ARMS as a Genotyping PCR, a New Technique for Detection of Liver Transplantation Recipients’ C3FF, C3FS, C3SS Allotypes as Predisposing Factor For Post-Transplantation Infections

2021 ◽  
Vol 30 (1) ◽  
pp. 183-190
Author(s):  
Samah M. Awad ◽  
Sanaa S. Hamam
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Viral Infections ◽  
Fungal Infections ◽  
Microbial Colonization ◽  
Amplification Refractory Mutation System ◽  
Sample Collection ◽  
Post Transplantation ◽  
Predisposing Factor ◽  
Microbiological Methods

Background: Complement is a crucial branch of both non-specific and specific immune system. C3 is the third complement component which plays a protective role in viral infections. There are two co-dominant inherited variants or allotypes for C3: C3 fast (C3F) and C3 slow (C3S). C3F variant has been linked to multiple diseases production including infections among liver transplantation recipients. Objectives: To investigate the most common risk factors for post-liver transplantation infections especially preoperative colonization. To identify types and rates of post-liver transplantation infections and their causing organisms. To identify C3 allotypes for both liver transplantation donors and recipients, and to correlate recipients’ allotypes with post-transplantation infections. Methodology: This study is a prospective study; it was conducted from January 2017 to August 2019 on 64 chronic cirrhotic patients, experienced liver transplantation in the National Liver Institute ICU, Menoufia, Egypt, and their donors. Blood cultures and other samples were collected according to site of infection using standard Microbiological sample collection methods and bacterial isolated were identified by standard microbiological methods using VITEK2 Compact automated ID/AST instrument. CMV IgG and IgM were detected by ELISA method. DNA was extracted and the extract was used for detection of C3S and C3F alleles by using Amplification Refractory Mutation System (ARMS). Results: The most common cause for liver transplantation was HCV related liver cirrhosis (26.56%). Risk factors for postliver transplantation were Pre-operative microbial colonization (100%) and long operative time (9.875±2.45 h). 39.8% of post-transplantation infections occurred during second week post-operatively and the commonest infections were drain infections (29.5%) and urinary tract infection (27.3%). 51.7% of liver transplantation recipients were C3FF, 32.8% were C3FS and 15.6% were C3SS. C3FF recipients showed increased relative risk to develop CMV (5.2) and bacterial & fungal infections (2.2) than other recipients’ allotypes. Conclusion: A comprehensive infectious diseases workup including detection of C3 allotype of the candidate for liver transplantation should be done pre-operatively to early detect and treat infections which can improve the outcome of the operation dramatically and improve patients’ life style. More studies should be done to find out if there is relation between donors’ and recipients’ C3 allotypes as currently no clear data still present.

Pleural Effusions Following Liver Transplantation: A Single-Center Experience

2020 ◽  
pp. 088506662093244
Author(s):  
Justin K. Lui ◽  
Lidia Spaho ◽  
Shahrad Hakimian ◽  
Michael Devine ◽  
Rosa Bui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Hospital Length Of Stay ◽  
Transplant Recipients ◽  
Single Center ◽  
Pleural Effusions ◽  
Post Transplantation ◽  
Significant Difference ◽  
Liver Transplant Recipients

Introduction: This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. Methods: A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. Results: In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. Conclusions: In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.

Risk Factors for Fungal Infections After Liver Transplantation

2018 ◽  
Vol 102 ◽  
pp. S56
Author(s):  
Dieter Hoyer ◽  
Halil I Karadag ◽  
Andreas Paul ◽  
Fuat H Saner
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Fungal Infections

Cytomegalovirus in Liver Transplant Patients

2021 ◽  
Vol 30 (3) ◽  
pp. 81-88
Author(s):  
Mahitab A. Youssef ◽  
Doaa T. Masallat ◽  
Ahmad M. Sultan ◽  
Sahar T. Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Bacterial Infections ◽  
Preventive Therapy ◽  
Meld Score ◽  
Cmv Infection ◽  
Post Transplantation ◽  
Transplant Patients ◽  
A Prospective Study

