Clinical outcomes of patients with hepatic insufficiency undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is currently a common treatment in high-risk aortic stenosis patients, but the impact of hepatic insufficiency on prognosis after TAVI is debatable and whether TAVI is superior to surgical aortic valve replacement (SAVR) in patients with hepatic insufficiency is uncertain. OBJECTIVE: To investigate the effect of abnormal liver function on the outcome and safety after TAVI and whether TAVI is superior to SAVR in patients with hepatic insufficiency. METHODS: PubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception up to 26 November 2021. Studies were eligible if mortality and complications after TAVI in patients with and without hepatic insufficiency, or mortality and complications for TAVI versus SAVR in patients with hepatic insufficiency were reported. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of each study. This meta-analysis was registered with PROSPERO (CRD42021253423) and was carried out by using RevMan 5.3 and Stata 14.0. RESULTS: This meta-analysis of 21 studies assessed a total of 222,694 patients. Hepatic insufficiency was associated with higher short-term (in-hospital or 30-day) mortality [OR = 1.62, 95% CI (1.18 to 2.21), P = 0.003] and 1-2 years mortality [HR = 1.64, 95% CI (1.42 to 1.89), P < 0.00001] after TAVI. Between TAVI and SAVR in patients with hepatic insufficiency, there was a statistically significant difference in in-hospital mortality [OR = 0.46, 95% CI (0.27 to 0.81), P = 0.007], the occurrence rate of blood transfusions [OR = 0.29, 95% CI (0.22 to 0.38), P < 0.00001] and the occurrence rate of acute kidney injury [OR = 0.55, 95% CI (0.33 to 0.91), P = 0.02]. CONCLUSIONS: TAVI patients with hepatic insufficiency may have negative impact both on short-term (in-hospital or 30-day) and 1-2-years mortality. For patients with hepatic insufficiency, TAVI could be a better option than SAVR.

Fulminant hepatic failure after simultaneous kidney-pancreas transplantation: a case report / Insuficiência hepática fulminante após transplante simultâneo de rim-pâncreas: um relato de caso

Abstract We describe an unusual case of hyperacute hepatic failure following general anesthesia in a patient receiving a simultaneous kidney-pancreas transplant. Despite an aggressive evaluation of structural, immunological, viral, and toxicological causes, a definitive cause could not be elucidated. The patient required a liver transplant and suffered a protracted hospital course. We discuss the potential causes of fulminant hepatic failure and the perioperative anesthesia management of her subsequent liver transplantation.

Resumo Descrevemos um caso incomum de insuficiência hepática hiperaguda após a anestesia geral em uma paciente que recebeu um transplante simultâneo de rim-pâncreas. Apesar de uma avaliação agressiva das causas estruturais, imunológicas, virais e toxicológicas, uma causa definitiva não pôde ser identificada. A paciente precisou de um transplante de fígado que resultou em prolongamento da internação hospitalar. Discutimos as potenciais causas da insuficiência hepática fulminante e o manejo da anestesia no período perioperatório de seu subsequente transplante de fígado.

Trasplante hepatorrenal simultáneo en pacientes adultos con hiperoxaluria primaria. Experiencia del Hospital Universitario 12 de Octubre / Liver-kidney simultaneous transplantation in adult patients with primary hyperoxaluria. Experience at Hospital Universitario 12 de Octubre

La hiperoxaluria primaria es un trastorno del metabolismo autosómico recesivo que origina una hiperproducción hepática de oxalato, que no puede ser metabolizado por el hígado y se elimina por vía renal formando litiasis, nefrocalcinosis y ocasionando un deterioro progresivo y precoz de la función renal que, generalmente, a pesar del tratamiento médico precisará de una terapia renal sustitutiva. La hiperoxaluria primaria (HOP) tipo 1 es el trastorno más frecuente, se debe a un déficit de la enzima alanina-glicolato aminotransferasa que se encuentra en los peroxisomas hepáticos. Por tanto, el trasplante hepatorrenal simultáneo (THRS) es el tratamiento definitivo para los pacientes con enfermedad renal crónica terminal. Sin embargo, algunos resultados sugieren que la morbimortalidad es mayor al realizar este procedimiento frente al trasplante renal aislado. Se presentan cinco pacientes adultos con hiperoxaluria primaria y un filtrado glomerular medio de 20,2 ± 1,3 ml/min/1,73 m2 a los que se les realizó un THRS entre 1999 y 2015 en el Hospital Universitario 12 de Octubre. No se observó recurrencia de la enfermedad ni pérdida del injerto hepático o renal durante el postoperatorio y únicamente un episodio de rechazo agudo tardío sin pérdida del injerto renal. La supervivencia de los receptores fue del 100% con una mediana de seguimiento de 84 meses. Debido a que el THRS permite la curación de la enfermedad y constituye una técnica segura, con una baja morbimortalidad y elevada supervivencia, debe considerarse como el tratamiento de elección en la hiperoxaluria primaria con enfermedad renal terminal (AU)

