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Bagheri Lankarani K, Honarvar B, Shafi Pour F, Bagherpour M, Erjaee A, Rouhezamin MR, Khorrami M, Amiri Zadeh Fard S, Seifi V, Geramizadeh B, Salahi H, Nikeghbalian S, Shamsaeefar A, Malek-Hosseini SA, Shirzadi S. Predictors of Death in the Liver Transplantation Adult Candidates: An Artificial Neural Networks and Support Vector Machine Hybrid-Based Cohort Study. J Biomed Phys Eng 2022; 12:591-598. [PMID: 36569570 PMCID: PMC9759643 DOI: 10.31661/jbpe.v0i0.2010-1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/24/2020] [Accepted: 12/13/2020] [Indexed: 06/17/2023]
Abstract
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.
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Affiliation(s)
- Kamran Bagheri Lankarani
- MD, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Honarvar
- MD, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farshad Shafi Pour
- PhD, Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Morteza Bagherpour
- PhD, Department of Industrial Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Asma Erjaee
- MD, Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Rouhezamin
- MD, Trauma Research Center, Rajaei Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojdeh Khorrami
- MD, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Amiri Zadeh Fard
- MD, Department of Internal Medicine, Gastroenterology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Seifi
- MD, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- MD, Department of Pathology, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Heshmatollah Salahi
- MD, Shiraz Organ Transplant Center, Shiraz University of Medical Sciences Shiraz, Iran
| | - Saman Nikeghbalian
- MD, Shiraz Organ Transplant Center, Shiraz University of Medical Sciences Shiraz, Iran
| | - Alireza Shamsaeefar
- MD, Shiraz Organ Transplant Center, Shiraz University of Medical Sciences Shiraz, Iran
| | | | - Saeedreza Shirzadi
- MD, Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- MD, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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2
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Rasekhi A, Gholami Z, Azizi M, Malek-Hosseini SA, Salahi H. Percutaneous Transhepatic Radiologic Intervention of Biliary Complications following Liver Transplantation: A Single-center Experience. Int J Organ Transplant Med 2022; 13:38-47. [PMID: 37641736 PMCID: PMC10460528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background Biliary complications are the leading cause of morbidity and mortality in patients undergo¬ing Liver Transplantation (LT). Post-biliary transplantation strictures (BSs) are a severe problem with a high risk of graft failure. However, management of these BSs has remained controversial, and consid¬erable variability has been reported in Percutaneous Transhepatic Radiological Interventions (PTRIs) related to broad differences in technical procedures. Objective This study aimed to evaluate the efficacy of percutaneous treatments in managing post-LT BSs in a center in Shiraz. Methods PTRIs including balloon dilatation, metallic stent, and internal or internal-external hand-made plastic stent insertion were done for 34 transplanted patients with BSs referring to the Interventional Radiology Unit of Shiraz Namazi Hospital. Technical success rate, patency rates, and complications were evaluated. Results The. In this study, 31 strictures were successfully treated without any significant difference between the anastomotic and non-anastomotic types of stricture (success rate: 91.2%). Based on the results, 12- , 24-, and 36-month primary patency rates were 90.1%, 84.5%, and 76.8%, respectively. The secondary patency rate was 100% at 12 and 24 months and 93.3% at 36 and 60 months. The rate of minor complica¬tions (mild cholangitis and hemobilia) was 6.4%, and no major complications were detected. Conclusion According to the findings, PTRI is an effective method for treating anastomotic and non-anas- tomotic strictures with a high success rate and low complications.
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Affiliation(s)
- A Rasekhi
- Medical Imaging Research Center, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z Gholami
- Medical Imaging Research Center, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Azizi
- Gastroenterology-Hepatology Research Center, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S A Malek-Hosseini
- Abu Ali Sina Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Salahi
- Abu Ali Sina Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
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3
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Hossein Aghdaie M, Azarpira N, Shamsaeefar A, Motazedian N, Kaviani M, Esfandiari E, Golbabapour S, Nikeghbalian S, Kazemi K, Salahi H, Malek-Hosseini SA, Geramizadeh B. Effects of Different Cold Preservation Solutions on the Functions of Cultured Isolated Human Hepatocytes. Int J Organ Transplant Med 2020; 11:15-25. [PMID: 33324474 PMCID: PMC7724769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hepatocyte transplantation using isolated human hepatocytes is an alternative source that can be used for the treatment of metabolic diseases and acute liver failure as a time bridge to liver transplantation. These cells can also be used for bioartificial liver systems and in vitro study of drug toxicity. OBJECTIVE To determine which cold preservation solution is better maintain the liver function. METHODS We prepared 4 cold preservation solutions made of different combination of antioxidants, chelating, membrane protective, and anti-apoptotic agents as well as inhibitor of cyclophilin D. For hepatocyte isolation, we used livers obtained from unused deceased donor livers and the liver of patients with Crigler-Najjar syndrome who were candidates of partial liver transplantation. After culture and cold preservation, the level of albumin, and urea production were measured as indices of liver functionality. RESULTS We found that albumin production significantly decreased after cold preservation in solution 1. There was no significant difference in urea production after cold preservation in solution 1 compared with control 24 h. No significant differences in albumin production were found after cold storage in solution 2 and solution 4 compared with control 24 h. Urea production significantly decreased after cold storage in solutions 2 and 4 compared with control 24 h. As a whole albumin and urea production were significantly decreased after cold preservation. Although albumin and urea production were decreased after cold preservation, but the results of albumin production of two solutions were not significantly different from that of the control group (p=0.109 and 0.951). CONCLUSION Cold preservation of cultured human hepatocytes in solution 2 and solution 4 could maintain the function of albumin production better than other cold preservation solutions in our experiments; solution 1 was more effective on urea production of cultured human hepatocytes at 4 °C for 24 h. To determine if these hepatocytes are suitable candidates for transplantation, further studies should be performed.
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Affiliation(s)
| | - N. Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences
| | - A. Shamsaeefar
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences
| | - N. Motazedian
- Transplant Research Center, Shiraz University of Medical Sciences
| | - M. Kaviani
- Transplant Research Center, Shiraz University of Medical Sciences
| | - E. Esfandiari
- Transplant Research Center, Shiraz University of Medical Sciences
| | - S. Golbabapour
- Transplant Research Center, Shiraz University of Medical Sciences
| | - S. Nikeghbalian
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences
| | - K. Kazemi
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences
| | - H. Salahi
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences
| | | | - B. Geramizadeh
- Transplant Research Center, Shiraz University of Medical Sciences,Department of Pathology, Shiraz University of Medical Sciences
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Eshraghian A, Nikeghbalian S, Dehghani M, Shamsaeefar A, Kazemi K, Nikoopour H, Eghlimi H, Gholami S, Salahi H, Malek-Hosseini SA. Nonalcoholic Steatohepatitis Is the Most Rapidly Growing Indication for Liver Transplantation in Iranian Patients. EXP CLIN TRANSPLANT 2019; 20:487-494. [DOI: 10.6002/ect.2019.0205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hossein Aghdaie M, Azarpira N, Esfandiari E, Kaviani M, Golbabapour S, Shamsaeefar A, Kazemi K, Dehghani M, Bahador A, Salahi H, Nikeghbalian S, Malek-Hosseini SA, Geramizadeh B. The Effects of Cold Preservation Solutions Supplemented with UDCA and α-Lipoic Acid on the Viability and Function of Isolated Human Hepatocytes. Int J Organ Transplant Med 2019; 10:108-113. [PMID: 31497273 PMCID: PMC6716222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Liver transplantation is the only treatment for end-stage and genetic liver diseases. The main burden of this treatment is the shortage of both living and cadaveric liver donors. An alternative treatment is using liver cell transplantation, which can be obtained from unused livers for transplantation. These hepatocytes should be kept ready in viable and functional situation in a frozen state to be instantly used when they would be needed. In our previous experience, we had isolated hepatocytes from unused livers. OBJECTIVE To find a preserving solution for increasing viability and function of the isolated hepatocytes that are stored to be transplanted. METHODS 9 cadaveric donor livers, which were not used for transplantation due to various causes such as severe steatosis, were selected to isolate hepatocytes. Various cold storage solutions were tried to find the best temperature for more viability and functionality for preservation of hepatocytes. University of Wisconsin (UW) solution and Williams E media were used as control media. 2 anti-apoptotic and anti-oxidative solutions, i.e., α-lipoic acid and ursodeoxycholic acid (UDCA), were used as cold preservatives solutions. The numbers of viable hepatocytes were estimated by trypan blue method; the functionality was assessed by the cells ability to produce urea. RESULTS The highest number of viable and functional hepatocytes was obtained from freshly isolated cells. However, after preservation, the number of these viable hepatocytes and their functionality were not significantly different in cold storage solutions comparing to the control media used. Functionality of the isolated hepatocytes stored in UW with and without UCDA solution was similar to freshly isolated hepatocytes. CONCLUSION Preservatives with anti-apoptotic and antioxidant activity could not increase the number of viable hepatocytes. Functionality of cold storing hepatocytes could be preserved similar to freshly isolated hepatocytes by UW solution with and without UCDA.
