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Lal BB, Alam S, Sibal A, Kumar K, Hosaagrahara Ramakrishna S, Shah V, Dheivamani N, Bavdekar A, Nagral A, Wadhwa N, Maria A, Shah A, Shah I, Nalwalla Z, Snehavardhan P, Srikanth KP, Gupta S, Sivaramakrishnan VM, Waikar Y, Suchismita A, Ashritha A, Sood V, Khanna R. Genotype correlates with clinical course and outcome of children with tight junction protein 2 (TJP2) deficiency-related cholestasis. Hepatology 2024:01515467-990000000-00790. [PMID: 38447037 DOI: 10.1097/hep.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIMS The study aimed to describe the clinical course and outcomes, and analyze the genotype-phenotype correlation in patients with tight junction protein 2 (TJP2) deficiency. APPROACH AND RESULTS Data from all children with chronic cholestasis and either homozygous or compound heterozygous mutations in TJP2 were extracted and analyzed. The patients were categorized into 3 genotypes: TJP2-A (missense mutations on both alleles), TJP2-B (missense mutation on one allele and a predicted protein-truncating mutation [PPTM] on the other), and TJP2-C (PPTMs on both alleles). A total of 278 cases of genetic intrahepatic cholestasis were studied, with TJP2 deficiency accounting for 44 cases (15.8%). Of these, 29 were homozygous and 15 were compound heterozygous variants of TJP2 . TJP2-A genotype was identified in 21 (47.7%), TJP2-B in 7 cases (15.9%), and TJP2-C in 16 cases (36.4%), respectively. Patients with the TJP2-C genotype were more likely to experience early infantile cholestasis (87.5% vs. 53.5%, p =0.033), less likely to clear jaundice (12.5% vs. 52.2%, p =0.037), more likely to develop ascites, and had higher serum bile acids. Patients with the TJP2-C genotype were more likely to die or require liver transplantation (native liver survival: 12.5% vs. 78.6%, p <0.001), with a median age at death/liver transplantation of 2.5 years. Cox regression analysis revealed that TJP2-C mutations ( p =0.003) and failure to resolve jaundice ( p =0.049) were independent predictors of poor outcomes. CONCLUSIONS Patients with the TJP2-C genotype carrying PPTMs in both alleles had a rapidly progressive course, leading to early decompensation and death if they did not receive timely liver transplantation.
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Affiliation(s)
- Bikrant Bihari Lal
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anupam Sibal
- Department of Pediatric Gastroenterology & Liver Transplantation, Indraprastha Apollo Hospitals, New Delhi, India
| | - Karunesh Kumar
- Department of Pediatric Gastroenterology & Liver Transplantation, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Vaibhav Shah
- Department of Pediatric Gastroenterology and Hepatology, Gujarat Superspeciality Clinic, Ahmedabad, Gujarat, India
| | - Nirmala Dheivamani
- Department of Pediatric Gastroenterology, Institute of Child Health and Hospital for Children, Chennai, Tamil Nadu, India
| | - Ashish Bavdekar
- Department of Pediatrics, KEM Hospital and Research Centre, Pune, Maharashtra, India
| | - Aabha Nagral
- Department of Pediatric Hepatology and Liver Transplant, Jaslok Hospital and Research Center, Mumbai, Maharashtra, India
- Department of Pediatric Hepatology and Liver Transplantation, Apollo Hospital, Navi Mumbai, Maharashtra, India
| | - Nishant Wadhwa
- Department of Pediatrics, Sir Gangaram Hospital, New Delhi, India
| | - Arjun Maria
- Department of Pediatrics, Sir Gangaram Hospital, New Delhi, India
| | - Aashay Shah
- Department of Pediatric Gastroenterology, PRISM Pediatric Gastro, Ahmedabad, Gujarat, India
| | - Ira Shah
- Department of Pediatric Infectious Disease, Pediatric Gastroenterology, and Hepatology B.J. Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Zahabiya Nalwalla
- Department of Pediatrics, B.J. Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Pandey Snehavardhan
- Department of Pediatric Hepatology and Liver Transplantation, Sahyadri Superspeciality Hospital Pvt Ltd, Pune, Maharashtra, India
| | - K P Srikanth
- Department of Pediatric Gastroenterology and Hepatology, Pediatric Gastroenterology & Hepatology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Subhash Gupta
- Department of Liver Transplantation, Centre for Liver and Biliary Sciences, Max Superspeciality Hospital, Saket, New Delhi, India
| | | | - Yogesh Waikar
- Department of Pediatric Gastroenterology, Superspeciality GI Kids Clinics, Nagpur, Maharashtra, India
| | - Arya Suchismita
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - A Ashritha
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikrant Sood
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rajeev Khanna
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Hosaagrahara Ramakrishna S, Hassan A, Kasala MB, Perumal K, Venkategowda C, Malleeswaran S, Periasamy M, Kaliyaperumal M, Patcha RV, Varghese J, Reddy MS. Pediatric combined living donor liver and kidney transplantation for primary hyperoxaluria type 2. Am J Transplant 2023; 23:1622-1625. [PMID: 37187295 DOI: 10.1016/j.ajt.2023.05.006] [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: 04/01/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023]
Abstract
We report the case of a 12-year-old boy with primary hyperoxaluria type 2 (PH2) presenting with end-stage renal disease and systemic oxalosis who underwent a combined living donor liver and kidney transplant from 3 donors, 1 of whom was a heterozygous carrier of the mutation. Plasma oxalate and creatinine levels normalized immediately following the transplant and remain normal after 18 months. We recommend combined liver and kidney transplantation as the preferred therapeutic option for children with primary hyperoxaluria type 2 with early-onset end-stage renal disease.
