Hepatic arterial embolization for massive bleeding from an intrahepatic artery pseudoaneurysm using N-butyl-2-cyanoacrylate after living donor liver transplantation.

Parenchymal pseudoaneurysm of the hepatic arteries with massive intraperitoneal bleeding is rare but a serious life-threatening complication when it occurs following liver transplantation. We report a case of an adult postliving donor liver transplant recipient who developed massive subcapsular bleeding combined with massive right pleural effusion from ruptured multiple small intrahepatic arteries, which developed from a pseudoaneurysm that was treated by hepatic arterial embolization. Successful embolization was performed via a percutaneous trans-catheter approach by depositing 20-25%N-butyl-2-cyanoacrylate (NBCA) through the multiple small intrahepatic arteries into the pseudoaneurysm. Complete occlusion of the feeding arteries and pseudoaneurysm cavity resulted to immediate cessation of bleeding. There was no re-bleeding; and normal liver graft function was noted postembolization. Hepatic arterial embolization with NBCA can be used as treatment for postliver transplant peripheral intrahepatic artery pseudoaneurysm bleeding.

Section 13. Short-course pretransplant antiviral therapy is a feasible and effective strategy to prevent hepatitis C recurrence after liver transplantation in genotype 2 patients.

BACKGROUND: Hepatitis C virus (HCV) recurrence in recipients who are viremic at time of liver transplantation (LT) is universal and carries poor prognosis. Pretransplant antiviral therapy to eradicate HCV reduces recurrence, but withdrawal rate is high. We conducted a short-course (4 weeks) of pegylated interferon alpha-2a (Peg-IFN-α2a) plus ribavirin (RBV) to prevent of HCV recurrence. PATIENTS AND METHODS: From October 2009 to December 2011, eighty-eight consecutive HCV patients for living donor LT with potential living donor at Kaohsiung Chang Gung Memorial Hospital were included. Patients were divided into treatment and nontreatment group depending on presence of HCV-RNA. Fixed dosage of Peg-IFN-α2a (135 µg/week) plus RBV (10 mg/kg per day) were given for 4 weeks to treatment group who passed the 4-week waiting time according to clinical safety assessment. RESULTS: Forty-eight patients with genotypes 1, 2, and 3 (n=29/18/1) were treated with IFN and RBV combination for 4 (range, 1-9) weeks. Serum HCV RNA became undetectable at transplantation in 26 (54%) patients. No difference between genotypes 1 (n= 14, 48%) and 2/3(n=12, 63%, P=0.25) was observed. Most patients experienced cytopenia during treatment, but no mortality was noted. In the treatment group, 13 patients remained free of HCV infection 6 months after transplant. Virologic response at transplantation (48% vs. 100%, P=0.015) and genotype 2/3 (50% vs. 84%, P=0.01) are strong predictors of lower HCV recurrence rate. Multivariate analysis showed that genotype 2/3 was the only independent predictive factor affecting HCV RNA negativity 6 months after liver transplantation (OR:11.25; P=0.014). CONCLUSIONS: Short-term pretransplant antiviral therapy is a feasible strategy in preventing HCV recurrence after LDLT especially in genotypes 2 and 3 recipients.

A survey of the oral status of children undergoing liver transplantation.

BACKGROUND: The purposes of this study were to examine the oral tissues and caries prevalence of children undergoing liver transplantation, and to evaluate the relationship between tooth staining and serum bilirubin level. METHODS: Thirty-four children (22 boys and 12 girls) under the age of 6 years with end-stage liver disease were referred from the Liver Transplantation Center at Kaohsiung Chang Gung Children's Hospital, Taiwan. Oral tissues were examined, and photographs taken to determine the green staining of the teeth and gingiva. A questionnaire was completed by their parents. Serum bilirubin levels were collected preoperatively in these children. Student's t-test was used to compare the mean decayed, missing, and filled tooth (dmft) difference between night-fed and non-night-fed groups, and to test the relationships between tooth staining and serum bilirubin levels. RESULTS: The caries prevalence of the 34 children undergoing liver transplantation was 61.8%. The mean dmft score of children 2 to 6 years old who were night-fed was significantly higher than that of children who were not (10.1 +/- 1.2 vs. 6.3 +/- 1.2; p = 0.038). Green staining of the teeth and gingiva was found in 61.3% of cases in children with biliary atresia. Total serum bilirubin levels were significantly higher in the green-stained group than in the non-stained group (17.87 +/- 2.50 vs. 2.20 0.65; p < 0.01). CONCLUSIONS: Oral findings of children undergoing liver transplant presented significant green staining of the teeth and gingiva related to high serum bilirubin levels. Children who were night-fed showed an increased risk of developing caries suggesting that oral hygiene instructions should begin as early as possible before liver transplantation.