MyMedR

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities

Khan JF, Shah DM, Sivapakiam S, Mokhtar S, Subramaniam M, Raman K, et al.

Transplantation, 2021 Dec 01;105(12):2507-2512.

PMID: 34818304 DOI: 10.1097/TP.0000000000003591

Matched MeSH terms: Liver Transplantation*

Intra-operative cell salvage and sickle cell trait in liver transplantation: time to reconsider?

Loh PS, Gilder F, Klinck J

Transpl Int, 2018 07;31(7):781-782.

PMID: 29672993 DOI: 10.1111/tri.13268

Matched MeSH terms: Liver Transplantation*

Fulltext Successful liver transplantation in hepatopulmonary syndrome – case report

Kam, Choy Chen, Lim, Chooi Bee

Malaysian Journal of Paediatrics and Child Health, 2016;22(101):0-0.

MyJurnal

Hepatopulmonary syndrome (HPS) is characterized by the triad of liver disease, pulmonary vascular dilatation and arterial oxygenation abnormality. It occurs in 4% to 47% in patient with liver cirrhosis [1]. We describe 2 cases of HPS with recovery from hypoxaemia after liver transplantation.(Copied from article)

Matched MeSH terms: Liver Transplantation

Liver transplantation--patient selection and timing

McCormick A, Sultan J

Med J Malaysia, 2005 Jul;60 Suppl B:83-7.

PMID: 16108182

Liver transplantation has been successfully used in the treatment of a large number of liver diseases. The largest patient group comprises patients with end stage decompensated liver disease. Decompensation is defined as the presence of cirrhosis and one or more of the following: jaundice, ascites, hepatic encephalopathy, hepatorenal syndrome or bleeding oesophageal varices. In general patients in this category should be considered for liver transplantation, if available. Guidelines for liver transplant assessment have been published by both the British Society of Gastroenterology and the American Association for the Study of Liver Disease. These guidelines provide a good basis for patient selection. As new information becomes available the indications for individual diseases may change somewhat. One of the most important changes in recent years was the introduction of the MELD/PELD scoring system. This is the model for end stage liver disease which provides a reasonably robust estimate of prognosis for individual patients. Prior to this patient waiting time on the transplant list was one of the principal determinants of priority for liver allocation. The MELD scoring system has been widely adopted with the aim of allocating the available livers to patients in the greatest clinical need.

Matched MeSH terms: Liver Transplantation*

Inferior vena cava occlusion and protein-losing enteropathy after liver transplantation in children

Lee WS, John P, McKiernan P, de Ville De Goyet J, Kelly DA

J Pediatr Gastroenterol Nutr, 2002 Apr;34(4):413-6.

PMID: 11930100

Matched MeSH terms: Liver Transplantation/adverse effects*

Fulltext Non-alcoholic fatty liver disease and obesity among adult donors are major challenges to living-donor liver transplantation: A single-center experience

Rajaram RB, Jayaraman T, Yoong BK, Koh PS, Loh PS, Koong JK, et al.

Asian J Surg, 2022 Jan;45(1):441-447.

PMID: 34384674 DOI: 10.1016/j.asjsur.2021.07.046

OBJECTIVES: Obesity and non-alcoholic fatty liver disease (NAFLD) are rampant in South East Asia. There is paucity of data exploring its' impact on donor suitability for living donor liver transplantation (LDLT). We aimed to describe and examine the factors related to non-utilization of potential donors in our LDLT programme.

METHODS: This is an analysis of prospectively collected data on potential donors for an adult LDLT programme, between January 2017 and December 2019.

RESULTS: Fifty-five donors for 33 potential recipients were evaluated. The mean age was 31.6 ± 8.5 years, 52.7% were female and the ethnic divisions were: Chinese (50.9%), Indian (25.5%) and Malay (23.6%). The mean body mass index (BMI) among potential donors was 25.1 ± 4.0 kg/m2; 25.5% of donors had normal BMI, 23.6% were overweight and 50.9% were obese. Using the CAP modality of Fibroscan®, we identified the following grades of hepatic steatosis: 36.6% S0, 19.5% S1, 2.4% S2 and 41.5% S3. The non-utilization rate of our donors was 74.5% (41/55) and the main reasons were significant hepatic steatosis and/or obesity. Compared to suitable donors, unsuitable donors had significantly greater mean BMI, mean CAP scores, higher rates of dyslipidaemia and NAFLD.

CONCLUSION: NAFLD and obesity represent major challenges to an emerging LDLT programme in Malaysia.

Matched MeSH terms: Liver Transplantation*

Fulltext Adult-to-adult living donor liver transplantation: Operative techniques to optimize the recipient's outcome

Koh PS, Chan SC

J Nat Sci Biol Med, 2017 Jan-Jun;8(1):4-10.