Primary hyperoxaluria (PH) is a metabolic liver disease with an autosomal recessive inheritance that results in oxalate overproduction that cannot be metabolized by the liver. Urinary excretion of oxalate results in lithiasis and nephrocalcinosis leading to a progressive loss of renal function that often requires renal replacement therapy despite medical treatment. Type 1 PH is the most common form and is due to a deficiency in the alanine-glycolate aminotransferase enzyme found in hepatic peroxisomes. Therefore, a liver-kidney simultaneous transplant (LKST) is the definitive treatment for end-stage renal disease (ESRD) patients. However, some studies suggest that the morbidity and mortality rates are greater when this procedure is performed instead of only a kidney transplant (IKT). Herein, we report five patients with PH and a mean glomerular filtration rate of 20.2 ± 1.3 ml/min/1.73 m2 who received a LKST between 1999 and 2015 at the Hospital Universitario 12 de Octubre. Recurrence and liver or kidney graft loss was not observed during the postoperative period and only one case of late acute rejection without graft loss was diagnosed. The recipient survival rate was 100% with a median follow up of 84 months. As LKST is a curative and safe procedure with a low mortality and high survival rate, it must be considered as the treatment of choice in adults with HP and ESRD (AU)

Rabies Virus Transmission in Solid Organ Transplantation, China, 2015-2016.

We report rabies virus transmission among solid organ transplantation recipients in Changsha, China, in 2016. Two recipients were confirmed to have rabies and died. Our findings suggest that more attention should be paid to the possibility of rabies virus transmission through organ transplantation for clinical and public health reasons.

Paecilomyces variotii Fungemia in a Patient with Lymphoma Needing Liver Transplant.

Paecilomyces sp. are emerging pathogens in immunocompromised patients. We report here a case of Paecilomyces variotii fungemia, cured with amphotericin and anidulafungin, illustrating difficulties of early diagnosis and therapeutic choice in such rare fungal infection.

Alterations of Serum IP-10 and TARC in Patients with Early Acute Rejection after Liver Transplantation.

BACKGROUND/AIMS: To analyze alterations of interferon-γ-induced protein 10 (IP-10) and thymus and activation-regulated chemokine (TARC) levels in early acute liver transplantation rejection. METHODS: Thirty-six patients with early acute liver transplantation rejection were classified as non-, mild, moderate, and severe rejection groups. The levels of serum IP-10 and TARC were determined on days 3, 2, 1, and 0 before biopsy. RESULTS: The IP-10 activities in all rejection groups were significantly higher (p < 0.05) than those in the non-rejection group at all time points and correlated with the extent of rejection (p < 0.05). The differences in TARC among the three rejection groups were significant (p < 0.05), and its highest level was found in the mild rejection group at all observed time points, whereas its lowest level was detected in the severe rejection group. The analysis of the TARC/IP-10 ratio revealed that the volume was correlated with the rejection degree. This ratio in the moderate and severe rejection groups on days 2, 1, and 0 before biopsy were 20% lower than that before transplantation. CONCLUSION: Serum IP-10 showed an increasing trend during early acute liver transplantation rejection. IP-10 increase or TARC/IP-10 ratio decrease combining with abnormal hepatic enzymatic alteration could be a valuable and specific sign for early rejection of the transplanted liver.

Treat chronic hepatitis C virus infection in decompensated cirrhosis - pre- or post-liver transplantation? the ironic conundrum in the era of effective and well-tolerated therapy.

