ABSTRACT
Liver transplantation [LT] has become an established therapeutic option for a large variety of fulminant and chronic liver diseases. Postoperative infections are the major cause of morbidity and the leading cause of mortality. The aim of this work was to investigate the incidence, types and possible predisposing factors for infection after living donor liver transplantation [LDLT] in children occurring early in the post operative period. We enrolled 22 children [10 boys [45.5%] and 12 girls[54.5%]] who underwent LDLT from 2003 to 2010 at National Liver Institute, Menofiya University, Egypt, the mean age +/- SD was 5.59 +/- 4.45 years [range, 7 months to 17yr] . We retrospectively investigated the proven episodes of bacterial, viral, and fungal infections. There were 62 infections episodes in 18 [81.2%] of 22 patients [2.8 infections/patient], two or more infections occurred in 14 out of 22 transplanted children [63.6%], bacterial infections accounted for 41 episodes of infection [66.1%], Viral infections accounted for 10 episodes of infection [16.1%] while fungal infections accounted for 11 episodes of infection [17.8%].The most common sites of bacterial infection were chest [24.4%], bile ducts [cholangitis] [17.1%] the blood stream [bacteremia] [12.2%] ,and abdomen either peritonitis or intra abdominal abscess [9.8%]. Most of the bacterial infections were polymicrobial mainly with gram negative bacilli occurred within the first month after LDLT. The most common causes of viral infection were cytomegalovirus in 4 patients, Epstein-Barr virus in 2 patients, Herpes Simplex virus types I and II presented in 4 patients. The mortality rate due to infection was 18.2% mainly caused by bacterial infection. This study found that infection is one of the important causes of morbidity and mortality after LDLT, so careful monitoring and management of infections is crucial for improving the outcome of LDLT in children
ABSTRACT
Non-organ-specific autoantibodies [NOSAs] are commonly detected in chronic hepatitis C [CHC] bat their significance remain on debate. To determine the prevalence of anti-nuclear [ANA], anti-smooth muscle [ASMA] and anti-liver kidney microsomes type 1 [anti-LKM1] antibodies and assess their association with patient demographics, biochemical and histological parameters of disease activity and response to antiviral therapy. One hundred and thirty naive chronic hepatitis C [CHC] patients were included. Clinical demographic and laboratory data at the time of liver biopsy were obtained. All cases were screened for autoantibodies by an enzyme linked immanosorbent assay [ELISA]. A pathologist reviewed all pathologic specimens using the modified histological activity index [HAL] of Ishak. All patients received combined antiviral therapy in the form of Pegylated Interferon alpha 2a-l60 micro g plus Ribavirin. Non-organ-specific autoantibodies [NOSAs] were observed in 38 patients [29.23%]: ANA in 25 [19.23%], ASMA in 18 [13.85%] and anti-LKM1 was the rarest occurring in only two CHC patients [1.54%]. Concomitant positivity for ANA and ASMA was observed in 7 of these 38 cases [5.38%]. The presence of NOSAs was associated with higher aspartate trasaminase [AST], alanine trasaminase [ALT] and gamma-globulin. There was a significant association between seropositivity of NOSAs and higher histological activity score of inflammation and hepatocellubr injury [P=0.024] and with increased plasma cell infiltrate [P=0.000]. In contrast, no differences were observed regarding age, gender, viral load, stage of fibrosis and response to combined antiviral therapy. The presence of non-organ-specific autoantibodies [NOSAs] in CHC is associated with more necroinflammatory grade without increased degree of fibrosis or failure of combined antiviral therapy