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Affiliation(s)
| | - N. Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences;
| | - E. Esfandiari
- Transplant Research Center, Shiraz University of Medical Sciences;
| | - M. Kaviani
- Transplant Research Center, Shiraz University of Medical Sciences;
| | - S. Golbabapour
- Transplant Research Center, Shiraz University of Medical Sciences;
| | - A. Shamsaeefar
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences;
| | - K. Kazemi
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences;
| | - M. Dehghani
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences;
| | - A. Bahador
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences;
| | - H. Salahi
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences;
| | - S. Nikeghbalian
- Department of Hepatobiliary Surgery, Shiraz University of Medical Sciences;
| | | | - B. Geramizadeh
- Transplant Research Center, Shiraz University of Medical Sciences;
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Eshraghian A, Nikeghbalian S, Kazemi K, Mansoorian M, Shamsaeefar A, Eghlimi H, Gholami S, Salahi H, Malek-Hosseini SA. Portal vein thrombosis in patients with liver cirrhosis and its impact on early and long-term outcomes after liver transplantation. Int J Clin Pract 2018; 73:e13309. [PMID: 30592793 DOI: 10.1111/ijcp.13309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/12/2018] [Revised: 12/25/2018] [Accepted: 12/26/2018] [Indexed: 12/15/2022] Open
Abstract
AIM Portal vein thrombosis (PVT) is a common complication amongst patients with liver cirrhosis. The PVT risk factors and its impact on post liver transplant outcome has not been well defined, yet. This study aimed to investigate PVT prevalence, its risk factors and influence on early and long-term outcomes after liver transplantation. METHODS Adult (>18 years) patients with liver cirrhosis undergoing liver transplantation between March 2013 to March 2015 were included. Presence or absence of PVT was recorded at transplant. PVT risk factors in patients with liver cirrhosis and its impact on early and long-term outcomes were analysed. RESULTS Portal vein thrombosis was diagnosed in 174 patients (17.3%). Large oesophageal varices (grade II and III vs grade I) (OR: 2.5; 95% CI: 1.46-4.26; P = 0.001), diabetes mellitus before transplantation (OR: 2.03; 95% CI: 1.13-3.64; P = 0.017) and cryptogenic-NASH (OR: 1.36; 95% CI: 1.08-1.72; P = 0.008) as a cause of underlying liver disease were the independent risk factors for PVT. PVT (OR: 2.05; 95% CI: 1.10-3.81; P = 0.023) was an independent predictor of early (within 90 days) posttransplant mortality, but did not influence long-term survival. CONCLUSION Portal vein thrombosis prevalence is high in pretransplant period. NASH related cirrhosis and diabetes mellitus might be risk factors for PVT. More intense screening of these patients for PVT is warranted.
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Affiliation(s)
- Ahad Eshraghian
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Nikeghbalian
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Kazemi
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsenreza Mansoorian
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hesameddin Eghlimi
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Siavash Gholami
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Heshmatollah Salahi
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Malek-Hosseini
- Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran
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7
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Malek-Hosseini SA, Jafarian A, Nikeghbalian S, Poustchi H, Lankarani KB, Nasiri Toosi M, Salahi H, Dehghani M, Eshraghian A, Sharafkhah M, Eghtesad S, Motamed-Gorji N, Kazemi K, Salimi J, Moini M, Shamsaeefar A, Moini M, Dehghani M, B Khosravi M, Najafi A, Sattari H, Geramizadeh B, Shafiee M, Toutouni MN, Sanei B, Nejatollahi SM, Taghavi A, Bahador A, Aliakbarian M, Eghtesad B, Malekzadeh R. Liver Transplantation Status in Iran: A Multi-center Report on the Main Transplant Indicators and Survival Rates. Arch Iran Med 2018; 21:275-282. [PMID: 30041524 DOI: pmid/30041524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Iran's experience with liver transplantation (LT) began more than two decades ago. The purpose of this article is to present the status of LT in Iran, review specific characteristics of the programs, their outcomes, and their growth to become one of the largest LT programs in the world. METHODS A questionnaire, asking for data on the number of transplants performed and specifics of the recipients and type of donors with focus on indications and outcomes was sent to LT programs. RESULTS During a period of 23 years, 4,485 LTs were performed at 6 centers in the country. Of these, 4106 were from deceased donors and 379 were from living donors. There were 3553 adults and 932 pediatric recipients. Hepatitis B and biliary atresia were the most common etiologies in adult and pediatric patients, respectively. Overall survival rates at 1, 5, and 10 years were 85%, 77%, and 71% for adults and 76%, 67% and 56% for pediatric patients, respectively. CONCLUSION Approval of the brain death law in Iran and coordinated efforts by the transplant centers to build comprehensive LT programs has resulted in the ability to procure more than 700 deceased donors per year with acceptable long-term survival.
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Affiliation(s)
- S Ali Malek-Hosseini
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Jafarian
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saman Nikeghbalian
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran B Lankarani
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Nasiri Toosi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Heshmatollah Salahi
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Dehghani
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahad Eshraghian
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sharafkhah
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Eghtesad
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazgol Motamed-Gorji
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Kazemi
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Salimi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Moini
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Shamsaeefar
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Moini
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masoud Dehghani
- Transplant Program, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad B Khosravi
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atabak Najafi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Sattari
- Transplant Program, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Shafiee
- Transplant Program, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad N Toutouni
- Transplant Program, Department of Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behnam Sanei
- Liver Transplant and Hepatobiliary and Pancreatic Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Mohammadreza Nejatollahi
- The Division of Hepatobiliary and Organ Transplantation, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Taghavi
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Bahador
- Shiraz Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Aliakbarian
- Transplant Program, Department of Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bijan Eghtesad
- Hepatobiliary/Liver Transplant Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Reza Malekzadeh
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Massoumi SJ, Mazloom Z, Rezaianzadeh A, Nikeghbalian S, Malek-Hosseini SA, Salahi H. GW27-e0163 One - year cohort study about changes in fasting blood sugar and incidence of diabetes mellitus after liver transplantation. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.07.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Masoumi SJ, Mazloom Z, Rezaianzadeh A, Nikeghbalian S, Malek-Hosseini SA, Salahi H. Prevalence of Metabolic Syndrome in Liver Transplant Recipients in Iran. Int J Organ Transplant Med 2016; 7:85-90. [PMID: 28435640 PMCID: PMC5396055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetSx) is common among liver transplant recipients. It contributes to morbidity and mortality. OBJECTIVE To determine the prevalence of MetSx in patients undergoing liver transplantation (LTx) in Iran. METHODS 202 liver transplant recipients of both sexes completed this study. Relevant information including age, sex, the underlying disease, systolic and diastolic blood pressure, waist circumference, fasting serum levels of blood sugar (FBS), triglyceride (TG), and HDL-cholesterol were measured. The prevalence of MetSx was evaluated at 1, 3, 6, 9, and 12 months after LTx. RESULTS The prevalence of MetSx was 36.6% after 1 month that decreased to 28.2% after 12 months of follow-up. The lowest prevalence of MetSx (27.7%) was observed 9 months after LTx. Our data showed a decrease in TG and an increase in HDL-C level and no significant changes in blood pressure, waist circumference and FBS during the study period. CONCLUSION The prevalence of MetSx after LTx is high when compared to the normal population. It seems that a change in diet after transplantation may affect the prevalence of MetSx.
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Affiliation(s)
- S. J. Masoumi
- School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Nutrition and Food Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z. Mazloom
- School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Nutrition and Food Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Zohreh Mazloom, PhD, School of Nutrition and Food Sciences, Shiraz, University of Medical Sciences, Shiraz, Iran, Tel/Fax: +98-71-3725-7288, E-mail:
| | - A. Rezaianzadeh
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. Nikeghbalian
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S. A. Malek-Hosseini
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Salahi
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Mansoorian M, Kazemi K, Nikeghbalian S, Shamsaeefar A, Mokhtari M, Dehghani SM, Bahador A, Salahi H, Amoozgar H, Malek Hosseini SA. Liver transplantation as a definitive treatment for familial hypercholesterolemia: A series of 36 cases. Pediatr Transplant 2015. [PMID: 26215798 DOI: 10.1111/petr.12562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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] [Indexed: 02/05/2023]
Abstract
FH is a genetic disorder characterized by an increase in serum LDL and total cholesterol values. The afflicted patients are at increased risk of premature atherosclerosis and myocardial infarction. Different treatment modalities are present, including pharmacological agents and surgical procedures. The most effective method of therapy in refractive cases is liver transplantation. Herein, we report our experience on 36 cases of patients with FH undergoing liver transplantation in our center, the main referral center of liver transplantation in Iran. The clinical findings, hospital courses, post-operative complications, and patient follow-up are also described.