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Affiliation(s)
| | - Akhila Hassan
- Department of Pediatrics Mazumdar Shaw Medical Centre, Narayana Health City, Bommasandra, Bangalore, India
| | - Mohan Babu Kasala
- Department of Pediatric Intensive Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Karnan Perumal
- Department of Pediatric Intensive Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Chaitra Venkategowda
- Department of Liver Anesthesia and Critical Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Selvakumar Malleeswaran
- Department of Liver Anesthesia and Critical Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Muthukumar Periasamy
- Department of Nephrology, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | | | - Rajanikanth V Patcha
- Department of Liver Transplant and Hepatopancreaticobiliary Surgery, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Joy Varghese
- Department of Hepatology and Liver Transplant, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Mettu Srinivas Reddy
- Department of Liver Transplant and Hepatopancreaticobiliary Surgery, Gleneagles Global Health City, Perumbakkam, Chennai, India
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Hosaagrahara Ramakrishna S, Shah N, Acharyya BC, Durairaj E, Verma L, Sankaranarayanan S, Wadhwa N, Venter C. The Need for Culturally Appropriate Food Allergy Management Strategies: The Indian Milk Ladder. Nutrients 2023; 15:3921. [PMID: 37764705 PMCID: PMC10535525 DOI: 10.3390/nu15183921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/02/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Cow's milk allergy (CMA) is one of the most common and complex food allergies affecting children worldwide and, with a few exceptions, presents in the first few months of life. Baked-milk-containing diets are well tolerated in the majority of milk-allergic children and allow dietary restrictions to be relaxed. In addition, the early introduction of tolerated forms of allergenic foods to an infant's diet in small amounts may enhance the outgrowth of their milk allergy through oral tolerance induction. The methods of milk introduction vary widely across the globe. METHODS We convened an expert group to develop a comprehensive milk ladder based on the calculated milk protein content of Indian foods. To validate the milk ladder, the foods chosen for the ladder were analyzed and the ladder was re-evaluated based on the cooked milk protein content. RESULTS Combining expert consensus and validation of milk protein content, we created the world's first milk ladder containing Indian foods. This is the first ladder that provides information on the timing and temperature of cooking, with validated milk protein content. CONCLUSIONS This is the first milk ladder based on the unique features of Indian food habits built by the consensus of Indian experts along with international collaboration with laboratory quantification of milk protein in each step. We believe the "The Indian Milk Ladder" will be a very helpful tool for pediatricians helping manage CMA in children as well as their parents and caregivers, not only in India, but in countries world-wide where these foods are commonly consumed.
