Intensive care unit readmission in adult Egyptian patients undergoing living donor liver transplant: A single-centre retrospective cohort study.

BACKGROUND: Patients who undergo living donor liver transplantation (LDLT) may suffer complications that require intensive care unit (ICU) readmission. AIM: To identify the incidence, causes, and outcomes of ICU readmission after LDLT. METHODS: A retrospective cohort study was conducted on patients who underwent LDLT. The collected data included patient demographics, preoperative characteristics, intraoperative details; postoperative stay, complications, causes of ICU readmission, and outcomes. Patients were divided into two groups according to ICU readmission after hospital discharge. Risk factors for ICU readmission were identified in univariate and multivariate analyses. RESULTS: The present study included 299 patients. Thirty-one (10.4%) patients were readmitted to the ICU after discharge. Patients who were readmitted to the ICU were older in age (53.0 ± 5.1 vs 49.4 ± 8.8, P = 0.001) and had a significantly higher percentage of women (29% vs 13.4%, P = 0.032), diabetics (41.9% vs 24.6%, P = 0.039), hypertensives (22.6% vs 6.3%, P = 0.006), and renal (6.5% vs 0%, P = 0.010) patients as well as a significantly longer initial ICU stay (6 vs 4 d, respectively, P < 0.001). Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age (OR = 1.048, 95%CI = 1.005-1.094, P = 0.030) and length of initial hospital stay (OR = 0.836, 95%CI = 0.789-0.885, P < 0.001). CONCLUSION: The identification of high-risk patients (older age and shorter initial hospital stay) before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.

Outcome of living donor liver transplantation in patients with preoperative portal vein thrombosis.

BACKGROUND AND STUDY AIMS: Portal vein thrombosis (PVT) is no longer an absolute contraindication for living donor liver transplantation (LDLT). This study aimed to assess the short-term outcomes of LDLT and compare the 1-year survival rates between patients with and without preoperative PVT. PATIENTS AND METHODS: This combined prospective and retrospective cohort study was conducted on patients who underwent LDLT at Ain Shams Centre for Organ Transplantation (ASCOT) between 2008 and 2020. The study included 60 patients with PVT and 60 patients without PVT. The two groups were compared in terms of preoperative data, operative details, postoperative complications, and 1-year survival. RESULTS: Most patients with PVT were Child C (65%) and had higher model for end stage liver disease scores (16.23 ± 4.03) compared to the non-PVT group (13.9 ± 4.5). The PVT group showed longer cold ischemic time (CIT), hospital stay, and intensive care unit stay and significantly shorter 1-year survival rate (63.3%) compared to the non-PVT group (86.7%) (P = 0.003). Those with PVT grades I, II, and III had 1-year survival rates of 72.5%, 50%, and 40%, respectively. CONCLUSION: Preoperative PVT reduces the 1-year survival after transplantation, with patients with higher PVT grades exhibiting lower 1-year survival. LDLT for PVT still remains challenging and requires further studies.

Egyptian protocol for living donor liver transplantation (LDLT) during SARS-CoV-2 pandemic.

BACKGROUND: The current SARS-CoV-2 pandemic may negatively impact the care of liver transplant candidates and recipients. MAIN BODY OF THE ABSTRACT: Accordingly, each country must have its national guidelines based on the current situation and according to available tools. Liver Transplantation Scientific Committee of Waiting List Project in Egypt was established in 13 April 2020. One of the major objectives of this Scientific Committee is the preparation of national protocol for Transplant Centers in Egypt to deal with living donor liver transplantation (LDLT) during SARS-CoV-2 pandemic. CONCLUSIONS: The protocol highlights basic hospital requirements for LDLT during SARS-CoV-2 pandemic, the patient selection from the waiting list, management of patients on the waiting list, and post-transplant management. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43066-020-00074-4.

Impact of biliary complications on quality of life in live-donor liver transplant recipients.

