A. Mazziotti

De Novo Hepatitis B and C Viral Infection after Liver Transplantation

Abstract. Hepatitis B (HBV) and hepatitis C (HCV) viral infections often recur after orthotopic liver transplantation (OLT), but viral infections acquired with OLT have not been widely investigated. The aim of the study was to evaluate the incidence, evolution, and diagnostic problems of de novo HBV and HCV infections in liver transplant recipients with long-term follow-up. Altogether 121 transplant recipients entered the study. HBV, HDV, and HCV infections were diagnosed by means of serology and the polymerase chain reaction (PCR). Three patients became hepatitis B surface antigen (HBsAg)-positive after OLT, all of whom showed signs of persistent viral replication. Twelve patients became anti-HCV-positive after OLT: After clearance of passive antibodies, active anti-HCV seroconversion was usually delayed. The viral genome was detected in 9 of 12 patients, with fluctuations of viremia during their follow-up. The other three patients, who were HBsAg-positive before and after OLT, were repeatedly HCV-RNA-negative despite persistent anti-HCV reactivity. Four pre-OLT HBsAg-positive patients had evidence of HBV-related liver transplant disease. The remaining 8 of 12 patients experienced repeated alanine aminotransferase increases more than two times normal after transplant. De novo infections due to primary hepatotropic viruses were frequent after OLT in our experience. Early diagnosis of infection, especially when the HCV is involved, may be problematic and should be taken into account in patients showing persistent aminotransferase abnormalities. Monitoring viral markers and accurate evaluation of biopsy specimens are mandatory. The interference between HBV and HCV might play a role in the replicative cycle of one or both viruses in co-infected patients.

Antimicrobial prophylaxis with ceftriaxone for prevention of early postoperative infections after 49 liver transplantations.

Summary Infection remains a major problem for individuals who undergo solid organ transplantation and liver transplant recipients are particularly susceptible to infectious complications with a high morbidity and mortality rate. The risk of these infections is determined by previous or future environmental exposures as well as the patient’s immune status. We report here the results of an open prospective study involving 49 consecutive liver transplantations, undertaken to evaluate the efficacy of ceftriaxone in the prevention of early postoperative infectious complications. Antimicrobial prophylaxis was done using a single dose of ceftriaxone (2 g i.v.) given at the induction of anesthesia and then 2 further once-daily doses were administered 2 days postoperatively. Early postoperative bacterial infection rate was 43.5% (20/46); this result is comparable or even lower than those documented in other studies. This study, even though open and non-comparative, showed that a once-daily regimen containing ceftriaxone provides adequate antimicrobial prophylaxis and significant cost-savings in comparison with multiple-dose prophylactic regimens in patients undergoing liver transplantation.

Complications of Liver Transplantation

Liver transplantation is a technically complex operation. Marked portal hypertension or previous surgery on the upper abdomen can make the recipient hepatectomy particularly challenging. Vascular anastomoses can be problematic in the presence of particular anatomical conditions of the donor or the recipient and in pediatric, split liver or living-related transplantation. In spite of the experience acquired through the increased number of operations carried out, which has led to a significant reduction in operative mortality, several technical complications may occur after this formidable operation that can prejudice the outcome of the graft and the patient. The recent developments in interventional radiology have radically changed the approach to these complications.

Loss of Heterozygosity of the Long Arm of Chromosome 16 in Hepatocellular Carcinoma on Liver Cirrhosis

The analysis of loss of heterozygosity in human neoplasms, has shown that several genomic regions are frequently lost, suggesting their involvement in the pathogenesis of cancer as putative sites for tumor suppressor genes. The long arm of chromosome 16 has been implicated in breast, prostate and hepatocellular carcinomas. Previous studies made on large, advanced cases of HCC, revealed large areas of deletion on 16q. A recent report from a Japanese series of large HCC delimitated a common area of deletion at 16q22–23. We tested 16 small (<3 cm) HCC for loss of somatic heterozygosity using a set of 8 polymorphic microsatellite markers spanning 16q22–24. Three out of 10 informative cases showed loss of heterozygosity at 16q24.3, defining a commonly deleted region, possible site for a tumor suppressor gene.