft nonfunction within 1 week of the transplant. Three had tumor recurrence at 10, 13, and 18 months after transplant; 2 of these occurred in patients with cholangiocarcinoma. Two of these 3 died from an advanced tumor within few months. Significant risk factors for recurrence were gross major vessel invasion, microvascular invasion, tumor size, poor histologic differentiation, and absence of pretransplant tumor control therapy. The latter 2, in addition to Mayo End-stage Liver Disease score and preoperative alpha-fetoprotein, were independent predictors of mortality. Conclusions: In our small experience, deceased-donor liver transplant and living-donor liver transplant for hepatocellular carcinoma showed good long-term outcomes. Liver transplant for hepatocellular carcinoma accompanying cholan­giocarcinoma had a poor outcome with late tumor recurrence. Use of marginal donors in patients with hepatocellular carcinoma might compromise the outcome in these patients.
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    Risk Factors for Biliary Complications After Living-Donor Liver Transplant: A Single-Center Experience
    (Başkent Üniversitesi, 2008-06) Alawi, Khalil; Sebayel, Mohammed; Abdo, Ayman; Al-Hamoudi, Waleed; Al-Bahili, Hamad; Al-Sofayan, Mohamed; Al-Saghier, Mohamed; Allam, Naglaa; Medhat, Yaser; Khalaf, Hatem
    Objectives: Biliary complications remain a major concern in living-donor liver transplant. They can lead to patient and graft loss. In this study, we retrospectively analyzed patients’ records to identify factors that increase the frequency of biliary complications in living-donor liver transplant with an aim toward decreasing this frequency. Materials and Methods: We performed 53 living-donor liver transplants between November 2002 and September 2007. Five cases were excluded because of graft or patient loss within 2 weeks resulting in 48 cases available for analysis. The effect of the following variables on the frequency of biliary complications was analyzed: recipient age, liver lobe used, number of graft bile ducts, number of biliary anastomoses, type of biliary anastomosis, and bile duct diameter 4 mm or smaller. Results: Biliary complications were seen in 14 cases (29.1%). These included 9 biliary strictures, 3 bile leaks, and 2 bile leaks eventually healing as biliary strictures. The presence of more than 1 graft bile duct increased the frequency of biliary complications (P = .03). The other variables did not have a statistically significant effect on the frequency of biliary complications. Conclusions: The rate of complications in our experience is comparable to that already published. The presence of more than 1 bile duct in the graft is a risk factor for biliary complications in living-donor liver transplant. A review of the data suggests additional risk factors.