PMID: 28250667 DOI: 10.4103/0976-9668.198356

Adult-to-adult living donor liver transplantation (LDLT) is widely accepted today with good outcomes and safety reported worldwide for both donor and recipient. Nonetheless, it remained a highly demanding technical and complex surgery if undertaken. The last two decades have seen an increased in adult-to-adult LDLT following our first report of right lobe LDLT in overcoming graft size limitation in adults. In this article, we discussed the operative techniques and challenges of adult right lobe LDLT incorporating the middle hepatic vein, which is practiced in our center for the recipient operation. The various issues and challenges faced by the transplant surgeon in ensuring good recipient outcome are explored and discussed here as well. Hence, it is important to understand that a successful recipient operation is dependent of multifactorial events starting at the preoperative stage of planning, understanding the intraoperative technical challenges and the physiology of flow modulation that goes hand-in-hand with the operation. Therefore, one needs to arm oneself with all the possible knowledge in overcoming these technical challenges and the ability to be flexible and adaptable during LDLT by tailoring the needs of each patient individually.

Matched MeSH terms: Liver Transplantation

Fulltext Ischaemia-perfusion injury in the liver. The role of hepatic microvasculature

Lim SP

JUMMEC, 1996;1:9-16.

Research into ischaemia and reperfusion injury especially in liver transplantation has been aimed primarily at preventing deterioration of organ function before harvest and at improving organ preservation techniques. Recent studies however, suggest that postischaemic organ function and viability can be improved not only through improved organ protection before ischaemia, but also with therapy aimed at ameliorating the organ reperfusion injury. In order to develop successful therapeutic interventions against ischaemia-reperfusion induced liver injury, it is necessary to consider the primary site of injury as well as to explore the mechanism(s) and possible factors which may contribute to the injury during ischaemia and reperfusion. Studies on hepatic ischaemia-reperfusion injury have focused mainly at hepatocellular level. Until recently, more attention has been drawn t o the important role of hepatic microcirculation on the pathophysiology of the above injury. The argument that hepatic microvasculature is the primary site of ischaemia-reperfusion injury and possible factors which cause this injury are among the issues reviewed in this article. KEYWORDS: ischaemia, reperfusion, liver, microvasculature, oxygen radicals

Matched MeSH terms: Liver Transplantation

Liver transplantation in the Asia Pacific region--trials and tribulations

Fan ST

Med J Malaysia, 2005 Jul;60 Suppl B:1-4.

PMID: 16108164

Matched MeSH terms: Liver Transplantation/methods; Liver Transplantation/trends*

Effect of diarrhoea on Tacrolimus trough level in a post liver transplant patient

Tan ST, Yoong BK

Med J Malaysia, 2020 11;75(6):734-735.

PMID: 33219186

Tacrolimus, which bonds to an immunophilin, FK506 binding protein (FKBP) has emerged as one of the most widely used immunosuppressant post solid organ transplantation. It offers excellent patient survival rates post-transplantation and a lesser number of acute rejections as compared to cyclosporine. Tacrolimus has a narrow therapeutic window with overexposure leading to acute and chronic forms of nephrotoxicity. Remarkably few data have been published on the overexposure to tacrolimus following mild diarrhoea in post-transplant patients who received treatment with tacrolimus. We observed a post-liver transplant patient with increased trough level of tacrolimus during severe diarrhoea with no complications following a timely adjustment on the dose of tacrolimus.

Matched MeSH terms: Liver Transplantation

Fulltext Intraspinal epidural hematoma in a warfarinized patient presenting with back pain: a case report

Jolina, W.N., Dazlin Masdiana, S., Afliza, A.B.

Medicine & Health, 2018;13(2):188-194.

MyJurnal

Warfarin is an anticoagulant that is commonly used as thrombo-prophylaxis in patients at risk of thrombo-embolic events. However, the use of warfarin is known to cause hemorrhage due to its anticoagulation effect. Although the common sites of hemorrhage are gastrointestinal and genitourinary tract, it can also occur in the least expected location. We report a rare case of spinal cord compression secondary to intraspinal epidural hematoma as a result of overwarfarinization in a patient who had undergone liver transplant. The patient underwent emergency decompression laminectomy of spinal cord and hematoma evacuation after the reversal of overwarfarinization to normal levels.

Matched MeSH terms: Liver Transplantation

Depression and psychosocial correlates of liver transplant candidates: a systematic review

Mohamed S, Sabki ZA, Zainal NZ

Asia Pac Psychiatry, 2014 Dec;6(4):447-53.

PMID: 25132651 DOI: 10.1111/appy.12145

Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review.

Matched MeSH terms: Liver Transplantation/psychology*

Outcome of biliary atresia in Malaysia: a single-centre study

Lee WS, Chai PF, Lim KS, Lim LH, Looi LM, Ramanujam TM

J Paediatr Child Health, 2009 May;45(5):279-85.

