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Hartleif S, Hodson J, Lloyd C, Cousin VL, Czubkowski P, D'Antiga L, Debray D, Demetris A, Di Giorgio A, Evans HM, Fischler B, Gonzales E, Gouw ASH, Hübscher SG, Jacquemin E, Lacaille F, Malenicka S, McLin VA, Markiewicz-Kijewska M, Mazariegos GV, Rajanayagam JK, Scheenstra R, Singer S, Smets F, Sokal E, Squires JE, Sturm E, Verkade H, Kelly DA. Long-term Outcome of Asymptomatic Patients With Graft Fibrosis in Protocol Biopsies After Pediatric Liver Transplantation. Transplantation 2023; 107:2394-2405. [PMID: 37143195 DOI: 10.1097/tp.0000000000004603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The histological prevalence of allograft fibrosis in asymptomatic children after liver transplantation (LT) is well documented. However, long-term graft and patient survival remain unclear. This retrospective multicenter study aims to determine the prevalence of allograft fibrosis and analyze the long-term outcome for patients transplanted in childhood. METHODS We reviewed clinical data of children who had undergone 10-y protocol liver biopsies. We excluded patients with autoimmune hepatitis, primary sclerosing cholangitis, hepatitis B or C, and retransplantation. In total, 494 patients transplanted in childhood across 12 international transplant centers were included. We evaluated the development of fibrosis by comparing the results with biopsies obtained 5 and 15 y post-LT. Histological findings were correlated with graft and patient survival up to 20 y post-LT. RESULTS In the 10-y biopsies, periportal or pericentral fibrosis was observed in 253 patients (51%), 87 (18%) had bridging fibrosis, 30 (6%) had cirrhosis, and 124 (25%) had no fibrosis. The prevalence and stage of graft fibrosis significantly progressed from 5 to 10 y. At 10 y, the severity of fibrosis correlated significantly with inflammation. Patients with graft cirrhosis in the 10-y biopsy were more likely to die or require retransplantation subsequently ( P = 0.027). CONCLUSIONS At 10 y post-LT, most patients transplanted in childhood developed fibrosis, based on the protocol liver biopsies. Although mild-to-moderate graft fibrosis did not largely affect patient or graft survival up to 20 y post-LT, this progressive fibrosis finding has substantial implications for developing cirrhosis and portal hypertension in adult care.
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Affiliation(s)
- Steffen Hartleif
- Pediatric Gastroenterology and Hepatology, University Hospital Tübingen, Tübingen, Germany
| | - James Hodson
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Carla Lloyd
- Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
| | - Vladimir L Cousin
- Swiss Pediatric Liver Centre, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
| | - Piotr Czubkowski
- Department of Liver Disorders and Transplantation, The Children's Memorial Health Institute, Warsaw, Poland
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Dominique Debray
- Pediatric Liver Unit, National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Anthony Demetris
- Division of Liver and Transplantation Pathology, Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Angelo Di Giorgio
- Pediatric Hepatology, Gastroenterology and Transplantation, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Helen M Evans
- Department of Pediatric Gastroenterology, Starship Child Health, University of Auckland, Auckland, New Zealand
| | - Björn Fischler
- Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Emmanuel Gonzales
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de référence de l'atrésie des voies biliaires et des cholestases génétiques, FSMR FILFOIE, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stefan G Hübscher
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Emmanuel Jacquemin
- Hépatologie et Transplantation Hépatique Pédiatriques, Centre de référence de l'atrésie des voies biliaires et des cholestases génétiques, FSMR FILFOIE, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Florence Lacaille
- Pediatric Liver Unit, National Reference Centre for Rare Pediatric Liver Diseases (Biliary Atresia and Genetic Cholestasis), FILFOIE, Necker-Enfants Malades Hospital, University of Paris, Paris, France
| | - Silvia Malenicka
- Pediatric Digestive Diseases, Astrid Lindgren Children's Hospital, Karolinska University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Valerie A McLin
- Swiss Pediatric Liver Centre, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland
| | | | - George V Mazariegos
- Department of Surgery, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Jeremy K Rajanayagam
- Paediatric Gastroenterology, Hepatology and Nutrition, The Royal Children's Hospital, Melbourne, Australia
| | - René Scheenstra
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan Singer
- Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Françoise Smets
- UClouvain, Clinical and Experimental Research Institute and Cliniques Universitaires Saint Luc, Service de Gastroentérologie Hépatologie Pédiatrique, Brussels, Belgium
| | - Etienne Sokal
- UClouvain, Clinical and Experimental Research Institute and Cliniques Universitaires Saint Luc, Service de Gastroentérologie Hépatologie Pédiatrique, Brussels, Belgium
| | - James E Squires
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Ekkehard Sturm
- Pediatric Gastroenterology and Hepatology, University Hospital Tübingen, Tübingen, Germany