The management of hepatitis C virus (HCV) infection in patients with decompensated cirrhosis has evolved dramatically over the past few years mainly due to the availability of all-oral antiviral regimens. The currently approved all-oral direct-acting antivirals (DAA) containing sofosbuvir, ledipasvir, daclatasvir and ribavirin, in various combinations, have shown to be safe and effective in patients with decompensated cirrhosis with sustained virological response (SVR) rates nearly comparable to those with well-compensated liver disease. Unique issues yet remain such as the challenges with renal insufficiency, tolerability of ribavirin and risk of further hepatic decompensation with a protease inhibitor-based regimen. While most patients who achieve SVR have demonstrated improvement in hepatic synthetic function over the short course of follow, the long-term beneficial effects are unknown. Further, the baseline predictors of improvement in hepatic function have not been well delineated and thus have left us in a quandary as to what we might expect with successful therapy and thus we are at a loss to well educate our patients. The major concern, in potential liver transplant candidates, is of unintended 'harm' by achieving SVR but without improvement in hepatic function to an extent where the patients might function well. As HCV therapies are as effective in liver transplant recipients, there is a growing sentiment in some of the transplant quarters that those with decompensated liver disease and awaiting liver transplant be treated for HCV after liver transplant. This strategy would thus eliminate any concern of leaving a patient in 'no person's' land by treating HCV successfully pretransplant but not to the point of functional normalcy, while also would maintain the risk of HCC. Yet a contrarian view would be that not all patients have access to liver transplantation (LT), cannot bear the cost, have comorbidities or contraindications to LT. While the debate continues, it is essential that we develop robust predictors of improvement in liver function so that we can carefully select our patients for therapy in the context of liver transplantation.

[STATE OF HEPATIC HEMODYNAMICS IN TRANSPLANTATION OF ITS RIGHT PART WITH MEDIAN HEPATIC VEIN].

Peculiarities of regional hemodynamics in transplantation of right hepatic part with median hepatic vein were studied. The blood flow parameters ­ the volume portal blood flow (VPBF), linear speed of blood flow (LSBF), the resistance index (RI) in hepatic artery; phasic structure of the blood flow along hepatic veins were determined in 31 patients in accordance to ultrasonographic flowmetry data. Maximal value of VPBF was observed on a second postoperative day, minimal one ­on the fourth day. Аrterial blood flow have had enhanced immediately after transplantation up to maximal one on the second day, and from second to the fourth day ­ have had reduced to minimal one. Phasic structure of blood flow along hepatic vein have had changed postoperatively in 12 (38%) patients. Changes in the hepatosplanchnic blood flow after transplantation constitutes a consequence of the vascular resistance reduction, the venous outflow and regenerative activity of the transplanted hepatic part improvement.

Differential Effects of Gut-Homing Molecules CC Chemokine Receptor 9 and Integrin-ß7 during Acute Graft-versus-Host Disease of the Liver.

Homing of allogeneic donor T cells to recipient tissue is imperative for the development of acute graft-versus-host disease (GVHD) after bone marrow transplantation (BMT). In this study we show that alteration of T cell homing due to integrin-ß7 deficiency on T cells or its ligand MAdCAM-1 in BMT recipients contributes to the pathophysiology of experimental GVHD. In contrast, lack of CC chemokine receptor 9 on donor T cells alters tissue homing but does not impact GVHD survival. We further demonstrate that MAdCAM-1 is aberrantly expressed in hepatic murine GVHD as well as in patients with active liver GVHD. However, infiltration of donor T cells in gut but not liver was dependent of MAdCAM-1 expression, indicating, that homing and/or retention of donor T cells rests on divergent molecular pathways depending on the GVHD target tissue.

