Drug-related Problems in Solid-Organ Transplant Recipients Hospitalized for COVID-19: An Experience of a Referral Tertiary Center in Iran.

Background: Transplanted patients receiving immunosuppressive agents are at a higher risk of Coronavirus-disease-2019 (COVID-19), and their polypharmacy state makes the choice of treatment challenging. This study aimed to assess the drug-related problems (DRP) and clinical pharmacists' interventions to manage transplanted patients and candidates for transplantation with COVID-19. Methods: This cross-sectional study was conducted in the COVID-19 intensive care unit of Shiraz Organ Transplantation Center (Iran), from March 2020 to April 2021. Patients were admitted to the COVID-19 intensive care unit based on clinical symptoms or positive polymerase chain reaction (PCR) tests. The clinical pharmacist reviewed all medications and physicians' orders on a daily basis and evaluated DRPs in accordance with the pharmaceutical care network of Europe (PCNE) classification (V 8.01). The treatment team was informed of the DRPs, and the acceptance or rejection of the intervention was also documented. Data were analyzed using SPSS (Version 25.0). In order to determine the proportion and determinants of drug-related problems, descriptive statistics and logistic regression were applied, respectively. Results: A clinical pharmacist reviewed 631 individuals with 11770 medication orders, and 639 DRPs were found in 69% of them with an average of 1.01±1 per patient. The most commonly reported DRPs were treatment efficacy issues followed by adverse drug reactions (ADRs). A total of 982 interventions were provided at prescriber, patient, and drug levels, of which 801 were accepted, and 659 (82.27%) were fully implemented. Conclusion: There have been considerable drug-related issues in managing transplanted patients with COVID-19. DRPs are more common in people with polypharmacy, more than three comorbidities, and hydroxychloroquine regimens.

Prognostic Value of Computed Tomographic Coronary Angiography for Long-Term Major Adverse Cardiac Events after Liver Transplantation.

Computed tomographic coronary angiography (CTCA) has prognostic value for early major adverse cardiac events (MACEs) after liver transplantation. However, the association between CTCA and long-term MACEs in liver transplant (LT) recipients remains unknown. We evaluated the association between CTCA and long-term MACEs within 5 years after living donor liver transplantation (LDLT). A total of 628 LDLT recipients who underwent CTCA were analyzed between 2010 and 2012. MACEs were investigated within 5 years after LDLT. The factors associated with long-term MACEs in transplant recipients were evaluated. Only 48 (7.6%) patients developed MACEs. In the Fine and Gray competing risk regression, a coronary artery calcium score (CACS) of >400 combined with obstructive coronary artery disease (CAD) (subdistribution hazard ratio: 5.01, 95% confidence interval: 2.37-10.58, p < 0.001), age (1.05, 1.01-1.10, p = 0.018), diabetes mellitus (2.43, 1.37-4.29, p = 0.002), dyslipidemia (2.45, 1.23-4.70, p = 0.023), and creatinine (1.19, 1.08-1.30, p < 0.001) were independently associated with long-term MACEs. CACS (>400) combined with obstructive CAD may be associated with MACEs within 5 years after LDLT, suggesting the importance of preoperative noninvasive CTCA in LT recipients. The evaluation of coronary artery stenosis on CTCA combined with CACS may have a prognostic value for long-term MACEs in LT recipients.

Unilateral Versus Bilateral Biliary Drainage for Post-Transplant Anastomotic Stricture.

Living donor liver transplantation is the most common type of liver transplantation in Asia. Post-transplant biliary stricture is frequent in living donor liver transplantation, and endoscopic management is considered to be the treatment of choice. However, endoscopic management is still challenging in patients who undergo right lobe living donor liver transplantation because of the anatomical alteration. In this article, we reviewed the recently updated results for proper endoscopic biliary drainage in post-living donor liver transplantation anatomical biliary stricture and compared unilateral and bilateral drainage.

History of liver transplantation in Poland.

