Sofosbuvir-Based Therapy for Genotype 4 HCV Recurrence Post-Liver Transplant Treatment-Experienced Patients.

Background and Aim. This is an open label prospective cohort study conducted at a tertiary care hospital. The primary endpoint is SVR12 in patients treated with sofosbuvir-based therapy in post-liver transplant patients with genotype 4 HCV recurrence. Methodology. Thirty-six treatment-experienced liver transplant patients with HCV recurrence received sofosbuvir and ribavirin ± peginterferon. Results. We report here safety and efficacy data on 36 patients who completed the follow-up period. Mean age was 56 years, and the cohort included 24 males and one patient had cirrhosis. Mean baseline HCV RNA was 6.2 log10 IU/mL. The majority of patients had ≥ stage 2 fibrosis. Twenty-eight patients were treated with pegylated interferon plus ribavirin in addition to sofosbuvir for 12 weeks and the remaining were treated with sofosbuvir plus ribavirin only for 24 weeks. By week 4, only four (11.1%) patients had detectable HCV RNA. Of the 36 patients, 2 (5.5%) relapsed and one died (2.75%). Conclusion. Our results suggest that sofosbuvir + ribavirin ± pegylated interferon can be utilized successfully to treat liver transplant patients with HCV recurrence.

Liver Transplantation for Budd-Chiari Syndrome With Large Solitary Focal Nodular Hyperplasia of the Liver in a Patient With Essential Thrombocythemia: Case Report. [Corrected].

Budd-Chiari syndrome is a rare condition caused by interrupted hepatic venous outflow in the hepatic veins, inferior vena cava, or right atrium. Reports from the literature have delineated on focal nodular hyperplasia (FNH)-like lesions in association with Budd-Chiari Syndrome. To our knowledge, there are no reports about true FNH lesions in patients with Budd-Chiari Syndrome. Focal nodular hyperplasia develops in disorders with aberrant circulation and vasculature. We report a case of Budd-Chiari syndrome in association with large solitary FNH in a 22-year-old man who was referred to our institution with sudden intermittent right upper quadrant abdominal pain, vomiting, diarrhea with pale stool, decreased appetite, dark urine, and abdominal distention for 15 days. Laboratory investigations revealed anemia, thrombocytosis, and abnormal liver function tests and coagulation profile. Imaging revealed hepatic vein thrombosis, confirming Budd-Chiari syndrome, and a 6.2 × 6.1 × 6.8 cm lesion in segment 8 of the liver. Primary cause of Budd-Chiari syndrome was essential thrombocythemia according to bone marrow biopsy and molecular testing results. The patient was treated medically and underwent transjugular intrahepatic portosystemic shunt insertion. The lesion in segment 8 continued to enlarge. Cadaveric liver transplantation was carried out. On gross and histologic examination of the explanted liver, the lesion was found to be a true FNH.

Living donor liver transplant versus cadaveric liver transplant survival in relation to model for end-stage liver disease score.

BACKGROUND: The Model for End-Stage Liver Disease (MELD) score is universally used to prioritize patients on the liver transplant waiting list. It is potentially used to predict survival as well. There has been conflicting evidence on the use of living donor liver transplantation (LDLT) in patients with high MELD scores. We reported retrospective data comparing survival between LDLT and deceased donor liver transplantation (DDLT) In relation to MELD score in a single-center experience. METHODS: We retrospectively reviewed our records from 2001 to 2013 for LDLT and DDLT. Data reviewed include the numbers of patients for LDLT and DDLT, age, sex, MELD score, etiology of liver disease, hepatocellular carcinoma, re-transplantation, median follow-up, mortality (with 1 month, 1 year, or after 1 year), and cause of death. Only adults are included in this analysis. Patients were categorized into MELD scores above and below 25. Kaplan-Meier analysis was used for survival, and the log-rank χ(2) test was used for comparison, with a value of P < .05 used for significance. RESULTS: The total number of transplanted patients at King Faisal Specialist Hospital, Riyadh, Saudi Arabia, was 491. There were 222 patients for LDLT and 269 patients for DDLT. The median age was 53 years (15-80 years), and 292 were male (59.5%). The overall 1-, 3-, and 5-year Kaplan-Meier survival rates of LDLT and DDLT were 89%, 85%, and 84%, respectively, for MELD score below 25, and 80%,78%, and 77%, respectively, for MELD score greater than or equal to 25. CONCLUSIONS: Our data showed no difference between the survival rates of the two groups (DDLT versus LDLDT), nor that high MELD score has a negative impact on survival. A larger cohort of patients may be needed to confirm these findings.