ALPPS monosegmento: una nueva variante de las técnicas de regeneración hepática rápida. Revisión crítica de los resultados iniciales de nuestra serie / Monosegment ALPPS: A new variant of the techniques for rapid hepatic regeneration. Critical review of the initial results of our series

La hepatectomía secuencial, descrita en la literatura anglosajona con el acrónimo ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) es una técnica novedosa que ofrece un crecimiento rápido y efectivo del volumen remanente hepático, y que permite la resección quirúrgica de lesiones hepáticas consideradas inicialmente irresecables. Los resultados a corto y largo plazo y la conveniencia de realizar esta técnica son cuestiones que permanecen en discusión a la espera de los resultados finales de los registros multicéntricos. El objetivo del presente trabajo es la revisión crítica de los resultados de la serie de casos realizados en nuestro centro (n = 8). Por otra parte, es posible con esta técnica dejar un único segmento hepático como remanente y realizamos una descripción de esta variante técnica novedosa (ALPPS monosegmento), llevada a cabo en uno de los casos

Associating Liver Partition and Portal vein ligation for Staged hepatectomy (ALPPS) is a novel surgical technique that provides fast and effective growth of liver remnant volume, allowing surgical resection of hepatic lesions initially considered unresectable. Short and long-term results and the convenience of carrying out this technique are issues that still remain under debate while waiting for the final outcomes of the multicenter registries with larger number of cases. The aim of this paper is to describe, from a critical point of view, the outcomes of the cases performed at our center (n = 8). On the other hand, it is possible to leave only one hepatic segment as a liver remnant and we illustrate this new surgical procedure (ALPPS monosegment) performed in one patient

[ROENTGEN-ENDOVASCULAR EMBOLIZATION OF THE PORTAL VEIN BRANCHES AS A PATIENTS CONDITIONING FOR EXTENSIVE HEPATIC RESECTION].

The results of surgical treatment of 316 patients, suffering focal hepatic diseases, in whom for preoperative preparation a portal vein embolization (PVE) was performed, were analyzed. PVE was applied in a small planned hepatic residual volume. The patients have aged from 21 to 77 yrs, (57 ± 10.6) yrs at average. During (22 ± 7) days after the procedure a hypertrophy of a planned postresectional hepatic volume by 58.6% was observed, while a hypertrophy degree have depended on the embolization volume performed: 57.3%--after embolization of branches of C(V)-C(VIII) hepatic segments, 66%--the segments C(V)-C(VIII) + C(IV). In 281 (89%) patients the extensive hepatic resection was performed, a fatal postresection hepatic insufficiency was not observed. A three-year and five-year disease-free survival have constituted 43.8 and 16.4% accordingly. Thus, a PVE constitutes a miniinvasive intervention, permitting to achieve a planned residual hepatic volume, to expand a diapazon of application of radical extensive hepatic resection in patients, suffering focal hepatic diseases while a small planned residual hepatic volume.

Shunt portosistémico congénito. Importancia del tratamiento precoz / Congenital portosistemic shunt. Importance of early treatment

Objetivos. El shunt porto-sistémico congénito (SPSC) es una patología infrecuente que puede producir complicaciones graves, como encefalopatía y tumores hepáticos con riesgo de degeneración maligna. La oclusión del shunt por cirugía o radiología intervencionista puede evitar, e incluso mejorar, las complicaciones. En algunos casos el trasplante hepático es la única opción. Describimos nuestra experiencia con esta patología. Pacientes y Método. Entre 1992 y 2013, ocho pacientes en edad pediátrica (cuatro varones y cuatro mujeres) fueron diagnosticados de un SPSC (cuatro extrahepáticos y cuatro intrahepáticos), de los cuales siete fueron diagnosticados después del año 2007. La mediana de edad al diagnóstico fue 5,5 años (1 mes-15 años). Cinco pacientes tenían patología asociada. Resultados. Cinco pacientes presentaban hiperamoniemia y afectación intelectual. Una niña debutó con coma. Cuatro pacientes presentaron tumoraciones hepáticas, incluyendo hiperplasia nodular focal/nódulos de regeneración (n=3), y adenomas (n=3). Una paciente con tumoraciones múltiples requirió una hepatectomía por síntomas compresivos. En dos pacientes se produjo degeneración a hepatocarcinoma, un niño de 5 años tratado con trasplante y otro en edad adulta tratado con hepatectomía. En un paciente de diagnóstico neonatal, el shunt cerró espontáneamente en seis meses. En cinco pacientes se ha realizado portografía directa con test de oclusión, realizándose cierre del shunt en tres casos por radiología intervencionista, uno con cirugía y en otro, con trasplante. Conclusiones. El tratamiento del SPSC ha de ser precoz para prevenir, e incluso revertir, las complicaciones, evitando el trasplante hepático. En la actualidad la radiología intervencionista juega un papel fundamental en la estrategia y el tratamiento de estos pacientes

