Leiomyosarcoma of the inferior vena cava presenting as Budd-Chiari syndrome. Vena cava replacement under veno-venous bypass and liver hypothermic perfusion.

We report the first case of leiomyosarcoma of the middle and upper part of the vena cava successfully treated by surgical resection, complete vena cava replacement and disobliteration of the hepatic veins under veno-venous bypass and liver hypothermic perfusion as described in "ex situ, in vivo liver surgery".

[Spontaneous Listeria monocytogenes peritoneal infection complicating hepatic transplantation]. / Infection péritonéale spontanée à Listeria monocytogenes compliquant une transplantation hépatique.

The incidence of listeriosis is increased in immunosuppressed patients. We report a case of spontaneous bacterial peritonitis with bacteraemia caused by Listeria monocytogenes in a 47-year old woman with liver transplantation. Complete recovery was achieved after amoxicillin and amikacin therapy. High doses of corticosteroids and OKT3 monoclonal therapy may have favoured the occurrence of infection. In liver transplant recipients, regular stool screening could be proposed, and trimethoprim-sulfamethoxazole antibioprophylaxy could be used when Listeria monocytogenes is isolated in stool culture or immunosuppressive therapy is increased.

[Causes of early mortality after liver transplantation: a twenty-years single centre experience]. / Mortalité trois mois après transplantation hépatique : étude monocentrique sur une période de vingt ans.

OBJECTIVE: To define the causes of mortality of patients who died within the first three months after a liver transplantation. TYPE OF STUDY: Retrospective, observational, and single centre study. PATIENTS AND METHODS: Between March 1989 and July 2010, all patients who died within three months after a liver transplantation were included. Demographic characteristics, preoperative and peroperative data, donor characteristics, postoperative complications and causes of mortality were collected. RESULTS: Among the 788 performed liver transplantations, 76 patients died in intensive care unit (11%). The main indications of liver transplantation were alcoholic cirrhosis (30%), hepatitis C (28%), hepatocarcinoma (15%), primitive or secondary biliary cirrhosis (10%). Fifty percent of the patients were categorized as Child C. The main causes of death were non-function or dysfunction with retransplantation contra-indication graft (18%), sepsis (18%), neurological complications (12%), hemorrhagic shock (13%), (9%), multiorgan failures (5%), cardiac complications (6%). CONCLUSION: In this study, the main causes of mortality were infectious, neurological and hemorrhagic. These results emphasize the necessity for better control of sepsis, haemorrhage and immunosupressors.

[Tigecycline for treatment of severe infections in intensive care: a drug use evaluation]. / Expérience de l'utilisation de la tigécycline dans le traitement des infections sévères en réanimation: une étude pilote.

OBJECTIVES: To report our experience of tigecycline use in a medical and surgical intensive care unit. To describe its prescription, microbiology findings, tolerance and efficacy. STUDY DESIGN: Prospective, observational, single center study. PATIENTS AND METHODS: All consecutive patients treated with tigecycline were included. Demography, indication of treatment, bacteriology before, during and in the month after treatment and ICU mortality were collected. The main endpoints were clinical and microbiological efficacy and tolerance. RESULTS: Twenty-four patients were included. In half of the cases, tigecycline was prescribed in monotherapy for a complicated intra-abdominal infection. Overall tolerance of tigecycline was good. Clinical and microbiological cure was obtained in six cases, not obtained in nine, indeterminate in six cases and not evaluable in the three cases of prophylaxis. During the treatment, four bacteria commonly sensitives were shown to be resistant to tigecycline. CONCLUSION: Our pilot study on 24 patients suggests that tigecycline is well tolerated in critically ill patients. Clinical cure in severe infections was compromised in nine patients essentially because of resistant pathogens suggesting its prescription on antibiogram. However, the impact of association or the increasing doses in severe critically ill patients should be evaluated.

[Heterotopic hepatic transplantation. Apropos of a case treated in the terminal stage of decompensated alcoholic cirrhosis]. / Transplantation hépatique hétérotopique. A propos d'un cas réalisé pour une cirrhose éthylique décompensée au stade terminal.

Heterotopic liver transplantation is an exceptional indication for acute or chronic liver disease. The authors report a case of auxiliary liver transplantation performed for end-stage alcoholic cirrhosis. The patient was contra-indicated for orthotopic transplantation because of poor general and nutritional status. The HLT was indicated because of intractable ascites, liver insufficiency and chronic encephalopathy. The operation was performed according to the technique described by Fortner. Liver function tests returned to normal within 3 days and the only postoperative complication were gastro-intestinal bleeding due to CMV viral infection. Liver function was assessed by HIDA scintigram which showed blood intake by the graft and atrophy of the native liver. The patient was discharged after 3 months. The follow-up is 17 months. At the 15th month control, liver CT showed multiple hypodense nodules biopsied and corresponding to metastasis from a probable pancreatic carcinoma. ERCP and morphologic explorations did not show the primary tumor. The authors discuss the indications of HLT, the rules of successful performance of HLT and the problem of the graft involvement by metastases.

Failure of ursodeoxycholic acid to prevent acute cellular rejection after liver transplantation.

BACKGROUND/AIMS: Acute rejection is still a major problem after liver transplantation. Ursodeoxycholic acid has beneficial effects in cholestasis by reducing the expression of major histocompatibility complex antigens. METHODS: We have performed a double-blind randomised study comparing ursodeoxycholic acid with placebo for the prevention of acute cellular rejection after liver transplantation. Twenty-six patients received ursodeoxycholic acid 600 mg per day and 24 patients received placebo for 2 months. RESULTS: Neither rejection incidence nor rejection severity was significantly different in the two groups (p > 0.90). CONCLUSIONS: We conclude that adjuvant ursodeoxycholic acid administration does not prevent rejection after liver transplantation.

Lethal acute graft-versus-host disease in a liver transplant recipient: relations with cell migration and chimerism.

We report herein the case of a patient who developed fatal acute graft-versus host disease (GvHD) after liver transplantation (LT). GvHD occurred 18 days after LT and was characterized by skin epidermolysis, diarrhea and leucopenia. Skin biopsy showed epidermal dyskeratosis with epithelial necrosis, a lesion consistent with GvHD. Despite immunosuppressive therapy, the patient died within 24 days. In our observation, GvHD occurred although five HLA compatibilities were identified between the donor and the recipient, an apparently favorable and uncommon situation. This case further supports the qualification that LT may be complicated by GvHD and strongly suggests that minor rather than major histocompatibility antigens are the main target of allogenic interactions of GvHD. The involvement of chimerism in GvHD is controversial and requires further investigation.