Short term donor outcomes after hepatectomy in living donor liver transplantation

Objective: to determine the outcome of living-donor liver transplant [LDLT] donors from the first liver transplant program in Pakistan

Study Design: cohort study

Place and Duration of Study: shifa International Hospital, Islamabad, from April 2012 to August 2014

Methodology: a total of 100 live donors who underwent hepatectomy were included. Demographics, etiologies, graft characteristics and operative variables were retrospectively assessed. Outcome was assessed based on morbidity and mortality

Results: median donor age was 28 [17 - 45] years and median body mass index [BMI] was 24 kg/m[2] [15 - 36]. Male to female ratio was 1.5:1. Hepatitis B and C were the most common underlying etiologies and accounted for 79/100 [79%] of LDLT's. Overall, 93/100 [93%] donors donated a right lobe graft. Median estimated graft weight to recipient body weight [GW/BW] ratio was 1.03 [0.78 - 2]. Standard arterial anatomy was present in 56% donors. The 90-day morbidity was 13/100 [13%] and overall morbidity was 17/100 [17%]. Bile leak was encountered in 3 [3%] patients. There was no donor Mortality

Conclusion: acceptable short-term donor outcomes were achieved in an LDLT program in Pakistan with careful donor selection and planning

Paediatric living donor liver transplantation: a single centre experience from Pakistan

Objective: To determine the outcomes of paediatric living donor liver transplantation [LDLT] recipients from Pakistan in terms of 90-day morbidity and mortality

Study Design: Cohort study

Place and Duration of Study: Shifa International Hospital, Islamabad, Pakistan, between April 2012 and April 2015

Methodology: All patients in paediatric age group [17 years] who underwent LDLT with a minimum follow-up of 3 months, were included. All grade 2 and above complications on Clavien-Dindo system were included as morbidity. The main outcome measure was 90-day morbidity and mortality

Results: Fourteen paediatric LDLTs were performed. Median age of the recipients was 8.5 years ranging between 6 months and 17 years. Wilson's disease and cryptogenic cirrhosis were the most common etiologies [28.6% each]. Acute liver failure was present in 5 [35.7%] patients. Overall 90-day morbidity and mortality was 71.4% and 14.2%; both were attributable to pulmonary infection. No difference was observed in morbidity [21.3% vs. 42.8%, p=0.3] and mortality rates [20% vs. 11%, p=1.0] between patients with acute and chronic liver failure. Estimated 3-year survival was 85%

Conclusion: Paediatric LDLT offers a promising treatment option for acute and chronic liver failure. Mortality was attributable to post-transplant pulmonary infections

Renal failure in patients with end stage liver disease and its impact on clinical outcome

To evaluate the prevalence of renal failure [RF] in the patients of end stage liver disease [ESLD], to determine the causes of RF in these patients and its impact on patient's outcome. Descriptive, analytical study. Shifa International Hospital, Islamabad, Pakistan, from May 2011 to March 2013. A total of 523 patients with end stage liver disease [ESLD] were evaluated, renal failure [RF] and its causes were recognized in these patients according to established criteria. Outcome of these patients was assigned as reversal of RF or mortality. Data was analyzed using SPSS version 16. Chi-square test was used for comparing proportions and t-test was used for comparing mean values. P < 0.05 was considered significant. Out of 523 patients, 261 [49.9%] had RF. Acute kidney injury [AKI] was the most common presentation seen in 160 [61%] patients. Hypovolemia and infections were the most frequent causes of RF. Mortality was significantly higher in the patients with RF, when compared to the patients without RF [31% vs. 4.5%, p < 0.001]. Reversal of RF was seen in 98 [37%] of the affected patients. Reversal was more common in the patients with hypovolemia. The mortality was higher in the patients with hepatorenal syndrome [HRS] and infections. Renal failure in the end stage liver disease is an important prognostic factor. Etiology of RF is the key factor in patients' outcome. Patients of ESLD with RF had higher mortality. Majority of the cases of RF were reversible in patients of ESLD coming in the setup

Cancer antigen-125 as a marker of ascites in patients with liver cirrhosis

To evaluate the correlation between Cancer Antigen-25 [CA-125] levels with the amount of ascites in patients with liver cirrhosis. Observational, analytical study. Shifa International Hospital, Islamabad, from March 2012 to February 2013. A total of 130 patients with liver cirrhosis [with and without ascites] had serum CA-125 levels measured. The amount of ascites was classified according to physical examination and ultrasound [USG] findings. CA-125 levels were compared and correlated with amount of ascites. Majority of patients [57%] had hepatitis C virus and 60% were in class Child Pugh C. There was moderate correlation between amount of ascites and CA-125 levels [r = 0.642, p < 0.001] with significant raised levels of CA-125 in patients with ascites [p < 0.001]. There was a moderate correlation between CA-125 levels and presence and amount of ascites.

Adrenal angiomyolipoma

Adrenal angiomyolipoma is a rare tumour arising from the mesenchymal tissue containing fat cells. A 72 years old lady presented with right upper quadrant pain. She underwent laparotomy after relevant imaging and investigations and was found to have a right sided adrenal angiomyolipoma confirmed on histopathology, which was encasing the inferior vena cava and renal veins. Due to its diagnostic difficulty, potential to achieve large size and possible complications; surgeons and pathologists should keep angiomyolipoma in mind when dealing with an adrenal mass

Iatrogenic bile duct injuries: Experience at PIMS

Cholecystectomy is one of the most familiar and commonly performed elective operation in general surgery. However, bile duct injury is a rare but one of the worst complications of this procedure. Although infrequent in expert hands, it is usually encountered when comparatively inexperienced surgeons are operating. These injuries present at variable time after the primary surgery. The prompt recognition and active management affects the morbidity and mortality associated with it. We evaluated the data of the hospital to find out the nature of injuries inflicted to extra hepatic bile duct and its management. This is a study of 20 cases of iatrogenic bile duct injury managed at the Department of Surgery Unit 1, PIMS. The study includes cases that had undergone cholecystectomy, open or laparoscopic in previous 11 years and sustained injury to the biliary tree and were managed accordingly. Patients with hepatobiliary malignancy were excluded. Twenty cases were found to have various types of bile duct injuries. All patients were females, and their average age was 35 years. In four cases the injury occurred during surgery at our hospital, while remaining 16 cases were referred from other hospitals. All the patients were explored and managed accordingly. They had uneventful recovery and had good outcome at 6 months. Although the fact is that, the sooner an injury is recognized and treated, the better is the outcome. However, in this study the duration of injury had no effect on final outcome