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Sohrabi Nazari S, Eslamian M, Sheikhbahaei E, Zefreh H, Lashkarizadeh MM, Shamsaeefar A, Kazemi K, Nikoupour H, Nikeghbalian S, Vatankhah P. Early hepatic artery thrombosis treatments and outcomes: aorto-hepatic arterial conduit interposition or revision of anastomosis? BMC Surg 2024; 24:62. [PMID: 38368356 PMCID: PMC10874575 DOI: 10.1186/s12893-024-02359-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/14/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Hepatic artery thrombosis (HAT) is one of the critical conditions after an orthotopic liver transplant (OLT) and leads to severe problems if not corrected promptly. However, multiple treatments have been proposed for HAT, in which surgical revascularization with either auto-hepatic conduit interposition (AHCI) or revision of the anastomosis is more familiar indeed indicated for some patients and in specific situations. In this study, we want to evaluate the success and outcomes of treating early HAT (E-HAT), which defines HAT within 30 days after OLT with either of the surgical revascularization techniques. METHOD In this retrospective study, we collected information from the medical records of patients who underwent either of the surgical revascularization procedures for E-HAT after OLT. Patients who needed early retransplantation (RT) or died without surgical intervention for E-HAT were excluded. Demographic data, OLT surgery information, and data regarding E-HAT were gathered. The study outcomes were secondary management for E-HAT in case of improper inflow, biliary complications (BC), RT, and death. RESULTS A total of 37 adult patients with E-HAT after OLT included in this study. These E-HATs were diagnosed within a mean of 4.6 ± 3.6 days after OLT. Two patients had their HA revised for the initial management of E-HAT; however, it changed to AHCI intraoperatively and finally needed RT. Two and nine patients from the AHCI and revision groups had re-thrombosis (12.5% vs. 47.3%, respectively, p = 0.03). RT was used to manage rethrombosis in all patients of AHCI and two patients of the revision group (22.2%). In comparison to the AHCI, revision group had statistically insignificant higher rates of BC (47.4% vs. 31.2%); however, RT for nonvascular etiologies (12.5% vs. 5.3%) and death (12.5% vs. 10.5%) were nonsignificantly higher in AHCI group. All patients with more than one HA exploration who were in the revision group had BC; however, 28.5% of patients with just one HA exploration experienced BC (p < 0.001). CONCLUSION Arterial conduit interposition seems a better approach for the initial management of E-HAT in comparison to revision of the HA anastomosis due to the lower risk of re-thrombosis and the number of HA explorations; indeed, BC, RT, and death remain because they are somewhat related to the ischemic event of E-HAT than to a surgical treatment itself.
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Affiliation(s)
- Sahar Sohrabi Nazari
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
| | - Mohammad Eslamian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
| | - Erfan Sheikhbahaei
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
- Isfahan Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Zefreh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
- Isfahan Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Alireza Shamsaeefar
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran.
| | - Kourosh Kazemi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
| | - Hamed Nikoupour
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
| | - Saman Nikeghbalian
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
| | - Pooya Vatankhah
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, 7th Floor, Khalili St, Shiraz, Iran
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Kazemi K, Rasekhi A, Nazari SS, Lashkarizadeh MM, Shamsaeefar A, Alikhani M, Akbari A, Shahriarirad R. Nonoperative management of biliopleural fistula following living-donor liver transplantation: A case report. Clin Case Rep 2023; 11:e8210. [PMID: 38028040 PMCID: PMC10654471 DOI: 10.1002/ccr3.8210] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message Biliopleural fistula is a rare but serious complication after liver transplantation that should be managed nonoperatively with antibiotics, pleural drainage, decompression of high-pressure biliary tract, or ultimately surgery in unresponsive cases. Abstract Bilious pleural effusion is a rare entity often iatrogenic, following hepatobiliary surgeries and biliary interventions, and has been reported only in a limited number of patients after liver transplantation. A 5-year-old girl underwent living donor liver transplantation due to progressive familial intrahepatic cholestasis. At the 7th day of the postoperative course, due to increased liver enzymes and bilirubin levels and intrahepatic bile duct dilatation on sonography, Magnetic Resonance Cholangiopancreaticography followed by a liver biopsy were performed; the findings demonstrated moderate intrahepatic bile duct dilatation and moderate cellular rejection associated with mild cholestasis, respectively. The patient was therefore administered a pulse of methylprednisolone; however, due to fever, peritonitis and also sonographic evidence of infected biloma collection adjacent to the transplanted liver, the patient underwent surgery. Laparotomy and peritoneal washout were performed and a Jackson-Pratt drain was inserted adjacent to the liver cut surface. Succeeding tachypnea on 28th post day, led to detection of right side massive pleural effusion on chest Xray and hence thoracostomy tube was inserted. A diagnosis of biliopleural fistula was established and broad-spectrum intravenous antibiotic therapy was started, followed by cholangiography, fistula closure, and bile duct stricture ballooning and internal-external biliary catheter insertion. The patient was discharged in generally good condition on the 50th posttransplant day. The diagnosis of biliopleural fistula is facilitated with the utilization of chest imaging and pleural fluid analysis, however, a high index of suspicion is required.
