Hepatitis B prophylaxis in hepatitis B-negative recipients transplanted with donor grafts positive for hepatitis B core antibodies.

BACKGROUND AND AIMS: Use of grafts from hepatitis B (HBV) core antibody (HBcAb(+)) individuals is a routine transplant practice. Herein, we have reported the results of 20 HBV-negative patients transplanted with a HBcAb-positive liver grafts in order to access the efficacy of HBV prophylaxis using immunoglobulin (IE) and antiviral drugs. METHODS: From January 2004 to December 2009, we performed 168 liver transplantations including 38 HBcAb-positive grafts (22.6%) in 18 cases of HBV-positive recipients and 20 HBV-negative recipients. Histological data obtained from these last 20 grafts during retrieval showed an Ishak 1 score in three and no fibrosis in the other cases. HBV prophylaxis included infusion of 10,000 UI IG during the anhepatic phase and every 24 hours for the first 7 days irrespective of the antibody titer as well as lamivudin (100 mg) administered daily. Once discharged, outpatient management provided modulated IG infusions according to when the antibody titer was lower than 400 UI. RESULTS: No patient displayed an HBV infection. The overall survival was 80%. Two patients died within the first month after transplantation due to septic complications; one patient succumbed at 24 months after transplantation because of a lymphoproliferative malignancy and another died due to an aggressive hepatitis C virus recurrence at 6 months post transplant. CONCLUSION: By using appropriate anti-HBV prophylaxis, HBcAb-positive grafts can be used safely for HBcAb-negative recipients.

The marginal donor: a single-center experience in orthotopic liver transplantation.

The use of marginal donors has become more common worldwide due to the sharp increase in recipients with a consequent shortage of suitable organs. The definition of "marginal donor" has not been reached by all centers. We herein analyzed our single-center experience over the last 3 years in liver transplantation (OLT) to evaluate the outcomes of using a high percentage of so-called "marginal donors", according to the current classification from the National (Italian) Center of Transplantation (CNT). Among the 78 OLT performed in 77 patients from January 1, 2003 to October 31, 2005, donor livers were divided into three groups according to the CNT classification. We evaluated donor variables, cold ischemia time (CIT), warm ischemia time (WIT), MELD score, and length of hospital stay. Histologic graft steatosis was correlated with estimated steatosis by ultrasound. There were no differences among the three graft recipient groups concerning CIT, WIT, MELD score, and the length of hospital stay. Steatosis is indicated in all series as a definite variable for a higher risk of postoperative mortality. CIT is necessarily related to donor retrieval policy and organization. Donor age seemed also to be related to a possible increase in postoperative mortality, but there are significant variations in the definition of the age limit. We failed to observe a correlation between a higher mortality rate and any of the variables currently listed to define a "marginal donor." A shorter CIT seemed to positively influence the role played by the other variables identifying a "marginal liver." Finally, the use of HCV(+) or HBV(+) grafts did not lead to an increased mortality.

[Upper gastrointestinal hemorrhage of unusual etiology: clinical case and technical note]. / Emorragia digestiva alta da causa rara: caso clinico e note di tecnica.

The Authors report a case of upper digestive tract haemorrhage at atypical side, the diagnosis being often difficult as well as therapeutical options, particularly referent to the surgical solutions adopted.

[Liver rupture in HELLP syndrome. Report of a case]. / Rottura epatica in corso di HELLP sindrome. Descrizione di un caso.

Liver rupture and hemorrhage, are the most unusual and serious complications of HELLP syndrome (hemolysis--elevated liver enzymes--low platelet count). The management should be aggressive by treating coagulopathy and favouring a prompt delivery. Liver rupture remains a surgical emergency with control of bleeding based on trauma surgery. The aggressive approach to the management of these patients led to a remarkable decrease of mortality rates.

[Traumatic liver injuries: advances in diagnostic and therapeutic methods]. / Lesioni traumatiche del fegato: evoluzione delle strategie diagnostico-terapeutiche.

One hundred five patients affected by traumatic rupture of the liver were admitted in the Emergency Surgical Unit at Ospedale "A. Cardarelli" in Napoli over a period of five years. In 40 patients a conservative treatment was applied, monitoring red blood count, and haemoglobin values as well as abdominal ultrasound and CT scans. The remaining 65 patients underwent surgery for liver trauma. Twelve out of 65 patients presented with an hepatic injury alone whereas in 53 liver injury was associated with other lesions, as splenic rupture, kidney hematoma, bone fracture, chest trauma, diaphragmatic or cranial injury. Eleven out of 65 patients underwent postoperative complications such as bile collection (nine) and biliary fistula (two); however, none of these complicated patients died or underwent further surgery. On the basis of their data the Authors conclude that a careful preoperative assessment and the monitoring of haemodynamic pattern are advisable in patients with liver trauma, allowing the choice of a conservative treatment whenever possible. In the patients undergoing surgical treatment, a more conservative approach should be advocated, with a wider use of intraparenchymal haemostasis and packing, both to improve the haemodynamic status and to refer the patient to specialized units.

[Budd-Chiari syndrome: retrospective study of 8 cases assessed with computerized tomography]. / Sindrome di Budd-Chiari: studio retrospettivo di otto casi esaminati con Tomografia Computerizzata.

PURPOSE: Budd-Chiari syndrome is a rare disease due to the obstruction of hepatic veins and, sometimes, of the inferior vena cava. The disease, whose etiopathogenesis is often unproven, may show acute or chronic clinical course with different features at pathology. We carried out a retrospective study of 8 consecutive patients with the Budd-Chiari syndrome to assess the diagnostic role of CT and to define the main patterns of the disease. MATERIAL AND METHODS: Our patient population consisted of 8 women with clinical and instrumental suspicion of Budd-Chiari syndrome. Three patients had acute and 5 chronic clinical presentation: the former had had acute symptoms right after delivery, while one of the latter was referred to oral contraceptive abuse, another was diagnosed 18 months after delivery and finally the cause was not known in the other 3 cases. CT was performed with contiguous slices (8 mm) of the upper abdomen, before and after i.v. contrast agent infusion. Liver images were always acquired 15-20 minutes after contrast agent administration. RESULTS: In the acute patients, CT showed increased liver volume, diffuse parenchymal hypodensity in unenhanced scans, except for some skip areas (segments I and IV, paracaval parenchyma) and strong postcontrast enhancement. Thrombosis of the suprahepatic veins was found in all patients and partial thrombosis of the inferior vena cava in one. Abundant peritoneal effusion was always found. In the chronic patients, CT showed caudate lobe and left lobe hypertrophy, mostly associated with right lobe hypo-atrophy. Moreover the hypertrophic areas showed bright and inhomogeneous contrast enhancement, with a reversed pattern at 15-20 minutes postcontrast. Thrombosis of the suprahepatic veins was found in 3 patients and partial thrombosis of the inferior vena cava in one. Peritoneal effusion was seen in 2 cases. CONCLUSIONS: The Budd-Chiari syndrome causes anatomical, morphological and volumetric changes in the hepatic parenchyma which are referrable to difficult venous flow and differ in acute vs chronic forms. CT permits to grade liver involvement by the organ's morphodensitometric changes, which are once again different in the acute vs the chronic disease. Moreover, thrombosis of suprahepatic veins and of the inferior vena cava and portal vein is often demonstrated. Therefore CT can be considered a valid diagnostic tool for use in the patients with suspected Budd-Chiari syndrome together with B-mode and color Doppler US.