BACKGROUND: Despite significant advancements in liver transplantation (LT) surgical procedures and perioperative care, post-LT biliary complications (BCs) remain a significant source of morbidity, mortality, and graft failure. In addition, data are conflicting regarding the health-related quality of life (HRQoL) of LT recipients. Thus, the success of LT should be considered in terms of both the survival and recovery of HRQoL. AIM: To assess the impact of BCs on the HRQoL of live-donor LT recipients (LDLT-Rs). METHODS: We retrospectively analysed data for 25 LDLT-Rs who developed BCs post-LT between January 2011 and December 2016 at our institution. The Short Form 12 version 2 (SF 12v2) health survey was used to assess their HRQoL. We also included 25 LDLT-Rs without any post-LT complications as a control group. RESULTS: The scores for HRQoL of LDLT-Rs who developed BCs were significantly higher than the norm-based scores in the domains of physical functioning (P = 0.003), role-physical (P < 0.001), bodily pain (P = 0.003), general health (P = 0.004), social functioning (P = 0.005), role-emotional (P < 0.001), and mental health (P < 0.001). No significant difference between the two groups regarding vitality was detected (P = 1.000). The LDLT-Rs with BCs had significantly lower scores than LDLT-Rs without BCs in all HRQoL domains (P < 0.001) and the mental (P < 0.001) and physical (P = 0.0002) component summary scores. CONCLUSION: The development of BCs in LDLT-Rs causes a lower range of improvement in HRQoL.

Biliary complications in recipients of living donor liver transplantation: A single-centre study.

BACKGROUND: Biliary complications (BCs) after liver transplantation (LT) remain a considerable cause of morbidity, mortality, increased cost, and graft loss. AIM: To investigate the impact of BCs on chronic graft rejection, graft failure and mortality. METHODS: From 2011 to 2016, 215 adult recipients underwent right-lobe living-donor liver transplantation (RT-LDLT) at our centre. We excluded 46 recipients who met the exclusion criteria, and 169 recipients were included in the final analysis. Donors' and recipients' demographic data, clinical data, operative details and postoperative course information were collected. We also reviewed the management and outcomes of BCs. Recipients were followed for at least 12 mo post-LT until December 2017 or graft or patient loss. RESULTS: The overall incidence rate of BCs including biliary leakage, biliary infection and biliary stricture was 57.4%. Twenty-seven (16%) patients experienced chronic graft rejection. Graft failure developed in 20 (11.8%) patients. A total of 28 (16.6%) deaths occurred during follow-up. BCs were a risk factor for the occurrence of chronic graft rejection and failure; however, mortality was determined by recurrent hepatitis C virus infection. CONCLUSION: Biliary complications after RT-LDLT represent an independent risk factor for chronic graft rejection and graft failure; nonetheless, effective management of these complications can improve patient and graft survival.

Effect of cyclosporine A versus tacrolimus on the response to antiviral therapy after hepatitis C genotype-4 recurrence post-liver transplantation: A prospective cohort trial.

WHAT IS KNOWN AND OBJECTIVE: The influence of immunosuppression on the response to antiviral therapy (AVT) for recurrent hepatitis C virus (HCV) infection in liver transplant (LT) recipients remains controversial, especially for the rarely investigated genotype 4. This study aims to compare the effects of the two widely used calcineurin inhibitors (CNIs) (cyclosporine A (CsA) and tacrolimus (Tac)) on the therapeutic response to different AVT regimens. METHODS: A prospective, dual-centre, cohort study of 126 Egyptian living donor liver transplant (LDLT) recipients with recurrent HCV genotype 4 infection, who were categorized into three groups according to the AVT used. Group I received pegylated interferon (Peg-IFN-α 2a) plus ribavirin (RBV) (n = 44), group II received the direct antiviral agent (DAA) sofosbuvir plus RBV (n = 52) and group III received daclatasvir and sofosbuvir (also DAAs) plus RBV (n = 30). Each group was further subdivided according to the primary immunosuppression (CsA or Tac). The sustained virological response (SVR) and relapse rates were considered the primary therapeutic outcomes of AVT. RESULTS: No significant intergroup differences were observed in the achievement of primary and secondary outcomes. SVR rates in the IFN-based regimen were 75% and 66.7% in CsA and Tac users and 81.2% and 83% in DAAs, respectively. Relapse rates in the IFN-based regimen were 10% and 16.7% in CsA and Tac users and 12.5% and 14.9% in DAAs, respectively. WHAT IS NEW AND CONCLUSION: Within the limitations of a relatively small study, CsA did not offer an advantage over Tac regarding the response to AVT after HCV genotype 4 recurrence in LDLT recipients.