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Affiliation(s)
- Mohsenreza Mansoorian
- Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kourosh Kazemi
- Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Nikeghbalian
- Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohsen Dehghani
- Pediatric Gastroenterology and Hepatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Bahador
- Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Heshmatollah Salahi
- Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Cardiac and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Ali Malek Hosseini
- Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Geramizadeh B, Yazdanpanah S, Salahi H, Marzban M. Adrenal cystic lymphangioma presented with hypertension: a case report. Nephrourol Mon 2015; 7:e27049. [PMID: 26034745 PMCID: PMC4450163 DOI: 10.5812/numonthly.7(3)2015.27049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/16/2015] [Accepted: 02/11/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction: Adrenal cystic lymphangioma is a rare benign tumor, which is nearly always asymptomatic and incidentally discovered during routine imaging work-ups or investigating other pathologies. Case Report: A 43-year-old female presented hypertension, which during routine work-up of her newly diagnosed hypertension an adrenal mass was discovered and after operation the pathologic diagnosis was lymphangioma of adrenal. Conclusions: In evaluation of adrenal masses cystic lymphangioma should be considered as a differential diagnosis.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Bita Geramizadeh, Department of Pathology, Medical School, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7136473238, E-mail:
| | | | - Heshmatollah Salahi
- Department of Surgery and Transplant, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Mahsa Marzban
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
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12
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Geramizadeh B, Nikeghbalian S, Kazemi K, Shamsaifar A, Bahador A, Salahi H, Malekhosseini SA, Kashtkar Jahromi M, Bakhshai Dehkordi A. Hepatocellular carcinoma in explanted livers of patients with genotype d HBV cirrhosis: report of the first experience from Iran. Arch Iran Med 2014; 16:348-50. [PMID: 23725068 DOI: 013166/aim.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study was conducted to determine the impact of hepatitis B virus (HBV) as a cause of hepatocellular carcinoma (HCC) in a single liver transplant center in Iran. METHODS We included all hepatectomy specimens from patients with HBV-related cirrhosis who underwent transplants from May 1993 until January 2012 in this study. From these, we determined the number that had HBV-induced HCC. Nested PCR results were used to determine the HBV genotype from sections of the hepatectomy pathology specimens. RESULTS During this time period there were 1361 cirrhotic livers transplanted in our center. Of these, 249 were attributed to HBV cirrhosis. Overall, HCC was detected in 40 (2.9%) subjects, of which 29 (1.2%) had HBV-related HCC. Genotype D was only genotype observed in all HBV subjects. CONCLUSIONS The results revealed that although HBV-related cirrhosis was the most frequent single cause for liver transplant, the frequency of HBV-induced HCC was very low among transplant recipients. Out of 1361 transplant recipients, only 29 (2.1%) were diagnosed with HBV-related HCC. All HBV subjects had genotype D.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.
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13
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Nikeghbalian S, Toutouni MN, Salahi H, Aliakbarian M, Malekhosseini SA. A comparative study of the classic and piggyback techniques for orthotopic liver transplantation. Electron Physician 2014; 6:741-6. [PMID: 25763139 PMCID: PMC4324279 DOI: 10.14661/2014.741-746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/02/2013] [Accepted: 12/22/2013] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Saman Nikeghbalian
- Assistant Professor, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Naser Toutouni
- Fellowship of Visceral Transplantation, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Heshmatollah Salahi
- Professor, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Aliakbarian
- Assistant Professor, Unit of Surgical Oncology Research, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Malekhosseini
- Professor, Unit of Visceral Transplantation, Department of Surgery, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Firoozifar M, Khosravi MB, Ghafari S, Sahmeddini MA, Eghbal H, Salahi H, Bahador A, Nikeghbalian S, Kazemi K, Shamsaeefar AR, Gholami S, Farhadi E, Shahnazi MA, Malek-Hosseini SA. Shiraz guideline for the management of patients with brain death. Int J Organ Transplant Med 2014; 5:34-7. [PMID: 25013676 PMCID: PMC4089328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - M. B. Khosravi
- Correspondence: Mohammad Bagher Khosravi, MD, Assistant Professor of Anesthesiology, Shiraz Organ Transplant Center, Namazi Hospital, Shiraz, Iran. E-mail:
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15
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Geramizadeh B, Nikeghbalian S, Dehghani SM, Bahador A, Salahi H, Malekhosseini S. Primary Involvement of Allografted liver in Post-Transplant Lymphoproliferative Disorders, Report of Two Pediatric Cases and Review of the Literature. Iran Red Crescent Med J 2013; 14:719-21. [PMID: 23396650 PMCID: PMC3560542 DOI: 10.5812/ircmj.1134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 08/21/2011] [Accepted: 09/19/2011] [Indexed: 02/05/2023]
Abstract
Post-transplant lymphoproliferative disorder is a lymphocyte proliferating disease, usually of B cell origin, and rarely of T cell. Involvement of liver itself in liver transplant recipients as the primary organ is not common. Herein we report our experience in two patients who primarily presented in the allografted liver, both of whom were promptly diagnosed after liver biopsy and treated successfully .Now after a few months; both of the patients are alive with normal liver function tests and negative imaging studies.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
- Corresponding author: Bita Geramizadeh, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98-711-6474331, Fax: E-mail:
| | - Sama Nikeghbalian
- Department of Hepatobiliary Surgery, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Bahador
- Department of Pediatric Surgery, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Heshmatollah Salahi
- Department of Surgery, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedali Malekhosseini
- Department of Surgery, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Hosseinzadeh M, Shokripur M, Salahi H. Primary pure squamous cell carcinoma of gallbladder presenting as acute cholecystitis. Iran J Med Sci 2012; 37:271-3. [PMID: 23390334 PMCID: PMC3565201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 03/06/2012] [Accepted: 04/08/2012] [Indexed: 11/02/2022]
Abstract
Squamous cell carcinoma of the gallbladder is rare and constitutes only 0.5-3% of all malignancies of this organ. Most of the reported cases have had a component of adenocarcinoma. We report a 70-year-old man who presented with acute onset right upper quadrant pain. He operated on based on a presumptive diagnosis of acute cholecystitis according to clinical and ultrasonographic findings. Histopathological examination of the infiltrating mass of the gallbladder revealed well differentiated keratinized squamous cell carcinoma invading full wall thickness. Thorough evaluations revealed no other primary site for the tumor. Pure primary squamous cell carcinoma of the gallbladder is rarely reported. Clinicians and pathologists must be aware of its vague clinical presentations.
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Affiliation(s)
- Massood Hosseinzadeh
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansureh Shokripur
- Department of Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Heshmatollah Salahi
- Department of Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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17
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Dehghani SM, Bahador A, Nikeghbalian S, Salahi H, Geramizadeh B, Malekpour A, Malek-Hosseini SA. Liver transplant in a case of arthrogryposis-renal tubular dysfunction-cholestasis syndrome with severe intractable pruritus. EXP CLIN TRANSPLANT 2012. [PMID: 23190456 DOI: 10.6002/ect.2012.0202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Arthrogryposis-renal tubular dysfunction-cholestasis syndrome (MIM No. 208085) is a rare multisystem disorder involving the liver, kidney, skin, and central nervous and musculoskeletal systems. The syndrome is an autosomal-recessive trait, associated with germ-line mutations in the VPS33B gene. We report an Iranian boy of consanguineous cousin parents who had congenital deformities of the upper and lower extremities, severe ichthyosis, cholestasis, intractable pruritus, metabolic acidosis, and failure to thrive. Owing to cholestasis, severe intractable pruritus, and poor quality of life, he underwent a living-related liver transplant from his mother, and his ichthyosis and pruritus dramatically improved. To the best of our knowledge, this is a first case of someone with arthrogryposis-renal tubular dysfunction-cholestasis syndrome who underwent a liver transplant and is in good condition more than 5 years after surgery.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Shiraz Transplant Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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18
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Lankarani KB, Mahmoodi M, Gholami S, Mehravar S, Malekhosseini SA, Heydari ST, Zarei E, Salahi H, Nikeghbalian S, Taghavi SA, Janghorban P, Ghaffarpasand F. Reducing Social Disparity in Liver Transplantation Utilization through Governmental Financial Support. Hepat Mon 2012; 12:e6463. [PMID: 23300495 PMCID: PMC3539062 DOI: 10.5812/hepatmon.6463] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 05/25/2012] [Accepted: 06/15/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND A high proportion of patients suffering from end stage liver disease are from low socioeconomic classes , which limits their access to liver transplantation as the most effctive treatment of this condition because of cost barrier. OBJECTIVES one of the most challenging aspects of liver transplantation is its affordability and utilization by those who need it the most. PATIENTS AND METHODS Since November 2005, Iran Ministry of Health had covered 100% of the costs of in-patient liver transplantation care. To determine the effects of this policy, patterns of utilization of liver transplantation were compared before and after implementation of the policy. Group one included 112 and group two included 120 individuals who received transplantation before (from early January 2003 to November 2005) and after (from November 2005 to the end of December 2007) the legislation entered into the effect, respectively. Socioeconomic characteristics of these patients were evaluated by data collected about house and car ownership, education level, employment status, and place of residence. RESULTS Coverage of the costs allowed more illiterate and semiliterate people (P = 0.032) as well as more unemployed or unskilled workers to receive transplantation (P = 0.021). The number of transplantations also increased in children and geriatric age group. This legislation also led to greater countrywide regional coverage of indigent patients. CONCLUSIONS This survey provides evidence that coverage of the costs by Ministry of Health was effective in reducing social discrimination in utilization of liver transplantation, and narrowed the gap between low and high socioeconomic classes in Iranian society.
