Clinical Practice Guidelines for Liver Transplantation in Saudi Arabia.

The demand for liver transplantation in the Kingdom of Saudi Arabia (KSA) is associated with the country's high burden of liver disease. Trends in the epidemiology of liver transplantation indications among recipients in KSA have changed over 20 years. Non-alcoholic steatohepatitis has eclipsed the hepatitis C virus in the country due to the effective treatment strategies for HCV. Risk factors for NASH, like type 2 diabetes mellitus, obesity, and hyperlipidemia, are becoming a major concern and a leading indication for liver transplantation in the KSA. There is also a significantly increased prevalence and incidence of genetic adult familial liver diseases in KSA. New immunosuppressive agents and preservation solutions, improved surgical capabilities, and early disease recognition and management have increased the success rate of liver transplant outcome but concerns about the side effects of immunosuppressive therapy can jeopardise long-term survival outcomes. Despite this, indications for liver transplantation continue to increase, resulting in ongoing challenges to maximize the number of potential donors and reduce patient mortality rate while expecting to get transplanted. The Saudi Center of Organ Transplant is the recognized National Organ Donation Agency for transplantation, which renders important support for procurement and allocation of organs. This guidance document aims to help healthcare providers in managing patients in the liver transplant setting.

Quality of life in living kidney donors: A single-center experience at the king abdulaziz medical city.

Chronic kidney disease (CKD) results in irreversible decline in renal function, which ultimately progresses to end-stage renal disease (ESRD). Transplantation is the treatment of choice for ESRD, and this is possible only if donor kidneys are available. Several doubts can appear in the minds of donors and among general public regarding the quality of life (QOL) after donation which can affect the willingness to donate. Therefore, we aimed to assess the QOL in living kidney donors in King Abdulaziz Medical City, Riyadh, Saudi Arabia using the kidney disease QOL instrument short form (KDQOL-SF). This was a cross-sectional survey of living kidney donors between 18 and 65 years of age who donated their kidneys between 2008 and 2014 and was conducted in the hepatobiliary and transplantation department of our hospital. The study measured 17 domains in KDQOL-SF. Each domain score is up to 100; the higher the score in each domain, the better the QOL. Data will be entered and analyzed using Statistical Package for the Social Sciences version 21.0. The descriptive statistics will be presented as frequency and percentage for the categorical variables (e.g., gender and income) and the mean ± SD for numerical variables (e.g., QOL score). The study included 60 donors who donated during the study period between 2008 and 2014. Males were 49 (82%) with the age (mean ± standard deviation) as 32 ± 6.5 years. The donors reported an "overall-mean-score" of 86.7 ± 14.6. Four domains had lower scores between 60 and 80: "sleep" (61.8 ± 13.8), "emotional-well-being" (71.6 ± 11.1), "quality-of-social-interaction," and "energy/fatigue." The other 13 domains had scores >80. The two highest domains: "role-physical" (97.9 ± 13.3) and "effect-of-kidney-disease" (97.4 ± 8). Comparing males and females scores, work status was higher in males with P = 0.03. Our findings suggest that donors have a good QOL which may result in more donations. It is important to improve the standard of care for donors to enable them to live their life to the fullest.

Outcome of duct-to-duct vs. Roux-en-Y hepaticojejunostomy biliary anastomoses in below 15-kg pediatric liver transplant recipients.

The best type of biliary anastomosis to use in lower weight pediatric liver transplant recipients is debatable. In this study, we share a single center's experience comparing the rate of anastomotic biliary complications based on the type of biliary anastomosis performed in this population of patients. A retrospective review of pediatric liver transplants for recipients weighing <15 kg from 11/2003 till 12/2011 was performed. Patients were grouped based on the type of biliary anastomosis into two groups: duct-to-duct (d-d) and Roux-en-Y hepaticojejunostomy (h-j) anastomoses. A total of 24 patients (12 males, 12 females) with a mean age of 26 ± 20 months and a mean weight of 9.27 ± 2.63 kg (range = 5.3-13.9 kg) were studied. All anastomotic complications occurred in patients who received left lateral segments. No statistical differences were found in the post-operative biliary (p = 0.86) or vascular (p = 0.99) complications between the two groups. Acknowledging the limited sample size, our data suggest that duct-to-duct anastomosis can be performed safely in pediatric liver transplantation recipients weighing below 15 kg.

Endoscopic extraction of vascular embolization coils that have migrated into the biliary tract in a liver transplant recipient.

Hepatic artery pseudoaneurysm (HAA) is a rare vascular complication of liver transplantation. Minimally invasive radiological interventions are generally considered before seeking surgical treatment of HAA. Coil embolization of the aneurysmal sac and or exclusion of pseudoaneurysm by deploying a stent over the aneurysm are effective interventions to control hemobilia arising from the HAA. Migration of coils inside the bile duct is a rarely reported complication in post-hepatic transplantation. Treatment options remain largely unexplored due to the rarity of its occurrence. Endoscopic retrograde cholangiographic removal of migrated vascular coils in the common bile duct following embolization of HAA has not been described in a liver transplant setting. We report a liver transplant recipient who underwent uneventful and successful endoscopic removal of migrated coils into the bile duct.

Outcomes in esophageal atresia and tracheoesophageal fistula.

BACKGROUND/PURPOSE: The purpose of this analysis was to investigate outcomes in newborns with esophageal atresia (EA) or tracheoesophageal fistula (TEF) with respect to prognostic classifications and complications. METHODS: Charts of all 144 infants with EA/TEF treated at British Columbia Children's Hospital (BCCH) from 1984 to 2000 were reviewed. Patient demographics, frequency of associated anomalies, and details of management and outcomes were examined. RESULTS: Applying the Waterston prognostic classification to our patient population, survival rate was 100% for class A, 100% for class B, and 80% for class C. The Montreal classification survival rate was 92% for class I and 71% for class II (P =.08). Using the Spitz classification, survival rate was 99% for type I, 84% for type II, and 43% for type III (P <.05). The Bremen classification survival rate was 95% "without complications" and 71% "with complications." Complications included stricture (52%), gastroesophageal reflux (31%), anastomotic leakage (8%), recurrent fistula (8%), and pneumonia (6%). Seventeen patients underwent fundoplication for gastroesophageal reflux, 16 pre-1992 and one post-1992. CONCLUSIONS: Comparing the major prognostic classifications, the Spitz classification scheme was found to be most applicable. In our institution, the trend in management of gastroesophageal reflux after repair of EA/TEF has moved away from fundoplication toward medical management.