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Affiliation(s)
- Kourosh Kazemi
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Alireza Rasekhi
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Sahar Sohrabi Nazari
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | | | - Alireza Shamsaeefar
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Mohammad Alikhani
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Ali Akbari
- Shiraz Transplant CenterAbu Ali Sina Hospital, Shiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- School of MedicineShiraz University of Medical SciencesShirazIran
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
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Karar H, Shafiekhani M, Mahmoudi MM, Azadeh N, Shamsaeefar A, Nazari SS, Jafari M, Ashrafzadeh K, Esmaeili M, Nikeghbalian S, Nikoupour H. Novel technique for arterial reconstruction in simultaneous pancreas-kidney transplantation, a randomized clinical trial. BMC Res Notes 2023; 16:295. [PMID: 37885028 PMCID: PMC10604519 DOI: 10.1186/s13104-023-06568-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
INTRODUCTION Simultaneous pancreas kidney (SPK) transplantation is an invaluable procedure to enhance the quality of life of insulin-dependent patients with advanced renal disease. The creation of vascular anastomoses of the donor's pancreas vessels to the recipient's, is of utmost importance to predict the graft outcome and surgical complications. In the study we introduce a novel technique for arterial reconstruction during SPK transplantation. METHODS Conventionally, during the SPK transplantation, a so-called Y-graft is anastomosed between donor's superior mesenteric and splenic artery to the recipient's right iliac artery. In the study we adopted a new technique by preparing an extra extension using the donor's carotid artery, to be anastomosed to the Y-graft and the iliac artery. In this non-blinded randomized clinical trial we compared the surgical complications and early outcomes between the 2 groups of patients with the traditional and new arterial reconstruction techniques during 3 months after transplantation. RESULTS Thirty adult patients were included in the study. The incidence of pancreatitis, vascular thrombosis and surgical site infection was lower in the new Y-graft and extension technique, which was not statistically significant. However, the calculated Cohen's d index showed the medium effect of new Y-graft and extension technique on complication after SPK transplantations. CONCLUSION The post-operative complications tend to be lower in the novel arterial reconstruction technique, however a study on a larger patient group is encouraged to confirm our primary results. TRIAL REGISTRATION The study was registered at the Iranian Registry of Clinical Trials on 12/05/2022; IRCT 20210625051701N2; ( http://www.irct.ir/ ).
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Affiliation(s)
- Hassan Karar
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Hepatobiliary and Transplant Surgery, The National Center of Gastrointestinal and Liver Disease, Ibn-Sina Specialized Hospital, Khartoum, Sudan
| | - Mojtaba Shafiekhani
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamad Mahdi Mahmoudi
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Azadeh
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Shamsaeefar
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Sohrabi Nazari
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Jafari
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kiarash Ashrafzadeh
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Esmaeili
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saman Nikeghbalian
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Nikoupour
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Hodjati H, Sohrabi Nazari S, Dehghani Nazhvani S, Karami MY, Geramizadeh B. Inferior Vena Cava Reconstruction by Gallbladder Patch: An Experimental Design. Bull Emerg Trauma 2017; 5:160-164. [PMID: 28795059 PMCID: PMC5547202] [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] [Received: 04/07/2017] [Revised: 04/22/2017] [Accepted: 04/22/2017] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy of the gallbladder for reconstruction of the inferior vena cava in a canine model. METHODS The experimental study was conducted on 5 dogs; an oval window with a diameter of (4×1 cm) was made in the inferior vena cava and then repaired using the autologous gallbladder patch with preservation of gallbladder function. The patency and functionality of the graft were assessed macroscopically and microscopically at 2 months postoperatively. RESULTS All the dogs were euthanized at 2 months, showing excellent patency of the vena cava macroscopically. In the microscopic examination, all the patches were completely endothelialized. No evidence of infection and inflammation and thrombosis was noted. CONCLUSION The gallbladder patch is an available and safe alternate for reconstruction of the inferior vena cava at least in animal model. However, further well designed prospective studies are needed to confirm this hypothesis.
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Affiliation(s)
- Hossein Hodjati
- Professor of vascular Surgery, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Sohrabi Nazari
- Trauma Research Center, General Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Yasin Karami
- Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Professor of pathology, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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Sagheb MM, Dormanesh B, Fallahzadeh MK, Akbari H, Sohrabi Nazari S, Heydari ST, Behzadi S. Efficacy of vitamins C, E, and their combination for treatment of restless legs syndrome in hemodialysis patients: A randomized, double-blind, placebo-controlled trial. Sleep Med 2012; 13:542-5. [DOI: 10.1016/j.sleep.2011.11.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/28/2011] [Accepted: 11/28/2011] [Indexed: 10/14/2022]
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