BACKGROUND Acute kidney injury(AKI)after liver transplantation(LT)is a frequent and multifactorial event related to increased morbidity and mortality.Risk factors for AKI after LT still need to be clarified.AIM To ide...BACKGROUND Acute kidney injury(AKI)after liver transplantation(LT)is a frequent and multifactorial event related to increased morbidity and mortality.Risk factors for AKI after LT still need to be clarified.AIM To identify the predictors of acute kidney injury after liver transplantation.METHODS The frequency and pre-and intraoperative predictors of AKI within the first 7 d after LT were evaluated in adult liver transplant candidates in a single LT center in Croatia.AKI was defined according to the Kidney Disease:Improving Global Outcomes criteria.RESULTS Out of 205 patients(mean age 57±10 years;73.7%males,52.7%with alcoholrelated liver disease)93(45.36%)developed AKI,and the majority of them(58.06%)had stage 1.Only 5.38%of patients required renal replacement therapy after LT.The majority of patients(82.8%)developed AKI within the first two days after the procedure.Multivariate logistic regression identified pre-LT body mass index(OR=1.1,95%CI:1.05-1.24)and red blood cell transfusion(OR=1.66,95%CI:1.09-2.53)as independent predictors of early post-LT AKI occurrence.30-d survival after LT was significantly better for patients without AKI(P=0.01).CONCLUSION Early AKI after LT is a frequent event that negatively impacts short-term survival.The pathogenesis of AKI is multifactorial,but pre-LT BMI and intraoperative volume shifts are major contributors.展开更多
Zoonoses represent a problem of rising importance in the transplant population.A close relationship and changes between human,animal and environmental health(“One Health”concept)significantly influence the transmiss...Zoonoses represent a problem of rising importance in the transplant population.A close relationship and changes between human,animal and environmental health(“One Health”concept)significantly influence the transmission and distribution of zoonotic diseases.The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population.Many reports on donor-derived or naturally acquired(re-)emerging arboviral infections such as dengue,chikungunya,West Nile,tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts.Hepatitis E virus has emerged as a serious problem after solid organ transplantation(SOT),leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes.Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality.In addition,ehrlichiosis may be more severe with higher casefatality rates in SOT recipients.Some unusual or severe presentations of borreliosis,anaplasmosis and rickettsioses were also reported among transplant patients.Moreover,toxoplasmosis as infectious complication is a well-recognized zoonosis in this population.Although rabies transmission through SOT transplantation has rarely been reported,it has become a notable problem in some countries.Since the spreading trends of zoonoses are likely to continue,the awareness,recognition and treatment of zoonotic infections among transplant professionals should be imperative.展开更多
BACKGROUND Donor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Dat...BACKGROUND Donor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Data on donor-origin neuroendocrine neoplasms (NENs) and the most appropriate treatment are scarce. Here, we report a case of a patient who developed a NEN confined to the liver after LT and was treated with liver re-transplantation (re-LT). CASE SUMMARY A 49-year-old man with no other medical co-morbidities underwent LT in 2013 for alcoholic liver cirrhosis. The donor was a 73-year-old female with no known malignancies. Early after LT, a hypoechogenic (15 mm) lesion was detected in the left hepatic lobe on abdominal ultrasound. The lesion was stable for next 11 mo, when abdominal magnetic resonance identified two hypovascular lesions (20 and 11 mm) with atypical enhancement pattern. Follow-up abdominal ultrasound revealed no new lesions for the next 2.5 years, when magnetic resonance showed a progression in size and number of lesions, also confirmed by abdominal computed tomography. Liver biopsy proved a well-differentiated NEN. Genetic analysis of the NEN confirmed donor origin of the neoplasm. As NEN was confined to liver graft only, in 2018, the patient underwent his second LT. At 12 mo after re-LT the patient is well with no signs of NEN dissemination. CONCLUSION The benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.展开更多
基金Supported by the Croatian Science Foundation grant“The Role of Notch Signalling Pathway in Pathogenesis of Hepatic Fibrosis”,No.UIP-2017-05-1965.