Spontaneous clearance of hepatitis C genotype 4 after liver retransplantation.

BACKGROUND: Hepatitis C virus (HCV)-related cirrhosis remains the most common indication for liver transplantation worldwide. Graft reinfection with HCV is nearly universal, causing significant morbidity and mortality. Spontaneous clearance of HCV after liver transplantation and retransplantation is extremely rare. We report a case of spontaneous clearance of HCV genotype 4 that occurred shortly after 2nd liver transplantation. CASE REPORT: A 32-year-old female patient received a cadaveric liver transplant for HCV-related cirrhosis in 2007. She was not treated for HCV before transplantation. The patient developed biopsy-proven HCV recurrence with elevated transaminases and 65,553 IU/mL HCV RNA, genotype 4. She could not tolerate interferon-based treatment. The patient's condition progressively worsened and required a 2nd cadaveric liver transplantation in March 2013. Immunosuppression initially included steroids and Prograf, which was then switched to cyclosporine after the patient developed seizure. She developed acute cellular rejection which was readily treated with immunosuppression adjustment. HCV RNA became negative in April, which was confirmed in May 2013. CONCLUSIONS: Spontaneous clearance of hepatitis C rarely occurs after liver transplantation and is extremely rare after retransplantation. This finding may be explained by alterations in the host immune responses to HCV after transplantation. To our knowledge, this is the first case of spontaneous clearance of HCV genotype 4 after liver retransplantation.

Donor organ shortage crisis: a case study review of a financial incentive-based system.

INTRODUCTION: Current organ supply system depends on altruistic noncoercive donation, which has failed to meet the demand of organ transplantation. Providing financial incentives to donors is one of several approaches to address organ shortage. However, its feasibility is debatable as it relates to medical, ethical, and economic dimensions. An incentive-based procurement system (IBPS) applied by the Mobile Donor Action Team (MDAT) was instituted in Riyadh, Saudi Arabia, resulting in a 3-fold increase in donation rate. The goal of this study was to provide a qualitative review of a 7-year experience with IBPS. MATERIALS AND METHODS: A qualitative approach was used. Documents were reviewed to create a chronological audit and shape interview questions. Sampling was purposeful and inclusive of MDAT members. Semi-structured interviews were conducted, and findings were subjected to thematic analysis. RESULTS: Documents reflected the evolution of MDAT. The essence of MDAT is field work and liberal use of financial incentives, which resulted in a 3-fold increase in the donation rate. MDAT members believed that IBPS is the main reason behind this increase. Moreover, IBPS is viewed as acceptable from a moral, ethical, and religious standpoint, with a high degree of professional satisfaction. CONCLUSIONS: Theoretical assumptions doubted the feasibility of IBPS. This real-life experience with IBPS proved the contrary. The findings may be applicable only to the setting in Riyadh, Saudi Arabia, however; further research is thus needed to explore its transferability to other settings. IBPS may be an alternative to altruistic noncoercive donation and should be piloted in different settings.

Regional variation in organ donation in Saudi Arabia.

INTRODUCTION: There is marked regional variation in organ donation among the different regions of Saudi Arabia. Our aim was to study the dominating factors for these variations to improve organ donation in low-donation areas. MATERIALS AND METHODS: This study was a retrospective review of the Saudi Center for Organ Transplantation data for cadaveric organ donation from 2006 to 2012, with the number of cases reported, documented, consented, and harvested in various regions (northern, southern, eastern, western, and central). The region, number, and size of contributing intensive care units (ICUs), overall donation rate, and transplanted rate (potential donor and those harvested, respectively) were also reviewed. RESULTS: Between 2006 and 2012, a total of 512 cases were procured and analyzed from Saudi Arabia. From the central region, 393 were acquired, representing 76.7% of the total consented cases. These 393 cases came from 30 of 97 contributing ICUs (31%). The eastern region was ranked second, followed by the western region. The conversion rate for all regions followed a similar trend. CONCLUSIONS: There is marked variation with regard to organ donation in different regions throughout Saudi Arabia, from 1.9% in the southern region to 76.7% in the central region. This finding is related to the presence of a Mobile Action Donor Team in the central region. The number of potential donors and the contributing ICUs were strong predictors of the number of actual donors. We suggest that having a mobile donor team in each region will increase the number of donors by at least 3 times within the next 3 to 5 years.