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Affiliation(s)
- Kamran B. Lankarani
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Kamran B. Lankarani, Health Policy Research Center, Building No 2, Eighth Floor, School of Medicine, Zand Blvd., Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel.: +98-7112309615, Fax: +98-7112309615, E-mail:
| | - Mojtaba Mahmoodi
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Siavash Gholami
- Shiraz Organ Transplantation Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Soheila Mehravar
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Sayed Taghi Heydari
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Elham Zarei
- Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Heshmatollah Salahi
- Shiraz Organ Transplantation Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Saman Nikeghbalian
- Shiraz Organ Transplantation Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | | | - Parisa Janghorban
- Shiraz Organ Transplantation Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Nikeghbalian S, Aliakbarian M, Kazemi K, Shamsaee far A, Salehipour M, Bahreini A, Mehdi SH, Salahi H, Bahador A, Malekhosseini SA. Clinical Experience in Organ Transplant From The Shiraz Transplant Center: 2011. EXP CLIN TRANSPLANT 2012; 10:307-9. [DOI: 10.6002/ect.2012.0121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Rajaeefard AR, Almasi-Hashiani A, Hassanzade J, Salahi H. Graft survival rate following renal transplantation in diabetic patients. Saudi J Kidney Dis Transpl 2012; 23:707-14. [PMID: 22805381 DOI: 10.4103/1319-2442.98143] [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: 11/04/2022] Open
Abstract
Diabetic nephropathy is the most common cause of kidney failure needing dialysis in most countries of the world. Kidney disease occurs in one-third of diabetic patients, and significantly increases the mortality rates and treatment costs. The aim of the present study was to investigate the survival rate and to determine factors that influence survival among diabetic patients who underwent transplantation at the Shiraz Namazi Hospital Transplant Center during the years 1999 to 2009. This study is a historical cohort study, which examined the graft survival rate among 103 kidney transplant patients with diabetes. The Kaplan-Meier method was used to determine the survival rate and the log-rank test was used to compare survival curves; P-value of less than 0.05 was considered significant. The mean follow-up period of patients was 48.15 ± 31.05 months (range: 3.07-118.03 months), and the estimated nine-year graft survival rate was 84.2% (±0.045). Based on the results of the Cox regression model, age of the donor was a contributing factor to graft survival rate. In summary, the graft survival rate in our cohort is satisfactory and comparable with reports from other larger centers in the world.
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Affiliation(s)
- A R Rajaeefard
- Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
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21
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Salehipour M, Bahador A, Nikeghbalian S, Kazemi K, Shamsaeifar AR, Ghaffaripour S, Sahmeddini MA, Salahi H, Bahreini A, Janghorban P, Gholami S, Malek-Hosseini SA. En-bloc Transplantation: an Eligible Technique for Unilateral Dual Kidney Transplantation. Int J Organ Transplant Med 2012; 3:111-4. [PMID: 25013633 PMCID: PMC4089291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Kidney transplantation is the best available treatment for patients with end-stage renal disease. OBJECTIVE To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). METHODS From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively. RESULTS Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2-6 months of post-operation follow up. CONCLUSION Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time.
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Affiliation(s)
- M. Salehipour
- Correspondence: Mehdi Salehipour MD, Associate Professor of Urology and Kidney Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran, Tel: +98-711-647-4308, Fax: +98-711-647-4307, E-Mail:
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Zahmatkeshan M, Geramizadeh B, Eshraghian A, Nikeghbalian S, Bahador A, Salahi H, Malek-Hosseini SA. De novo fatty liver due to vascular complications after liver transplantation. Transplant Proc 2011; 43:615-7. [PMID: 21440778 DOI: 10.1016/j.transproceed.2011.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The incidence, risk factors, and natural history of de novo nonalcoholic fatty liver disease (NAFLD) after liver transplantation have not been well described. In this report we examined the risk factors and demographic characteristics of 3 patients. MATERIALS AND METHODS During a 16-year period, we performed 900 liver transplantations. We reviewed donor and recipient liver biopsies to identify patients who developed de novo fatty liver following liver transplantation, recording the pretransplantation and posttransplantation blood sugar values and lipid profiles as well as body mass indices (BMI) of affected patients. RESULTS Three patients developed de novo fatty liver after transplantation. The primary liver diseases among these patients were as follows: Crigler-Najjar syndrome, biliary atresia, and tyrosinemia. All of the patients who developed NAFLD were children. None of them had obesity; all had normal blood sugar values and lipid profiles (triglyceride cholesterol) at the time of and after the operation. Two patients received liver allografts from living related donors and 1 from a deceased donor. The BMI, lipid profile, and blood sugars of all donors were normal. Preoperative donor liver biopsy specimens showed normal histological findings with no evidence of a fatty liver, but the postoperative liver biopsy in recipients specimens revealed steatosis and fatty liver (20%-40% fat). Portal vein thrombosis and hepatic artery thrombosis were observed in the patients using color Doppler sonography. CONCLUSION De novo NAFLD after liver transplantation occurred less frequently than noted in previous reports. All 3 patients experienced complicated courses. Portal vein thrombosis and hepatic artery thrombosis seemed to be important factors for development of de novo fatty liver after transplantation.
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Affiliation(s)
- M Zahmatkeshan
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
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23
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Hassanzadeh J, Hashiani AA, Rajaeefard A, Salahi H, Khedmati E, Kakaei F, Nikeghbalian S, Malek-Hossein A. Long-term survival of living donor renal transplants: A single center study. Indian J Nephrol 2011; 20:179-84. [PMID: 21206678 PMCID: PMC3008945 DOI: 10.4103/0971-4065.73439] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Kidney transplantation is the treatment of choice for end-stage renal disease. The aim of this study was to determine the ten-year graft survival rate of renal transplantation in patients who have been transplanted from live donors. This is a historical cohort study designed to determine the organ survival rate after kidney transplantation from live donor during a 10-year period (from March 1999 to March 2009) on 843 patients receiving kidney transplant in the transplantation center of Namazi hospital in Shiraz, Iran. Kaplan-Meier method was used to determine the survival rate, log-rank test was used to compare survival curves, and Cox proportional hazard model was used to multivariate analysis. Mean follow-up was 53.07 ± 34.61 months. Allograft survival rates at 1, 3, 5, 7, and 10 years were 98.3, 96.4, 92.5, 90.8, and 89.2%, respectively. Using Cox proportional hazard model, the age and gender of the donors along with the creatinine level of the patients at discharge were shown to have a significant influence on survival. The 10-year graft survival rate of renal transplantation from living donor in this center is 89.2%, and graft survival rate in our cohort is satisfactory and comparable with reports from large centers in the world.
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Affiliation(s)
- J Hassanzadeh
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
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24
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Almasi-Hashiani A, Rajaeefard AR, Hassanzade J, Salahi H, Nikeghbalian S, Janghorban P, Malek-Hosseini SA. Graft survival rate of renal transplantation: a single center experience, (1999-2009). Iran Red Crescent Med J 2011; 13:392-7. [PMID: 22737500 PMCID: PMC3371934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/29/2010] [Indexed: 10/26/2022]
Abstract
BACKGROUND Renal transplantation is the best option for treatment of the end-stage renal diseases and has more advantages than dialysis. The objective of this study is to determine the ten-year graft survival rate of renal transplantation and its associated factors in patients who have been transplanted from March 1999 to March 2009 in Nemazee Hospital Transplantation Center. METHODS This is a historical cohort study of 1356 renal transplantation carried out during 1999 to 2009. Kaplan-Meier method was used to determine the survival rate, log rank test to compare survival curves, and Cox regression model to determine hazard ratios and for modeling of variables affecting survival. RESULTS The 1, 3, 5, 7 and 10 years graft survival rates were 96.6, 93.7, 88.9, 87.1 and 85.5 percent, respectively.Cox regression model revealed that the donor source and creatinine level at discharge were effective factors in graft survival rate in renal transplantation. CONCLUSION Our study showed that 10 year graft survival rate for renal transplantation in Nemazee Hospital Transplantation Center was 85.5% and graft survival rate was significantly related to recipients and donor's age,donor source and creatinine level at discharge. Our experience in renal transplantation survival rate indicates asuccess rate comparable to those noted in other reports.
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Affiliation(s)
- A Almasi-Hashiani
- Department of public Health, School of health, Arak University of Medical Sciences, Arak, Iran
| | - A R Rajaeefard
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Abdolreza Rajaeefard, PhD, Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98-711-7251009, Fax: +98-711-7260225, E-mail:
| | - J Hassanzade
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Salahi
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Nikeghbalian
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P Janghorban
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S A Malek-Hosseini
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Salahi R, Dehghani SM, Salahi H, Bahador A, Abbasy HR, Salahi F. Liver abscess in children: a 10-year single centre experience. Saudi J Gastroenterol 2011; 17:199-202. [PMID: 21546724 PMCID: PMC3122091 DOI: 10.4103/1319-3767.80384] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Accepted: 09/02/2010] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIM Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries. MATERIALS AND METHODS The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients' records retrospectively. RESULTS There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscess were immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later taken for open drainage, with an overall mortality rate of 5.5%. CONCLUSION The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to cases reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries.
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Affiliation(s)
- Roohollah Salahi
- Trauma Research Center, Iran, Shiraz, Sciences Medical of University Shiraz, Center Archrese, Shiraz, Iran
| | | | | | | | - Hamid R. Abbasy
- Trauma Research Center, Iran, Shiraz, Sciences Medical of University Shiraz, Center Archrese, Shiraz, Iran
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Salehipour M, Roozbeh J, Eshraghian A, Nikeghbalian S, Salahi H, Bahador A, Malek-hosseini SA. Postrenal transplant urinary leakage caused by segmental infarction of a renal allograft treated by partial nephrectomy. EXP CLIN TRANSPLANT 2011; 9:153-155. [PMID: 21453236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Kidney transplant is the final treatment for patients with end-stage renal disease. Urinary leakage is the most-common surgical complication early after transplant. Another complication in the early posttransplant period is segmental allograft infarction. We report a kidney recipient who developed urinary leakage secondary to a segmental infarction of the upper pole of the transplanted kidney 2 months after transplant. The patient was treated successfully by a partial nephrectomy of the infracted upper lobe of the kidney. Three months after the partial nephrectomy of the allograft, serum blood urea nitrogen and creatinine were normal, and the patient was able to partake in her daily activities. Partial nephrectomy in the context of infarction of a kidney allograft is safe and can be used in similar cases.
