Arvinder Singh Soin

Outcome of 200 pediatric living donor liver transplantations in India

ObjectiveTo describe our experience of pediatric living donor liver transplantation from India over a period of 12 years.Materials and MethodsA retrospective analysis of 200 living donor liver transplantation in children (18 years or younger) was done for demographic features, indications, donor and graft profile and outcome.ResultsBetween September 2004 and July 2016, 200 liver transplants were performed on 197 children. Fifty transplants were done in initial 6 years and 150 in next 6 years. All donors (51% mothers) were discharged with a mean stay of 7 days. The leading indications of liver transplants were cholestatic liver disease (46%) followed by metabolic liver disease (33%) and acute liver failure/acute on chronic liver failure (28.5%). Biliary leakage (8.5%), biliary stricture (9%), hepatic artery thrombosis (4.5%) and portal vein thrombosis (4%) were the most common surgical complications; all could be managed by surgical or interventional radiological measures, except in one child who died. Sepsis, acute rejection and CMV hepatitis in first 6 months were seen in 14.5%, 25% and 17% cases, respectively. Post-transplant lymphoproliferative disease was seen in only 1.5%. Re-transplant rate was 1.5%. The overall 1 year survival rate was 94% and 5 year actuarial survival was 87% with no statistically significant difference between children weight <10 kg vs. >10 kg. Outcome in acute liver failure did not differ significantly between those with acute on chronic liver failure vs. those with chronic liver disease.ConclusionsAdvances in medical and surgical techniques associated with multidisciplinary teams including skilled pediatric liver transplant surgeons, anesthetists, dedicated pediatric hepatologists, pediatric intensivists, interventional radiologists and pathologists resulted in an excellent outcome of living related liver transplants in children. Low age and weight of the baby does not seem to be a contraindication for liver transplantation as outcome were comparable in our experience.

Cytomegalovirus infection in living donor liver transplant recipients significantly impacts the early post-transplant outcome: A single center experience

Cytomegalovirus (CMV) is the most common viral infection in liver transplant recipients that influences the outcomes of liver transplantation. However, its impact on early outcomes following living donor liver transplantation (LDLT) is not fully defined in the Indian subcontinent. This study was done to assess the impact of CMV infection on early post‐transplant outcomes in LDLT recipients.

Fast tracking in adult living donor liver transplantation: A case series of 15 patients

Background and Aims: Fast tracking (FT) for more efficacious use of resources may be difficult after living donor liver transplantation (LDLT) due to a partial liver graft, complex vascular anastomoses and longer operating time. Our study was aimed at reporting our experience with FT (on table extubation) in LDLT recipients. A secondary objective of our study was to look at defining a subgroup of patients who could be prospectively planned for FT. Methods: We studied the demographics and outcomes of 15 LDLT recipients extubated immediately in the operating suite based on an uneventful intraoperative course, haemodynamic stability after graft reperfusion and improvement of metabolic parameters post-implantation and vascular anastomoses. Results: Twelve recipients were males, and mean age, body mass index (BMI) and Model for End Stage Liver Disease (MELD) score were 43 ± 12 years, 23 ± 3 kg/m2 and 15.5 ± 6, respectively, most were Child–Turcotte–Pugh Class B. Diabetes and hypothyroidism were present in 1 and 2 patients, respectively. Post-extubation, none required immediate re-intubation and one patient needed non-invasive ventilation for 2 h. Conclusion: Fast tracked recipients were young, with a low BMI, low MELD scores, minimal comorbidities and good immediate graft function post-reperfusion.

Edge Probability and Pixel Relativity-Based Speckle Reducing Anisotropic Diffusion

Anisotropic diffusion filters are one of the best choices for speckle reduction in the ultrasound images. These filters control the diffusion flux flow using local image statistics and provide the desired speckle suppression. However, inefficient use of edge characteristics results in either oversmooth image or an image containing misinterpreted spurious edges. As a result, the diagnostic quality of the images becomes a concern. To alleviate such problems, a novel anisotropic diffusion-based speckle reducing filter is proposed in this paper. A probability density function of the edges along with pixel relativity information is used to control the diffusion flux flow. The probability density function helps in removing the spurious edges and the pixel relativity reduces the oversmoothing effects. Furthermore, the filtering is performed in superpixel domain to reduce the execution time, wherein a minimum of 15% of the total number of image pixels can be used. For performance evaluation, 31 frames of three synthetic images and 40 real ultrasound images are used. In most of the experiments, the proposed filter shows a better performance as compared to the state-of-the-art filters in terms of the speckle region’s signal-to-noise ratio and mean square error. It also shows a comparative performance for figure of merit and structural similarity measure index. Furthermore, in the subjective evaluation, performed by the expert radiologists, the proposed filter’s outputs are preferred for the improved contrast and sharpness of the object boundaries. Hence, the proposed filtering framework is suitable to reduce the unwanted speckle and improve the quality of the ultrasound images.

Edge Aware Geometric Filter for Ultrasound Image Enhancement

Despeckling of ultrasound images is essential for subsequent computational analysis. In this paper, an edge aware geometric filter (GF) is proposed for speckle reduction. The behaviour of conventional GF is approximated using commonly used functions like unit step. These approximations help in identifying the natural relationship between GF and other existing spatially adaptive filters. Subsequently, the modifications in GF framework are proposed to take the advantage of edge characteristics. The proposed filter requires almost no parameter tuning and provides good quality outputs for synthetic as well as real ultrasound images. It is compared with the state-of-the-art speckle reducing filters. Improvements of 10.46% and 42% are noticed in mean square error and figure of merit, respectively.

Cardiac Ultrasound Image Enhancement Using Tissue Selective Total Variation Regularization

Speckle reduction is desired to improve the quality of ultrasound images. However, a uniform speckle reduction from the entire image results in loss of important information, especially in cardiac ultrasound images. In this paper, a tissue selective total variation regularization approach is proposed for the enhancement of cardiac ultrasound images. It measures the pixel probability of belonging to blood regions and uses it in the total variation framework. As a result, the unwanted speckle from the blood chamber regions is removed and the useful speckle in the tissue regions is preserved. This helps to improve the visible contrast of the images and enhances the structural details. The proposed approach is evaluated using synthetic as well as real images. A better performance is observed as compared to the state-of-the-art filters in terms of speckle region’s signal to noise ratio, structural similarity measure index, figure of merit, and mean square error.

Management of hepatitis B in the peri-transplant period.

Hepatitis B virus (HBV) infection is an important indication for liver transplantation worldwide. The most important concern is the prevention of viral recurrence in the post transplant period. With the introduction of Hepatitis B immunoglobulin, there has been a significance reduction in the rate of HBV recurrence with improved patient & graft survival rates. The combination of oral nucleosides along with Hepatitis B immunoglobulin has further reduced the rate of HBV recurrence, and currently the outcome of liver transplantation for HBV infection is comparable to other indications for liver transplantation.