| | - Henkjan Verkade
- Pediatric Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Deirdre A Kelly
- Liver Unit, Birmingham Women's and Children's Hospital, Birmingham, United Kingdom
- University of Birmingham, Birmingham, United Kingdom
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Zhao S, Zhang Z, Si Z, Dong C, Sun C, Wang K, Zhang W, Zheng W, Wei X, Gao W, Shen Z. Impact of different ischemia times on biliary stricture after living donor liver transplantation with biliary atresia. Liver Transpl 2023. [PMID: 36748552 DOI: 10.1097/LVT.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/04/2023] [Indexed: 02/08/2023]
Abstract
Biliary atresia (BA) is the most common indication for pediatric liver transplantation, and biliary stricture (BS) remains an Achilles' heel for pediatric living donor liver transplantation (LDLT). We investigated the impact of different ischemia times on BS after LDLT in patients with BA. We retrospectively analyzed patients (<18 y) with BA who underwent LDLT between January 2016 and December 2020. Cases with hepatic artery thrombosis, bile leakage, early BS (<2 wk), and early death (<3 mo) were excluded. In all, 572 cases were included. A total of 26 cases (4.55%, 26/572) developed BS: 25 patients with anastomotic stricture and 1 patient with anastomotic stricture combined with left hepatic duct stricture. In addition, the time to diagnosis of BS ranged from 1.8 to 53.0 months (mean, 13.0 mo and median, 8.2 mo) after transplantation. A multivariate logistic regression analysis showed that arterial ischemia time (AIT), per 10 minutes (OR=1.222, 95% CI: 1.007-1.438, p =0.04) was the only independent risk factor for the development of BS after LDLT in patients with BA. What is more, the 5-year cumulative risk of BS between the AIT ≥40 minutes and AIT <40 minutes groups was 2.79% versus 10.57%. AIT was the only independent risk factor for the development of BS after LDLT with BA, and AIT ≥40 minutes would increase the 5-year cumulative risk of BS in our study. A shorter AIT, especially AIT <40 minutes, should be kept to decrease BS.
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3
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Marra P, Bonaffini PA, Ippolito D, Sironi S. Developments in diagnosis and management of post-liver transplantation biliary complications: the radiologist's perspective. Hepatobiliary Surg Nutr 2022; 11:457-461. [PMID: 35693400 PMCID: PMC9186186 DOI: 10.21037/hbsn-22-141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 08/30/2023]
Affiliation(s)
- Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy
- Department of Diagnostic Radiology, San Gerardo Hospital, Monza, Italy
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- School of Medicine, University of Milano-Bicocca, Milan, Italy
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Dulcetta L, Marra P, Carbone FS, Bonaffini PA, Sallemi C, Sansotta N, Colledan M, D'Antiga L, Sironi S. Biliary complications in pediatric liver transplantation: findings of percutaneous transhepatic cholangiography in a large single-center cohort. Pediatr Radiol 2022; 52:1061-1074. [PMID: 35107594 DOI: 10.1007/s00247-021-05278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/09/2021] [Accepted: 12/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although biliary complications after orthotopic liver transplantation represent a common source of morbidity and mortality, decreasing graft survival, consensus is lacking on their management in the pediatric population. OBJECTIVE The aim of this study was to present the prevalence of such biliary complications and their interventional radiologic management with representative images. MATERIALS AND METHODS This retrospective study reports our experience with percutaneous transhepatic cholangiography in the management of biliary complications after orthotopic liver transplantation in pediatric patients. This study enrolled all pediatric patients (<18 years old) who underwent percutaneous transhepatic cholangiography for the management of biliary complications after orthotopic liver transplantation at a tertiary care center between January 2010 and December 2020. Diagnosis of biliary complications and indication to perform percutaneous transhepatic cholangiography were based on clinical, laboratory or radiologic data. RESULTS Among the 301 orthotopic liver transplantations, 78 (26%) developed biliary complications that were managed by interventional radiology: these included 52 (17.3%) biliary strictures, 19 (6.3%) bile leaks, 5 (1.7%) biliary stones, 1 (0.3%) iatrogenic biliary obstruction and 1 (0.3%) vanishing syndrome. The median time interval between orthotopic liver transplantation and the diagnosis of biliary complications was 6.0 years (interquartile range [IQR] 8.2 years). Percutaneous transhepatic cholangiography and biliary duct catheterization were successful in all cases, with low rates of complications that were variable among subgroups. CONCLUSION A wide spectrum of biliary complications can occur after pediatric orthotopic liver transplantation. In this large single-center experience, we highlight the value of percutaneous transhepatic cholangiography in their diagnosis and management. Percutaneous treatments in pediatric patients are safe and effective, providing resolution or serving as a bridge to surgery, including re-transplantation.