PMID: 19493120 DOI: 10.1111/j.1440-1754.2009.01490.x

This study aimed to determine the outcome of the operation of children with biliary atresia (BA) at a tertiary paediatric referral centre in Malaysia.

Matched MeSH terms: Liver Transplantation*

Liver transplantation in chronic hepatitis B

Gane E

Med J Malaysia, 2005 Jul;60 Suppl B:88-9.

PMID: 16108183

Matched MeSH terms: Liver Transplantation*

Placement of removable metal biliary stent in post-orthotopic liver transplantation anastomotic stricture

Tee HP, James MW, Kaffes AJ

World J Gastroenterol, 2010 Jul 28;16(28):3597-600.

PMID: 20653071

Postoperative biliary strictures are the most common cause of benign biliary stricture in Western countries, secondary to either operative injury or bile duct anastomotic stricture following orthotopic liver transplantation (OLT). Surgery or endoscopic interventions are the mainstay of treatment for benign biliary strictures. We aim to report the outcome of 2 patients with refractory anastomotic biliary stricture post-OLT, who had successful temporary placement of a prototype removable covered self-expandable metal stent (RCSEMS). These 2 patients (both men, aged 44 and 53 years) were given temporary placement of a prototype RCSEMS (8.5 Fr gauge delivery system, 8 mm x 40 mm stent dimensions) in the common bile duct across the biliary stricture. There was no morbidity associated with stent placement and removal in these 2 cases. Clinical parameters improved after the RCSEMS placement. Long-term biliary patency was achieved in both the patients. No further biliary intervention was required within 14 and 18 mo follow-up after stent removal.

Matched MeSH terms: Liver Transplantation/adverse effects*

Hepatopulmonary Syndrome and Portopulmonary Hypertension in Children: Recent Advances in Diagnosis and Management

Lee WS, Wong SY, Ivy DD, Sokol RJ

J Pediatr, 2018 05;196:14-21.e1.

PMID: 29514741 DOI: 10.1016/j.jpeds.2017.12.068

Matched MeSH terms: Liver Transplantation/adverse effects

Approach to the treatment of primary liver cancer

Primrose JN

Med J Malaysia, 2005 Jul;60 Suppl B:104-7.

PMID: 16108188

Matched MeSH terms: Liver Transplantation

Extracorporeal liver support and the role of liver transplantation

Tan SS

Med J Malaysia, 2005 Jul;60 Suppl B:133-5.

PMID: 16108194

Matched MeSH terms: Liver Transplantation

Unusual contribution of the first jejunal vein in the formation of the portal vein

Nayak SB, Shetty SD, Packirisamy V, Vasudeva SK

Morphologie, 2021 May 05.

PMID: 33965324 DOI: 10.1016/j.morpho.2021.04.003

Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.

Matched MeSH terms: Liver Transplantation

Population Pharmacokinetic Models of Tacrolimus in Adult Transplant Recipients: A Systematic Review

Kirubakaran R, Stocker SL, Hennig S, Day RO, Carland JE

Clin Pharmacokinet, 2020 11;59(11):1357-1392.

PMID: 32783100 DOI: 10.1007/s40262-020-00922-x

BACKGROUND AND OBJECTIVES: Numerous population pharmacokinetic (PK) models of tacrolimus in adult transplant recipients have been published to characterize tacrolimus PK and facilitate dose individualization. This study aimed to (1) investigate clinical determinants influencing tacrolimus PK, and (2) identify areas requiring additional research to facilitate the use of population PK models to guide tacrolimus dosing decisions.

METHODS: The MEDLINE and EMBASE databases, as well as the reference lists of all articles, were searched to identify population PK models of tacrolimus developed from adult transplant recipients published from the inception of the databases to 29 February 2020.

RESULTS: Of the 69 studies identified, 55% were developed from kidney transplant recipients and 30% from liver transplant recipients. Most studies (91%) investigated the oral immediate-release formulation of tacrolimus. Few studies (17%) explained the effect of drug-drug interactions on tacrolimus PK. Only 35% of the studies performed an external evaluation to assess the generalizability of the models. Studies related variability in tacrolimus whole blood clearance among transplant recipients to either cytochrome P450 (CYP) 3A5 genotype (41%), days post-transplant (30%), or hematocrit (29%). Variability in the central volume of distribution was mainly explained by body weight (20% of studies).

CONCLUSION: The effect of clinically significant drug-drug interactions and different formulations and brands of tacrolimus should be considered for any future tacrolimus population PK model development. Further work is required to assess the generalizability of existing models and identify key factors that influence both initial and maintenance doses of tacrolimus, particularly in heart and lung transplant recipients.

Matched MeSH terms: Liver Transplantation

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