ABSTRACT
Background and Study Aims: Hepatitis C virus [HCV]-related cirrhosis is the leading cause of liver transplantation[LT]. All patients who undergo LT with detectable serum HCV-RNA experience graftreinfection, which is the most frequent cause of graft loss and death in these patients. We estimated the rate of HCV recurrence and evaluated the current therapeutic regimens
Patients and Methods: The records of consecutive 325 living donor LT [LDLT] surgeries performed between May 2004 and August 2014 were retrospectively analysed; 207 of them were followed-up throughout the study. Clinical, laboratory, radiological and histopathological examinations were performed thoroughly. Patients received treatment in the form of either pegylated interferon [PEG-IFN] or sofosbuvir, both in combination with ribavirin
Results: In total, 90.3% of recipients who were transplanted because of HCV-related end-stage liver disease experienced recurrence due to the virus. The donor age was older in the HCV recurrent group versus the non-recurrence group [28.7 +/- 7.1 versus 22.6 +/- 2.6 years: p
Conclusions: Older donor age and prolonged warm ischaemia time are independent predictors of HCV recurrence after LDLT, and early treatment with the direct-acting sofosbuvir is helpful in resolving the problem of post-LT HCV recurrence
ABSTRACT
Background: Living related liver transplantation is an established line of treatment for end stage liver disease. Massive transfusion is a frequent practice in this procedure. A variety of coagulation abnormalities may complicate the post-operative period
Patients and methods: The study was conducted in Mansoura University between May 2004 and July 2006. 21 patients were included in the study. Time of normalization [TON] of 7 coagulation parameters [prothrombin concentration, international normalization ratio, activated partial thromboplastin time, platelet count, factor V, VII and fibrinogen concentration] to predefined normalization cutoff limits were recorded. Mean of normalization times of 6 of these parameters [excluding platelets] was calculated as overall normalization time [ONT]. These times were then compared between two pairs of groups based on either total intraoperative blood transfusion [average transfusion AT Vs massive transfusion MT groups or intraoperative colloid/blood infusion ratio [Low colloid/blood LCB Vs high colloid/blood HCB] groups. Correlation analysis was performed to test association between intra-operative replacement protocol and post-operative coagulation profile
Results: Patients with higher pre-operative MELD score had more intra-operative blood components transfusion [absolute and compared to colloids]. Apart from ONT 5, which was significantly longer in the MT and LCB groups compared to AT and H08 groups, no significant differences were observed between each pair of groups. Significant linear correlation existed between ONT and total blood components transfusion volume
Conclusion: The recorded TON of coagulation system components favours the start of prophylactic anti-coagulants after the 3rd post-operative day in absence of clinically significant bleeding. The pre-operative and intra-operative conditions are not appropriate alone to anticipate the time by which the coagulation system will be normalized making thrombosis a risk