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Affiliation(s)
| | - Neil Shah
- The Portland Hospital, London W1W 5AH, UK
- Reckitt Nutrition, Slough SL1 3UH, UK
| | - Bhaswati C Acharyya
- Department of Paediatric Hepatology & Gastroenterology, AMRI Hospitals, Kolkata 700028, India
- Department of Paediatric Hepatology & Gastroenterology, Institute of Child Health, Kolkata 700017, India
| | - Emmany Durairaj
- Department of Clinical Nutrition, Mazumdar Shaw Medical Centre, Narayana Health City, Bengaluru 560099, India
| | - Lalit Verma
- Department of Paediatric Hepatology & Gastroenterology, Global Hospitals, Mumbai 400012, India
| | - Srinivas Sankaranarayanan
- Department of Paediatric Hepatology & Gastroenterology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai 600024, India
- Department of Paediatric Hepatology & Gastroenterology, Apollo Children Hospital, Chennai 600006, India
| | - Nishant Wadhwa
- Institute of Child Health, Division of Paediatric Gastroenterology, Hepatology & Nutrition, Sir Gangaram Hospital, New Delhi 110060, India
| | - Carina Venter
- Paediatrics, Section of Allergy & Immunology, Denver School of Medicine, University of Colorado, Denver, CO 80204, USA
- Paediatrics, Section of Allergy & Immunology, Children's Hospital Colorado, Denver, CO 80218, USA
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Ramakrishna SH, Nayak SP, Rao S, Joseph D'cruz AL, Garg M, Ramachandran K. Kasai Portoenterostomy at a Slightly Delayed Age and Native Liver Survival in Children With Biliary Atresia: Single Center Experience. Indian Pediatr 2023; 60:655-658. [PMID: 37260066] [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: 06/02/2023]
Abstract
OBJECTIVES We studied the modifiable prognostic factors that extend native liver survival at 2 years after Kasai portoenterostomy (KPE). METHODS We reviewed hospital records of patients with neonatal cholestasis, with focus on infants diagnosed with biliary atresia in a tertiary care hospital between January, 2014 and May, 2021. We determined the association of outcome with clinical and laboratory variables. RESULTS Infants who underwent KPE at a median (IQR) age of 76 (72-79) days had best outcomes, with minimal severe post-KPE complications and 2-year survival rate of 84.6%, compared to other infants (younger and older days at KPE). The median (IQR) weight at KPE in this group was 4.66 (4.2, 5.0) kg. CONCLUSION In contrast to traditional recommendations, babies with median age at KPE of 76 days had superior native liver survival (84.6%) and reduced post-KPE complications, as compared to earlier KPE age. Nutritional status and weight of infant at KPE could be associated with this survival difference. This observation needs confirmation through multicentric prospective study.
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Affiliation(s)
- Somashekara Hosaagrahara Ramakrishna
- Department of Pediatric Hepatology, Gleneagles Global Health City, Perumbakkam, Chennai, Tamil Nadu. Correspondence to: Dr Somashekara Hosaagrahara Ramakrishna, Department of Pediatric Hepatology, Gleneagles Global Health City, Perumbakkam, Chennai, Tamil Nadu 600 100.
| | - Samar Pratim Nayak
- Department of Pediatrics, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, Karnataka
| | - Sanjay Rao
- Department of Pediatric Surgery and Division of Solid Organ Transplantation, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, Karnataka
| | - Ashley Lucien Joseph D'cruz
- Department of Pediatric Surgery and Division of Solid Organ Transplantation, Mazumdar Shaw Medical Centre, Narayana Health, Bangalore, Karnataka
| | - Mansi Garg
- Independent Statistical Researcher, Bangalore, Karnataka
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Hosaagrahara Ramakrishna S, Kasala MB, Perumal K, Malleeswaran S, Patcha RV, Varghese J, Sathiyasekaran M, Reddy MS. When Push Comes to Shove! Emergency ABO-Incompatible Pediatric Living Donor Liver Transplant for Acute Wilson's Disease. J Clin Exp Hepatol 2022; 12:658-663. [PMID: 35535085 PMCID: PMC9077158 DOI: 10.1016/j.jceh.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022] Open
Abstract
ABO-incompatible living donor liver transplantation (ABOi-LDLT) is on the rise as a viable option in countries with limited access to deceased donor grafts. While reported outcomes of ABOi-LT in children are similar to ABO- Compatible liver transplant (ABOc-LT), most children beyond 1-2 years of age will need desensitization to overcome the immunological barrier of incompatible blood groups. The current standard protocol for desensitization is Rituximab that targets B lymphocytes and is given 2-3 weeks prior to LT. However, this timeline may not be feasible in children requiring emergency LT for acute liver failure (ALF) or acute-on-chronic liver failure (ACLF). In this emergency situation of ABOi-LT, a safe multipronged approach may be an acceptable alternative solution. We report a child with acute Wilson's disease with rapidly deteriorating liver function who underwent a successful ABOi-LDLT using a rapid desensitization protocol.
