Society of pediatric liver transplantation: Current registry status 2011-2018

BACKGROUND

SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies.

OBJECTIVE

To report the outcomes of the SPLIT registry from 2011 to 2018.

METHODS

This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period.

RESULTS

A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.

Exposure to bacteroides fragilis endotoxin during cardiac surgery

Although endotoxemia has been observed during cardiac surgery, the identity of endotoxins to which patients are exposed is unknown. We tested the hypothesis that antibodies to Bacteroides fragilis (an anaerobic gut commensal and a common pathogen) decrease during cardiac surgery, thereby reflecting systemic exposure to this type of endotoxin. Serum antiendotoxin antibody levels were measured in 55 patients during routine cardiac surgery at the following times: Preoperatively, Pre-CPB (immediately before initiation of cardiopulmonary bypass [CPB]), Pre-CPB+5 (5 min after initiation of CPB), and End (end of surgery). Antiendotoxin antibody levels were determined by using enzyme-linked immunosorbent assay. Total immunoglobulin M (IgM) levels were measured by using laser nephelometry and decreases in total IgM levels were used to control changes in antiendotoxin antibody levels attributable to hemodilution. Median (interquartile range) hemodilution corrected IgM anti-B fragilis antibody levels decreased by 12% (5%-20%) from Preoperatively to End of surgery (P < 0.001). In contrast, median hemodilution corrected anti-B fragilis antibody levels did not change significantly from Pre-CPB to Pre-CPB+5, validating the correction for hemodilution. Immunoglobulin G anti-B fragilis antibody levels and IgM and immunoglobulin G anticore antibody levels decreased similarly during surgery. Intraoperatively, levels of anti-B fragilis endotoxin antibodies decreased significantly out of proportion to hemodilution. These results suggest that cardiac surgical patients are exposed to B fragilis endotoxin.

IMPLICATIONS

We prospectively measured hemodilution-corrected antiendotoxin antibody levels in 55 cardiac surgical patients. We observed significant decreases in hemodilution-corrected levels of antibody to both Bacteroides fragilis and the core of endotoxin.

A novel leukotriene B4-receptor antagonist in endotoxin shock: a prospective, controlled trial in a porcine model

OBJECTIVE

To evaluate the hypothesis that treatment with LY255283, a novel leukotriene B4-receptor antagonist, is beneficial in an animal model of the adult respiratory distress syndrome induced by endotoxin.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Laboratory at a large university medical center.

SUBJECTS

Twenty-five, immature, random-bred swine.

INTERVENTIONS

Four groups of pigs were studied: the LPS group of animals (n = 6) were infused with Escherichia coli lipopolysaccharide (strain 0111:B4, 250 micrograms/kg) from 0 to 60 mins; the LPS + 255283 group of animals (n = 6) were infused with lipopolysaccharide as above, but were also treated with LY255283 (30 mg/kg, then 10 mg/kg/hr), beginning at -15 mins; the 255283 group of animals (n = 6) were infused with the same dose of LY255283, but were not challenged with lipopolysaccharide; and the RL control group of subjects (n = 7) received only the lactated Ringer's solution vehicle. Beginning at 30 mins, all groups were infused with dextran-70 solution as needed to maintain cardiac output at 90% to 110% of baseline value.

MEASUREMENTS AND MAIN RESULTS

Treatment with LY255283 significantly (p < .05) ameliorated lipopolysaccharide-induced systemic arterial hypotension, pulmonary arterial hypertension, and arterial hypoxemia. Treatment with this drug also abrogated lipopolysaccharide-induced increases in pulmonary extravascular water content and bronchoalveolar lavage fluid protein concentration.

CONCLUSIONS

These data suggest that leukotriene B4 may be an important mediator of acute lung injury in this porcine model of septic shock and acute lung injury. Further studies to assess the specificity of LY255283 as a leukotriene B4 antagonist are necessary in order to exclude the possibility that the beneficial effects of this compound are due to pharmacologic actions other than the blockade of LTB4 receptors.

Profile of toxoplasmosis in two different localities in Dakahlia Governorate

The profile of toxoplasmosis was studied among the inhabitants of two different localities in Dakahlia in relation to age, sex, occupation and contact with animals and/or birds. The total percentage of seropositive Toxoplasma antibodies using Dot-ELISA was 23.8%. The seropositivity rate was higher among the inhabitants of the village particularly in those in contact with farm animals. The results are discussed.

Malaria as a cause of prolonged fever among children in Mansoura fever hospital

Prolonged fever represents a diagnostic dilemma in small age group. Little attention was given as regard parasitic infections and prolonged fever. The objective of this study was to throw some light upon the role of malaria infection as a cause of prolonged fever. The study revealed malaria by blood film in 5 out of 129 children by IFA test 8 patients were seropositive intermittent fever was the main symptom of presentation.

