Browsing by Author "Nikeghbalian, Saman"

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Acute Renal Failure in the First 100 Orthotopic Liver Transplant Patients in Southern Iran
(Başkent Üniversitesi, 2007-12) Rais-Jalali, Ghanbar-Ali; Malek-Hosseini, Seyed Ali; Salahi, Heshmatolah; Bahador, Ali; Nikeghbalian, Saman; Roozbeh, Jamshid; Behzadi, Saeed; Daniali, Farzad; Sagheb, Mohammad Mahdi
Postoperative acute renal failure is a frequent and serious medical complication following orthotopic liver transplant. Here, we report our experiences with liver transplant recipients who developed acute renal failure in the early period following orthotopic liver transplant. Among 100 liver transplants performed between April 1993 and January 2004, we retrospectively analyzed 91 patients (mean age, 29.9 ± 14.0 years) who had undergone orthotopic liver transplant. The underlying causes of liver failure were cryptogenic liver cirrhosis (n=27), viral hepatitis (n= 21) (hepatitis-B–related liver cirrhosis [n=13], hepatitis-C–related liver cirrhosis [n=7], and hepatitis-B– and C–related liver cirrhosis [n=1]), autoimmune hepatitis (n=18), Wilson’s disease (n=10), primary sclerosing cholangitis (n=8), biliary atresia (n=3), Budd-Chiari syndrome (n=2), and primary biliary cirrhosis (n=2). The immunosuppressive regimen included mycophenolate mofetil (azathioprine for 10 patients), cyclosporine, and steroids. Six patients received a combination of tacrolimus and steroids. Ten patients (10.9%) experienced acute renal failure, 7 (70%) were men, and none of them required renal replacement therapy and/or died. Four patients were diagnosed as having cryptogenic liver cirrhosis; 2 with hepatitis-C–related liver cirrhosis, 2 with autoimmune liver cirrhosis; 1 with primary biliary cirrhosis; and 1 hepatitis-B–related liver cirrhosis. Six patients were Child-Pugh's classification C, and the others were B. The rate of postoperative acute renal failure in our patients was relatively low when compared with other series, and our outcomes were good.
Effect of D-Penicillamine on Liver Fibrosis and Inflammation in Wilson Disease
(Başkent Üniversitesi, 2008-12) Kazemi, Kourosh; Malek-Hosseini, Seyed Ali; Dehghani, Seyed Mohsen; Kakaei, Farzad; Dehghani, Masood; Nejatollahi, Seyed Mohammad Reza; Bahador, Ali; Salahi, Heshmatollah; Nikeghbalian, Saman; Geramizadeh, Bita
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 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.
Effects of Surgical Technique on Postoperative Renal Function After Orthotopic Liver Transplant
(Başkent Üniversitesi, 2009-03) Gholami, Siavosh; Malek-Hosseini, Seyed Ali; Nikeghbalian, Saman; Salahi, Heshmatollah; Bahador, Ali; Kazemi, Kourosh; Kakaei, Farzad; Rajaei, Elnaz
Objectives: The classic technique for orthotopic liver transplant consists of the total excision of the retrohepatic inferior vena cava during native hepatectomy. Controversy about the effects of the classic technique on postoperative renal function continues. The aim of this study was to evaluate the effects of the chosen hepatectomy technique on postoperative renal function. Materials and Methods: Of 253 patients who received an orthotopic liver transplant between June 2006 and July 2008 in the Shiraz transplant unit, only 15 underwent operation with the classic technique. Patient demographics and factors including cold ischemic time, warm ischemic time, operative time, transfusions, blood loss, and early postoperative renal function were assessed retrospectively. The criteria for acute renal failure were a serum creatinine level of > 133 µmol/L (1.5 mg/dL), an increase in the baseline serum creatinine level by 50%, or oliguria requiring renal replacement therapy. Results: All patients received a liver from a deceased donor, and none required venovenous bypass during the operation. The minimum mean arterial blood pressure value of the patients during clamping was 65 ± 19 mm Hg. The mean preoperative plasma creatinine level was 87.51 ± 39.78 µmol/L (0.99 ± 0.45 mg/dL). During the first week after transplant, 7 patients (46.6%) experienced acute renal failure, and 3 of those 7 required renal replacement therapy. By the sixth postsurgical month, 4 of those 7 patients had died (1 from adult respiratory distress syndrome, 2 from sepsis, and 1 from recurrent cholangiocarcinoma). In all other patients, the plasma creatinine level had returned to the normal range by the third postsurgical week 3 or during short-term follow-up. Conclusions: Use of the classic technique for orthotopic liver transplant may increase the rate of postoperative renal failure, but that complication usually resolves during short-term follow-up.