Experimental research on liver transplantation was introduced in Poland by Waldemar Olszewski with his team. It was in 1972. Not until 15 years later, in 1987, did Stanislaw Zielinski in Szczecin and Marian Pardela in Katowice make an attempt of transplanting liver in humans. In 1989, the attempt was made by Jacek Pawlak and Marek Krawczyk in Warsaw. The first successful liver transplantation in Poland was performed by Piotr Kalicinski at the Children's Memorial Health Institute, Warsaw. Also, in early 1990s the attempts were made by Jerzy Polanski in Warsaw and Piotr Szyber in Wroclaw. In the next years, liver transplantations were connected with three centers in Szczecin and were associated with the following persons: Roman Kostryka, Maciej Wójcicki and Samir Zeaira. In Warsaw, 1994, Jacek Pawlak, Bogdan Michalowicz and Krzysztof Zieniewicz performed another successful liver transplantation. The program started to develop rapidly and is still up and running. In 2000, Wojciech Rowinski and Marek Pacholczyk created another liver transplant center in Warsaw, while in 2005 Lech Cierpka and Robert Król did the same in Katowice. In the following years, liver transplantation was initiated by Maciej Slupski in Bydgoszcz (2017) and Zbigniew Sledzinski in Gdansk (2018). In the developing liver transplant centers, an exceptional contribution was made by Pawel Nyckowski, Jacek Pawlak, Krzysztof Zieniewicz, Waldemar Patkowski, Tadeusz Wróblewski, Rafal Paluszkiewicz, Marek Pacholczyk, Andrzej Chmura, Maciej Kosieradzki and Marek Krawczyk - all employees of the Medical University of Warsaw. In Wroclaw, Dariusz Patrzalek and Pawel Chudoba were very active in the field of liver transplantations. In 1996, the Organizing-Coordinating Center for Transplantation POLTRANSPLANT was brought to life. It was directed by Janusz Walaszewski, then by Roman Danielewicz and Artur Kaminski. In 1999, Piotr Kalicinski and Marek Krawczyk started the program for liver fragment harvesting and transplantation from living donors. Until the end of 2016, 4186 liver transplantations including 314 liver transplants from living donors were performed in Poland. Currently, the active centers are three centers from Warsaw, namely Pediatric Surgery and Transplantation Surgery, Children's Memorial Health Institute; Department of General, Transplant and Liver Surgery, Medical University of Warsaw; Department of General and Transplant Surgery, Medical University of Warsaw. Other active centers include Department of General and Transplant Surgery, Provincial Hospital in Szczecin, Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Department of Vascular, General and Transplant Surgery in Wroclaw. Liver transplant programs have also been initiated at the Department of Liver and General Surgery, Bydgoszcz, and Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk.

Temporary abdominal closure and delayed biliary reconstruction due to massive bleeding in patients undergoing liver transplantation: an old trick in a new indication.

BACKGROUND: Massive bleeding during liver transplantation (LT) is difficult to manage surgical event. Perihepatic packing (PP) and temporary abdominal closure (TAC) with delayed biliary reconstruction (DBR) can be applied in these circumstances. METHOD: A prospective database of LT in a major transplant center was analyzed to identify patients with massive uncontrollable bleeding during LT that was resolved by PP, TAC, and DBR. RESULTS: From January 2009 to July 2013, 20 (3.6%) of 547 patients who underwent LT underwent DBR. Mean intraoperative blood loss was 20,500 ml at the first operation. The DBR was performed with a mean of 55.2 h (16-110) after LT. Biliary reconstruction included duct-to-duct (n = 9) and hepatico-jejunostomy (n = 11). Complications occurred in eight patients and included portal vein thrombosis, cholangitis, severe bacteremia, pneumonia. There was one in-hospital death. In the follow-up of 18 to 33 months we have seen one patient died 9 months after transplantation. The remaining 18 patients are alive and well. CONCLUSIONS: In case of massive uncontrollable bleeding and bowel edema during LT, the combined procedures of PP, TAC, and DBR offer an alternatively surgical option to solve the tough situation.

