Eyolution of living doner liver transplantation in Egypt

To date, cadaveric organ donation is illegal in Egypt. Therefore, Egypt recently introduced living donor liver transplantation [LDLT], aiming to save those who are suffering from end stage liver disease. Herein, we study the evolution of LDLT in Egypt. In Egypt, between August 2001 and February 2004, we approached all centers performing LDLT through personal communication and sent a questionnaire to each center asking for limited information regarding their LDLT experience. We identified and approached 7 LDLT centers, which collectively performed a total of 130 LDLT procedures, however, 3 major centers performed most of the cases [91%]. Overseas surgical teams, mainly from Japan, France, Korea, and Germany, either performed or supervised almost all procedures. Out of those 7 LDLT centers, 5 centers agreed to provide complete data on their patients including a total of 73 LDLT procedures. Out of those 73 recipients, 50 [68.5%] survived after a median follow-up period of 305 days [range 15-826 days]. They reported single donor mortality. Hepatitis C virus cirrhosis, whether alone or mixed with schistosomiasis, was the main indication for LDLT. Egypt recently introduced LDLT with reasonable outcomes; yet, it carries considerable risks to healthy donors, it lacks cadaveric back up, and is not feasible for all patients. We hope that the initial success in LDLT will not deter the efforts to legalize cadaveric organ donation in Egypt

Prognostic significance of hepatic veins waveforms study by doppler ultrasonography in cirrhotic patients with portal hypertension

Doppler Ultrasonographic [U/S] waveform changes in the hepatic veins can be found in chronic parenchymal liver disease, especially in the late stages. In this prospective study, 150 Egyptian bilharzial cirrhotic patients with portal hypertension but without hepatocellular carcinoma [HCC] in addition to 20 age and sex matched apparently healthy control were studied. Diagnosis was confirmed with liver biopsy in 121 patients [those with prolonged prothrombin time 3 seconds more than control and platelet count less than 90000 per mm were excluded]. Doppler wave form patterns in patients were classified into 4 types: [I, II, III and IV], while we found that all the control group was of type I Doppler waveform Prognostic value of the hepatic veins waveforms together with clinical and biochemical parameters were evaluated with their relation to the outcome of our patients. Out of 150 of our patients 112 were male and 38 were females, their ages ranged between 29-65 years [with mean +/- SD = 47.08 +/- 7.70 years]. All were experienced variceal bleeding. Most of the patients [130] were HCV positive. By the end of the follow up period [18 months] 23 [15:3%] patients have died, all due to liver cell failure. A univariate analysis that followed by a multivariate one showed that flat Doppler waveform [type IV] changes in the right hepatic vein with the following characteristics of patients [rebleeding varices, presence of encephalopathy, increase s.billrubin and decrease prothrombin%] were independently related to survival. Doppler U/S study [which is a non-invasive maneuver] of the right hepatic vein has improved the prognostic accuracy in patients with cirrhosis and portal hypertension. Moreover type IV [flat waveform with fluttering] was associated with bad prognosis and poor survival

Elevated nitric oxide and endotoxemia in schistosonol hypertension

Nitric oxide [NO] is supposed to play a role in mediating vasodilatation and hyperdynamic circulation in liver cirrhosis and alcoholic hepatitis. It has been suggested that endotoxin might mediate increased synthesis of NO in endotoxemic patients with cirrhosis. The level of NO in schistosomal portal hypertension [SchPH] has not been studied, and whether endotoxemia plays a role in this condition is not known. To evaluate the level of NO and endotoxin in patients with schistosomal portal hypertension, and compare it to those in patients with post-necrotic cirrhosis and to normal individuals The study included 45 consenting patients; 27 with SchPH and living -schistosoma ova on rectal biopsy [11 Child A, 9 B, 7 C], and 1.8 with post-necrose cirrhosis [4 Child A, 6 B, 8 C]; and 15 healthy volunteers. Patients underwent upper GI endoscopy with grading of esophageal varices if present, ultrasonography with measurement of portal vein diameter, and liver biopsy. Patients and controls had plasma nitrite [NO[2]] measured as an indicator of NO production, and plasma endotoxin assayed by limulus amebocyte lysate test Patients with SchPH had significantly higher plasma NO[2] than controls [7.18 +/- 3 7 micro Mol/I vs 1.68 +/- 0.8 micro Mol/L p<0.005]. Endotoxin level was also significantly higher in SchPH than controls [0.46 +/- 0.09 Eu/ml vs. 0.15 +/- 0.05 Eu/ml. p < 0.05]. Non schistosomal patients had levels of NO[2] [6.3 +/- 3 micro Mol/L] and endotoxin [0.45 +/- 0.09 Eu/ml] similar to SchPH [both p > 0 05]. No difference was noted between Child classes in SchPH regarding NO[2] and endotoxin levels. NO[2] levels were positively correlated to the degree of portal hypertension assessed by portal vein diameter on ultrasound in SchPH. No correlation was found between NO[2] and endotoxin levels in SchPH [r = 0.48] SchPH is associated with increased NO production, and endotoxemia, similar to post-necrotic cirrhosis. The level of NO production increased with the severity of portal hypertension in this condition, and was not related to the level of endotoxemia