- Email: [email protected]
Adult Liver Transplantation – Initial Experience From a Tertiary Care Centre at North Kerala
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Sharat Varma. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.064
quantification of ‘‘ASMA positive area percentage’’ was performed on the baseline biopsy. Histological and fibrosis assessment using Metavir and liver allograft fibrosis scores (LAFSc), was performed on all biopsies. The difference of fibrosis severity between the ‘‘baseline’’ and ‘‘follow-up’’ was termed ‘‘prospective change in fibrosis’’. Results: Significant association was seen between extent of ASMA positivity on baseline biopsy and ‘‘prospective change in fibrosis’’ using Metavir (p value = 0.02), cumulative LAFSc (p value = 0.02), and portal LAFSc (p value = 0.01) values. ASMA positive area percentage >1.05 predicted increased fibrosis on next biopsy with 90.0% specificity. Additionally an association was observed between extent of ASMA positivity and concomitant ductular reaction (p = 0.06) but not with histological inflammation in the portal tract or lobular area. Conclusion: ASMA quantification can predict the future course of fibrosis after liver transplantation. CONFLICTS OF INTEREST The authors have none to declare.
Liver Transplantation
with mean follow-up of 4.3 years, 281 serial PBs (3.1 biopsy/child) and human leukocyte antigen (HLA) antibody data. PBs were taken 1-2, 2-3, 3-5, 5-7, and 710 years post-LT, and evaluated for inflammation and fibrosis using liver allograft fibrosis score (LAFSc). The evolution of fibrosis, inflammation and related predisposing factors were analysed. Results: HLA-DRB1*03/04 allele and Class II DSA were significantly associated with portal fibrosis (p = 0.03; p = 0.03, respectively). Portal inflammation was predisposed by Class II DSA (p = 0.02) and nonHLA antibody presence (p = 0.01). Non-portal fibrosis wasn’t predisposed by inflammation. Lobular inflammation was associated with non-HLA antibodies. Conclusion: We conclusively demonstrated that allograft inflammation results in fibrosis and is associated with post-LT Class II DSA and non-HLA antibodies. The HLA-DRB1*03/04 allele caused genetic predisposition for fibrosis.
Corresponding author: Sharat Varma. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.065
5 TO EVALUATE SIGNIFICANCE OF ALPHA SMOOTH MUSCLE ACTIN (ASMA) EXPRESSION ON LIVER BIOPSY AS PREDICTOR OF FUTURE GRAFT FIBROSIS IN PEDIATRIC LIVER TRANSPLANT (LT) RECIPIENTS Sharat Varma, Xavier Stéphenne, Mina Komuta, Caroline Bouzin, Jerome Ambroise, Francoise Smets, Raymond Reding, Etienne Sokal Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium
Background & Aim: Activated hepatic stellate cells express cytoplasmic alpha-smooth muscle actin (ASMA) prior to secreting collagen and consequent liver fibrosis. We hypothesized that quantifying ASMA could predict severity of future fibrosis after liver transplantation (LT). Methods: 32 pairs of protocol biopsies i.e. ‘‘baseline’’ and ‘‘follow-up’’ biopsies taken at 1-2 year intervals from 18 stable pediatric LT recipients, transplanted between 2006 and 2012 were selected. Morphometric
6 ADULT LIVER TRANSPLANTATION – INITIAL EXPERIENCE FROM A TERTIARY CARE CENTRE AT NORTH KERALA Rajneesh Rajan, Anish Kumar, K. Biju, Tony Jose, Sujith Janardhanan, Tajimal Rabia, G. Ramakrishnan, Rakesh Babu, Kishore Kanianchalil, Seethalekshmy Natarajan, Rohit Ravindran, Rajesh Nambiar, Sajeesh Sahadevan Malabar Institute of Medical Sciences, Calicut, India
Background & Aim: This study retrospectively analyses the initial experience of liver transplantation (LT) from a tertiary care centre. We are presenting data from our centre which started off with combined LDLT and DDLT programme. Its important for each transplant centre to analyze the success rate of their transplant programme and ours is one centre which started both LDLT and DDLT programme together. The aim of the study was to assess the success rate, intraoperative blood transfusion and hemodialysis requirement, postoperative infectious, vascular and
Journal of Clinical and Experimental Hepatology | July 2016 | Vol. 6 | No. S1 | S59–S62
S61
LIVER TRANSPLANTATION
Liver Transplantation
