The Effects of Sex Hormones on Liver Regeneration after Liver Trauma in Animal Model

Background: The surgical management of liver injuries remains a great challenge for the traumatologists and general surgeons. We hypothesized that administration of 17 â-estradiol, a female sex hormone, improves hepatocellular healing after liver trauma.Methods: In an experimental model, 60 rats were divided into six subgroups: A (male control), B (male and estradiol), C (castrated male and estradiol), D (female control), F (female and estradiol), and G (oopherectomized female). After inducing liver trauma, estradiol subgroups received 3 doses of intravenous 17 â-estradiol (1 mg/kg) every 8 hours. 2 weeks post trauma, animals were sacrificed and hepatocellular regeneration was measured with the help of stereologic parameters of regeneration. Hepatocellular healing was compared between previous left lobe samples and the new post-traumatic right lobe samples.Results: Stereological parameters of rats receiving 17 b-estradiol after trauma was much better regarding mean angiogenesis point counting and volume density, compared with non-receiver groups after 2 weeks of trauma (P < 0.005). There was no significant difference for hepatocyte nucleus, hepatocyte point counting and volume density between estradiol receiver and non-receiver groups. In a comparison between subgroups, female sex had the same effect as giving estradiol. Oopherectomized female rats had more fibrogenesis but less angiogenesis (P < 0.005). Fibrogenesis was more in groups that were estradiol non-receiver (P < 0.005). In an explicit comparison of control females and males, estradiol infused males and females, and castrated male or oopherectomized female groups showed that stereological parameters of hepatocyte and hepatocyte nucleus were lower in female subgroups, but angiogenesis was better for female groups except for oopherectomized females.Conclusions: This study did support the administration of exogenic female hormone as an approach to augment the angiogenesis as a good index of regeneration for traumatic liver in rats

Immunosuppressive regimens on conversion of cytomegalovirus infection to disease in liver transplant recipients

Background: Cytomegalovirus (CMV) disease is one of the most common infectious complications after liver transplantation. It is the cause of numerous morbidity and mortalities. Intensity of immunosuppression defined as overall immunosuppressive drug dosage seems to affect infectious complications. The main purpose of this study is to investigate the intensity of immunosuppression on conversion of CMV infection to disease in this population. Methods: In this cross-sectional study, we retrospectively evaluated and analyzed the data of all recipients who underwent orthotopic liver transplantation (OLT) between March 2014 and March 2016 and had positive serum PCR for CMV after transplantation in follow- up course. Of 134 recipients, only 66 adult liver transplant recipients were eligible to be studied.  Multiple variables such as MELD score, cold ischemic time, warm ischemic time, operative data, immunosuppressive drugs and regimen, plasma CMV viral load, donor and recipient CMV IgG serostatus were recorded and analyzed. Results: of the 66 patients, 50 (76) had CMV infection and 16 (24) had disease. There was significant association between donor CMV IgG serostatus, extra corticosteroid pulse therapy, acute cellular rejection, serum tacrolimus level and conversion of CMV infection to CMV disease (P=0.005, 0.001, 0.031, 0.031). Conclusion: It seems that the intensity of immunosuppression has influence on conversion rate of CMV infection to disease in liver recipients

Predictors of Death in the Liver Transplantation Adult Candidates: An Artificial Neural Networks and Support Vector Machine Hybrid-Based Cohort Study

Background: Model for end-stage liver disease (MELD) is currently used for liver transplantation (LT) allocation, however, it is not a sufficient criterion. Objective: This current study aims to perform a hybrid neural network analysis of different data, make a decision tree and finally design a decision support system for improving LT prioritization.Material and Methods: In this cohort follow-up-based study, baseline characteristics of 1947 adult patients, who were candidates for LT in Shiraz Organ Transplant Center, Iran, were assessed and followed for two years and those who died before LT due to the end-stage liver disease were considered as dead cases, while others considered as alive cases. A well-organized checklist was filled for each patient. Analysis of the data was performed using artificial neural networks (ANN) and support vector machines (SVM). Finally, a decision tree was illustrated and a user friendly decision support system was designed to assist physicians in LT prioritization. Results: Between all MELD types, MELD-Na was a stronger determinant of LT candidates’ survival. Both ANN and SVM showed that besides MELD-Na, age and ALP (alkaline phosphatase) are the most important factors, resulting in death in LT candidates. It was cleared that MELD-Na <23, age <53 and ALP <257 IU/L were the best predictors of survival in LT candidates. An applicable decision support system was designed in this study using the above three factors.  Conclusion: Therefore, Meld-Na, age and ALP should be used for LT allocation. The presented decision support system in this study will be helpful in LT prioritization by LT allocators

