Hector Vilca Melendez

Single-center experience with liver transplantation from controlled non-heartbeating donors: a viable source of grafts.

Background:To increase the number of livers available for transplantation a non-heartbeating donor (NHBD) liver transplant program was started after obtaining hospital ethical committee approval. Methods:Controlled donors with a warm ischemia of <30 minutes were considered. A 5-minute stand-off period was observed from asystole to skin incision. A super-rapid technique was used for the retrieval. Methods used to assess the suitability for transplantation included liver function tests, morphologic and histologic assessment, and hepatocyte viability testing. Results:Sixty livers were retrieved from NHBDs. Of these, 33 were judged suitable for transplantation. Of these one was exported and transplanted, and one could not be matched to a suitable recipient. A further 27 were not used because of liver appearance in 21, prolonged hypoxia and hypotension in 4, poor perfusion in 1, and donor malignancy in 1. Mean donor age was 39.4 years (range, 0.75–67 years). Causes of death were head trauma in 10 donors, intracranial bleed in 24, and anoxic/ischemic brain injury in 26. Mean warm ischemia time was 14.7 minutes (range, 7–40 minutes). Thirty-two patients were transplanted (one split liver), and the mean age of the recipients was 38.4 years (range, 0.7–72 years). All grafts had good early function except one right lobe split. There were 4 deaths resulting from ischemic brain injury, chronic rejection, biliary sepsis, and multiorgan failure following retransplantation for primary nonfunction. Overall patient and graft survival is 87% and 84%, respectively, at a median follow-up of 15 months. Conclusions:Early results suggest that controlled NHBDs are a significant new source of grafts, but careful donor selection and short cold ischemia are mandatory.

Liver transplant for giant cell hepatitis with autoimmune haemolytic anaemia

Giant cell hepatitis (CGH) with autoimmune haemolytic anaemia (AHA) is a distinct entity with an aggressive course. Immunosuppression may help early disease. A case is reported of a child with GCH and AHA with early disease recurrence after liver transplantation for end stage liver disease.

A validated technique for the analysis of biliary bile acid secretion in donor livers prior to transplantation

Abstract Many parameters currently used for the pre‐transplant assessment of liver allografts, are not reliable enough in predicting the likelihood of early graft dysfunction or non‐function. It is generally accepted that bile secretion is a sign of hepatic function post‐transplant and that bile flow shows a close linear relationship to the secretion of bile acids (“apparent choleretic activity”). We have studied bile flow, biliary bile acid concentrations and composition and measured apparent choleretic activity from hepatic bile collected with a new technique under controlled conditions at the time of retrieval from 18 donor livers. More than three samples were collected from each of 13 donors and a total of 65 samples of hepatic bile were analysed. Of these, ten showed typical apparent choleretic activity with a positive slope in the regression line analysis (correlation coefficient of 0.9), validating our collection technique.

Clinical and histological outcomes following living-related liver transplantation in children.

OBJECTIVES Living-related liver transplantation (LRLT) was developed to increase the donor pool of size-matched organs for children. In the UK only one centre performed LRLT between 1993 and 2008. This study reports the clinical and histological outcomes following adult-to-paediatric LRLT at our centre. METHODS Forty-six LRLTs were reviewed. Recipients had a mean age, weight and PELD score of 2.4years (range 0.5-11years), 11.0kg (3.7-32.3kg) and 11.7 (-20.3 to 49.1) respectively. The incidence of post-transplant paediatric morbidity, abnormal liver function tests and histological abnormalities was reviewed. RESULTS Patient and graft survival rates were 97.8%, 95.1% and 95.1%, and 97.8%, 92.1% and 71.7% at 1, 5 and 10years post-transplant respectively. Three children were re-transplanted at 44, 100 and 119months post-transplant. Nine children developed neuropsychological problems, 6 experienced educational difficulties, 5 developed post-transplant lymphoproliferative disorder and 5 suffered height or weight growth<2 centile. Normal LFTs were found in 41.7%, 50%, 68% and 64.7% of children at median follow-up of 6, 13, 61 and 85months respectively. Liver histology showed hepatitis, acute rejection, non-specific changes, biliary pathology, vascular pathology and chronic rejection in 32.9%, 29.5%, 13.4%, 10.1%, 6% and 2% of biopsies respectively. CONCLUSIONS The prevalence of paediatric morbidity and histological abnormalities emphasize the need for specialist and long-term follow-up following LRLT in children.

Su1028 Renal Impairment During the Immediate Postoperative Period Is Associated With Increased Risk of Biliary Stricture (BS)- Retrospective Study

Introduction: Biliary stricture is a common complication following orthoptic Liver transplantation. The reported incidence of biliary stricture is 5-15% following deceased donor liver transplantation (1). There is no published data to suggest renal impairment following OLT either increases or decrease the incidence of strictures. We conducted retrospective review to assess the above. Methods: A retrospective review of all adult patients who had OLT between January 2008 and February 2013 were included. Information was obtained from electronic patient record, radiology, endoscopy and pathology reports. We assessed if renal impairment both during the immediate post operative period and at 3 months and 1 year had any impact on the development of strictures. Statistical analysis was done using PRISM 6. Fisher Exact test and chi-squared test were used as appropriate. Results: 812 patient episodes were reviewed of which 304 patients were repatriated to other centers so, they were excluded.508 patients were included in the analysis. The mean age at which they had OLT was 49.71± 12.56 (Male: female-328: 180). The mean blood loss during surgery was 7.5± 6.5 l. 14.2% (71) had biopsy proven rejection. 39(7.6%) patients developed biliary strictures. The odds ratio for developing BS in DCD is 9.02 (95% CI 4.4-18.4, P <0.0001). Patients who had haemofiltration were at increased risk of developing BS (RR 2.33,95% CI 1.28-4.5). Patients whose glomerular filtration rate (GFR) decreased below 60 in the first 14 days were at increased risk of developing biliary stricture (P=0.01). The above trend was not maintained at 3 months and 1 year. The rest of the comparators are shown in the table. Conclusion: Our study shows that there was a modest but significant increase in risk of developing biliary strictures if they had haemofiltration or if their GFR decreased below 60 in the first 14 days following liver transplant. The risk of developing BS is increased by 9 fold if the graft is DCD.