Validation of the "Metroticket" model in a cohort of patients transplanted for hepatocellular carcinoma in southern Brazil.

This retrospective study evaluated the ability of the Metroticket model to predict five-yr post-transplant survival in patients with hepatocellular carcinoma (HCC) based only on explant data. Five-yr survival after transplant was estimated using the Metroticket Calculator, and observed survival was calculated using the Kaplan-Meier method. Metroticket-predicted survival was compared between deceased and surviving patients using the Mann-Whitney test. The accuracy of Metroticket estimates in discriminating between these two patient groups was assessed using the c-statistic. Median patient age (n = 109) was 55.7 yr, and 72.5% of the sample were men. Metroticket-predicted and observed post-transplant survival at five yr was 71.1% and 58.7%, respectively. Predictions were calculated using the explant data of the 64 survivors and 45 deceased patients. Median five-yr survival was 72.9% in the former and 69.7% in the latter. The c-statistic of the Metroticket model for distinguishing surviving from deceased patients was 0.55. In this cohort, the Metroticket model was unable to accurately predict five-yr post-transplant survival based only on explant data.

Hepatic Artery Pseudoaneurysm: A Life-Threatening Complication of Liver Transplantation.

Hepatic artery pseudoaneurysm is a rare but serious complication following liver transplantation. A 50-year-old male patient with ulcerative colitis, sclerosing cholangitis, and end-stage liver disease underwent right lobe transplantation from a living donor. The patient was hospitalized because of impairment in liver function tests and massive pretibial edema three months after surgery. In color Doppler ultrasound and multidetector computed tomography, a pseudoaneurysm with peripheral large thrombus was detected at the anastomosis site extending anterior to the hepatic artery. The patient died as a result of unstable hemodynamic conditions.

Severe hepatic necrosis of unknown causes following ABO-incompatible liver transplantation.

Emergency ABO-incompatible (ABO-I) liver transplantations (LTx) have been performed increasingly to treat severe liver failure. Herein, we report a case of severe hepatic necrosis after ABO-I LTx. A 53-year-old man with blood group O was diagnosed as having severe hepatitis B and acute-on-chronic liver failure, and underwent an emergency liver transplantation implanting a blood-group-B liver from a cardiac-death donor. A routine anti-rejection, anti-infection and anti-virus therapy was given after operation. On post-operative day (POD) 16, the recipient had fever and erythra. Laboratory and radiographic examinations suggested a severe hepatic necrosis of unknown causes. The patient was managed with a 10-d methylprednisolone pulse therapy. He was discharged on POD 35 with stable condition, and no recurrent disease was found during the follow-up.

Adult liver transplantation using left lobe: a report of 9 cases / 中华器官移植杂志

Objective To investigate clinical effectiveness and feasibility of adult liver transplantation using the left lobe.Methods We analyzed the clinical data of 9 recipients who underwent adult liver transplantation using left lobe from March 2007 to April 2011,including 5 cases receiving split liver transplantation and rest 4 cases receiving living donor liver transplantation.Mean graft weight was 444.6 g (325-570 g) and mean graft-recipient weight ratio was 0.886％ (0.65％-1.18％ ).The middle hepatic vein was reserved in 7 cases.Six cases underwent Laden back surgical and 3 cases underwent classical surgical procedures.During the operation,PVP of 4 cases exceeded 20 mm Hg (2.67 kPa),3 cases were subjected to splenic artery ligation and 1 case to splenectomy.All recipients after operation were treated with triple drug maimenance therapy of Tacrolimus,Mycophenolate Mofetil and corticosteroids.We followed-up the recipients long-term,and the incidence of vascular complications and biliary complications,patient and graft survival,restoration of liver function were observed.Results No serious complications occurred in 4 living donors subject to left lobotomy and the liver function had a good recovery.The median follow-up period of these 9 recipients was 15.7 months ( 1 month to 51 months).Overall 1-year patient and graft survival rate was 77.8％ (7/9).Two cases died after operation.In the remaining 7 cases,1 case had initial poor graft function,and cases had initial good graft function.The main complications after operation included biliary anastomotic strictures in 1 case,small-for-size syndrome in 1 case,portal vein thrombosis in 1 case,initial poor graft function in 1 case and abdominal infection in 2 cases.Conclusion With strict for selecting and good matching donor-recipient,adult liver transplantation using left lobe is safe and feasible.