Background: Graft survival in liver transplant recipients is significantly lower in patients with a history of CMV infection compared to those without. In the absence of any preventive therapy 75% of recipients develop CMV infection post liver transplant. Objectives: This study detected the incidence of cytomegalovirus in liver transplant patients and evaluated post-transplant risk factors for HCMV and its complications. Methodology: A prospective study was conducted from the September 2018 till March 2020. Sixty subjects were involved; 30 patients were admitted for liver transplantation at the Gastroenterology Surgery Center (GISC), Mansoura university, and 30 donors. MELD score was calculated, blood samples were taken, CMV antibodies and CMV DNA were detected. Post transplantation follow up for 6 months and complications were reported. Results: HCMV viremia was detected in 46.6% recipients and in 10% donors by PCR. One recipient was positive for IgM and the rest were IgG positive and all donors were IgG positive. The most common reported complication after liver transplantation was bacterial infections (46.4%). Conclusions: Half of patients developed CMV infection after transplantation. The commonest risk factors for posttransplant CMV infection were seropositive donor or recipient >60 AU/mL, HCV patients, body mass index >25 and DM. Patients with positive HCMV infection had significantly higher MELD score than those reported negative HCMV

scholarly journals Causes of Death and Survival in Alcoholic Cirrhosis Patients Undergoing Liver Transplantation: Influence of the Patient’s Clinical Variables and Transplant Outcome Complications

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 968
Author(s):  
J. M. Bolarín ◽  
M. D. Pérez-Cárceles ◽  
J. P. Hernández del Rincón ◽  
A. Luna ◽  
A. Minguela ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Sudden Death ◽  
Molecular Mechanisms ◽  
Causes Of Death ◽  
Viral Infections ◽  
Multiorgan Failure ◽  
Alcoholic Cirrhosis ◽  
Post Transplantation ◽  
Term Survival ◽  
Clinical Complications

Background. Clinical and molecular mechanisms involved in the cause and time of death of alcoholic cirrhosis (AC) patients undergoing liver transplantation (LT) are not entirely understood. In sudden death cases, judicial autopsy practice is mandatory for determining the cause and circumstances of death. The medico-legal autopsy data are essential for helping health authorities to guide future public health activities, assess the effectiveness of health systems, and adopt the necessary preventive measures to improve and adapt the treatments in order to increase these patients’ survival. Objective. Our study aimed to determine the different clinical and sociodemographic causes that influence the different causes of death and the short- and long-term survival of AC patients undergoing liver transplantation. Methods. A total of 122 deceased AC patients undergoing LT were analyzed at different times post-transplantation. The main pre- and post-transplant complications were analyzed in relation to the cause of death and the patient’s survival, as well as the causes and time at which the patient’s death occurred. Results. A total of 53.3% of non-sudden death was observed. A large number of the deaths of AC patients undergoing transplantation were due to non-sudden death, sepsis, and graft failure (GF), the main causes of death in the sample being similar in both sexes. In non-sudden deaths, there were no significant differences between the death rates either related or not related to the liver transplant. Sepsis was the main cause, with the highest percentage (21.3%) of mortality, followed by GF (18.9%) and multiorgan failure (15.6%) at ten years. Furthermore, our results showed how pre-transplant clinical complications, such as viral infections and encephalopathy, influence the age at which multiorgan failure occurs in the transplanted patient. Conclusion. Multiorgan failure is the leading cause of sudden death, with higher mortality during the first year after transplantation, followed by sepsis and GF. Our results show the vulnerability of AC patients, both in the hospital period after the transplant and outside.

Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era

2013 ◽  
Vol 27 (4) ◽  
pp. E454-E461 ◽  
Author(s):  
Faouzi Saliba ◽  
Valérie Delvart ◽  
Philippe Ichaï ◽  
Najiby Kassis ◽  
Françoise Botterel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Fungal Infections ◽  
Transplantation Outcomes

scholarly journals Orthotopic Liver Transplantation in Human-Immunodeficiency-Virus-Positive Patients in Germany

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
E. Anadol ◽  
S. Beckebaum ◽  
K. Radecke ◽  
A. Paul ◽  
A. Zoufaly ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Viral Infections ◽  
Survival Rates ◽  
Hiv Positive ◽  
Post Transplantation ◽  
Immunodeficiency Virus ◽  
Chiari Syndrome ◽  
Hcv Coinfection ◽  
End Stage

