Combined liver-kidney transplantation in a patient with acute liver failure coexisting with acute renal failure.

Acute renal failure (ARF) is common among patients with liver failure awaiting liver transplantation due to the increased waiting time for available liver grafts and extended survival from improved intensive care. The role of combined liver and kidney transplantation (LKT) in this situation is quite controversial. A case of acute liver failure (ALF) complicated with ARF is reported. Non-A, non-B hepatitis was the cause of ALF. He had hemodialysis for one month before transplantation. Combined LKT was performed because of prolonged pre-transplant hemodialysis and the potential of irreversible renal failure. Severe impairment of both native kidneys was confirmed by renal scan at 6 months after transplantation. Combined LKT may be needed for patients with acute liver failure complicated with prolonged acute renal failure.

Dysplastic nodules and small primary carcinoma of the liver: a study detecting the early morphological changes during hepatocarcinogenesis.

OBJECTIVE: Detect the early histological changes relating to human hepatocarcinogenesis in three nodular hepatocellular lesions. MATERIAL AND METHOD: Three cases of dysplastic nodules and one of small hepatocellular carcinoma were obtained from the authors' surgical-pathology file during 2000-2005 for a histopathological study in relevance to the early changes during hepatocarcinogenesis by employing hematoxylin and eosin stain, as well as some immunohistochemical staining. RESULTS: One nodular hepatocellular lesion, diagnosed as a complex lesion of focal nodular hyperplasia contained a microscopic focus (1.5 mm in diameter) of combined hepatocellular and cholangiocarcinoma. CONCLUSION: The small dysplastic hepatocytes subjected to neoplastic transformation combined hepatocellular and cholangiocarcinoma and are the precursorial cells of hepatocellular carcinoma. Chronic viral hepatitis B or C, aflatoxin B, and nitrosamine(s), as well as some nodular hepatocellular lesions share distinct roles in the complex process of hepatocarcinogenesis pertaining to this Southeast Asian country.

Failure of hepatitis B surface antibody to protect acute fulminating hepatitis in a renal transplant recipient.

A 58-year-old man who had a living-related kidney transplantation (KT) 13 years ago and had received a double-dosage course of hepatitis B virus (HBV) vaccination prior to KT developed acute liver failure. An exhaustive work-up for the cause of acute liver failure revealed that HBsAg was negative but anti-HBs and anti-HBcAbs were positive. HBV DNA was 535,000 copies/ml. The strongly positive staining of HBsAg and HBcAg of liver biopsy was shown by immunohistochemistry examination. HBV harboring surface mutant of hepatitis B surface gene was thought to be the cause of acute fulminant hepatitis despite the presence of protective immunity to wild-type HBV. The patient expired from acute liver failure even though an antiviral drug was started promptly. This is the first case report of liver biopsy suggestive of acute fulminating HBV that developed in a long-term kidney recipient despite the presence of high anti-HBsAb titer.