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Key Words
- ABOc-LT, ABO-compatible liver transplantation (ABOi-LDLT)
- ABOi-LDLT, ABO-incompatible living donor liver transplantation
- ACLF, Acute-on-chronic liver failure
- ALF, Acute liver failure
- AMR, Antibody-mediated rejection
- CMV, Cytomegalovirus
- CSF, Cerebrospinal fluid
- GRWR, Graft-to-recipient weight ratio
- LDLT, Living donor liver transplantation
- LT, Liver transplant
- MMF, Mycophenolate mofetil
- PVT, Portal vein thrombosis
- Rituximab
- acute Wilson’s disease
- acute-on-chronic liver disease
- emergency ABOi-LDLT
- living donor liver transplantation
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Affiliation(s)
| | - Mohan Babu Kasala
- Department of Pediatric Intensive Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Karnan Perumal
- Department of Pediatric Intensive Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Selvakumar Malleeswaran
- Liver Anesthesia and Critical Care, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Rajanikanth V Patcha
- Department of Liver Transplant and Hepatopancreaticobiliary Surgery, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Joy Varghese
- Department of Hepatology and Liver Transplant, Gleneagles Global Health City, Perumbakkam, Chennai, India
| | - Malathy Sathiyasekaran
- Senior Pediatric Gastroenterologist, MGM, Rainbow and Kanchi Kamakoti CHILDs Trust Hospitals, Chennai, India
| | - Mettu Srinivas Reddy
- Department of Liver Transplant and Hepatopancreaticobiliary Surgery, Gleneagles Global Health City, Perumbakkam, Chennai, India
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Krishnan SK, Varghese J, Patcha R, Hosaagrahara Ramakrishna S, Reddy MS. Delayed Expulsion of biliary cast after hepaticojejunostomy for post-liver transplantation biliary stricture-better cut than canulate? Pediatr Transplant 2021; 25:e14115. [PMID: 34409710 DOI: 10.1111/petr.14115] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biliary strictures after living donor liver transplantation (LDLT) are a significant cause of post-transplant morbidity. Endoscopic therapy is usually the first choice of treatment though surgical treatment may provide better biliary drainage. METHODS We report a case of LDLT performed in a child for acute liver failure who developed an anastomotic biliary stricture with biliary cast formation. We performed a Roux en Y hepaticojejunostomy to treat the stricture. RESULTS Allograft function improved after surgery with no further episodes of cholangitis. Two months after the surgery, the child passed a large biliary cast in the stools. This reiterates the advantage of wide biliary drainage provided through surgical therapy. CONCLUSIONS Surgery for biliary strictures following LDLT may provide superior long term biliary drainage- especially when biliary casts are present.
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Affiliation(s)
- Sathish Kumar Krishnan
- Department of HPB & Liver Transplantation, Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, India
| | - Joy Varghese
- Department of Hepatology & Transplant Hepatology, Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, India
| | - Rajanikanth Patcha
- Department of HPB & Liver Transplantation, Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, India
| | | | - Mettu Srinivas Reddy
- Department of HPB & Liver Transplantation, Institute of Liver Disease & Transplantation, Gleneagles Global Health City, Chennai, India
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Pratim Nayak S, Hosaagrahara Ramakrishna S, Jyothinagaram Sivaprakas B, Kannan S. Mauriac syndrome: a rare cause of massive hepatomegaly. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00939-3] [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: 11/29/2022] Open
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Ramakrishna SH, Patil SJ, Jagadish AA, Sapare AK, Sagar H, Kannan S. Fructose-1,6-bisphosphatase deficiency caused by a novel homozygous Alu element insertion in the FBP1 gene and delayed diagnosis. J Pediatr Endocrinol Metab 2017; 30:703-706. [PMID: 28599390 DOI: 10.1515/jpem-2017-0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Received: 02/18/2017] [Accepted: 04/03/2017] [Indexed: 11/15/2022]
Abstract
Fructose-1,6-bisphosphatase (FBPase) enzyme deficiency is one of the treatable autosomal recessive inherited metabolic disorders. If diagnosed early, FBPase deficiency has a favorable prognosis. We report the clinical and biochemical findings of a 9.5-year-old female child with FBPase deficiency. FBPase deficiency is caused by a homozygous Arthrobacter luteus (Alu) insertion in the FBP1 gene, reported for the first time.
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Affiliation(s)
| | - Siddaramappa Jagdish Patil
- Medical Genetics, Mazumdar-Shaw Medical Center, Narayana Health City, No 258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore560099, Karnataka,India
| | | | - Anil Kumar Sapare
- Department of Pediatrics, Narayana Health City, Bangalore, Karnataka,India
| | - Hiremath Sagar
- Pediatrics Pulmonology and Intensivist, Narayana Health City, Bangalore, Karnataka,India
| | - Subramanian Kannan
- Department of Endocrinology, Narayana Health City, Bangalore, Karnataka,India
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