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Affiliation(s)
- Mehdi Salehipour
- Organ Transplant Center, Shiraz University of Medical Science, Shiraz, Fras, Iran
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27
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Nemayandeh M, Yaghobi R, Geramizadeh B, Ayatollahi M, Malek-Hosseini SA, Nikeghbalian S, Salahi H, Bahador A, Karimi MH. Hematologic and biochemical indices and viral hepatitis in liver transplant patients. Transplant Proc 2011; 43:612-4. [PMID: 21440777 DOI: 10.1016/j.transproceed.2011.01.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE OF STUDY The pathogenic role of important hepatotropic viral agents to induce hepatic dysfunction and failure may lead to the need for liver transplantation. We focused on the use of hematologic and biochemical laboratory diagnostic indexes to follow the clinical impact of hepatitis B virus (HBV); hepatitis C virus (HCV); and hepatitis G virus-related liver complications in transplant patients. MATERIALS AND METHODS We collected 141 EDTA-treated blood samples pre- and post-liver transplantation for 2 years among 67 transplant patients. We evaluated the statistical relationships between hematologic and biochemical indices with HBV, HCV, and HGV infections among transplant recipient samples using version 15 of SPSS software. RESULTS HBV polymerase chain reaction (PCR) positivity significantly correlated with partial thromboplastin (P=.011) pretransplant, with creatinine (P=.026) and Na (P=.034) levels at 1-week posttransplant, and also with alkaline phosphatase (P=.027) and mean corpuscular hemoglobin concentration (P=.050) at 2 weeks posttransplantation. Significant correlations were detected between HCV-reverse transcriptase (RT)-PCR-positive results and blood urea nitrogen (P=.008) and Na (P=.021) levels in the first aspartate aminotransferase and with (P=.025) in the second week after liver transplantation. Also, significant relationships were noted between HGV-RT-PCR-positive results and alkaline phosphatase (P=.05) and creatinine (P=.002) levels in the first and second weeks after liver transplant, respectively. CONCLUSION Detection of significant correlations between HBV, HCV, and HGV infections with laboratory indices suggested that monitoring hematologic and biochemical liver function-related criteria aid the management of clinical complications of viral hepatitis in liver transplant patients.
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Affiliation(s)
- M Nemayandeh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz, Iran
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28
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Geramizadeh B, Malek-Hosseini SA, Bahador A, Salahi H, Nikeghbalian S, Sharifian M, Lankarani KB, Imanieh MH, Dehghani M. Post-transplantation lymphoproliferative disorder after liver transplantation: report of 5 cases among more than 550 liver transplants in Iran. Arch Iran Med 2011; 13:417-9. [PMID: 20804309 DOI: 010135/aim.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Post-transplantation lymphoproliferative disorders (PTLD) are a spectrum of diseases defined as polyclonal or monoclonal proliferations of lymphocytes which occur after solid organ transplants. In this study, we report our first experiences with PTLD following liver transplantation in Iran. METHODS We retrospectively analyzed five cases of PTLD which followed liver transplantation among more than 550 liver transplants in our center. Of these, three were pediatric cases and two were adults. The underlying causes were tyrosinemia, autoimmune hepatitis, and progressive familial intrahepatic cholestasis (PFIC) in the three pediatric cases. HCV hepatitis was the primary cause for cirrhosis in one of the adults and the other adult was labeled as cryptogenic cirrhosis. All cases, except for one, developed PTLD during the first year following liver transplantation. RESULTS Patients were diagnosed as PTLD, B-cell, MALT and Hodgkin-like (according to the WHO classification of PTLD). The three pediatric patients died despite discontinuation of immunosuppressive drugs and chemotherapy. Fortunately both adult patients, until now, are still alive. CONCLUSION The incidence of PTLD in our center is lower than previous reports from other centers (0.9%), with a 60% mortality rate and worse prognosis in the pediatric age group.
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Affiliation(s)
- Bita Geramizadeh
- Transplant Center, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Hassanzadeh J, Hashiani AA, Rajaeefard A, Salahi H, Khedmati E, Kakaei F. Authors' reply. Indian J Nephrol 2011; 21:138. [PMID: 21769183 PMCID: PMC3132340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- J. Hassanzadeh
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A. A. Hashiani
- Faculty of Health, Arak University of Medical Sciences, Arak, Iran,Address for correspondence: Mr. Amir Almasi Hashiani, School of Health, Arak University of Medical Sciences, Arak, Iran. E-mail:
| | - A. Rajaeefard
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Salahi
- Shiraz Organ Transplantation Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - E. Khedmati
- Department of Social Welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - F. Kakaei
- Department of Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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30
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Azarpira N, Geramizadeh B, Nikeghbalian S, Bahador A, Yaghobi R, Karimi H, Ayatolahi M, Aghdai MH, Salahi H, Malek-Hosseini SA, Roozbeh J, Sagheb M, Raisjalali GH, Behzadi A. Endothelial Nitric Oxide Synthase Gene T-786C Polymorphism in Renal Transplant Recipients. Int J Organ Transplant Med 2011; 2:87-92. [PMID: 25013599 PMCID: PMC4089251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nitric oxide (NO) is a major mediator in vascular biology, regulating regional blood flow. NO and the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functional polymorphism in the promoter region substantially reduces promoter activity of the endothelial nitric oxide synthase (eNOS) gene and compromises endothelial NO synthesis. OBJECTIVE To examine the association between T-786C (rs 2070744) single nucleotide polymorphism (SNP) in eNOS gene and the development of acute rejection in renal transplant patients. METHODS 60 renal transplant recipients (30 with episodes of acute rejection (ARs) and 30 without rejection (non-ARs)), between June 2008 and March 2010, were included in this study. The polymorphism was determined by PCR-restriction fragment-length polymorphism analysis. RESULTS The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% in ARs and non-ARs, respectively (p=0.28). The frequency of T-allele was 76.7% and 66.3%; and for C-allele was 66.6% and 33.3% in ARs and non-ARs, respectively (p=0.09). There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection. CONCLUSION We could not detect any significant association between polymorphism in T-786C of eNOS gene and the development of acute rejection.
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Affiliation(s)
- N. Azarpira
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran
| | - B. Geramizadeh
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran
| | - S. Nikeghbalian
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran,Organ Transplant Center, Shiraz , University of Medical Sciences, Shiraz, Iran
| | - A. Bahador
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran
| | - R. Yaghobi
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran
| | - H. Karimi
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran
| | - M. Ayatolahi
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran
| | - M. H. Aghdai
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran
| | - H. Salahi
- Organ Transplant Center, Shiraz , University of Medical Sciences, Shiraz, Iran
| | - S. A. Malek-Hosseini
- Shiraz Transplant Research Center, University of Medical Sciences, Shiraz, Iran,Organ Transplant Center, Shiraz , University of Medical Sciences, Shiraz, Iran
| | - J. Roozbeh
- Organ Transplant Center, Shiraz , University of Medical Sciences, Shiraz, Iran
| | - M. Sagheb
- Organ Transplant Center, Shiraz , University of Medical Sciences, Shiraz, Iran
| | - G. H. Raisjalali
- Organ Transplant Center, Shiraz , University of Medical Sciences, Shiraz, Iran
| | - A. Behzadi
- Organ Transplant Center, Shiraz , University of Medical Sciences, Shiraz, Iran
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31
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Yaghobi R, Geramizadeh B, Zamani S, Rahsaz M, Azarpira N, Karimi MH, Ayatolahi M, Hossein Aghdai M, Nikeghbalian S, Bahador A, Salahi H, Malek-Hosseini SA. The molecular and antigenic tissue impact of viral infections on liver transplant patients with neonatal hepatitis. Int J Organ Transplant Med 2011; 2:108-15. [PMID: 25013603 PMCID: PMC4089257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Pathogenesis of neonatal hepatitis relates to various underlying causes including viral infections. Both hepatotropic and non-hepatotropic viruses may induce liver failures in infants before birth, during delivery, or shortly after birth. OBJECTIVES The tissue impact of HCMV, HSV, HBV, HCV, and rotavirus and adenovirus infections was evaluated in studied infants with neonatal hepatitis. METHODS The history of viral infections was analyzed in paraffin-embedded biopsy and autopsy tissues of 22 infants with neonatal hepatitis between years 1996 and 2007, retrospectively. The tissue molecular presentation of HBV, HCV, HCMV, HSV, adenovirus, and rotavirus was evaluated by different qualitative simple and nested PCR and RT-PCR protocols. Immunohistochemistry (IHC) method was used for studying the antigenic prevalence of HSV-1, 2; HBV, HCMV and adenovirus infections. Also the laboratory liver indices of all patients with neonatal hepatitis were analyzed. RESULTS The HBV and HSV genomes were detected in 3 (14%) of 22 infants. The rotavirus and HCV-RNA and also the HCMV-DNA were detected separately in 1 (4%) of 26 paraffin-embedded autopsy and biopsy tissues. The HBV and HSV-1 specific antigens were separately diagnosed in 1 (4%) of 26 neonatal samples by IHC protocols. Also the HSV-2 antigen was seen in 5 (23%) of 22 liver autopsy and biopsy specimens. Co-infections with HCMV, HSV, HBV, HCV, and rotavirus were detected in these infants with hepatitis. CONCLUSION Diagnosis of single and mixed molecular and antigenic traces of HCMV, HSV, HBV, HCV and rotavirus underlines the etiologic role of these viruses in clinical pathogenesis of neonatal hepatitis.
