Başkent Üniversitesi Yayınları
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Item Determining the Incidence of Aspergillosis After Liver Transplant(Başkent Üniversitesi, 2010-09) Badiee, Parisa; Shakiba, Elaheh; Nikeghbalian, Saman; Malekhosseini, Seyed Ali; Alborzi, AbdolvahabObjectives: Aspergillus has become an increasingly frequent cause of life-threatening opportunistic infections in liver transplant recipients. This study seeks to determine the incidence of invasive aspergillosis in liver transplant recipients using routine and molecular methods in a teaching hospital in Shiraz, the unique center for liver transplant in Iran. Materials and Methods: Four hundred eight recipients who underwent liver transplant were followed for Aspergillus infections by microscopic examination, culture, and nested polymerase chain reaction. Blood samples were cultured by bedside inoculation to BACTEC medium. Results: The female-to-male ratio was 151:257 (mean age, 29.6 years; mean hospitalization, 26 days). Sensitivity and specificity of the nested polymerase chain reaction was 92.8% and 94%. Aspergillosis was detected in 19 recipients (4.6%) by routine and molecular method (4 proven, 10 probable, and 5 possible) of whom 12 recipients died (63.2%). Conclusions: This study found the incidence rate of invasive aspergillosis as an uncommon complication of liver transplant recipient cases but associated with poor outcomes. The rate is consistent with those reported in previous studies, but molecular assay that is more-sensitive and specific was used in the present study.Item Hepatic Abscesses After Liver Transplant: 1997–2008(Başkent Üniversitesi, 2009-12) Malek-Hosseini, Seyed Ali; Janghorban, Parisa; Nikeghbalian, Saman; Salahi, Roohallah; Salahi, Heshmatallah; Bahador, Ali; Kakaie, Farzad; Kazemi, KorushObjectives: Infectious complications (such as liver abscesses) remain one of the major causes of posttransplant morbidity and mortality. Management may be problematic and is often based on experience with hepatic abscess in nontransplant patients. We reviewed our experience with hepatic abscess in liver transplant recipients to assess their presentation, clinical features, treatment, and outcome. Materials and Methods: A retrospective review of all liver transplant in Shiraz transplant center from September 1997 through September 2008 was performed. Hepatic abscess was defined as a parenchymal hepatic lesion consistent with abscess (as described by a radiologist), positive liver or concurrent blood cultures, or both (within 24 hours), and compatible clinical findings. Results: Of 560 liver recipients, we identified 5 patients (23-42 y) who had experienced 7 episodes of hepatic abscess, 30-240 days after transplant. All patients had received liver from deceased donors. Biliary reconstruction was done by duct-to-duct anastomosis in 4 and hepatico-jejunostomy in 1 case. Pretransplant diagnoses included hepatitis B cirrhosis, autoimmune hepatitis (2 cases), Caroli disease, and cryptogenic cirrhosis. Liver aspirates showed E. coli in 4 cases, and Aspergillus in 1 case. The main predisposing factor was bile-to-duct anastomosis stricture in 3, diabetes mellitus in 2, and hepatic artery thrombosis in 1 of the patients. Two patients died owing to liver and multiorgan failure, despite percutaneous and operative drainage with broad spectrum antibiotics and antifungals. Conclusions: Hepatic abscess, a rare complication after liver transplant, was associated with hepatic artery thrombosis, biliary anastomosis stricture, and diabetes mellitus. Mortality was higher than in patients who had not undergone transplant. Prolonged antibiotic therapy and drainage are required to improve the outcome in these patients.Item 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, ElnazObjectives: 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.Item 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, BitaBackground: 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.Item 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 MahdiPostoperative 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.