Journal of Liver Transplantation最新文献

portal hypertension and bacterial infections are frequent in cirrhosis and their coexistence may render this population susceptible to severe drug-induced thrombocytopenia. We describe frequency, clinical characteristics and prognosis of Piperacillin/Tazobactan associated thrombocytopenia. 84 patients [Child 10±1, MELD 18±8; SIRS and ACLF in 28% and 24%] were included. Thrombocytopenia developed in 12 patients and was associated with a higher frequency of bleeding from multiple sites and platelet transfusion. Severe/persistent thrombocytopenia correlated with in-hospital mortality. In conclusion, development of thrombocytopenia is frequent in cirrhotic patients treated with Piperacillin/Tazobactan and this complication, especially in most severe forms, is associated with high morbidity and mortality.

Background

Living Donor Liver Transplantation (LDLT) is common in Pakistan, where the deceased organ donation is lacking. However, not all potential living donors are suitable for the procedure due to various medical, technical, psychosocial, and ethical reasons. This study aims to investigate the reasons for the ineligibility of potential living liver donors in Pakistan.

Methods

Between June 2022 and March 2023, 530 potential living liver donors were assessed for liver transplant recipients at the Pakistan Kidney and Liver Institute & Research center (PKLI&RC). Potential donors were evaluated in three steps, including laboratory tests imaging, and consultations. Prospectively maintained data on all potential donors were examined and retrospectively assessed to identify the causes of donor rejection.

Results

Of the 530 potential living donors evaluated, 364 of the potential donors were considered ineligible (68.67% of donors were rejected). From these rejected donors, 193 (53%) were males, and 171 (47%) were females. The mean age of the rejected donors was 26 years old. The most common reason for disqualifying potential living liver donors was a withdrawal of consent (65 cases, 17.9%). Other factors contributing to ineligibility included fatty liver infiltration reflected by a liver attenuation index (LAI) < 0, future liver remnant (FLR) < 28%, and a graft-to-recipient weight ratio (GRWR) < 0.6. Medical issues, such as abnormal liver function tests and positive hepatitis serology, also resulted in disqualification.

Conclusion

This study highlights the importance of meticulous assessment of potential living liver donors to ensure their safety and the success of the transplant. The high rate of withdrawal of consent and the prevalence of medical issues indicates the need for addressing ethical concerns and improving public education on the donation process. This study also emphasizes the importance of a deceased organ donation in developing countries like Pakistan to ensure the availability of organs for transplantation.

Introduction

In 2012, the German transplant scandal was uncovered and reported in the national and international media. This article offers an anthropological analysis of the scandal and examines its ‘scandalous’ characteristics by taking a close look at its extraordinary and ordinary features.

Methods

The article is based on ethnographic research using multiple methods including participant observation, interviewing as well as media and document analysis.

Results

The transplant scandal in Germany revealed systemic ‘scandalous’ features of the national transplant system. From a significant lack of transparency in decision making, a weak legal framework for accountability, adherence to moralizing rules about alcohol and abstinence, to media coverage that individualized the scandal.

Conclusions

Looking at extraordinary events such as transplant scandals from an anthropological perspective offers an analysis that goes beyond the singular, scandalous event. An anthropological analysis allows to highlight the ordinary and ambivalent ‘scandalous’ features of transplant medicine It examines transplant medicine at the intersection of biomedicine, politics, and morality.

Introduction

Obesity-associated comorbidities increase risks for patients undergoing liver transplant. In this study, we explore patient perspectives and motivation for healthy weight management among patients on the liver transplant waiting list.

Methods

This is a cross-sectional, observational, electronic survey-based study. A survey on weight management was administered to patients on the liver transplant waiting list. Demographic and clinical data were collected from patients’ medical records. Data was analyzed using Pearson's chi-squared, Fisher's exact, and Student's t-tests.

Results

Respondents had a mean age of 54.4 years, were predominately male (62.0%) with a mean BMI of 29.2 kg/m² with alcoholic cirrhosis as the leading etiology of liver disease (33.9%). Among patients with a BMI≥30 kg/m², 59.0% perceived that they were overweight and 23.1% believed they were underweight. Among patients with BMI≥30 kg/m² who perceived they were overweight, 39.1% were actively trying to lose weight and 60.9% were trying to keep from gaining weight. Regardless of current weight, there was a median increase in BMI for patients who categorized themselves as having lost weight or maintained weight since being waitlisted.

Conclusion

Many patients with a BMI≥30 kg/m² did not perceive themselves as overweight and were not actively trying to lose weight. Weight perception was not consistent with actual weight change while waitlisted for liver transplant. Further research is needed to understand how weight awareness and weight perception impacts motivation for weight loss.

In patients undergoing orthotopic liver transplantation (OLTx) surgery, the intraoperative hemodynamic monitoring technique that is most utilized is still the pulmonary artery catheter (PAC). The popularity of transesophageal echocardiography (TEE) is increasing, so today's updated issue is the following: should the use of PAC and/or volumetric monitoring with transpulmonary thermodilution and/or advanced volumetric PAC be limited in clinical practice, only for some high risk patients? Could we use the TEE, if necessary, in less critical ill patients undergoing OLTx surgery?

We can integrate all of the aforementioned monitoring techniques in an increasing modular step wise monitoring concept. But in an uncertain hemodynamic situation, transthoracic and/or transoesophageal echocardiographic evaluation represents a cornerstone.

The use of echocardiography during OLTx is more and more common with several benefits demonstrated particularly by the TEE in this patient population.

To achieve and maintain adequate tissue perfusion becomes difficult in case of major bleeding, an event quite possible to occur during OLTx, affecting the immediate and the late outcome.

All the clinicians agree that bleeding interfere with the choice of hemodynamic monitoring and or vice versa.

A reasonable compromise is to find a balance between the need to extend monitoring in high-risk surgical patients and the average consumption of blood products that characterizes each individual transplant center. This is also in line with what is shown in literature in terms of Maximum Surgical Blood Ordering Schedule (MSBOS).

Portopulmonary hypertension (PoPH) is a rare but serious disorder carrying a very poor prognosis. PoPH is defined as the presence of pulmonary arterial hypertension (PAH) associated with portal hypertension, with or without underlying liver disease. We are reporting our institutional experience of anaesthetic management of an 8-year old female child weighing 20 kg with severe PoPH who underwent liver transplantation (LT). The use of pulmonary vasodilators in the perioperative period along with a carefully planned anaesthetic strategy was critical in the successful outcome of this potentially lethal disorder.