biliary complications and mortality related to Live and deceased donor transplantation. Results: Between September 2013 and June 2016, we performed total 37 liver transplantations (18 DDLT and 19 LDLT). There were 2 patients with acute liver failure, 2 with acute on chronic liver failure, 2 with HCC and 31 patients with decompensated cirrhosis liver. Mean MELD score was 24. Average duration of ICU stay was 7 days and average duration of hospital stay was 18 days. Average blood transfusion requirement was 2 units/transplant. Five patients required intraoperative hemodialysis and three patients (8.1%) required vascular interventions postoperatively. Among the infectious complications, one had tuberculosis and one had hepatitis B flare and one had cholangitis. 9 patients (24.32%) were treated for CMV infections. Three patients had preoperative complex biliary anatomy requiring three duct anastamosis and only one patient (2.7%) sufferred from post transplant biliary complication requiring biliary enteric anastamosis. Explant liver showed HCC in 2 patients. Out of 37, four patients died (10.8%). Among the 4 who died, two patients were having advanced cirrhosis, and two had ALF. There were no donor related complications or mortality. Conclusion: The overall survival and morbidity in this study is comparable to those from other centres. Complication rates are minimal due to patient selection criteria, good intensive care management and timely interventions. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Rajneesh Rajan. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.066
Nalini Bansal, Vivek Vij, Mukul Rastogi, Manav Wadhawan, Ajay Kumar Fortis Hospital, Delhi, India
Background & Aim: Post transplant liver biopsies form a critical part of management of complications arising post transplant. The objective of this study was to analyze the Indian experience in pathologic diagnosis of liver biopsies after orthotopic liver transplantation (OLTx) cases with special emphasis on cases presenting with intrahepatic cholestasis IHC. Type, incidence and timing of major complications were analyzed All cases with IHC were retrospectively analyzed with clinical inputs for to look for cryptic clues in sub classifying such cases. Methods: 45 post-transplant liver biopsies from 39 OLTx patients from Fortis Hospital Delhi, and Noida were retrospectively analyzed from May 2015 to May 2016. The biopsies were stained with H&E and MT. Results: The number of liver biopsies performed for each patient ranged from 1 to 3. The timing of these biopsies varied from the five days to >4 year posttransplant. Of the 39 patients who underwent post transplant liver biopsies most common etiology of liver transplant was HCV CLD in 66.6% cases. The common complications were acute cellular rejection (33.3%), biliary stricture (13.3%), HCV recurrence (11.1%), plasma cell hepatitis (4.4%), chronic hepatitis (4.4%), and intrahepatic cholestasis (22.2%). Cases with IHC were further being analyzed and results will follow. Conclusion: This study evaluated the types, incidence and timing of major complications occurring after OLTx. Cases of IHC will be analyzed further to give new insight into the understanding of liver diseases in post transplant patients. CONFLICTS OF INTEREST The authors have none to declare.
7 RETROSPECTIVE ANALYSIS OF POST TRANSPLANT LIVER BIOPSIES – FROM DIAGNOSIS TO THERAPY – CAN WE GUIDE FURTHER? EXPERIENCE FROM A TERTIARY CARE CENTER IN INDIA
S62
Corresponding author: Nalini Bansal. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.067
© 2016, INASL
CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Sharat Varma. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.064
quantification of ‘‘ASMA positive area percentage’’ was performed on the baseline biopsy. Histological and fibrosis assessment using Metavir and liver allograft fibrosis scores (LAFSc), was performed on all biopsies. The difference of fibrosis severity between the ‘‘baseline’’ and ‘‘follow-up’’ was termed ‘‘prospective change in fibrosis’’. Results: Significant association was seen between extent of ASMA positivity on baseline biopsy and ‘‘prospective change in fibrosis’’ using Metavir (p value = 0.02), cumulative LAFSc (p value = 0.02), and portal LAFSc (p value = 0.01) values. ASMA positive area percentage >1.05 predicted increased fibrosis on next biopsy with 90.0% specificity. Additionally an association was observed between extent of ASMA positivity and concomitant ductular reaction (p = 0.06) but not with histological inflammation in the portal tract or lobular area. Conclusion: ASMA quantification can predict the future course of fibrosis after liver transplantation. CONFLICTS OF INTEREST The authors have none to declare.
Liver Transplantation
with mean follow-up of 4.3 years, 281 serial PBs (3.1 biopsy/child) and human leukocyte antigen (HLA) antibody data. PBs were taken 1-2, 2-3, 3-5, 5-7, and 710 years post-LT, and evaluated for inflammation and fibrosis using liver allograft fibrosis score (LAFSc). The evolution of fibrosis, inflammation and related predisposing factors were analysed. Results: HLA-DRB1*03/04 allele and Class II DSA were significantly associated with portal fibrosis (p = 0.03; p = 0.03, respectively). Portal inflammation was predisposed by Class II DSA (p = 0.02) and nonHLA antibody presence (p = 0.01). Non-portal fibrosis wasn’t predisposed by inflammation. Lobular inflammation was associated with non-HLA antibodies. Conclusion: We conclusively demonstrated that allograft inflammation results in fibrosis and is associated with post-LT Class II DSA and non-HLA antibodies. The HLA-DRB1*03/04 allele caused genetic predisposition for fibrosis.
