Humoral response to different SARS-CoV-2 vaccines in orthotopic liver transplant recipients.

BACKGROUND: The safety and efficacy data of the different types of available vaccines is still needed. The goal of the present analysis was to evaluate the humoral response to the COVID-19 vaccines in orthotopic liver transplant (OLT) recipients. METHODS: Participants were included from February to September 2021. No prioritized vaccination roll call applied for OLT patients. Controls were otherwise healthy people. Blood samples were drawn after 15 days of the complete vaccine doses. The samples were analyzed according to the manufacturer's instructions using the Liaison XL platform from DiaSorin (DiaSorin S.p.A., Italy), and SARS-COV-2 IgG II Quant (Abbott Diagnostics, IL, USA). RESULTS: A total of 187 participants (133 OLT, 54 controls, median age: 60 years, 58.8% women) were included for the analysis; 74.3% had at least one comorbidity. The serologic response in OLT patients was lower than in controls (median 549 AU/mL vs. 3450 AU/mL, respectively; p = 0.001). A positive humoral response was found in 133 OLT individuals: 89.2% with BNT162b2 (Pfizer-BioNTech), 60% ChAdOx1 nCOV-19 (Oxford-AstraZeneca), 76.9% with CoronaVac (Sinovac, Life Sciences, China), 55.6% Ad5-nCov (Cansino, Biologics), 68.2% Gam-COVID-Vac (Sputnik V) and 100% with mRNA-1273. In controls the serological response was 100%, except for Cansino (75%). In a multivariable model, personal history of COVID-19 and BNT162b2 inoculation were associated with the serologic response, while the use of prednisone (vs. other immunosuppressants) reduced this response. CONCLUSION: The serologic response to COVID-19 vaccines in OLT patients is lower than in healthy controls. The BNT162b2 vaccine was associated with a higher serologic response.

Transillumination of Calot's Triangle on Laparoscopic Cholecystectomy: A Feasible Approach to Achieve a Critical View of Safety.

Background Laparoscopic cholecystectomy is currently one of the most commonly performed procedures globally. Morbidity of laparoscopic cholecystectomy is low; however, bile duct injury is still a feared complication. Despite worldwide efforts, the global incidence of bile duct injury remains higher for laparoscopic cholecystectomy compared with open cholecystectomy. Despite the general belief that the learning curve and lack of laparoscopic skills represent the most common causes of bile duct injuries, the principal cause is the misidentification of biliary anatomy. The aim of our study is to determine if laparoscopic transillumination is a feasible approach to bile and vascular structures visualization during laparoscopic cholecystectomy because the only other method for real-time visualization is fluorescent cholangiography, which can be cost-prohibitive and requires specialized equipment and training. Materials and methods We performed a retrospective comparison of outcomes between the transillumination approach in 10 patients receiving laparoscopic cholecystectomy (group A) and a control group of 50 conventional laparoscopic cholecystectomy patients (group B). We compared demographic data, type of surgery, operative time, bleeding, intraoperative and postoperative complications, and hospital stay. We used a conventional four-port positioning for laparoscopic cholecystectomy, and a 5-mm/30° scope was used as a light source and placed behind the area identified as Calot's triangle. Results Group A consisted of 10 patients (9 women, 1 man), with a mean age of 50.7 (± 17.4) years. The mean body mass index (BMI) in group A was 26.8 (± 0.65) kg/m2. In group A, three of the cholecystectomies were conducted as emergency procedures. Group B consisted of 50 patients (40 women, 10 men), with a mean age of 49.7 (±15.2) years. The mean BMI in group B was 27.5 (±4.5) kg/m2, and two cholecystectomies were emergency procedures. In comparing the transillumination approach with conventional cholecystectomy, we found no statistical differences in operative time, bleeding, complications, or mean hospital stay. Conclusions Laparoscopic transillumination is a feasible method for real-time visualization of Calot's triangle structures. Our initial experience with transillumination did not provide better outcomes than conventional cholecystectomy.