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Affiliation(s)
- Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy. .,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy
| | - Naire Sansotta
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Colledan
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo D'Antiga
- Department of Paediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127, Bergamo, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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5
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Marra P, Carbone FS, Dulcetta L, Bonaffini PA, Muglia R, D'Antiga L, Sironi S. A New Biodegradable Stent to Improve the Management of Biliary Strictures in Pediatric Split Liver Transplantation. Cardiovasc Intervent Radiol 2022. [PMID: 35199216 DOI: 10.1007/s00270-022-03083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/07/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Cholestasis due to benign biliary strictures is the most common biliary complication after pediatric split liver transplantation (SLT), decreasing graft survival, but consensus about its management lacks. Percutaneous transhepatic cholangiography, bilioplasty and internal-external biliary drainage (IEBD) are standard treatments. The aim of this report is to present the preliminary experience with a new biodegradable biliary stent in the management of post-SLT biliary strictures. MATERIALS AND METHODS Between September 2020 and April 2021, SLT patients with a single anastomotic benign biliary stricture underwent percutaneous transhepatic implantation of an innovative 10F helical-shaped biodegradable biliary stent, featuring a slow degradation profile, in addition to the standard treatment with bilioplasty and IEBD. The device is unique and the first to be CE-marked for the use in this indication. RESULTS Six pediatric patients (4 males; median age 8.6 years, interquartile range 3.7 years) underwent percutaneous stent implantation, without complications nor clinical cholestasis during a median follow-up of 271 days (IQR 120.25). Stent dislodgement occurred in one case. CONCLUSION Preliminary data suggest that implantation of a new biodegradable biliary stent may be considered in the management of post-SLT cholestasis in pediatric patients. Some technical tips are useful during implantation. This device may prolong biliary drainage, potentially relieving the discomfort of long-term IEBD.
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Yan KL, Gomes AS, Monteleone PA, Venick RS, McDiarmid SV, Vargas JH, Farmer DG. Management of Biliary Stricture in Pediatric Liver Transplantation Patients: Long-Term Outcomes. Liver Transpl 2021; 27:1788-1798. [PMID: 33977642 DOI: 10.1002/lt.26095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 01/13/2023]
Abstract
Postoperative biliary complications have been reported to occur in 10% to 33% of pediatric liver transplantation (LT) recipients. Percutaneous intervention has become the primary treatment method for these complications; however, the efficacy and outcomes of these patients have not been well studied. Institutional pediatric LT from 1998 to 2019 were retrospectively reviewed to determine the patients referred for percutaneous treatment of post-LT biliary strictures. Clinical parameters, percutaneous transhepatic cholangiograms (PTCs), biliary catheter placement, cholangioplasty, and long-term outcomes were analyzed. Of the 396 consecutive pediatric LT recipients during our study period, 50 (12.6%) were diagnosed with biliary strictures on PTC. LT biliary reconstructions were Roux-en-Y hepaticojejunostomy in 28 patients (56%), choledochojejunostomy in 11 patients (22%), and choledochocholedochostomy in 11 patients (22%). Median age at LT was 23.2 months (interquartile range [IQR], 10.9-90.6), and 14 patients (28%) developed hepatic artery thrombosis. A total of 44 patients (88%) were treated with internal/external biliary catheters, of whom 38 (76%) underwent balloon cholangioplasty. By 12 months, 84% of patients had complete stricture resolution and catheter removal. Median total duration of catheter drainage was 152 days (IQR, 76-308). A total of 8 patients required additional surgery (biliary reconstruction or repeat LT [re-LT]) or died with a drainage catheter in place from complications unrelated to PTC intervention. Among the 6 patients (12%) treated with unilateral external biliary drainage catheters, 2 had catheters removed for inadequate drainage but then had spontaneous biliary obstruction resolution, 1 underwent duct reconstruction, and 3 required long-term catheterization. Biliary strictures following pediatric LT can be successfully treated with internal/external biliary drainage catheters and cholangioplasty if the stricture can be crossed. However, patients with isolated strictured ducts may require long-term external catheter drainage until re-LT or percutaneous obliteration of isolated ducts.
