ABSTRACT
The recipients of liver transplantation [LT] are subjected to lifelong immunosuppression with its many drawbacks. De novo and recurrent malignancy in transplant recipients are attributed to attenuation of immunosurveillance. In the present study, we present our experience with de novo malignancies encountered after both deceased and living donor liver transplantations. Retrospective study of patients referred to LT center between April 2001 and January 2010. Various data were collected including type of malignancy and histopathologic features, immunosuppression regimen, and patient survival. Of 248 LT procedures performed in 238 patients [10 retransplants], 8 patients [3.4%] developed de novo post-LT malignancies. De novo malignancies included post-LT lymphoproliferative disorders [PTLD] in 5 patients who were all Epstein-Barr virus [EBV] positive, and who were treated successfully with anti-CD20 monoclonal antibody therapy, reduction of immunosuppression, and control of EBV activity; urinary bladder cancer in 1 patient who was treated with radical surgical resection and chemotherapy but died of bone and lung metastasis within 1 year of diagnosis; endometrial carcinoma in 1 patient who was treated with radical surgical resection; and Kaposi sarcoma in 1 patient who was successfully treated with surgical excision and reduction of immunosuppression. EBV-associated PTLD is the most frequently encountered de novo malignancy after LT and is easily treatable by chemotherapy and reduction of immunosuppression
ABSTRACT
There are few reports on hepatitis C virus genotype 4 [HCV-4] recurrences after orthotopic liver transplantation [OLT]. Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes. All patients who underwent OLT [locally or abroad] for HCV related hepatic cir-rhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed. Of 116 patients who underwent OLT for hepatitis C, 46 [39.7%] patients satisfied the criteria of recur-rent hepatitis C. Twenty-nine [63%] patients were infected with HCV genotype 4. Mean [SD] for age was 54.9 [10.9] years. Nineteen of the HCV genotype 4 patients [65.5%] were males, 21 [72.4%] received deceased donor grafts, and 7 [24.1%] developed >1 acute rejection episodes. Pathologically, 7 [24.1%] and 4 [13.8%] patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 [31%] HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease. This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes
Subject(s)
Humans , Male , Female , Liver Transplantation/adverse effects , Recurrence , GenotypeABSTRACT
Saudi Arabia is a leading country in the Middle East in the field of deceased-donor liver transplantation [DDLT] and living-donor liver transplantation [LDLT]. We present out experience with DDLT and LDLT at King Faisal Specialist Hospital and Research Center [KFSHRC] for the period from April 2001 to January 2007. We performed 122 LT procedures [77 DDLTs and 45 LDLTs] in 118 patients [4 re-transplants] during this period of time. The number of adult and pediatric procedures was 107 and 11, respectively. The overall male/female ratio was 66/52 and the median age of patients was 43 years [range, 2-63 years]. In the DDLT group, the median operating time was 8 hours [range, 4-19], the median blood transfusion was 6 units [range, 0-40], and the median hospital stay was 13 days [range, 6-183]. In the DDLT group, after a mean follow-up period of 760 days [range, 2-2085], the overall patient and graft survival rate was 86%. In the LDLT group, the median opera ting time was 11 hours [range, 7-17], the median blood transfusion was 4 units [range, 0-65], and the median hospital stay was 15 days [range, 7-127]. In the LDLT group, and after a mean follow-up period of 685 days [range, 26-1540], the overall patient and graft survival rates were 90% and 80%, respectively with no significant difference in patient and graft survivals between groups. Biliary complications were significantly higher in LDLT compared to DOLT [P<0.05]. Vascular complications were also significantly higher in LDLT compared DDLT [P<0. 05]. Both DDLT and LDLT are being successfully performed at KFSHRC with early experience indicating a higher rate of biliary and vascular complications in the LDLT group