Частота возникновения и факторы риска развития хронического отторжения при остром отторжении трансплантированной печени у детей

Background. Chronic graft rejection (CR) represents an increasing concern in pediatric liver transplantation (LT). Risk factors of CR in this population are uncertain. In present study, we aimed to ascertain if clinical parameters could predict the occurrence of CR in LT children.Methods. We retrospectively analyzed the results from 47 children who had experienced acute hepatic rejection in Namazee hospital, Shiraz, Iran during 2007–2017.Results. Out of 47 children, 22 (46.8%) and 25 (53.2%) were boys and girls respectively. Ascites, gastrointestinal bleeding, and spontaneous bacterial peritonitis were observed in 20 (44.4%), 14 (31.1%), and 4 (9.1%) respectively. Posttransplant vascular and biliary complications were observed in 3 (7%) and 4 (9.3%) cases respectively. The mean time from LT to normalization of liver enzymes was 14.2 ± 7.5 days. The mean of acute rejection episodes was 1.4 ± 0.6 (median = 1 (22, 46.8%), range of 1–3). Six (12.7%) patients experienced CR. The mean time from LT to CR was 75 ± 28.4 days. A significant association was found between CR and patients’ condition (being inpatient or outpatient) before surgery (P = 0.03). No significant relationship was found between CR and post-transplant parameters except for biliary complications (P = 0.01). Both biliary complication (RR = 33.7, 95% CI: 2.2–511, P = 0.01) and inpatient status (RR = 10.9, 95% CI: 1.1–102.5, P = 0.03) significantly increased the risk of CR.Conclusion. Being hospitalized at the time of LT, and development of biliary complications might predict risk factors for development of CR in LT children.Актуальность. Хроническое отторжение (ХО) трансплантата становится все более серьезной проблемой при трансплантации печени (ТП) у детей. Факторы риска ХО в этой популяции остаются неопределенными. В настоящем исследовании мы стремились выяснить, можно ли спрогнозировать возникновение ХО у детей с ТП по клиническим параметрам.Методы. Мы провели ретроспективный анализ 47 случаев острого отторжения трансплантата печени у детей, прооперированных в больнице Намази (г. Шираз, Иран) в период с 2007-го по 2017 год.Результаты. В исследование включили 47 детей: 22 (46,8%) мальчика и 25 (53,2%) девочек. Асцит, желудочно-кишечное кровотечение и спонтанный бактериальный перитонит наблюдались в 20 (44,4%), 14 (31,1%) и 4 (9,1%) случаях соответственно. Посттрансплантационные сосудистые и билиарные осложнения отмечались в 3 (7%) и 4 (9,3%) случаях соответственно. Показатели печеночных ферментов нормализовались в среднем через 14,2 ± 7,5 дня после ТП. Среднее количество эпизодов острого отторжения составило 1,4 ± 0,6 (медиана = 1 (22; 46,8%), диапазон 1–3). У 6 (12,7%) пациентов наблюдалось ХО. Среднее время от ТП до ХО составило 75 ± 28,4 дня. Мы выявили статистически значимую корреляцию между ХО и предоперационным периодом (нахождение в стационаре или амбулаторная подготовка, р = 0,03). ХО статистически значимо коррелировало с наличием билиарных осложнений (р = 0,01), другие послеоперационные факторы статистически значимо на него не влияли. Билиарные осложнения (ОР = 33,7, 95% ДИ 2,2–511, р = 0,01) и предоперационный статус пациента (ОР = 10,9, 95% ДИ 1,1–102,5, р = 0,03) значительно повышали риск ХО.Заключение. Госпитализация при подготовке к трансплантации и раннее выявление билиарных осложнений могут предотвратить развитие ХО трансплантата у детей после ТП

A comparative study on ascetic fluid biochemical markers in cirrhotic children with and without spontaneous bacterial peritonitis: A cross-sectional observation