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Affiliation(s)
- R. Yaghobi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,,Correspondence: Ramin Yaghobi, PhD, Shiraz Transplant Research Center, Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
Tel: +98-711-647-6331
Fax: +98-711-647-6331
E-mail:
| | - B. Geramizadeh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - S. Zamani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - M. Rahsaz
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - N. Azarpira
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - M. H. Karimi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - M. Ayatolahi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - M. Hossein Aghdai
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - S. Nikeghbalian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,,Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - A. Bahador
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - H. Salahi
- Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - S. A. Malek-Hosseini
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,,Organ Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Geramizadeh B, Safari A, Bahador A, Nikeghbalian S, Salahi H, Kazemi K, Dehghani SM, Malek-Hosseini SA. Hepatic angiosarcoma of childhood: a case report and review of literature. J Pediatr Surg 2011; 46:e9-11. [PMID: 21238632 DOI: 10.1016/j.jpedsurg.2010.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 08/26/2010] [Accepted: 09/04/2010] [Indexed: 02/05/2023]
Abstract
Angiosarcomas are rare tumors that predominantly affect adults. Hepatic angiosarcoma in a child is an extremely rare event and is associated with a poor prognosis. Herein, we report our experience in a case of hepatic angiosarcoma in a child who presented with a huge unresectable mass that underwent liver transplantation.
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33
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Roozbeh J, Eshraghian A, Raeesjalali G, Behzadi S, Nikeghbalian S, Sagheb MM, Salehipour M, Bahador A, Salahi H, Malekhosseini SA. Outcomes of kidney transplantation in patients with systemic lupus erythematosus: a single-center study. Iran J Kidney Dis 2011; 5:53-56. [PMID: 21189436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 09/21/2010] [Indexed: 05/30/2023]
Abstract
INTRODUCTION. This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus (SLE) and a matched control group of non-SLE kidney recipients. MATERIALS AND METHODS. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. RESULTS. In each group, 12 patients (36.4%) received a kidney from a deceased donor, 15 (45.4%) from a living unrelated donor, and 6 (18.2%) from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 ± 18.1 days in the SLE group, while it was 13.0 ± 7.3 days in the controls (P = .006). One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients (P = .17). One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls (P = .26). Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications (P = .59). CONCLUSIONS. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys.
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Affiliation(s)
- Jamshid Roozbeh
- Shiraz Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Iran
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Davari HR, Malek-Hosseini SA, Salahi H, Bahador A, Nikeghbalian S, Nemati MH, Sanjarian MA, Khosravi MB, Shahbazi S, Saberfiruzi M, Dehghani SM, Kazemi K. Liver transplantation and aortic valve replacement. Int J Organ Transplant Med 2011; 2:32-6. [PMID: 25013592 PMCID: PMC4089243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Surgical procedures involving heart and liver are rare and have been limited to either combined heart and liver transplantation or coronary artery bypass graft surgery (CABG) or aortic valve surgery and orthotopic liver transplantation (OLT). Aortic valve replacement (AVR) and pulmonary valve vegetectomy for bacterial endocarditis after OLT have also been reported. There are only five cases with aortic stenosis and cirrhosis reported to have combined AVR and liver transplantation. In the presence of cirrhosis, AVR has a significant risk for mortality because of bleeding from coagulopathy, renal failure, infection, and poor post-operative wound healing. Herein, we report on a case and management analysis of combined sequential AVR, and OLT in a 40-year-old cirrhotic man with Child and MELD score of C and 29, respectively. Echocardiography detected severe aortic insufficiency (AI) with enlarged left ventricle. Due to severe AI, the cardiologist recommended AVR prior to transplantation. The patient underwent metallic AVR. 4 months later, he received OLT. Both operations were successful and uneventful. Prioritizing AVR before OLT was successful in this patient. However, each patient must be evaluated individually and multiple factors should be assessed in pre-operation evaluation.
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Honar N, Imanieh MH, Haghighat M, Dehghani SM, Zahmatkeshan M, Geramizadeh B, Badiee P, Nikeghbalian S, Kazemi K, Bahador A, Salahi H, Malek-Hosseini SA. Evaluation of Candida infection after six months of transplantation in pediatric liver recipients in iran. Int J Organ Transplant Med 2011; 2:105-7. [PMID: 25013602 PMCID: PMC4089262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is the standard treatment of end-stage liver diseases (ESLD). Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. OBJECTIVE To determine the incidence of late-onset (after 6 months of LT) Candida infection in recipients. METHODS A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. RESULTS One recipient (2%) developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder (PTLD). CONCLUSIONS The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications.
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Affiliation(s)
- N. Honar
- Gastroenterohepatology Research Center,
| | - M. H. Imanieh
- Gastroenterohepatology Research Center,,Shiraz Transplant Research Center
| | | | - S. M. Dehghani
- Gastroenterohepatology Research Center,,Shiraz Transplant Research Center,Correspondence: Seyed Mohsen Dehghani, MD, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
E-mail:
| | | | | | - P. Badiee
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Honar N, Imanieh MH, Dehghani SM, Haghighat M, Geramizadeh B, Yaghobi R, Alborzi A, Ziaeian M, Kazemi K, Nikeghbalian S, Bahador A, Salahi H, Malek Hosseini SA. Evaluation of cytomegalovirus infection after six months of liver transplantation in children in shiraz, southern iran. Int J Organ Transplant Med 2011; 2:20-4. [PMID: 25013590 PMCID: PMC4089245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Liver transplantation (LT) is a life-saving treatment for end-stage liver diseases (ESLD). Cytomegalovirus (CMV) infection is one of the important causes of morbidity after LT. OBJECTIVE To evaluate the incidence of late-onset (after 6 months of LT) CMV infection in pediatric recipients. METHODS A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. RESULTS Three recipients (6%) developed late-onset CMV infection. These patients finally responded to ganciclovir. CONCLUSION CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children.
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Affiliation(s)
- N. Honar
- Gastroenterohepatology Research Center,
| | - M. H. Imanieh
- Gastroenterohepatology Research Center, ,Shiraz Transplant Research Center,
| | - S. M. Dehghani
- Gastroenterohepatology Research Center, ,Shiraz Transplant Research Center, ,Correspondence: Seyed Mohsen Dehghani, MD,
Associate Professor of Pediatric Gastroenterology,
Shiraz Transplant Research Center, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences,
Shiraz, 71937-11351, Iran. Tel: +98 711 626 1775 Fax: +98 711 647 4298 E-mail:
| | | | | | | | - A. Alborzi
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M. Ziaeian
- Clinical Microbiology Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Malek-Hosseini SA, Baezzat SR, Shamsaie A, Geramizadeh B, Salahi R, Salahi H, Lotfi M. Huge immature teratoma of the liver in an adult: a case report and review of the literature. Clin J Gastroenterol 2010; 3:332-6. [PMID: 26190492 DOI: 10.1007/s12328-010-0183-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [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: 07/06/2010] [Accepted: 10/01/2010] [Indexed: 12/16/2022]
Abstract
Teratoma tumors are tumors of childhood and, to the best of our knowledge, only 9 cases of hepatic teratoma and 1 case of immature teratoma of the liver had been reported in adults in the English literature. We present the second case of immature liver teratoma in a 22-year-old woman who presented with a 4-month history of abdominal pain and fullness sensation. A computed tomography (CT) scan of the abdomen and pelvis showed a huge well-defined heterogeneous mass in the right lobe of the liver containing fat, calcification, and cystic and solid parts, all suggestive of a teratoma. A right hepatectomy and an omentectomy were performed. The pathology report showed a 27 cm mass composed of ectodermal, mesodermal and endodermal components with minimal atypia and foci of immature components suggestive of immature teratoma, which is the largest liver teratoma to be reported. The patient was discharged in good health. During 8 months of follow-up, a CT scan and α-fetoprotein levels were both normal, and the patient is still alive.
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Affiliation(s)
| | - Saeed Reza Baezzat
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaie
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roohollah Salahi
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Heshmatollah Salahi
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Hashiani AA, Rajaeefard A, Hasanzadeh J, Kakaei F, Behbahan AG, Nikeghbalian S, Salahi H, Bahador A, Salehipour M, Malek-Hosseini SA. Ten-year graft survival of deceased-donor kidney transplantation: a single-center experience. Ren Fail 2010; 32:440-7. [PMID: 20446781 DOI: 10.3109/08860221003650347] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Kidney transplantation is the treatment of choice for end-stage renal disease that restores the patients' quality of life and reduces the morbidity and mortality rates induced by renal failure and its complications. However, after transplantation the organ and patient survival rates are important issues of interest in many centers worldwide. SUBJECTS AND METHODS This is a historical cohort study planned to determine the organ survival rate after kidney transplantation from deceased donor during a period of 10 years (March 1999-March 2009) in Shiraz Transplant Center, Namazi Hospital, Shiraz, Iran. We tried to clarify the probable contributory risk factors implicating in graft loss. Kaplan-Meier method was used to determine the survival rate. Log-rank test was used to compare survival curves, and Cox regression model to define the hazard ratio and for modeling of factors implicating in survival rate. RESULTS Mean follow-up period was 37.54 +/- 28.6 months. Allograft survival rates at 1, 3, 5, and 9 years after kidney transplantation from deceased donor (calculated by Kaplan-Meier method) was found to be 93.7, 89.1, 82.1, and 80.1%, respectively. Duration of dialysis before operation and creatinine level at discharge were showed to be the most important factors influencing survival rate of renal allograft. CONCLUSION Overall long-term graft survival in our cohort is satisfactory and comparable with reports from large centers in the world. Duration of dialysis before operation and creatinine level at discharge are the only independent factors that could correlate with long-term graft survival in our cohort.
