Kaposi Varicelliform Eruption Associated With Chickenpox in a Liver Transplant Recipient.

A 43-year-old male patient developed varicella virus (chickenpox) 4 months after receiving a liver transplant. Within 5 days of complete recovery, he presented with widespread cutaneous vesicular eruptions involving the face, back, abdomen, and upper extremities. Tzanck smear showed ground glass inclusions in the nuclei of multinucleated giant cells, suggestive of viral pathology. The patient was subsequently diagnosed with Kaposi varicelliform eruption, a rare dermatologic emergency. He was treated with high-dose intravenous acyclovir and fully recovered.

Living-Donor Liver Transplant Follow-Up: A SingleCenter Experience.

OBJECTIVES: Liver transplant is a definite treatment of decompensated liver disease. Because of the shortage of livers from deceased donors, living-donor liver transplant is becoming more common. Here, we analyzed our clinical experience in the follow-up care of these patients. MATERIALS AND METHODS: Liver transplant recipients seen at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan) were included in this analysis. Baseline characteristics and follow-up events were recorded. RESULTS: Our study population included 76 liver transplant patients registered at our clinic. Median age was 42 years, with 62 patients (81.6%) being males. The most common indication of transplant was hepatitis C virus-related cirrhosis (42 patients; 55%), followed by hepatitis B-hepatitis D virus coinfection (8 patients; 10.5%). Anastomotic biliary stricture developed in 16 patients (21.1%),which required biliary stenting. Biliary leak developed in 5 patients (6.6%), and renal cell carcinoma developed in 1 patient. Two recipients died due to hepatitis C virus-related fibrosing cholestasis hepatitis and pulmonary com plications. Posttransplant diabetes mellitus developed in 36 (47.1%), hypertension in 17 (38.6%), and dyslipidemia in 19 patients (25%). Of 42 patients with hepatitis C virus infection, 26 were treated with pegylated interferon and ribavirin, of which 65.3% achieved sustained virologic response at 24 weeks. The other 16 patients received sofosbuvir com - bined with ribavirin for 24 weeks. A sustained virologic response at 12 weeks was achieved in 5 patients, with not yet determined results in the remaining patients. Seven patients were lost to follow-up. CONCLUSIONS: Hepatitis C-related cirrhosis was the most common indication for liver transplant, and infection recurrence was observed in our patients. Biliary anastomotic stricture formation was the most prevalent complication after transplant. As liver transplants are becoming more widely available for Pakistani patients at home and abroad, gastroenterologists and trainees in our country should be sensitized, educated, and skilled in the posttransplant care of these patients.

Effectiveness of Sofosbuvir and Ribavirin for Eradicating Hepatitis C Virus in Renal Transplant Recipients in Pakistan: Where Resources Are Scarce.

OBJECTIVES: Although direct-acting antiviral agents have revolutionized hepatitis C virus treatment, these novel agents are not widely available in the developing world. Further, no treatment recommendation for renal transplant recipients includes these agents. We aimed to evaluate the effectiveness of sofosbuvir and ribavirin, the only direct-acting antiviral agents available in Pakistan, in renal transplant recipients. MATERIALS AND METHODS: All renal transplant recipients receiving sofosbuvir and ribavirin from August 2015 to March 2016 were enrolled in the study. Patients' demographics and baseline laboratory parameters were collected. Rapid virologic response, early virologic response, end-of-treatment response, and sustained virologic response at 12 and 24 weeks were analyzed. Statistical analyses were performed using IBM SPSS Statistics software, version 20.0. RESULTS: Of the 37 renal transplant recipients, the mean age was 37.2 ± 10.7 years and the majority (33 [89.2% ]) were men. Twenty-five patients were treatment naive; of the remaining 12 patients, 10 were responders, 2 were nonresponders, and 5 were relapsers to pretransplant hepatitis C treatment. The genotype most commonly seen posttransplant was genotype 1 (56.8%). Rapid virologic response was achieved in 33 patients (89.2%). Early virologic response, end-oftreatment response, and sustained virologic response at 12 weeks were achieved in all 37 patients (100%). Until the time of data collection, 14 patients had achieved a sustained virologic response at 24 weeks. No complications were noted during therapy. In 2 of 4 patients who developed decompensated cirrhosis, treatment led to the resolution of ascites. CONCLUSIONS: Sofosbuvir and ribavirin are well tolerated and effective in renal transplant recipients for eradicating hepatitis C virus. Their effectiveness is not limited to renal transplant recipients with genotypes 1, 2, 3, and 4 but also extends to those with mixed genotype (in this study, genotypes 1 and 3).

De novo malignancy after liver transplant.

OBJECTIVES: Patients who have liver transplant are at high risk of developing de novo malignancies. The purpose of this study was to evaluate incidence and histologic type of de novo malignancies after liver transplant in a liver transplant center. MATERIALS AND METHODS: In 1700 patients who had orthotopic liver transplant from deceased and living donors from January 1992 to October 2012, de novo malignancies after transplant were analyzed. RESULTS: There were 38 patients (2.2%) who developed de novo malignancy. Pathologic diagnosis was posttransplant lymphoproliferative disorder in 24 patients (63%), gastrointestinal adenocarcinoma in 4 patients (10%), Kaposi sarcoma in 3 patients (8%), pancreatic head adenocarcinoma in 2 patients (5%), papillary thyroid carcinoma in 1 patient (3%), lumbosacral multiple myeloma in 1 patient (3%), conjunctive carcinoma in 1 patient (3%), testicular cancer in 1 patient (3%), and metastatic adenocarcinoma to the vertebrae of unknown origin in 1 patient (3%). In the 24 patients who had posttransplant lymphoproliferative disorder, 20 patients (83%) were children aged <10 years, and 5 patients (21%) died of this disease. CONCLUSIONS: Posttransplant lymphoproliferative disorder was the most common malignancy among liver transplant recipients. This disease primarily involved children and was a major cause of morbidity and mortality. Preventive and early diagnostic strategies are justified to decrease morbidity and mortality from de novo malignancy after liver transplant.