Objectives. This summary evaluates the outcomes of orthotopic liver transplantation (OLT) of HIV-positive patients in Germany.Methods. Retrospective chart analysis of HIV-positive patients, who had been liver-transplanted in Germany between July 1997 and July 2011.Results. 38 transplantations were performed in 32 patients at 9 German transplant centres. The reasons for OLT were end-stage liver disease (ESLD) and/or liver failure due to hepatitis C (HCV) (), hepatitis B (HBV) (), multiple viral infections of the liver () and Budd-Chiari-Syndrome. In July 2011 19/32 (60%) of the transplanted patients were still alive with a median survival of 61 months (IQR (interquartile range): 41–86 months). 6 patients had died in the early post-transplantation period from septicaemia (), primary graft dysfunction (), and intrathoracal hemorrhage (). Later on 7 patients had died from septicaemia (), delayed graft failure (), recurrent HCC (), and renal failure (). Recurrent HBV infection was efficiently prevented in 11/12 patients; HCV reinfection occurred in all patients and contributed considerably to the overall mortality.Conclusions. Overall OLT is a feasible approach in HIV-infected patients with acceptable survival rates in Germany. Reinfection with HCV still remains a major clinical challenge in HIV/HCV coinfection after OLT.

scholarly journals Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

2018 ◽  
Vol 68 (9) ◽  
pp. 1482-1493 ◽  
Author(s):  
Marta Francesca Di Pasquale ◽  
Giovanni Sotgiu ◽  
Andrea Gramegna ◽  
Dejan Radovanovic ◽  
Silvia Terraneo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Viral Infections ◽  
Fungal Infections ◽  
Secondary Analysis ◽  
Community Acquired Pneumonia ◽  
Empiric Antibiotic Therapy ◽  
Immunocompromised Patients ◽  
Steroid Use ◽  
Hematological Cancer ◽  
International Multicenter Study

Abstract Background The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non–community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses.

scholarly journals Late Recurrence of Hepatocellular Carcinoma in a Patient 10 Years after Liver Transplantation Unrelated to Transplanted Organ

2021 ◽  
pp. 1755-1761
Author(s):  
Kornelia Morisson-Sarapak ◽  
Maciej Wrzesiński ◽  
Samir Zeair ◽  
Marta Wawrzynowicz-Syczewska
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Viral Infections ◽  
Sustained Viral Response ◽  
Pegylated Interferon ◽  
Late Recurrence ◽  
Substantial Risk ◽  
Cirrhotic Patients ◽  
Chronic Hcv

Liver transplantation (LTx) is an accepted method of hepatocellular carcinoma (HCC) treatment in cirrhotic patients; however, it has many limitations, and there is a substantial risk of recurrence. Most relapses occur within the first 2 posttransplant years. We aimed to present a late extrahepatic recurrence of HCC 10 years after LTx, and we discuss the possible risk factors and ways to improve transplantation results. A 68-year-old patient with liver cirrhosis and HCC on the background of chronic HCV and past HBV infection was transplanted urgently due to the rapid decompensation. Anti-HCV treatment before surgery was unsuccessful. Pretransplant computed tomography showed 1 focal 4.5 cm lesion consistent with HCC. Histopathology of the explanted organ showed 2 nodules outside the Milan criteria. Angioinvasion was not found. The patient achieved a sustained viral response to pegylated interferon and ribavirin 2 years post-LTx. Eight years were uneventful. CT of the abdomen performed occasionally was normal. Ten years after LTx, the patient unexpectedly presented with shortness of breath, fatigue, and weight loss. Two metastatic nodules of HCC in the lungs and pelvis were found. Although late HCC recurrence post-LTx is rare, it should be always considered, especially when risk factors such as viral infections and underestimation of tumor advancement were identified. We advocate that oncological surveillance of HCC relapse has to be continued during the whole posttransplant period. High AFP levels, the unfavorable neutrophil to lymphocyte ratio, and better estimation of primary tumor size seem to be useful in the identification of good candidates for transplantation.

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