AIM. Congenital portosistemic shunt (CPSS) is an uncommon condition that can cause serious complications such as encephalopathy and liver tumors at risk of malignant degeneration. Occlusion of the shunt by surgery or interventional radiology can prevent and even improve such complications. In some cases, liver transplantation is the only curative option. We describe our experience with this condition. Patients and Methods. Between 1992 and 2013, eight children (four male and four female) were diagnosed with CPSS (four extrahepatic and four intrahepatic) in our center, of which seven were diagnosed after 2007. The mean age at diagnosis was 5.5 years (1 month-15 years). Five patients had associated comorbidities. Results. Five patients had developed hyperammonemia and intellectual impairment, one of those manifested with an onset of coma. Four patients have developed at diagnosis liver tumors, including focal nodular hyperplasia/regenerative nodules (n=3) and adenomas (n=3). One patient with multiple tumors required a hepatectomy owing to compressive symptoms. Two patients, developed malignant degeneration, a child under five years treated with liver transplantation and another in adulthood treated with hepatectomy. In one patient, diagnosed in the neonatal period, the shunt occlusion occurred spontaneously. Direct portography with the occlusion test was performed in five patients, the shunt was occluded with interventional radiology in three cases, surgery in one and liver transplantation in the remaining. Conclusions. The treatment of the SPSC must be early to prevent and even to reverse its complications, avoiding liver transplantation. Currently, interventional radiology is essential in the strategy to follow and treatment of these patients

Desarrollo de un modelo experimental de ligadura portal asociada a transección parenquimatosa (ALPPS) en ratas / Development of an experimental model of portal vein ligation associated with parenchymal transection (ALPPS) in rats

ANTECEDENTES: La insuficiencia hepática postresección es una de las principales causas de muerte en el postoperatorio de una hepatectomía mayor. La técnica ALPPS aparece como una estrategia prometedora para evitarla, pero no existen estudios experimentales al respecto. El objetivo del trabajo es desarrollar un modelo experimental de ALPPS en ratas. MÉTODO: Se desarrolló un modelo experimental de ALPPS en 30 ratas Sprague Dawley. Se realizó la ligadura de la rama portal izquierda del lóbulo medio (LM), con lo cual se demarca el sector izquierdo (SILM) y derecho (SDLM); posteriormente se realizó la transección parenquimatosa por la línea isquémica. Se evaluaron el peso del animal, el volumen y peso del LM y de ambos. Sacrificio a los 3, 7 y 14 días (10 por grupo). RESULTADOS: No se presentaron complicaciones hemorrágicas ni ascitis en el postoperatorio. El incremento del volumen del LM fue del 24,1; 86,9 y 120,4% a los 3, 7 y 14 días. El SDLM (no ligado) se incrementó un 34,4; 78,8 y 102,0% a 3, 7 y 14 días. El SILM disminuyó un 42,6; 64,8, y 79,3% en los días 3, 7 y 14. CONCLUSIÓN: La realización del ALPPS fue posible en ratas, logrando los resultados esperados. Futuros estudios son necesarios para compararlo con la técnica de hepatectomía en 2 tiempos

BACKGROUND: Liver failure migth be a cause of death after major hepatectomies. The ALPPS technique appears to be a promising strategy to avoid it, however no experimental studies supporting this procedure have been previously described. The aim was to develop an experimental model of ALPPS in rats. Method. Experimental. A total of 30 Sprague Dawley rats were used. To develop the ALPPS procedure, ligation of the left portal branch of the middle lobe (LM) was performed. This demarcates the left side (SILM) from the right side (SDLM); parenchyma transection was performed following the demarcated line. The animal's weight, volume and weight of both LM were analyzed. Sacrifice at 3, 7 and 14 days after the procedure (10 per group) was performed. RESULTS: No bleeding or ascites were observed during the postoperative period. The LM increased by 24.1, 86.9 and 120.4% at 3, 7 and 14 days. The SDLM increased by 34.4, 78.8 and 102.0% at 3, 7 and 14 days. The SILM decreased 42.6, 64.8, and 79.3% at day 3, 7 and 14 days respectively. CONCLUSION: The ALPPS procedure can be performed in rats, achieving the expected results. Comparison studies to 2 staged hepatectomy will be necessary

Lack of association between CD40 polymorphisms and acute rejection in German liver transplant recipients.

