ABSTRACT
INTRODUCTION AND OBJECTIVES: Lately, there has been a steady increase in early liver transplantation for alcohol-associated hepatitis (AAH). Although several studies have reported favorable outcomes with cadaveric early liver transplantation, the experiences with early living donor liver transplantation (eLDLT) are limited. The primary objective was to assess one-year survival in patients with AAH who underwent eLDLT. The secondary objectives were to describe the donor characteristics, assess the complications following eLDLT, and the rate of alcohol relapse. MATERIALS AND METHODS: This single-center retrospective study was conducted at AIG Hospitals, Hyderabad, India, between April 1, 2020, and December 31, 2021. RESULTS: Twenty-five patients underwent eLDLT. The mean time from abstinence to eLDLT was 92.4 ± 42.94 days. The mean model for end-stage liver disease and discriminant function score at eLDLT were 28.16 ± 2.89 and 104 ± 34.56, respectively. The mean graft-to-recipient weight ratio was 0.85 ± 0.12. Survival was 72% (95%CI, 50.61-88) after a median follow-up of 551 (23-932) days post-LT. Of the 18 women donors,11 were the wives of the recipient. Six of the nine infected recipients died: three of fungal sepsis, two of bacterial sepsis, and one of COVID-19. One patient developed hepatic artery thrombosis and died of early graft dysfunction. Twenty percent had alcohol relapse. CONCLUSIONS: eLDLT is a reasonable treatment option for patients with AAH, with a survival of 72% in our experience. Infections early on post-LT accounted for mortality, and thus a high index of suspicion of infections and vigorous surveillance, in a condition prone to infections, are needed to improve outcomes.
Subject(s)
COVID-19 , End Stage Liver Disease , Hepatitis, Alcoholic , Liver Transplantation , Humans , Female , Liver Transplantation/adverse effects , Living Donors , Treatment Outcome , Retrospective Studies , Severity of Illness Index , Neoplasm Recurrence, Local , Hepatitis, Alcoholic/diagnosis , Hepatitis, Alcoholic/surgery , Ethanol , Graft SurvivalABSTRACT
BACKGROUND AND AIMS: Recent studies have reported poor humoral immune response to mRNA vaccines in patients with chronic liver disease (CLD). However, the immunogenicity of ChAdOx1 (vector-based) and BBV152 (inactivated virus) vaccines in patients with CLD and liver transplant recipients (LTRs) is unknown. Therefore, we aimed to assess the immunogenicity of ChAdOx1 and BBV152 vaccines in patients with CLD (including cirrhosis patients) and LTRs. METHODS: In this single-center prospective study, consecutive completely vaccinated (ChAdOx1 or BBV152) non-cirrhosis CLD patients, those with cirrhosis, and LTRs were compared with matched healthy controls for anti-spike antibody and cellular response. RESULTS: Sixty healthy individuals, 50 NCCLD patients, 63 compensated and 50 decompensated cirrhosis, and 17 LTRs were included. The proportion of non-responders was similar among the healthy control (8 %), non-cirrhosis CLD (16 %), and compensated cirrhosis groups (17.5 %;p = 0.3). However, a higher proportion of patients with decompensated cirrhosis (34 %) and LTRs (59 %) were non-responders than the healthy controls (p = 0.001). Cluster of differentiation (CD) 4-effector cells were lower in patients with non-cirrhosis CLD and compensated cirrhosis. CD4-naïve, CD4-effector, B, and B-memory cells were lower in the decompensated cirrhosis group. Although the central memory cells were higher in the decompensated cirrhosis group, they could not differentiate into effector cells. CD4- and CD8-naïve cells were higher in the marrow in the LTRs, while the CD4-effector memory cells and CD4- and CD8-effector cells were lower in the LTRs. Furthermore, B cells were more deficient in the LTRs, suggesting poor antibody response. CONCLUSION: Patients with decompensated cirrhosis and LTRs demonstrated suboptimal humoral and cellular immune responses against recombinant and inactivated COVID-19 vaccines.
Subject(s)
COVID-19 , Coronavirus , Liver Diseases , Liver Transplantation , Humans , COVID-19 Vaccines , Prospective Studies , Liver Cirrhosis , Immunity , Transplant RecipientsABSTRACT
IDDF2022-ABS-0185 Table 1Clinical characteristics of patients with Giloy-induced liver injuryCharacteristics Number of patients (Total-16 patients) Gender Male 7 (43.75%) Female 9 (56.25%) Age (mean ± SD) 48.3±14 years Presentation type Acute hepatitis 6 (37.5%) ACLF 10 (62.5%) Mean duration for symptom onset after consumption of giloy 84.3±35 days Mean BMI 23.23±3 kg/m2 Comorbidities Type 2 diabetes 9 (56.25%) Interstitial lung disease (on inhalational steroids) 2 (12.5%) Hypertension 1 (6.25%) None 5 (31.25%) NAFLD 2 (6.25%) Symptoms Jaundice 16 (100%) Ascites 8 (50%) Fatigue 12 (75%) Pruritus 4 (25%) Liver function tests Peak total bilirubin (Mean ± SD) 17 ± 9.4 mg/dl Peak ALT (mean ± SD) 365± 219 U/L Peak AST (mean ± SD) 558 ± 475 U/L Peak ALP (mean ± SD) 186 ± 114 U/L Peak serum IgG (mean ± SD) 2400 ± 1213 mg/dl Peak INR (mean ± SD) 2.63 ± 1.05 AIH serology ANA 1(6.25%) ASMA - Anti LKM1 - AMA - Seronegative (biopsy proven) - Liver biopsy 10 (62.5) Drug induced liver injury 5 (31.25%) Features of AIH 5 (31.25%) Treatment N-Acetyl Cysteine infusion+Ademetionine 3 (18.75%) Steroids 10 (62.5%) Plasma Exchange 3 (18.75%) Outcome Alive 16 (100%) One listed for liver transplant Mean duration for recovery 37 ± 16 days IDDF2022-ABS-0185 Figure 1ConclusionsGiloy, a commonly used immunity booster, can produce drug-induced liver injury, which often mimics autoimmune hepatitis and responds to steroids.