Immunity to hepatitis A virus in liver transplant recipients: A population-based study in Iran / Inmunidad al virus de la hepatitis A en receptores de trasplante de hígado: un estudio poblacional en Irán

Background: Acute hepatitis A is usually a self-limited viral disease but can be severe and even fatal in special groups of patients including those with chronic liver disease and recipients of liver transplantation. To take appropriate preventive measures, it is important to determine the immune status against the hepatitis A virus in patients at risk of grave clinical outcomes following infection. To assess the need for immunization against hepatitis A, we aimed to determine the immune status against hepatitis A in a population of liver transplant recipients. We also investigated the association between hepatitis A immune status and demographic factors such as age and sex, underlying liver disease, source of drinking water, geographical area of residence and socioeconomic status.Methods: This cross-sectional study was performed on 242 recipients of allogenic liver transplants at Abu Ali Sina Organ Transplant Hospital in Shiraz, Iran, between January 2017 and April 2017. The level of immunity was assessed using hepatitis A antibody detection kits.Results: The rate of immunity against hepatitis A was detected as 88.8% in our study population. In the multivariable logistic regression model, younger age (OR=1.175, P<0.001) and higher education level (OR=2.142, P=0.040) were the main determinants of non-immune status. However, hepatitis A immunity was independent of gender, monthly family income, water supply source, residential area and underlying liver disorder.Conclusion: Although a significant proportion of liver transplant recipients in this study showed evidence of natural immunity to hepatitis A, a considerable proportion of younger patients and those with a higher level of education were non-immune. The results of this study signify the importance of screening for hepatitis A immunity in this at-risk population of patients and the need for vaccinating non-immune patients.

Antecedentes: La hepatitis A aguda suele ser una enfermedad viral autolimitada, pero puede ser grave e incluso mortal en grupos especiales de pacientes, incluidos aquellos con enfermedad hepática crónica y los receptores de un trasplante de hígado. Para tomar las medidas preventivas adecuadas, es importante determinar el estado inmunológico frente al virus de la hepatitis A en pacientes con riesgo de sufrir resultados clínicos graves después de la infección. Para evaluar la necesidad de inmunización contra la hepatitis A, nuestro objetivo fue determinar el estado inmunológico contra la hepatitis A en una población de receptores de trasplante de hígado. También investigamos la asociación entre el estado inmunológico de la hepatitis A y factores demográficos como la edad y el sexo, la enfermedad hepática subyacente, la fuente de agua potable, el área geográfica de residencia y el nivel socioeconómico.Métodos: este estudio transversal se realizó en 242 receptores de trasplantes de hígado alogénicos en el hospital de trasplantes de órganos “Abu Ali Sina” en Shiraz, Irán, entre enero de 2017 y abril de 2017. El nivel de inmunidad se evaluó mediante kits de detección de anticuerpos contra la hepatitis A.Resultados: La tasa de inmunidad contra la hepatitis A se detectó como 88,8% en nuestra población de estudio. En el modelo de regresión logística multivariable, la edad más joven (OR=1,175, p<0,001) y el nivel de educación superior (OR=2,142, p=0,040) fueron los principales determinantes del estado no inmunitario. Sin embargo, la inmunidad contra la hepatitis A fue independiente del sexo, el ingreso familiar mensual, la fuente de suministro de agua, el área residencial y la enfermedad hepática subyacente.

Immunity to hepatitis A virus in liver transplant recipients: A population-based study in Iran.

BACKGROUND: Acute hepatitis A is usually a self-limited viral disease but can be severe and even fatal in special groups of patients including those with chronic liver disease and recipients of liver transplantation. To take appropriate preventive measures, it is important to determine the immune status against the hepatitis A virus in patients at risk of grave clinical outcomes following infection. To assess the need for immunization against hepatitis A, we aimed to determine the immune status against hepatitis A in a population of liver transplant recipients. We also investigated the association between hepatitis A immune status and demographic factors such as age and sex, underlying liver disease, source of drinking water, geographical area of residence and socioeconomic status. METHODS: This cross-sectional study was performed on 242 recipients of allogenic liver transplants at Abu Ali Sina Organ Transplant Hospital in Shiraz, Iran, between January 2017 and April 2017. The level of immunity was assessed using hepatitis A antibody detection kits. RESULTS: The rate of immunity against hepatitis A was detected as 88.8% in our study population. In the multivariable logistic regression model, younger age (OR=1.175, P<0.001) and higher education level (OR=2.142, P=0.040) were the main determinants of non-immune status. However, hepatitis A immunity was independent of gender, monthly family income, water supply source, residential area and underlying liver disorder. CONCLUSION: Although a significant proportion of liver transplant recipients in this study showed evidence of natural immunity to hepatitis A, a considerable proportion of younger patients and those with a higher level of education were non-immune. The results of this study signify the importance of screening for hepatitis A immunity in this at-risk population of patients and the need for vaccinating non-immune patients.

