Volume 64 - 2001 - Fasc.1 - Original articles
Adult-to-adult living related liver transplantation : initial experience
The number of adult patients on the liver transplantation waiting lists is growing steadily. Adult living related liver transplantation (LRLT) represents the ultimate means to expand the donor pool. The success of this model of "small for size" grafting relies on strict donor and recipient selection. The choice of the graft (2 left and 4 right hepatectomies) was made on the minimal ratio between estimated graft and recipient body weights (0.8-1%), necessary to meet the recipient's metabolic demands. Our experience with six adults is reported. Donor morbidity was minimal (one wound infection) ; there was no mortality. Four (66%) recipients are doing well, two died of infectious complications. All recipients had a complicated post-transplant course. Due to its complexity, both in donor and recipient, LRILT should only be developed very carefully in experienced liver transplant centers.
Long-term terlipressin administration improves renal function in cirrhotic patients with type 1 hepatorenal syndrome : a pilot study
Background: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis. Recently, ornipressin, a potent splanchnic vasoconstrictor, was reported to improve renal function in patients with HRS. However, this treatment is associated with a high incidence of vascular complications. Terlipressin is thought to be as effective as ornipressin with less systemic complications. Aims : To evaluate the effectiveness and safety of terlipressin administration in cirrhotic patients with type I HRS. Patients : Twelve consecutive patients fulfilling HRS criteria of the International Ascites Club were included in the study. Median plasma creatinine and sodium, urine volume and sodium before treatment were 3,4 mg% 12,5-4,01 ; 127 mEqA 1124-1301, 500 ml/24h 1100-1031) and 7 mEq/24h fl-171. Methods : Terlipressin was administered iv 2 mg bid in 8 patients and tid in 4 others for at least one week and up to 2 months. Results : After one week of treatment median plasma creatinine decreased to 1.8 mg% 11.3-2.11 together with an increase in urine volume, sodium excretion, creatinine and free-water clearance. Three patients underwent successful liver transplantation with a near normal renal function after 34, 36 and 111 days. The 9 other patients died during follow-up (4 from sepsis, 2 from digestive bleeding and 3 from liver failure). No ischaemic complications were encountered during the treatment. Conclusions : Long-term terlipressin administration is safe and effective to control type I HRS. However, it does not cure the underlying disease and therefore, may only be considered as a bridge to a definitive treatment as liver transplantation.
Clinical picture of chronic hepatitis C in children - Polish experience
The aim of this study was to investigate long-term clinical, virologic and histologic outcome of hepatitis C virus infection in children. Sixty children (16 girls and 44 boys) have been followed for I to 5 years (mean 1.7 @ 0.9 years). HCV RNA and anti-HCV were checked every six months. Biopsy specimens were evaluated for the grade of inflammation and stage of fibrosis (scores 0-4). ALT was measured every 3 months. Presumed duration of HCV infection was from I to 16 years (mean 7.4 ± 3 years). Fifteen (25%) children could have been infected by blood transfusion, 5 (8%) during surgical procedures, 29 (50%) were multiply hospitalized. Twenty-five children infected as neonates had lower staging score than 24 infected later in life (p = 0.021). Two girls (aged 13 and 14) were diagnosed with acute hepatitis C, with maximum ALT of 1272 U/I and 1638 U/I respectively. In 11 children (18%) median ALT of more than 3 times the normal value (> 105 U/1) was noted. Six children (10%) had continuously normal ALT. Histopathology revealed mild to moderate inflammatory activity (0-2 points) in 52 children (87%). Seven specimens (11%) were scored for 3 to 4 staging points, 3 of them (5%) were diagnosed with liver cirrhosis. We have found statistically significant correlation between median ALT and grading (r = 0.36 ; p = 0.005) as well as staging scores (r = 0.32; p = 0.016), median AST and grading (r = 0.36; p = 0.006) as well as staging (r = 0.36 ; p = 0.007) scores but also median GGT and staging score (r = 0.39 ; p = 0.004).
