The potential liver donor with tuberculosis: A fresh look at international recommendations based on a survey of practice in Indian liver transplant centres

BACKGROUND The western recommendations for the use of organs from liver donors with tuberculosis (TB) come from an environment where the burden of disease is low and cadaveric organ donation rates are high—in complete contrast to the Indian scenario, where these recommendations may be too restrictive. METHODS A questionnaire relating to current practice on the use of organs from liver donors with TB was sent to all liver transplant centres in India. RESULTS Responses were obtained from 94% of centres. Two-thirds accepted organs from deceased donors with TB in the elective setting, especially for recipients with a high MELD (Model for end-stage liver disease) score. The proportion rose by 1.5 times in the setting of acute liver failure. Two-thirds advised anti-TB treatment (ATT) for corresponding recipients, and the remaining advised isonicotinic acid hydrazide (INH) prophylaxis. Untreated living donors with TB were not accepted. Half the respondents accepted living donors after completion of ATT, and did not treat recipients postoperatively. The remainder accepted them after 8 weeks of treatment and advised INH prophylaxis or ATT for recipients. CONCLUSIONS That this practice has not impacted recipient outcomes suggests that the guidelines for management of liver donors and recipients may need to be altered for populations endemic for TB.

Combination of TACE and Sorafenib Improves Outcomes in BCLC Stages B/C of Hepatocellular Carcinoma: A Single Centre Experience

ABSTRACT Background & Aim. Transarterial chemoembolization (TACE) or sorafenib is recommended for hepatocellular carcinoma BCLC stages B and C respectively. We studied the role of combination of TACE and sorafenib in BCLC stages B/C. Material and methods. We undertook an observational study on a cohort of cirrhotics with HCC from August 2010 through October 2014. Patients in BCLC stages B/C who had received TACE and/or sorafenib were included. mRECIST criteria were used to assess tumor response. The primary end point was overall survival. Results. Out of 124 patients, 47.6% were in BCLC-B and 52.4% in BCLCC. Baseline characteristics were comparable. The predominant etiology was cryptogenic (37.2% and 38.5%, p = NS). 49.1% in BCLC-B and 56.9% in BCLC-C had received TACE+sorafenib. In BCLC-B, the overall survival improved from 9 months (95% CI 6.3-11.7) using TACE only to 16 months (95% CI 12.9-19.1) using TACE+sorafenib (p < 0.05). In BCLC-C, addition of TACE to sorafenib improved the overall survival from 4 months (95%CI 3-5) to 9 months (95%CI 6.8-11.2) (p < 0.0001). As per mRECIST criteria, patients on TACE+sorafenib had reduced progressive disease (37.8% vs. 83.3%), improved partial response (43.2% vs. 3.3%) and one had complete response compared to those on sorafenib alone (p < 0.0001) in BCLC-C but not in BCLC-B group. Hand foot syndrome was noted in 27.7% patients on sorafenib and post TACE syndrome in 80.2% patients, but both were reversible. No major adverse events were noted. Conclusion. TACE+sorafenib was more effective than TACE or sorafenib alone in HCC BCLC stages B or C with a significant survival benefit and improved tumour regression especially in BCLC-C patients.

Determining standard liver volume: assessment of existing formulae in Indian population.

BACKGROUND: With the increasing numbers of living-related donor liver transplantation, accurate means of calculating standard liver volume (SLV) based on patient body indices becomes important. Three formulae reported in literature for this purpose have been derived from studies on Western and Japanese populations. AIM: To assess the existing formulae for calculation of SLV in Indian population. METHOD: Total liver volume (TLV) of 238 patients was measured using axial helical CT images obtained for conditions unrelated to the hepatobiliary system. Body surface area (BSA) was calculated from height and weight. Measurements obtained using CT were compared with the SLV calculated based on the previously reported formulae. RESULTS: Though there was significant difference (p< 0.001) between the TLV obtained by CT and the SLV calculated using the three formulae, they also showed good agreement. On an average the formula derived from the Japanese population underestimated the SLV by 63 (202) cc (p< 0.001). Regression models for SLV (SLV = 243 + [186 x BSA] + [11.4 x Weight], SLV = 375.23 + [14.24 x body weight], SLV = -204.092 + [874.461 x BSA]) were derived from the data obtained from our population. Age and gender had no effect on the SLV. CONCLUSIONS: Formulae derived from Japanese population for calculation of SLV is not suitable for the Indian population. The newly described formulae may prove useful in the Indian population.

Schwannoma of bile duct--a case report.

This is a case report of a 29 year old woman who presented with painless and progressive obstructive jaundice. Imaging investigations of the abdomen revealed a tumour of the common bile duct. She was treated by complete excision of the bile duct and hepaticojejunostomy. The histopathology report of the tumour read as benign schwannoma.

Inferior mesenteric artery aneurysm: case report and literature review.

A 70 year old man presented with retrosternal and epigastric pain. He was in shock. The diagnosis on admission was acute myocardial infarction. CT scan of the abdomen showed coeliac and superior mesenteric artery (SMA) occlusion. In addition there appeared to be large collateral from the inferior mesenteric artery (IMA) with a retroperitoneal collection. He underwent emergency laparotomy and a ruptured IMA aneurysm was detected. The aneurysm was excised and the IMA was ligated. He developed progressive multi-system organ failure post operatively. We discuss the aetiology, presentation, diagnosis and treatment of IMA aneurysms.