Intraluminal oxygenation ameliorates ischemia/reperfusion-induced gut mucosal hyperpermeability in pigs

We tested the hypothesis that intraluminal oxygenation can prevent increased gut mucosal permeability to a hydrophilic solute caused by mesenteric ischemia/reperfusion (I/R). Studies were performed using pentobarbital-anesthetized immature pigs. Paired 20 cm segments of ileum were perfused intraluminally at 200 ml/hr with either nitrogenated or oxygenated 37 degrees C Ringer's lactate. Beginning at T = -90 min, fluorescein disodium acetate was infused intravenously (12.5 mg/kg bolus, then 12.5 mg/kg/hr). Permeability was assessed by calculating the plasma-to-lumen clearance of fluorescein. Five pigs were subjected to complete mesenteric ischemia (T = 0-120 min) followed by reperfusion (T = 120-270 min). In nitrogenated segments, I/R resulted in a 1015 +/- 195% increase in fluorescein clearance (P < 0.01 vs baseline). In contrast, the increase in fluorescein clearance induced by I/R in oxygenated segments was only 264 +/- 63% (P < 0.01 vs baseline). Intraluminal oxygenation afforded significant (P < .01) protection against I/R-induced mucosal hyperpermeability at all time points from T = 150-270 min. Histologic sections revealed complete villous epithelial denudation in nitrogenated segments, whereas the mucosal epithelium was largely intact in oxygenated segments. After reperfusion, mucosal ATP levels normalized in oxygenated segments, but there was only partial recovery of ATP levels in nitrogenated segments. These data indicate that intraluminal oxygenation ameliorates mucosal hyperpermeability induced by I/R.

Effect of granulocyte colony-stimulating factor on systemic and pulmonary responses to endotoxin in pigs

Granulocyte colony-stimulating factor (G-CSF) stimulates the production and function of neutrophils (PMNs). Administration of G-CSF to non-neutropenic animals has been shown to improve survival in experimental models of infection, but PMNs have been implicated as mediators of acute lung injury induced by lipopolysaccharide (LPS) or bacteremia. Thus G-CSF-induced neutrophilia might be deleterious in sepsis. To investigate this possibility, we studied four groups of pigs: G+E50 (n = 6) were pretreated for 5 days with recombinant bovine (rb) G-CSF (5 micrograms/kg/day) and then challenged with LPS (50 micrograms/kg); NS+E50 (n = 6) were similarly pretreated with saline and challenged with LPS (50 micrograms/kg); E250 (n = 6) were not pretreated and were infused with a larger dose of LPS (250 micrograms/kg); RL (n = 7) were controls infused with lactated Ringer's solution. Pretreatment with rbG-CSF increased the peripheral absolute neutrophil count approximately fivefold (p < 0.05 vs. RL group). Comparisons of the NS+E50 and G+E50 groups showed that pretreatment with rhG-CSF did not affect LPS-induced alterations in mean arterial blood pressure or arterial oxygenation. Indices of pulmonary injury also were similar in these two groups, although pulmonary edema and protein leakage into alveoli were greater in the E250 group. We conclude that G-CSF-induced neutrophilia does not adversely effect physiologic responses to LPS in pigs.

Evaluation of adult Schistosoma mansoni and cercarial antigens in serodiagnosis of schistosomiasis using IHAT and ELISA

Examination of 200 bilharzial cases divided into four groups and 50 normal controls to evaluate the efficiency of adult Schistosoma mansoni and cercarial antigens in serodiagnosis of schistosomiasis using IHAT and ELISA revealed that IHA test showed high sensitivity that decreased with the progress of clinical status of the disease if adult worm antigen was utilized. Also IHAT adult antigen was more sensitive for serodiagnosis than with cercarial antigen, while ELISA is less sensitive using both cercarial and adult antigens.

Immune response of gametocytes of Plasmodium falciparum in exogenous cases in Dakahlia Governorate, Egypt

Following chloroquine treatment gametocytes numbers fell with a constant rate of loss over a period from 15-21 days. The gametocytes had a half-life of 2-4 days. The sex ratio was constant 4 female: 1 male. Antibodies to the gametocytes were detected in some patients. It was concluded that the gametocytes of P. falciparum are long-lived and can stimulate antibody production but the immune response appears to play no part in their elimination, which probably takes place in the spleen as a part of the normal process of removing old, damaged and malformed red cells.

The effect of the initial inoculum dose and post-infection period on larval dispersal in experimental murine toxocariasis

The distribution of Toxocara canis larvae throughout the tissues of mice was studied in three groups of fourty mice each using three inocula sizes, (200/500 and 1000 eggs/mice). The results obtained revealed a significant interaction between the duration of infection, the inoculum size and the dispersal rate of larvae through the examined organs of experimented with mice.

Human fascioliasis: a parasitic health problem in Dakahlia Governorate, Egypt

Fascioliasis has a cosmopolitan distribution and is prevalent in sheep-raising countries. Now, it is an increasingly important parasite of man in the Mediterranean countries. In Dakahlia G., human fascioliasis has imposed itself as a parasitic health problem. In this paper, 23 human cases were selected to throw some light on the signs, symptoms and diagnosis of the disease. It was concluded that painful hepatomegaly, fever, anaemia and marked eosinophilia are tetrad suggesting fascioliasis in patient who has consumed watercress as green salade. Data concerning treatment and follow up will be published later.

Some histopathological and histochemical aspects of human ancylostomiasis

Using Watson's intestinal capsule small intestinal mucosal biopsies were taken from 30 patients with parasitologically proved pure ancylostomiasis and 12 normal controls. Biopsies were examined pathologically and histochemically for the enzymes, Alkaline phosphatase, succinic dehydrogenase, non specific esterases and acid phosphatase. The study revealed normal histological as well as normal enzymatic activity of the intestinal mucosa.