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Salehipour M, Salahi H, Fathikalajahi A, Mohammadian R, Emadmarvasti V, Bahador A, Nikeghbalian S, Kazemi K, Dehghani M, Malek-Hosseini SA. Is perioperative intravesically applied antibiotic solution effective in the prophylaxis of urinary tract infections after renal transplantation? Urol Int 2010; 85:66-9. [PMID: 20299778 DOI: 10.1159/000296303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 12/22/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the efficacy of intravesically applied amikacin for the prophylaxis of urinary tract infections (UTIs) occurring in the first 3 months after kidney transplantation. METHODS In a prospective, randomized, controlled trial, 200 consecutive renal transplant recipients were randomly divided into two equal groups. The bladders of the first group, the amikacin group, were filled with saline solution containing amikacin (1 g in adults and 30 mg/kg in pediatric patients) whereas the bladders of the patients of the second group, the control group, were filled with saline solution. Patients were followed up for 3 months after transplantation with urine cultures to evaluate the prevalence of posttransplantation UTIs in both groups. RESULTS The overall incidence of UTIs was found to be significantly lower in the amikacin group (25 vs. 49%; p = 0.0007). In addition, male patients, patients with end-stage renal disease due to glomerulonephritis, patients receiving renal transplantation for the first time, or those from the amikacin group receiving a living-related graft had a significantly lower incidence of UTIs than their counterparts in the control group (p < 0.05). UTIs were most frequently caused by Escherichia coli (28.9%). CONCLUSIONS Perioperative bladder irrigation with amikacin solution significantly decreases the overall incidence of UTIs in the first 3 months after kidney transplantation.
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Affiliation(s)
- Mehdi Salehipour
- Shiraz Organ Transplantation Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. salehipour @ sums.ac.ir
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Dehghani SM, Haghighat M, Imanieh MH, Zahmatkeshan M, Borzooei M, Amoozegar H, Zamirian M, Gholami S, Bahador A, Nikeghbalian S, Salahi H, Malek-Hosseini SA. Tacrolimus related hypertrophic cardiomyopathy in liver transplant recipients. ARCHIVES OF IRANIAN MEDICINE 2010; 13:116-9. [PMID: 20187665 DOI: pmid/20187665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently there are a number of reports on the cardiotoxicity of tacrolimus in post-transplant patients. There is no protocol for cardiovascular evaluation in these patients. This study was performed to evaluate the cardiotoxicity of tacrolimus in liver transplant recipients. METHODS We evaluated 63 post-liver transplant patients who received tacrolimus. They were evaluated for cardiovascular complications by physical examination, electrocardiographic and echocardiographic examinations within three and six months following liver transplantation. Serum tacrolimus levels were checked by ELISA. For comparison, we selected 50 post-liver transplant patients who received no tacrolimus and evaluated them for cardiovascular function identically. RESULTS Among 63 patients, 42 were male (66.7%) and 21 were female (33.3%); 70% of the patients were adults, and 19 (30%) were within the pediatric age group. The cardiovascular examinations, electrocardiogram and echocardiography of all patients three months post-transplantation were normal except for two children who developed tacrolimus related cardiac complications. Both had high serum tacrolimus levels. No adults developed cardiovascular complications. In the control group, the results of the cardiovascular evaluations were normal in all cases. CONCLUSION The cardiovascular toxicity of tacrolimus, such as hypertrophic cardiomyopathy, may be observed in pediatric patients. Therefore, we recommend routine regular cardiovascular evaluation of children after liver transplantation.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Shiraz Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Kakaei F, Nikeghbalian S, Kazemi K, Salahi H, Bahador A, Dehghani SM, Dehghani M, Nejatollahi SM, Shamsaeefar A, Khosravi MB, Malek-Hosseini SA. Liver transplantation for homozygous familial hypercholesterolemia: two case reports. Transplant Proc 2010; 41:2939-41. [PMID: 19765481 DOI: 10.1016/j.transproceed.2009.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Homozygous familial hypercholesterolemia (HFHC) is a rare inherited condition with an incidence of one in one million. It is associated with severe premature atherosclerosis and early death from cardiovascular complications. Mutation in the gene that encodes the synthesis of the cellular receptor for low-density lipoprotein (LDL) is responsible for this metabolic disorder. Currently, the only effective treatment for this disease is liver transplantation, which alone or in association with medications, normalizes plasma cholesterol level. The authors report the results of liver transplantation for two cases of HFHC. The first case, a 15-year-old boy received a whole liver from a deceased donor, and the second, an 11-year-old boy, received a left liver lobe transplant from his mother's sister. Their preoperative fasting lipid concentrations were grossly raised. The older boy had severe atherosclerotic heart disease and had undergone coronary artery bypass grafting 5 months before transplantation. Both had preoperative plasma cholesterol levels higher than 750 mg/dL with normal thyroid and liver function tests. After the operation, the patients received methylprednisolone as pulse therapy followed by oral prednisolone, mycophenolate mofetil, and tacrolimus for immunosuppression. Their hospital stays were 24 and 13 days, respectively. The first case needed reexploration because of bleeding on the second day after the operation. The lipid concentrations rapidly returned to the normal range in the first week after the operation, remaining in this range over the first 6 months of follow-up. Liver transplantation offers an highly effective treatment for HFHC. It is better to operate on patients before severe atherosclerotic changes in the coronary arteries. All patients must undergo a complete cardiac evaluation before surgery.
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Affiliation(s)
- F Kakaei
- Shiraz Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Nikeghbalian S, Mardani P, Mansoorian MR, Salahi H, Bahador A, Geramizadeh B, Kakaei F, Johari HG, Malekhosseini SA. The effect of ischemic preconditioning of the pancreas on severity of ischemia/reperfusion-induced pancreatitis after a long period of ischemia in the rat. Transplant Proc 2010; 41:2743-6. [PMID: 19765423 DOI: 10.1016/j.transproceed.2009.07.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The role of ischemia/reperfusion injury in the pathogenesis of acute pancreatitis is still ill-defined. It is accepted, however, that ischemia/reperfusion induces the development of postimplantation pancreatitis that is responsible for considerable morbidity. Preconditioning by brief exposure to ischemia protects the organ against damage evoked by subsequent severe ischemia. This study was undertaken to examine whether two brief ischemic periods protect the pancreas against severe ischemia/reperfusion-induced pancreatitis. MATERIALS AND METHODS This study was performed on 30 rats in three groups. The first group (control) underwent a laparatomy without clamping of any artery. The second group underwent 30-minute clamping of the inferior splenic artery followed by 1-hour reperfusion of the pancreas, and the third group underwent clamping of inferior splenic artery (2 x 5 minutes with 5-minute interval) as ischemic preconditioning and then 30-minute clamping of inferior splenic artery followed by 1-hour reperfusion. RESULTS Exposure to 30-minute pancreatic ischemia followed by 1-hour reperfusion led to the development of severe alterations greater than the other group that underwent ischemic preconditioning and then ischemia/reperfusion. Ischemia preconditioning applied prior to induction of pancreatitis reduced plasma lipase and interleukin-1beta concentrations as well as less histological signs of pancreatic damage. CONCLUSION We concluded that pancreatic ischemic preconditioning reduced the severity of ischemia/reperfusion-induced pancreatitis. This effect seemed to be related at least in part to the release of the proinflammatory mediator interleukin-1beta.
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Affiliation(s)
- S Nikeghbalian
- Transplantation Research Center, Shiraz University of Medical Science, Shiraz, Iran
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Geramizadeh B, Keramati P, Bahador A, Salahi H, Nikeghbalian S, Dehghani SM, Malek-Hosseini SA. Congenital hepatic fibrosis and need for liver transplantation. Int J Organ Transplant Med 2010; 1:98-100. [PMID: 25013573 PMCID: PMC4089230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Herein, we describe two patients who underwent liver transplantation with the clinical diagnosis of hepatic failure and cryptogenic cirrhosis; histopathology of the explanted hepatectomy specimen revealed congenital hepatic fibrosis. To the best of our knowledge, coexistence of hepatic failure and cirrhosis in congenital hepatic fibrosis, have not yet been reported in the English literature.
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Affiliation(s)
- B. Geramizadeh
- Transplant Research Center, Shiraz, Iran, ,Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran,,Correspondence: Bita Geramizadeh, MD, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran. PO Box: 71345-1864.
Tel/Fax: +98-711-647-4331
.