Outcome of transarterial chemoembolization in Egyptian patients with hepatocellular carcinoma and branch portal vein thrombosis.

BACKGROUND/AIM: Portal vein tumor thrombosis (PVTT) is a common complication in hepatocellular carcinoma (HCC) and it was considered a relative contraindication for transarterial chemoembolization (TACE) by many centers. This study aimed to assess the outcomes after TACE in patients with branch PVT regarding Child classification, radiological response, and 1-year survival. METHODS: Thirty HCC patients (24 male, 6 females) Child A cirrhotics with branch PVT underwent TACE. Follow up was done at 1, 3, 6, and 12 months after first TACE. All patients underwent laboratory investigations including liver function tests to assess deterioration in liver functions and triphasic spiral computed tomography to assess radiological response according to modified response evaluation criteria in solid tumors (mRECIST) criteria, and survival analysis was recorded. RESULTS: TACE succeeded to achieve disease control in 93.3%, 86.3%, 57.7%, and 44.4% of patients after 1, 3, 6, and 12 months, respectively. Post-TACE liver decompensation occurred in the form of ascites in 30%, jaundice in 10%, and hepatic encephalopathy in 3.3% within 1 month of TACE. One month survival after TACE was 100%, 3 months was 96.6%, 6 months was 86.6%, and 1-year survival was 60%. Mean overall survival of the included patients was 17 months (SE = 1.59). CONCLUSION: TACE seems an alternative option for patients with unrespectable HCC with portal vein thrombosis in patients with good liver function tests.

Assessment of health-related quality of life in Egyptian HCV-infected recipients after living donor liver transplantation.

OBJECTIVE: Understanding issues pertaining to quality of life is essential for any disease, particularly in recipients of liver transplantation. The aim of this study was to evaluate the impact of liver transplantation on Egyptian recipients' health-related quality of life (HRQOL). METHODS: A prospective study carried out at the Ain Shams Center for Organ Transplantation (Cairo, Egypt), including 35 recipients for the evaluation of HRQOL using short form 36 score (Arabic version) and Beck Depression Inventory scores pre-transplantation and 1 and 6 months afterwards. RESULTS: The mean age of the recipients was 49.27 ± 8.16 years. Among them, 17 patients were highly educated. A statistically significant improvement in all dimensions of their HRQOL was observed after liver transplantation. Their physical functioning was 45.00 ± 34.34 before liver transplantation while after 1 and 6 months it was 57.50 ± 20.66 and 74.83 ± 19.27, respectively (P < 0.001). All 17 patients completed their first year after transplantation, showing a statistically significant improvement in all dimensions of their HRQOL one year after liver transplantation except that in mental health, role limitation due to emotional health emotional and social functioning domains. CONCLUSION: HRQOL is an important aspect of liver transplantation that should not be neglected.

VALUE OF CEREBROSPINAL FLUID TUMOR NECROSIS FACTOR-ALPHA (TN-ALPHA) FOR RAPID DIAGNOSIS OF BACTERIAL MENINGITIS.