CD40 and its ligand, CD154, are major costimulatory molecules whose interactions are important in alloreactive transplant rejection. The aim of this study was to examine the association of CD40 polymorphisms with the susceptibility to acute rejection episodes in liver transplantation. In total, 112 liver transplant recipients with biopsy proven acute rejections (BPAR), 97 without BPAR (WBPAR), and 112 healthy control individuals were enrolled in the study. Two single nucleotide polymorphisms (SNPs) of CD40 gene (rs1883832 and rs4810485) were genotyped by polymerase chain reaction-allele specific restriction enzyme analysis (PCR-ASRA). Both SNPs has been tested for a recessive and a dominant model. No significant differences were found in the genotype and allele frequencies of the SNPs rs1883832 and rs4810485 between BPAR liver recipients and WBPAR recipients. Our results do not suggest an important role of tested CD40 SNPs in the susceptibility to acute liver transplant rejection in a Caucasian population.

Detección precoz, prevención y manejo de la insuficiencia renal en el trasplante hepático / Early detection, prevention and management of renal failure in liver transplantation

La insuficiencia renal es una complicación frecuente de la población con trasplante hepático que se asocia con una elevada morbimortalidad. Se han descrito múltiples factores de riesgo para el desarrollo de insuficiencia renal postrasplante hepático en los periodos pre y postrasplante hepático, así como en el propio momento del trasplante. Para reducir el impacto de la insuficiencia renal postrasplante hepático es necesaria una actitud activa para la identificación de los pacientes con factores de riesgo, la implementación de estrategias preventivas y la detección precoz del deterioro de la función renal. Tomando como base las evidencias publicadas y la experiencia clínica, el presente documento incluye recomendaciones para la monitorización de la función renal en los pacientes con trasplante hepático, la prevención y el manejo de la insuficiencia renal postrasplante hepático, y la derivación al nefrólogo. Asimismo, se actualizan las pautas inmunosupresoras probadas para la prevención o el control del deterioro de la función renal tras el trasplante hepático

Renal failure is a frequent complication in liver transplant recipients and is associated with increased morbidity and mortality. A variety of risk factors for the development of renal failure in the pre- and post-transplantation periods have been described, as well as at the time of surgery. To reduce the negative impact of renal failure in this population, an active approach is required for the identification of those patients with risk factors, the implementation of preventive strategies, and the early detection of progressive deterioration of renal function. Based on published evidence and on clinical experience, this document presents a series of recommendations on monitoring RF in LT recipients, as well as on the prevention and management of acute and chronic renal failure after LT and referral of these patients to the nephrologist. In addition, this document also provides an update of the various immunosuppressive regimens tested in this population for the prevention and control of post-transplantation deterioration of renal function

IV Reunión de Consenso de la Sociedad Española de Trasplante Hepático 2012. Excepciones al Model for End-stage Liver Disease en la priorización para trasplante hepático / IV Consensus Meeting of the Spanish Society of Liver Transplantation 2012. Exceptions to Model for End-stage Liver Disease in prioritizing liver transplantation

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p21 promotes sustained liver regeneration and hepatocarcinogenesis in chronic cholestatic liver injury.