Ciliated Hepatic Foregut Cyst Mimicking a Hydatid Cyst: A Case Report and Review of Literature

A ciliated hepatic foregut cyst is a rare cystic lesion of the liver. A 25-year-old man who was referred from an area endemic for hydatid cysts, presented with abdominal pain. Clinical, paraclinical, and imaging studies all suggested the presence of a hydatid cyst. Pathological studies after the resection of the cyst showed the presence of a ciliated hepatic foregut cyst

Liver transplantation and COVID-19: a case report and cross comparison between two identical twins with COVID-19

BACKGROUND: To this date little information exists on the effects, clinical course and outcome of the COVID-19 among patients undergoing transplantation. CASE PRESENTATION: A 35 year old male referred with loss of sense of smell and taste after having close contact with his brother who was diagnosed with COVID-19 five days prior to his symptoms. The patient had undergone liver transplantation 3 years prior to his referral due to primary sclerosing cholangitis in association with ulcerative colitis and was using immunosuppressive medications. The patient referred to a local physician with mild symptoms of fatigue, cough, myalgia, dizziness, and nausea/vomiting with a fear of contracting the disease. Except for a CRP of 32 his other blood tests were normal. After 3 days of hospital admission the patient was discharged with a good condition. His brother had developed fever, chills, headache, mild dyspnea and an objective loss of sense of smell and taste and was sent home and advised to self-quarantine. Both patients had CT scans in favor of COVID-19. CONCLUSION: Our patient who had liver transplantation and COVID-19 did not present more severe symptoms compared to his counterpart without liver transplantation and did not need to be hospitalized or be given antiviral drugs for COVID-19

A comparative study of the classic and piggyback techniques for orthotopic liver transplantation

Background: The classic technique of hepatectomy with venovenous bypass may cause a longer anhepatic phase and increase the rate of some complications, such as post-operative renal failure and thromboembolic events. But, in some cases, such as tumors and anatomic difficulties, the surgeon is obligated to use the classic technique even though there is some controversy about the safety of this technique without venovenous bypass in liver transplantation. The aim of this study was to compare the results of using the classic technique without venovenous bypass and the piggyback technique for liver transplantation. Methods: A retrospective case-series study was conducted on 227 consecutive successful liver transplants, including 55 cases in which the classic technique was used and 172 cases in which the piggyback technique was used. The transplants were performed from March 2010 through June 2011 in the Visceral Transplantation Ward at Namazi Hospital in Shiraz, Iran. The piggyback method was the preferred approach for hepatectomy, but the classic technique without venovenous bypass was performed in cirrhotic cases with anatomic difficulties, when there was a tumor, or when the surgeon preferred it. Results: There were no significant differences in post-operative rise in creatinine, decreases in intraoperative blood pressure, transfused packed red blood cells (RBC), or survival rates between the groups. Warm ischemic time (duration that donor liver is out of ice until it’s blood reperfusion in the recipient) was approximately seven minutes longer in the classic group (P = 0), but it was less than 52 minutes, which is an acceptable time for this phase. Hospital stays were shorter in the classic group than in the piggyback group (P = 0.024). Conclusion: Although the piggyback technique is the preferred technique for hepatectomy in liver transplantation, the classic technique without venovenous bypass can be used safely in cirrhotic livers when necessary or if the physician prefers it

Effect of oral d-penicillamine vs. colchicine on experimentally induced peritoneal adhesions in rats

To evaluate the effects of d-penicillamine on prevention or reduction of adhesion band formation and to compare its effects with those of colchicine in an animal model. A prospective experimental study. Rats in an academic research environment. Eighty female rats were randomly divided into four equal groups. In the end, group 4 was excluded because of high mortality rates. Adhesion bands were induced by intraperitoneal injection of 2.5 mL of a 10% sterile talc solution. The first group served as control, group 2 received oral d-penicillamine (35 mg/kg per day), group 3 received oral colchicines (0.02 mg/kg per day), and group 4 received both drugs for 3 consecutive weeks. Formation of adhesion bands was quantitatively graded according to the Nair classification. The proportion of control rats with substantial adhesion bands was significantly higher than that of rats in groups 2 or 3 (84.2%, 20%, and 33.3%). No difference regarding the grades of adhesion bands was found between the d-penicillamine and colchicine groups. Oral d-penicillamine is as effective as oral colchicine in prevention of peritoneal adhesion band formation in rats. Use of d-penicillamine for this purpose should be weighed against its possible side effects