E-mail:
| | | | - A. Bahador
- Transplant Ward and Center, Nemazee Hospital, Shiraz, Iran
| | - H. Salahi
- Transplant Ward and Center, Nemazee Hospital, Shiraz, Iran
| | | | - S. M. Dehghani
- Transplant Ward and Center, Nemazee Hospital, Shiraz, Iran
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Kakaei F, Nikeghbalian S, Salahi H, Bahador A, Kazemi K, Dehghani M, Shamsaeefar A, Sanei B, Ghaffaripour S, Rajaei E, Gholami S, Malek-Hosseini SA. Liver transplantation in the presence of old portal vein thrombosis. Int J Organ Transplant Med 2010; 1:44-8. [PMID: 25013563 PMCID: PMC4089218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 08/08/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) has been mentioned as a potential obstacle to liver transplantation (LTx). OBJECTIVE To review the impact of PVT on orthotopic liver transplant (OLT) outcome. METHOD Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 (7.9%) cases had old PVT with recanalization. Data were retrospectively collected regarding the demographics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5. RESULTS The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary sclerosing cholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean±SD operation time was 7.2±1.5 hrs. The mean±SD transfusion requirement was 5.4±2.8 units of packed cells. The mean±SD duration of hospital stay in these patients was 17.7±10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular accident, despite a full anticoagulant therapy. The mean±SD follow-up period for those 28 patients discharged from hospital was 16.6±7.9 months; none of them developed relapse of PVT. The overall mortality and morbidity was 28% and 32%, respectively. There was no relapse of PVT in the other patients. CONCLUSION The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality.
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Roozbeh J, Sattarinezhad A, Afshariani R, Eshraghian A, Sagheb MM, Raeesjalali G, Behzadi S, Nikeghbalian S, Salehipour M, Salahi H, Bahador A, Malek-Hosseini SA. The effect of simvastatin on lowering panel reactive antibody titer in sensitized dialysis patients: a randomized placebo controlled clinical trial. Int J Organ Transplant Med 2010; 1:85-90. [PMID: 25013570 PMCID: PMC4089224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Patients with panel reactive antibodies (PRA) have many difficulties to find a crossmatch-negative kidney for transplantation and are at a higher risk of post-transplantation rejection. OBJECTIVE To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized patients. METHODS 82 patients with end-stage renal disease (ESRD) with a PRA ≥25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched controls receiving placebo tablets. At the end of the second and 12(th) month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplantation. Serum creatinine levels were checked at monthly intervals post-operation. RESULTS The mean±SD PRA level at the end of the second month was 36.63%±31.14% and 45.34%±24.36% in cases and controls, respectively (P=0.012). Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month. The mean±SD PRA level at the end of the 12(th) month was 24.02%±31.04% in cases and 43.15%±26.56% in controls (P=0.001). 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean±SD creatinine level 6 months after kidney transplantation was 2.05±1.14 mg/dL and 3.15±1.09 mg/dL in cases and controls consecutively (P=0.02). CONCLUSION Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes.
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Affiliation(s)
- J. Roozbeh
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.,Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - A. Sattarinezhad
- Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - R. Afshariani
- Department of Health and Nutrition, School of Health, Shiraz University of Medical Sciences.
| | - A. Eshraghian
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.,Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. ,Correspondence: Ahad Eshraghian, MD, Department of Internal Medicine, Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran
Tel: +98-711-627-6211
Fax: +98-711-627-6211
E-mail:
| | - M. M. Sagheb
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.,Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - G. Raeesjalali
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.,Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - S. Behzadi
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.,Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - S. Nikeghbalian
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
| | - M. Salehipour
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
| | - H. Salahi
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
| | - A. Bahador
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
| | - S. A. Malek-Hosseini
- Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
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Khosravi MB, Sattari H, Ghaffaripour S, Lahssaee M, Salahi H, Sahmeddini MA, Bahador A, Nikeghbalian S, Parsa S, Shokrizadeh S, Malek-Hosseini SA. Post-reperfusion Syndrome and Outcome Variables after Orthotopic Liver Transplantation. Int J Organ Transplant Med 2010; 1:115-20. [PMID: 25013576 PMCID: PMC4089235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Post-reperfusion syndrome (PRS) is an important complication during liver transplantation. OBJECTIVE We studied the occurrence and severity of PRS in patients who underwent orthotopic liver transplantation (OLT) to investigate how PRS was correlated to clinical variables and outcomes. METHODS We retrospectively recorded intra- and peri-operative data for 184 adult patients who received cadaveric OLT during a 3-year period from 2005 to 2008. Patients were divided into two groups according to the severity of PRS: Group 1 (mild or no PRS) comprised 152 patients; and group 2 (significant PRS) consisted of 32 patients. RESULTS There were no significant differences in demographic and pre-operative data between groups. Group 2 had more total blood loss than group 1 (p=0.036), especially after reperfusion (p=0.023). Group 2 required more packed red cell transfusions (p=0.005), more fresh frozen plasma (p=0.003) and more platelets (p=0.043) than group 1. Fibrinolysis was more frequent in group 2 (p=0.004). Hospital stay in group 2 was significantly longer than in group 1 (p=0.034), but the frequencies of other outcomes including infection, retransplantation, dialysis, rejection and extended donor criteria did not differ significantly between groups. CONCLUSIONS Bleeding, blood transfusion and fibrinolysis occurred more often in the group of severe PRS after reperfusion. Although postoperative complications like rejection, infection and the dialysis rate were not significantly different in the two groups, hospital stay was more prolonged in the group with severe PRS.
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Dehghani SM, Shakiba MA, Ziaeyan M, Imanieh MH, Haghighat M, Bahador A, Nikeghbalian S, Salahi H, Alborzi A, Malek-Hosseini SA. Vaccination status in pediatric liver transplant candidates. Pediatr Transplant 2009; 13:820-2. [PMID: 19413722 DOI: 10.1111/j.1399-3046.2009.01177.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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] [Indexed: 02/05/2023]
Abstract
Infection is a recognized and potentially serious complication in children following solid organ transplantation. This problem is particularly important for young children undergoing any organ transplantation who often have not completed standard childhood immunizations at the time of transplantation and who are therefore at risk for vaccine-preventable infections. To evaluate the vaccination status in liver transplant candidates, vaccination charts of 100 patients who were referred to Organ Transplant Center of Nemazee Hospital were reviewed and the vaccination status considered appropriate according to the recommendation of NIP and the patients' age. Fifty-eight percent of patients were completely vaccinated for HBV, 85% for OPV, 97% for BCG, 63% for DTP, and 58% of the patients were completely vaccinated for MMR. We concluded that the vaccination charts should be periodically reviewed and updated to prevent the vaccine-preventable disease in liver transplant candidates not only before but also after transplant. Every effort should be made to assure that candidates are immunized early in the course of their disease. Also it may be indicated to recommend a special guideline for immunization of liver transplant candidates and add other vaccines such as Haemophilus influenzae and Streptococcus pneumoniae vaccine to their vaccination program.
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Affiliation(s)
- Seyed Mohsen Dehghani
- Shiraz Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Nikeghbalian S, Nejatollahi SM, Salahi H, Bahador A, Dehghani SM, Kazemi K, Dehghani M, Kakaei F, Ghaffaripour S, Sattari H, Gholami S, Anvari E, Malek-Hosseini SA. Experience of living donor liver transplantation in Iran: a single-center report. Transplant Proc 2009; 41:2868-71. [PMID: 19765459 DOI: 10.1016/j.transproceed.2009.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Living donor liver transplantation (LDLT) has been accepted as a valuable treatment for patients with end-stage liver disease seeking to overcome the shortage of organs and the waiting list mortality. The aim of this study was to report our experience with LDLT. METHODS We retrospectively analyzed 50 LDLTs performed in our organ transplant center from January 1997 to March 2008. We reviewed the demographic data, family history, operative and hospital stay durations as well as postoperation complications among donors and recipients. We also performed a retrospective analysis of recipient chemical and biochemical data. RESULTS Among 50 patients (30 males and 20 females) of overall mean age of 7.21 +/- 5.35 who underwent LDLT (10 right lobe, 38 left lobe, and 2 left lateral segments), 47 received a liver graft from their parent, two from a brother, and one from an uncle. The most common indications for LDLT were end-stage liver disease due to Wilson's disease (16%), cryptogenic cirrhosis (16%), tyrosinemia (14%), biliary atresia (12%), autoimmune hepatitis (12%), and progressive familial intrahepatic cholestasis (12%). The mean follow-up was 16.91 +/- 23.74 months. There were 13 (26%) recipient mortalities including vascular complications; three to sepsis after bowel perforation, two from liver dysfunction, two from chronic rejection due to noncompliance, and one from diffuse aspergillosis. The morbidity rate was 50%, including 19 reexplorations during the hospital course and five biliary complications. CONCLUSION This study demonstrated that LDLT can decrease the number of patients awaiting liver transplantation especially in the pediatric group. However, because of relatively high mortality and morbidity, we must improve our treatment outcomes.
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Affiliation(s)
- S Nikeghbalian
- Department of Hepatobiliary and Transplantation Surgery, Shiraz Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Bahador A, Salahi H, Nikeghbalian S, Dehghani SM, Dehghani M, Kakaei F, Kazemi K, Rajaei E, Gholami S, Malek-Hosseini SA. Pediatric Liver Transplantation in Iran: A 9-Year Experience. Transplant Proc 2009; 41:2864-7. [PMID: 19765458 DOI: 10.1016/j.transproceed.2009.07.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A Bahador
- Department of Hepatobiliary and Transplantation Surgery, Shiraz Transplant Center, Shiraz University of Medical Sciences, Shiraz, Iran
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