Dengue hemorrhagic fever(DHF)is one of the most rapidly emerging infections of tropical and subtropical regions worldwide.It affects more rural and urban areas due to many factors,including climate change.Although mos...Dengue hemorrhagic fever(DHF)is one of the most rapidly emerging infections of tropical and subtropical regions worldwide.It affects more rural and urban areas due to many factors,including climate change.Although most people with dengue viral infection are asymptomatic,approximately 25%experience a selflimited febrile illness with mild to moderate biochemical abnormalities.Severe dengue diseases develop in a small proportion of these patients,and the common organ involvement is the liver.The hepatocellular injury was found in 60%-90%of DHF patients manifested as hepatomegaly,jaundice,elevated aminotransferase enzymes,and critical condition as an acute liver failure(ALF).Even the incidence of ALF in DHF is very low(0.31%-1.1%),but it is associated with a relatively high mortality rate(20%-68.3%).The pathophysiology of liver injury in DHF included the direct cytopathic effect of the DENV causing hepatocytes apoptosis,immunemediated hepatocyte injury induced hepatitis,and cytokine storm.Hepatic hypoperfusion is another contributing factor in dengue shock syndrome.The reduction of morbidity and mortality in DHF with liver involvement is dependent on the early detection of warning signs before the development of ALF.展开更多
Auxiliary partial liver transplantation(LT)involves implanting a functional partial graft from a discarded liver segment to supplement the native liver,offering an alternative for patients ineligible for standard LT.1...Auxiliary partial liver transplantation(LT)involves implanting a functional partial graft from a discarded liver segment to supplement the native liver,offering an alternative for patients ineligible for standard LT.1–4 Currently,most discarded allografts are derived from benign left-lobe lesions(e.g.,cavernous hemangioma or focal nodular hyperplasia[FNH])5-7 and are obtained from the left rather than the right liver lobes because the left lobes’anatomy is simpler and easier to reconstruct in vitro.8,9 However,this approach results in the loss of many potentially functional allografts from the right hepatic lobes.Grafts from patients with cystic echinococcosis(CE)have previously been used for whole-LT(Supplementary Table 1);however,grafts from patients with hepatic alveolar echinococcosis(AE)—a parasitic disease with infiltrative growth and higher morbidity10—have not yet been explored as allograft sources for heterotopic auxiliary LT.We present the first case of heterotopic auxiliary LT using a discarded partial right-lobe allograft from an AE patient for a critically ill girl with portal hypertension(PHT)who lacked access to a suitable liver graft.The graft(232 mL)was anastomosed to splenic vessels following splenectomy.The AE donor recovered uneventfully.The recipient had normal graft function(volume increased to 443 mL)and tested negative for anti-Echinococcus IgG at the 12-month follow-up.In this report,we examine the technical feasibility of using allografts from patients with AE,thereby evaluating a previously unreported source of discarded grafts in urgent pediatric LT.展开更多
文摘Dengue hemorrhagic fever(DHF)is one of the most rapidly emerging infections of tropical and subtropical regions worldwide.It affects more rural and urban areas due to many factors,including climate change.Although most people with dengue viral infection are asymptomatic,approximately 25%experience a selflimited febrile illness with mild to moderate biochemical abnormalities.Severe dengue diseases develop in a small proportion of these patients,and the common organ involvement is the liver.The hepatocellular injury was found in 60%-90%of DHF patients manifested as hepatomegaly,jaundice,elevated aminotransferase enzymes,and critical condition as an acute liver failure(ALF).Even the incidence of ALF in DHF is very low(0.31%-1.1%),but it is associated with a relatively high mortality rate(20%-68.3%).The pathophysiology of liver injury in DHF included the direct cytopathic effect of the DENV causing hepatocytes apoptosis,immunemediated hepatocyte injury induced hepatitis,and cytokine storm.Hepatic hypoperfusion is another contributing factor in dengue shock syndrome.The reduction of morbidity and mortality in DHF with liver involvement is dependent on the early detection of warning signs before the development of ALF.
基金supported by the Key Project of the National Natural Science Foundation of China(U24A20746)Sichuan Provincial Department of Science and Technology(2024NSFSC0748).
文摘Auxiliary partial liver transplantation(LT)involves implanting a functional partial graft from a discarded liver segment to supplement the native liver,offering an alternative for patients ineligible for standard LT.1–4 Currently,most discarded allografts are derived from benign left-lobe lesions(e.g.,cavernous hemangioma or focal nodular hyperplasia[FNH])5-7 and are obtained from the left rather than the right liver lobes because the left lobes’anatomy is simpler and easier to reconstruct in vitro.8,9 However,this approach results in the loss of many potentially functional allografts from the right hepatic lobes.Grafts from patients with cystic echinococcosis(CE)have previously been used for whole-LT(Supplementary Table 1);however,grafts from patients with hepatic alveolar echinococcosis(AE)—a parasitic disease with infiltrative growth and higher morbidity10—have not yet been explored as allograft sources for heterotopic auxiliary LT.We present the first case of heterotopic auxiliary LT using a discarded partial right-lobe allograft from an AE patient for a critically ill girl with portal hypertension(PHT)who lacked access to a suitable liver graft.The graft(232 mL)was anastomosed to splenic vessels following splenectomy.The AE donor recovered uneventfully.The recipient had normal graft function(volume increased to 443 mL)and tested negative for anti-Echinococcus IgG at the 12-month follow-up.In this report,we examine the technical feasibility of using allografts from patients with AE,thereby evaluating a previously unreported source of discarded grafts in urgent pediatric LT.