Post liver transplant complications of Budd-Chiari syndrome.

BACKGROUND/PURPOSE: Budd-Chiari syndrome (BCS) is a rare, life-threatening disease characterized by hepatic venous outflow obstruction. Liver transplantation (LT) is widely accepted as an effective therapeutic measure for irreversible liver failure due to BCS. There is debate on differences in the post LT course and complications in patients with BCS as compared to non-Budd-Chiari (NBC) patients. METHOD: In this retrospective study, data on all patients who received a liver transplant for BCS at the Shiraz Organ Transplantation Center between January 1996 and September 2017 were reviewed and compared to data of a control group who had received liver transplants over the same period but due to other causes (NBC). RESULTS: Out of 4225 patients who received liver transplants in the study period, 108 had BCS and an age- and gender-matched control group consisted of 108 NBC cases. The mean ± standard deviation (SD) of model for end-stage liver disease (MELD) scores were 19.1 ± 3 and 20 ± 3 for BCS and NBC groups, respectively (p = 0.33). One-, 3-, 5-, and 10-year survival rates in the BCS group were as follows: 82%, 78%, 76%, and 76% compared with the NBC rates of 83%, 83%, 83%, and 76%, respectively (p = 0.556). There was no difference between the two groups in complication rates after 6 months. In the later period, vascular thrombosis was more common in BCS. CONCLUSIONS: Whole-organ LT from deceased donors in patients with BCS had comparable outcomes with LT due to other causes of end-stage liver disease. In most instances, these patients should receive lifelong anticoagulation.

The use of micro pulse oximetery as a new detector of tissue perfusion in solid organ transplantation.

Vascular complications are a frequent cause of transplant failure; angiography, duplex sonography, computerized tomography (CT) scan, CT-angiography and microdialysis are the methods that were suggested for the detection of arterial obstruction after transplantation. In this study, we suggest a new method. Eight healthy adult dogs were included in the trial. All cases were operated by the same surgeon and the liver, pancreas, spleen, kidney and bowel tissue were exposed. The probes of the device, which were designed for this study, were inserted on the organ parenchyma. The device, a neonatal pulse oximeter, has two probes that were fixed by a holder in front of each other; the distance between the probes was changeable via a spring. The pulse and the oxygen saturation of the tissue were measured initially. Following this, by inducing ischemia with vessel clamping, the pulse and the oxygen saturation were measured again. The collected data were analyzed under the supervision of a statistician. In the liver and spleen, we could not detect a clear pulse wave and oxygenation. On the other hand, in the pancreas, kidney and bowel, we detected a clear curve of oxygenation and pulse in all cases. Obstruction caused significant changes: the pulse was not detected and the oxygenation decreased significantly. Our study suggests that with early diagnosis, the surgeons can detect arterial occlusion immediately and early intervention may decrease parenchymal damage. This study is the first experience in this field, and these findings need to be validated with further studies.

Comparison of immediate renal dysfunction in split and partial liver transplantation versus full size liver transplantation in Shiraz transplant centre.

BACKGROUND: Renal dysfunction (RD) is a common complication following liver transplantation. Postoperative renal function after split liver transplant (SLT) and (partial living related liver transplant) (LRLT) has not been well studied yet. MATERIAL/METHODS: Renal function immediately after surgery was analyzed retrospectively in 32 patients that received SLT and LRLT. Serum creatinine (SCr) was measured before surgery, and, after transplantation daily during the first week and at 14, 21, and 28 days after transplantation. Patient's medical records were reviewed to find clinical data;Model for end-stage liver disease (MELD) score, Child-Turcotte-Pugh score (CTP) class, the length of surgery, length of anhepatic phase, hospital and ICU admission, incidence of acute rejection, renal dysfunction, and sepsis. These data compared between groups. RESULTS: Length of surgery and anhepatic phase was longer in SLT and LRLT group (P<0.05). The incidence of acute rejection, reoperation, and complication such as sepsis was higher in SLT and LRLT group than FSLT group (P<0.05). There were no significant difference between groups with respect to MELD, CTP score, the need for transfusions, the length of admission to the hospital and ICU. Immunosuppression regimens were similar in both groups. RD developed in 25.8% of SLT and LRLT patients, but in only 9.5% of FSLT patients (p=0.063). The requirement for RRT in SLT and LRLT group (12.5%) was greater than that in the FSLT group (2.3%); P=0.20. CONCLUSIONS: Although the number of patients studied was small, our data suggests a higher incidence of RD in patients receiving SLT and LRLT.