BACKGROUND AND AIMS: The cyclin-dependent kinase inhibitor p21 has been implicated as a tumour suppressor. Moreover, recent genetic studies suggest that p21 might be a potential therapeutic target to improve regeneration in chronic diseases. The aim of this study was to delineate the role of p21 in chronic liver injury and to specify its role in hepatocarcinogenesis in a mouse model of chronic cholestatic liver injury. METHODS: The degree of liver injury, regeneration and tumour formation was assessed in Mdr2(-/-) mice and compared with Mdr2/ p21(-/-) mice. Moreover, the role of p21 was evaluated in hepatoma cells in vitro and in human hepatocellular carcinoma (HCC). RESULTS: Mdr2(-/-) mice developed HCCs as a consequence of chronic inflammatory liver injury. In contrast, tumour development was profoundly delayed in Mdr2/ p21(-/-) mice. Delayed tumour development was accompanied by markedly impaired liver regeneration in Mdr2/ p21(-/-) mice. Moreover, the regenerative capacity of the Mdr2/ p21(-/-) livers in response to partial hepatectomy declined with age in these mice. Hepatocyte transplantation experiments revealed that impaired liver regeneration was due to intrinsic factors within the cells and changes in the Mdr2/ p21(-/-) microenvironment. In human HCCs, a subset of tumours expressed p21, which was associated with a significant shorter patient survival. CONCLUSIONS: We provide experimental evidence that p21 is required for sustained liver regeneration and tumour development in chronic liver injury indicating that p21 needs to be tightly regulated in order to balance liver regeneration and cancer risk. Moreover, we identify p21 as a negative prognostic marker in human HCC.

[The role of transjugular hepatic biopsy in preparation of the patients for the large hepatic resection].

The results of transjugular hepatic biopsy (TJHB) were analyzed in 32 patients, in whom the performance of hepatic radical resection was planned for the focal hepatic diseases. The biopsy procedures have had succeeded in 100% of observations. The severe complications were absent. The specimen length have constituted 12 mm at average, fragmentation was noted in 32% of observations. All the specimen were recognized as affordable for histological studying. In 24 patients in terms of 2-4 weeks after biopsy the embolization of lobar branches of portal vein was performed with the objective to enhance the assumed residual hepatic volume. In all the patients in terms of 2-8 weeks the spacious radical hepatic resection was succeeded. The data obtained witness that application of TJHB is expedient in the patients, who are prepared for spacious radical hepatic resection, for estimation of the organ parenchyma state and prognostication of postoperative hepatic insufficiency.

Servicio de hepatología y Trasplante hepático infantil del Hospital Universitario La Paz / Hepatology and Pediatric Liver Transplant in the Hospital Universitario La Paz

Las enfermedades hepáticas infantiles son diversas y raras. El tratamiento mediante trasplante hepático es necesario en el 60-80% de casos de hepatopatía de inicio neonatal. El Servicio de Hepatología del Hospital Infantil Universitario (HIU) La Paz, Madrid, ofrece experiencia especializada en el diagnóstico y tratamiento de niños con enfermedad hepática, fue constituido en 1975, acumula una gran casuística de estas enfermedades raras, dispone de programa de trasplante hepático desde 1986, con un total de 626 procedimientos de trasplante hasta 2012, de los cuales 122 fueron realizados con donante vivo relacionado. La supervivencia de pacientes trasplantados en la última década es de 95,5% al año y 88,5% a 10 años. Los resultados en niños con trasplante de donante vivo muestran supervivencia del 95,5% a 7 años. En conjunto, el Servicio de Hepatología y Trasplante Hepático HIU la Paz reúne las características idóneas de un centro de referencia nacional (AU)

Pediatric liver diseases are heterogeneous, rare entities. For those with neonatal onset, liver transplantation will be necessary in 60-80%. Service of Hepatology at Hospital Infantil Universitario La Paz, Madrid, offers specialized skills in diagnosis and treatment in children with liver disease. Activity started in 1975, it sums up a large series of these rare diseases, and has a liver transplantation (LT) program since 1986, 626 procedures of transplantation performed up to 2012, 122 interventions using living-related donors. LT survival results achieved in the last decade are: 95,5% at 1 year and 88,5% at 10th year. Survival is 95,5% at 7th year in children undergoing, living-donor liver transplantation. Overall, the Service of hepatology-Liver Transplantation meets optimum requirements of a national referral centre (AU)

[The clinical experience with hepatocyte transplantation for the treatment of hepatic insufficiency].

Hepatocyte transplantation represents a supplementary strategy for treating liver diseases. Several methods including extracorporeal devices, cell transplantation and implanted tissue-engineered units were proposed as liver support before liver transplantation. The ability to repopulate the liver with healthy and disease-resistant hepatocytes opens up new possibilities for correcting genetic disorders and treating patients with chronic liver diseases. Some results of experimental and clinical therapy of liver diseases are summarized in this review.