Meningitis is common in tropical areas and also in Egypt and has a world-wide distribution. This study evaluated the potential role of CSF TNF alpha in diagnosis and differenfial diagnosis of acute meningitis (bacterial versus asepic meningitis). This case-control study was conducted between Ain Shams University Tropical Medicine Department and Embaba Fever Hospital. Fifty patients with suspected meningitis were recruited during from January 2014 to June 2014. They were divided according to culture results into 2 groups: GI: 40 patients with acute bacteria men ingitis (proved by CSF culture), G2: 10 patients matched according to age and sex with clinical sings of CNS infection but without laboratory evidence of bacterial origin, (Suspected cases, and negative culture). Both groups were subjected to thorough history taking, full clinical examination, and laboratory invistigations including CSF analysis & CS TNF was measured by ELISA. The results showed a highly significantdifference between cases and control reading CSF TNF (P=0.00). The criteria's of diagnostic validity test as 100% for all at cutoff > or = 275 ng/ml and < or = 700 ng/ml with 100% specificity and sensitivity. A significant correlation between CSF-TNF and each of ESR (P=003) & CSF cells (P=0.015), without significant correlation regarding other parameters (P>0.05).

Risk factors for early intrahepatic distant recurrence after radiofrequency ablation for hepatocellular carcinoma in Egyptian patients.

OBJECTIVE: Early tumor recurrence, either local or intrahepatic distant recurrence (IDR), after successful radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) remains a significant problem. The study aimed to determine the potential risk factors for IDR within one year after successful RFA in HCC patients. METHODS: In total, 105 patients with 138 lesions who underwent RFA and were followed up for at least one year were included in this study. The patients' data was retrospectively reviewed. Multiple host and tumoral potential risk factors were analyzed. RESULTS: IDR was found in 62 (59.0%) of all patients. Cumulative IDR-free survival rates in all patients studied were 81.9%, 45.4% and 35.2% at 1, 2 and 3 years, respectively, after RFA. Univariate and multivariate analysis showed that both tumor size >2.8 cm and primary multinodular tumors were significant risk factors for IDR within one year after RFA. CONCLUSIONS: Patients with tumors of >2.8 cm in diameter or multinodular HCC should be closely monitored for early recurrence after RFA. Combined or systemic therapies should be tried for these patients to improve their disease-free and overall survival.

Evaluation of salivary and serum anti-Helicobacter pylori in Egyptian patients with H. pylori related gastric disorders.

Helicobacter pylori is a common and important transmissible bacterial human pathogen. Although several diagnostic tests are available for the detection of H. pylori infection, all of them have both advantages and disadvantages, and none can be considered as a single gold standard. Serological methods analyzing (serum and saliva) by using enzyme immunoassays, which are simple, reproducible and inexpensive, can detect either antigen or antibody. This study evaluated the frequency of anti- H. pylori serum and salivary antibodies positivity among Egyptian patients with gastric disorders and the validity of salivary, serum serological tests for diagnosis of H. pylori, comparing this with gold standard tests performed on endoscopy biopsy. This prospective, case-controlled study included 45 Egyptian patients who attended Ain Shams University Hospitals Cairo, Egypt between January 2013 and June 2013. There were 29 males &16 females their mean age was 51.78 +/- 7 (range 18-60). Among the ulcerogenic drugs, Aspirin was the most common drug (46.7%). The evidence revealed the sensitivity of Rapid Urease Test (RUT) was 100%, specificity was 71.4%, Positive Predictive value (PPV) was 88.6% and Negative Predictive value (NPV) was 100%. The sensitivity of serum IgG was 68.97% and specificity was 42.86%; while the sensitivity of serum IgA was 89.6% and the specificity was 50%. Correlating the salivary IgG results with H. pylori status diagnosed by culture, salivary IgG succeeded to diagnose 19 cases from the 31 positive H. pylori patients with a sensitivity of 63.33% & specificity of 92.86% whereas the results of salivary IgA showed a sensitivity of 80% and specificity of 92.86%.