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Affiliation(s)
- Kimberly L Yan
- School of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Antoinette S Gomes
- School of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles
| | - Phillip A Monteleone
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles
| | - Robert S Venick
- Department of Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Sue V McDiarmid
- Department of Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Jorge H Vargas
- Department of Pediatric Gastroenterology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
| | - Douglas G Farmer
- Department of Surgery, Liver Transplantation, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA
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Sansotta N, De Luca E, Nicastro E, Tebaldi A, Ferrari A, D’Antiga L. Incidence of Cholangitis and Sepsis Associated with Percutaneous Transhepatic Cholangiography in Pediatric Liver Transplant Recipients. Antibiotics (Basel) 2021; 10:antibiotics10030282. [PMID: 33801816 PMCID: PMC8001276 DOI: 10.3390/antibiotics10030282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background. Percutaneous transhepatic cholangiography (PTC) is an established treatment in the management of biliary strictures. The aim of our study was to determine the incidence of PTC-related infectious complications in transplanted children, and identify their precise aetiol-ogy. Methods. We retrospectively reviewed all PTC performed from January 2017 to October 2020 in our center. Before the procedure, all patients received antibiotic prophylaxis defined as first line, while second line was used in case of previously microbiological isolation. Cholangitis was defined as fever (>38.5°) and elevated inflammatory markers after PTC, while sepsis included hemodynamic instability in addition to cholangitis. Results. One hundred and fifty-seven PTCs from 50 pediatric recipients were included. The overall incidence of cholangitis and sepsis after PTC was 44.6% (70/157) and 3.2% (5/157), respectively, with no fatal events. Blood cultures yielded positive results in 15/70 cases (21.4%). Enterococcus faecium and Pseudomonas aeruginosa were the most common isolated pathogens. Multidrug-resistant (MDR) pathogens were found in 11/50 patients (22%). Conclusion. PTC is associated with a relatively high rate of post-procedural cholangitis, although with low rate of sepsis and no fatal events. Blood cultures allowed to find a precise aetiology in roughly a quarter of the cases, showing prevalence of Enterococcus faecium and Pseudomonas aeruginosa.
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Affiliation(s)
- Naire Sansotta
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.N.); (L.D.)
- Correspondence:
| | - Ester De Luca
- Department of Pediatrics, University of Milano Bicocca, 20126 Milan, Italy;
| | - Emanuele Nicastro
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.N.); (L.D.)
| | - Alessandra Tebaldi
- Infectious Diseases Unit, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Alberto Ferrari
- FROM Research Foundation, Statistics, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Lorenzo D’Antiga
- Paediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy; (E.N.); (L.D.)
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Fatima N, Sheikh N, Satoskar AR, Akhtar T, Tayyeb A, Ashfaq I, Ryan N, Ambreen S, Jha BK, Oghumu S. Effect of Short-Term Tacrolimus Exposure on Rat Liver: An Insight into Serum Antioxidant Status, Liver Lipid Peroxidation, and Inflammation. Mediators Inflamm 2021; 2021:6613786. [PMID: 33679236 DOI: 10.1155/2021/6613786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
Tacrolimus (TAC) is an immunosuppressive drug, optimally used for liver, kidney, and heart transplant to avoid immune rejection. In retrospect, a multitude of studies have reported effects of TAC, such as nephrotoxicity, diabetes, and other complications. However, limited information is available regarding short-term exposure of TAC on the liver. Therefore, the present study was designed to unravel the effects of short-term exposure of TAC on a rat model. The animal model was established by TAC administration for 6, 12, 24, and 48 h time points. Liver histopathological changes were observed with PAS-D, reticulin stain, and immunostaining of PCNA and CK-7 coupled with glycogen quantification in a liver homogenate. TUNEL assay was performed to evaluate the DNA damage in the liver. Concentration of GSH and activities of SOD and CAT in the serum were measured to assess the antioxidant status, whereas liver tissue MDA level was measured as a biomarker of oxidative stress. Hepatic gene expression analysis of IL-10, IL-13, SOCS-2, and SOCS-3 was performed by RT-PCR. Results revealed marked changes in liver architecture of all TAC-treated groups, as evidenced by sinusoid dilation, hepatocyte derangement, glycogen deposition, and collapsed reticulin fibers. Significant increase in PCNA and CK-7 immunostaining along with the presence of TUNEL-positive cells was revealed in treatment groups as compared to the control group. Serum antioxidant enzyme status was markedly decreased, whereas the liver MDA level was increased in TAC treatment groups indicating oxidative stress induction. The gene expression profile of cytokines was significantly upregulated in treatment groups highlighting an inflammatory response. In conclusion, results of the current study propose that even a short-term TAC exposure can induce change in antioxidant status and lipid peroxidation. Therefore, these factors should be considered to avoid and minimize immunosuppression-related issues in a prolonged course of treatment.
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