文摘BACKGROUND Acute kidney injury(AKI)after liver transplantation(LT)is a frequent and multifactorial event related to increased morbidity and mortality.Risk factors for AKI after LT still need to be clarified.AIM To identify the predictors of acute kidney injury after liver transplantation.METHODS The frequency and pre-and intraoperative predictors of AKI within the first 7 d after LT were evaluated in adult liver transplant candidates in a single LT center in Croatia.AKI was defined according to the Kidney Disease:Improving Global Outcomes criteria.RESULTS Out of 205 patients(mean age 57±10 years;73.7%males,52.7%with alcoholrelated liver disease)93(45.36%)developed AKI,and the majority of them(58.06%)had stage 1.Only 5.38%of patients required renal replacement therapy after LT.The majority of patients(82.8%)developed AKI within the first two days after the procedure.Multivariate logistic regression identified pre-LT body mass index(OR=1.1,95%CI:1.05-1.24)and red blood cell transfusion(OR=1.66,95%CI:1.09-2.53)as independent predictors of early post-LT AKI occurrence.30-d survival after LT was significantly better for patients without AKI(P=0.01).CONCLUSION Early AKI after LT is a frequent event that negatively impacts short-term survival.The pathogenesis of AKI is multifactorial,but pre-LT BMI and intraoperative volume shifts are major contributors.
基金This study was supported in part by the Croatian Science Foundation,project No.IP 2016-06-7456:Prevalence and molecular epidemiology of emerging and re-emerging neuroinvasive arboviral infections in CroatiaCRONEUROARBO(to TVC).
文摘Zoonoses represent a problem of rising importance in the transplant population.A close relationship and changes between human,animal and environmental health(“One Health”concept)significantly influence the transmission and distribution of zoonotic diseases.The aim of this manuscript is to perform a narrative review of the published literature on emerging and neglected zoonoses in the transplant population.Many reports on donor-derived or naturally acquired(re-)emerging arboviral infections such as dengue,chikungunya,West Nile,tick-borne encephalitis and Zika virus infection have demonstrated atypical or more complicated clinical course in immunocompromised hosts.Hepatitis E virus has emerged as a serious problem after solid organ transplantation(SOT),leading to diverse extrahepatic manifestations and chronic hepatitis with unfavorable outcomes.Some neglected pathogens such as lymphocytic choriomeningitis virus can cause severe infection with multi-organ failure and high mortality.In addition,ehrlichiosis may be more severe with higher casefatality rates in SOT recipients.Some unusual or severe presentations of borreliosis,anaplasmosis and rickettsioses were also reported among transplant patients.Moreover,toxoplasmosis as infectious complication is a well-recognized zoonosis in this population.Although rabies transmission through SOT transplantation has rarely been reported,it has become a notable problem in some countries.Since the spreading trends of zoonoses are likely to continue,the awareness,recognition and treatment of zoonotic infections among transplant professionals should be imperative.
文摘BACKGROUND Donor-origin cancer is a well-recognized but rare complication after liver transplantation (LT). The rise in the use of extended criteria donors due to the current shortage of organs increases the risk. Data on donor-origin neuroendocrine neoplasms (NENs) and the most appropriate treatment are scarce. Here, we report a case of a patient who developed a NEN confined to the liver after LT and was treated with liver re-transplantation (re-LT). CASE SUMMARY A 49-year-old man with no other medical co-morbidities underwent LT in 2013 for alcoholic liver cirrhosis. The donor was a 73-year-old female with no known malignancies. Early after LT, a hypoechogenic (15 mm) lesion was detected in the left hepatic lobe on abdominal ultrasound. The lesion was stable for next 11 mo, when abdominal magnetic resonance identified two hypovascular lesions (20 and 11 mm) with atypical enhancement pattern. Follow-up abdominal ultrasound revealed no new lesions for the next 2.5 years, when magnetic resonance showed a progression in size and number of lesions, also confirmed by abdominal computed tomography. Liver biopsy proved a well-differentiated NEN. Genetic analysis of the NEN confirmed donor origin of the neoplasm. As NEN was confined to liver graft only, in 2018, the patient underwent his second LT. At 12 mo after re-LT the patient is well with no signs of NEN dissemination. CONCLUSION The benefits of graft explantation should be weighed against the risks of re-LT and the likelihood of NEN dissemination beyond the graft.