Corresponding author: Sharat Varma. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.065
5 TO EVALUATE SIGNIFICANCE OF ALPHA SMOOTH MUSCLE ACTIN (ASMA) EXPRESSION ON LIVER BIOPSY AS PREDICTOR OF FUTURE GRAFT FIBROSIS IN PEDIATRIC LIVER TRANSPLANT (LT) RECIPIENTS Sharat Varma, Xavier Stéphenne, Mina Komuta, Caroline Bouzin, Jerome Ambroise, Francoise Smets, Raymond Reding, Etienne Sokal Université Catholique de Louvain, Cliniques Universitaires St Luc, Brussels, Belgium
Background & Aim: Activated hepatic stellate cells express cytoplasmic alpha-smooth muscle actin (ASMA) prior to secreting collagen and consequent liver fibrosis. We hypothesized that quantifying ASMA could predict severity of future fibrosis after liver transplantation (LT). Methods: 32 pairs of protocol biopsies i.e. ‘‘baseline’’ and ‘‘follow-up’’ biopsies taken at 1-2 year intervals from 18 stable pediatric LT recipients, transplanted between 2006 and 2012 were selected. Morphometric
6 ADULT LIVER TRANSPLANTATION – INITIAL EXPERIENCE FROM A TERTIARY CARE CENTRE AT NORTH KERALA Rajneesh Rajan, Anish Kumar, K. Biju, Tony Jose, Sujith Janardhanan, Tajimal Rabia, G. Ramakrishnan, Rakesh Babu, Kishore Kanianchalil, Seethalekshmy Natarajan, Rohit Ravindran, Rajesh Nambiar, Sajeesh Sahadevan Malabar Institute of Medical Sciences, Calicut, India
Background & Aim: This study retrospectively analyses the initial experience of liver transplantation (LT) from a tertiary care centre. We are presenting data from our centre which started off with combined LDLT and DDLT programme. Its important for each transplant centre to analyze the success rate of their transplant programme and ours is one centre which started both LDLT and DDLT programme together. The aim of the study was to assess the success rate, intraoperative blood transfusion and hemodialysis requirement, postoperative infectious, vascular and
Journal of Clinical and Experimental Hepatology | July 2016 | Vol. 6 | No. S1 | S59–S62
S61
LIVER TRANSPLANTATION
Liver Transplantation
biliary complications and mortality related to Live and deceased donor transplantation. Results: Between September 2013 and June 2016, we performed total 37 liver transplantations (18 DDLT and 19 LDLT). There were 2 patients with acute liver failure, 2 with acute on chronic liver failure, 2 with HCC and 31 patients with decompensated cirrhosis liver. Mean MELD score was 24. Average duration of ICU stay was 7 days and average duration of hospital stay was 18 days. Average blood transfusion requirement was 2 units/transplant. Five patients required intraoperative hemodialysis and three patients (8.1%) required vascular interventions postoperatively. Among the infectious complications, one had tuberculosis and one had hepatitis B flare and one had cholangitis. 9 patients (24.32%) were treated for CMV infections. Three patients had preoperative complex biliary anatomy requiring three duct anastamosis and only one patient (2.7%) sufferred from post transplant biliary complication requiring biliary enteric anastamosis. Explant liver showed HCC in 2 patients. Out of 37, four patients died (10.8%). Among the 4 who died, two patients were having advanced cirrhosis, and two had ALF. There were no donor related complications or mortality. Conclusion: The overall survival and morbidity in this study is comparable to those from other centres. Complication rates are minimal due to patient selection criteria, good intensive care management and timely interventions. CONFLICTS OF INTEREST The authors have none to declare. Corresponding author: Rajneesh Rajan. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.066
Nalini Bansal, Vivek Vij, Mukul Rastogi, Manav Wadhawan, Ajay Kumar Fortis Hospital, Delhi, India
Background & Aim: Post transplant liver biopsies form a critical part of management of complications arising post transplant. The objective of this study was to analyze the Indian experience in pathologic diagnosis of liver biopsies after orthotopic liver transplantation (OLTx) cases with special emphasis on cases presenting with intrahepatic cholestasis IHC. Type, incidence and timing of major complications were analyzed All cases with IHC were retrospectively analyzed with clinical inputs for to look for cryptic clues in sub classifying such cases. Methods: 45 post-transplant liver biopsies from 39 OLTx patients from Fortis Hospital Delhi, and Noida were retrospectively analyzed from May 2015 to May 2016. The biopsies were stained with H&E and MT. Results: The number of liver biopsies performed for each patient ranged from 1 to 3. The timing of these biopsies varied from the five days to >4 year posttransplant. Of the 39 patients who underwent post transplant liver biopsies most common etiology of liver transplant was HCV CLD in 66.6% cases. The common complications were acute cellular rejection (33.3%), biliary stricture (13.3%), HCV recurrence (11.1%), plasma cell hepatitis (4.4%), chronic hepatitis (4.4%), and intrahepatic cholestasis (22.2%). Cases with IHC were further being analyzed and results will follow. Conclusion: This study evaluated the types, incidence and timing of major complications occurring after OLTx. Cases of IHC will be analyzed further to give new insight into the understanding of liver diseases in post transplant patients. CONFLICTS OF INTEREST The authors have none to declare.
7 RETROSPECTIVE ANALYSIS OF POST TRANSPLANT LIVER BIOPSIES – FROM DIAGNOSIS TO THERAPY – CAN WE GUIDE FURTHER? EXPERIENCE FROM A TERTIARY CARE CENTER IN INDIA
S62
Corresponding author: Nalini Bansal. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2016.06.067
© 2016, INASL