Outcome and characteristics of patients on the liver transplant waiting list: Shiraz experience

The only curative therapy for end-stage liver disease is transplantation but due to a shortage of available donor livers the waiting list mortality is high. This study aimed to evaluate the outcome and characteristics of patients on the waiting list for liver transplantation in Shiraz, southern Iran during the period from April 2004 to March 2007. Medical records of all chronic liver disease patients >/= 14 years that were on the waiting list for liver transplantation at the Nemazee Hospital Organ Transplant Center during April 2004 to March 2007 were reviewed. Hospital records were used to retrieve demographic, clinical and laboratory data. Records of the referring gastroenterologists provided information about the etiology and complications of liver disease. The patients were followed at the end of the study period by clinic visits or telephone contact. There were 646 patients on the waiting list for liver transplant during April 2004 to March 2007. Hepatitis B was the most common etiology of liver disease [31.2%]. Of those on the waiting list, 144 patients 22.3%] underwent liver transplant and 166 [25.7%] died while waiting for a transplant. The mean waiting period for transplant was 6.6 months. Receiving a transplant was correlated with the etiology of liver disease and Rh blood group [p<0.05] but had no significant association with gender or ABO blood type. Among non-transplanted patients, survival was lower in those who had a history of encephalopathy, SBP or uncontrolled ascites and in patients with a Child-Turcotte-Puph [CTP] class C and/or a Model of End-stage Liver Disease [MELD] score >/= 15. Hepatitis B virus is the most common cause of end-stage chronic liver disease amongst patients on the waiting list for liver transplant in Shiraz, southern Iran. Patients with a MELD score >/= 15 particularly those with a history of SBP, hepatic encephalopathy or uncontrolled ascites are recommended for waiting list enrollment

Meningococcal carrier rate before and after hajj pilgrimage: effect of single dose ciprofloxacin on carriage

We determined the carriage rate of Neisseria meningitidis before and after hajj pilgrimage among a group [1] of 674 randomly selected Iranian pilgrims, and the effect of 500 mg of ciprofloxacin given 24 hours before return on the reduction of meningococcal carriers among another group [2] of 123 randomly selected Iranian pilgrims. Throat specimens taken 1 hour before departure on the hajj and immediately on return were cultured. Carriage rates of N. meningitidis in group 1 were 5.2% before and 4.6% after pilgrimage [P = 0.65]; 3 new serogroups [Z, Z' and A] were identified on return. In group 2, the carriage rate decreased from 8.1% to zero before and after pilgrimage

Histopathologic changes in patients with H. pylori positive chronic gastritis, before and after treatment

To evaluate histopathologic changes, between pre and post anti-Helicobacter pylori treatment using three different modalities, 108 patients with duodenal ulcer and H. pylori positive chronic gastritis were selected. Biopsies for histopathology and rapid urease test were taken from antrum and body and fundus regions, before and after treatment. Histopathologic evaluation was based on updated Sydney System. H. pylori in 45 of 108 patients [41.7%] became histologically eradicated, however rapid urease test was negative in 83 patients [76.8%]. The grade of gastritis and mean eosinophilic infiltration count were significantly decreased on post treatment biopsies in both eradicated and non eradicated patients [P value = 0.000,0.005 and 0.000,0.032 respectively]. Active inflammation was resolved in both eradicated and non eradicated groups [P Value = 0.000 and 0.002 respectively]. Density of H. pylori was significantly decreased in non eradicated group. Changes in atrophy and intestinal metaplasia were not statistically significant due to inadequate patients number, suffering from atrophy and/or intestinal metaplasia. Eradication of H. pylori is accompanied by significant histopathologic improvement. To evaluate reversibility of atrophy and intestinal metaplasia, larger study groups is needed. In comparison with histopathology, rapid urease test has low sensitivity

Living-related liver trasplantation in children: the Shiraz experience

The liver transplantation program was established at Shiraz Nemazee Hospital in 1993. Shortage of cadaver organ supply due to various social and legal issues urged us to develop a living-related liver transplantation [LRLT] program. So far 7 [6 males, 1 female] living-related liver transplantations have been performed at this center. The mean age of patients was 8.21 years [ +/- 4.16], with a range of 4.5 to 14 years. Live donors [3 mothers, 2 fathers, and 1 brother] with a mean age of 30.83 years [ +/- 4.11] underwent procurement of the left lateral segment without mortality or any serious morbidity. The native liver disease was idiopathic cirrhosis [1 case], biliary atresia [3 cases], Budd-Chiari syndrome [1 case], neonatal cirrhosis [1 case], and cryptogenic cirrhosis [1 case]. Allografts were implanted using piggy-back surgical technique. Baseline immunosuppression consisted of a triple drug regimen including cyclosporine, mycophenolate mofetil and steroids. Acute graft rejection was treated with intra-venous bolus of methyl-prednisolone. Early death occurred in 2 patients due to vascular thrombosis. Biliary complication was observed in 1 patient. Five patients are alive with a normal functioning liver. In conclusion, LRLT program is promising in Iran. It can help to overcome the shortage of organs and minimize the mortality of patients in the waiting list