Perioperative anesthetic management for fulminant hepatic failure patients receiving liver transplantation / 第二军医大学学报

Objective: To summarize our experience in perioperative anesthetic management for fulminant hepatic failure (FHF) patients receiving liver transplantation. Methods: The clinical anesthetic data of 48 FHF patients receiving orthotopic liver transplantations (OLT) from January 2006 to January 2007 were retrospectively analyzed, and the anesthetic management experience was summarized. General anesthesia was applied; the hemodynamics was monitored during the operation and doses of adrenaline and phenylephrine were adjusted according to the monitoring results. Blood samples were obtained before operation, before anheptic, 30 min after anhepatic P base, 5 min before neohepatic phase, and 5 min, 30 min and 60 min after neohepatic phase for blood gas and electrolyte analysis and for determination of coagulation function; the drugs were subsequently adjusted according to analysis results. Results: All the 48 patient underwent successful anesthetic management and there was no death during opearation. The average blood loss during operation was (5 219±478) ml. Mild alkalosis, hypokalemia, hyponatrium, and hypocalcemia were present before operations. pH, BE and HCO3-were obviously reduced 30 min after anhepatic phase and increased 60 min after neohepatic phase. Kalemia was obviously increased 30 min following anhepatic phase and began to increase 60 min following neohepatic phase. Calium concentration was decreased at the end of preanhepatic phase (P

Major Complications after Orthotopic Liver Transplantations

A retrospective study was conducted to determine the incidence of major complications after liver transplantations which had been performed at Asan Medical Center from August 1992 to October 1996. Among the 43 orthotopic liver transplantations(OLTs), 27 were cadaveric donor liver transplantation(CDLT) including one retransplantation, 16 were living donor liver transplantation(LDLT). The over-all incidence of major complication was 52.4%, and there were no statistical difference between CDLT and LDLT. But the one-year cumulative survival was better in LDLT than CDLT(86.2% vs 63.3% : p < 0.1). To reduce the incidence of major complications after OLT, proper management of donors, early transplantation of recipients and shortening of cold ischemic time are mandatory especially in CDLT.

Perioperative anesthetic management for fuiminant hepatic failure patients receiving liver transplantation / 第二军医大学学报

Objective:To summarize our experience in perioperative anesthetic management for fulminant hepatic failure (FHF)patients receiving liver transplantation.Methods:The clinical anesthetic data of 48 FHF patients receiving orthotopic liver transplantations(OLT)from January 2006 to January 2007 were retrospectively analyzed,and the anesthetic management expe- rience was summarized.General anesthesia was applied;the hemodynamics was monitored during the operation and doses of adrenaline and phenylephrine were adjusted according to the monitoring results.Blood samples were obtained before operation, before anheptic,30 min after anhepatic phase,5 min before neohepatic phase,and 5 min,30 min and 60 min after neohepatic phase for blood gas and electrolyte analysis and for determination of coagulation function;the drugs were subsequently adjusted according to analysis results.Results:All the 48 patient underwent successful anesthetic management and there was no death dur- ing opearation.The average blood loss during operation was(5 219?478)ml.Mild alkalosis,hypokalemia,hyponatrium,and hy- pocalcemia were present before operations,pH,BE and HCO_3~- were obviously reduced 30 min after anhepatic phase and in- creased 60 min after neohepatic phase.Kalemia was obviously increased 30 min following anhepatic phase and began to increase 60 min following neohepatic phase.Calium concentration was decreased at the end of preanhepatic phase(P