Background: Cirrhotic ascites is frequently complicated with spontaneous bacterial peritonitis (SBP). Objectives: Here, we assessed the diagnostic validity of some inflammatory markers in children with SBP. Methods: This cross-sectional study was performed in the Pediatric Gastroenterology Ward of Namazi hospital of Shiraz. SBP was considered as ≥ 250 polymorphonuclear cell (PMN) /µL ascetic fluid (AF). Results: Out of 150 liver cirrhotic patients with ascites, 41 (27.3) were diagnosed with SBP. Mean WBC count and PMN per µL of AF were significantly higher in SBP patients than non-SBP (P < 0.0001). The highest specificity for the diagnosis of SBP was recorded for AF smear test (100). Positive AF smear and culture tests rendered the highest positive predictive values (PPV, 100 and 88.2 respectively). The highest negative predictive value (NPV) was related to AF leukocyte esterase test (94.2). The highest area under the curve (AUC) for diagnosis of SBP belonged to WBC count (0.956), total cell count (0.817), and LDH concentration (0.814) of AF. A cut off value of 290 WBC per µL AF resulted in respective 95.1 and 88.1 sensitivity and specificity. Trespass of WBC count and lactate dehydrogenase (LDH) level of AF higher than cutoff values (290 cells/µL, and 175 (u/L), respectively) resulted in 82.9, 92.7, 81, and 93.5 sensitivity, specificity, PPV and NPV, respectively. Conclusions: Total cell and WBC counts of AF strongly correlated with ascetic PMN count. Ascetic LDH, alone or in combination with WBC count of AF can be used as a potential surrogate for PMN counts in diagnosis of SBP. © 2019, Journal of Comprehensive Pediatrics

A case report and literature review of the late presenting congenital diaphragmatic hernia

Late presenting congenital diaphragmatic hernia is a disease associated with defective diaphragm and penetration of different organs into the thoracic cavity. In the present case, a 3-year-old boy was referred to our hospital complaining of acute abdominal pain. No other gastrointestinal symptoms including nausea, vomiting, or constipation were observed. The patient represented no respiratory problems such as dyspnea or respiratory distress syndrome. Radiograph of the thoracic and abdominal cavities showed bowel loops occupying the entire space of the left hemithorax and right-shifted mediastinum. The patient was referred to the pediatric surgery center. The defect was resolved by prompt surgical intervention. A follow-up radiograph within 6 months of surgery showed complete recovery. © 2018 Annals of Pediatric Surgery

The effects of prebiotic supplementation on weight gain, diarrhoea, constipation, fever and respiratory tract infections in the first year of life

AimThis study was conducted to evaluate the effect of prebiotics on some common clinical ailments in healthy term infants. MethodsSixty healthy-term, breastfed (BF) infants were included. Along with these infants, 120 healthy-term formula-fed infants were randomly assigned to either the prebiotic formula (PF, n = 60) or regular formula (RF, n = 60) groups. Ready-to-use prebiotic-supplemented formula containing galacto-oligosaccharides and polydextrose (ratio 1:1) was used. ResultsAt 2 months of age, PF infants demonstrated significantly higher weight gain than BF and RF. At 6 months of age, bodyweight was significantly higher in the RF group compared to BF and PF groups (P < 0.05). Similar results were seen at 8, 10 and 12 months of age. At 10 months of age, the duration of diarrhoea was significantly shorter in PF-fed compared to the RF (P = 0.03) group. A significant difference was found between PF and RF (P < 0.0001) and BF and RF groups (P = 0.002) for diarrhoea duration. Means of constipation episodes per year were 0.03 0.18, 0.433 +/- 0.77 and 0.1 +/- 0.30 for the BF, RF and PF groups, respectively, with significant difference found between BF and RF (P = 0.006) and PF and RF (P = 0.02). The means of episodes of respiratory tract infections per year for BF, RF and PF groups were 1 +/- 0.69, 1.6 +/- 0.88 and 1 +/- 0.58, respectively (P = 0.01). ConclusionPrebiotic-supplemented and regular formula were similar to breast milk regarding prophylactic effects for diarrhoea, constipation and respiratory tract infections in the first year of life. Prebiotic-supplemented formula may be an appropriate substitution for breast milk when breast milk in unavailable