Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 5 Articles
Introduction: Presently, liver transplantation is becoming a more common treatment option for adults and children suffering from liver failure. Antibody-mediated rejection (AMR), a phenomenon that is exceedingly uncommon and inadequately comprehended, may induce graft dysfunction. The objective of the investigation was to evaluate the clinical and histopathological manifestations of AMR in pediatric patients. Material and methods: The retrospective study comprised sixty-two liver core biopsies from forty-two pediatric patients. In a total of 10 biopsies, 7 children were diagnosed with AMR, while 35 of them exhibited features of acute T-cell-mediated rejection (TCMR) in 52 biopsies. The C4d binding assay was conducted in all biopsies using the immunohistochemical (IHC) method. Bilirubinostasis, steatosis and acute and chronic rejection were re-assessed in all specimens. The 6-grade Ishak scale was employed to evaluate fibrosis. The TCMR activity was established using the Banff classification. AMR was assessed according to a novel histopathological grading system that was developed by the authors. Depending on the type of rejection, the relationship between histopathological grading, morphological characteristics, and laboratory parameters was established for each group. Standard methods were implemented to conduct statistical analysis. Results: At the time of biopsy, the median age of patients was 47.6 months (15.03–98.83) and the median time from transplantation was 0.9 months (0.3–7.6). The study’s findings provided evidence that histopathological lesions were the least specific manifestation, which supported the presence of AMR. A positive C4d staining statistically increases the likelihood of AMR diagnosis, whether or not there are associated morphological abnormalities. The type of rejection and laboratory tests did not exhibit any statistically significant correlation. Conclusions: The diagnosis of AMR in a transplanted liver is intricate and requires a multifaceted approach. However, the proposed histopathological grading may be a helpful method for selecting patients who should be assessed for donor-specific antibodies (DSAs) or in whom AMR should be suspected when DSAs cannot be determined....
Enzyme replacement therapy (ERT) for central nervous system symptoms and newborn screening (NBS) is available in Japan for patients with mucopolysaccharidosis type II (MPS II). Of 12 suspected cases identified through the NBS program, 3 patients were diagnosed with neuronopathic MPS II (2 directly from the screened cohort and 1 affected sibling). We reviewed the clinical courses of these patients, who were treated with intracerebroventricular (ICV) ERT using idursulfase beta (Hunterase®) followed by umbilical cord blood transplantation (CBT). Heparan sulfate (HS) in the cerebrospinal fluid (CSF) was longitudinally measured as a therapeutic biomarker, and developmental age was evaluated. All patients achieved successful engraftment with no severe complications, except for one patient with sinusoidal obstruction syndrome. The CSF HS concentration showed a temporary increase during the ERT discontinuation period, which can be attributed to CBT, and a subsequent reduction after the resumption of ICV-ERT. The patients exhibited age-appropriate development. The pattern of change in HS indicates the importance of continuing ICV-ERT even after hematopoietic stem cell transplantation. The study results demonstrate that the combination of ICV-ERT and CBT may yield promising outcomes in patients with neuronopathic MPS II, underscoring the importance of early intervention through NBS....
Background: Normothermic machine perfusion (NMP) is increasingly being used to improve organ utilization in liver transplantation (LT). However, its non-physiological perfusion setting may cause focal hepatic hypoperfusion (FHH), which remains insufficiently characterized in terms of its incidence, risk factors, and clinical impact. Methods: Data on liver grafts that underwent NMP prior to LT at the Department of General, Visceral, and Transplant Surgery, University Hospital Münster, between October 2019 and August 2024 were retrospectively analyzed. Recipients who underwent contrast-enhanced computed tomography within 30 days post-LT were included. The primary outcomes were the Comprehensive Complication Index (CCI) and overall graft survival rate. Ninety-one patients met the inclusion criteria and were stratified according to the presence of FHH in the FHH+ (n = 27) and FHH- (n = 64) groups. Results: FHH was detected in 29.7% of the grafts. Higher graft weight was the only independent predictor of FHH. In addition, graft weight correlated with the extent of FHH (τ = 0.40, p < 0.001). FHH did not affect graft or patient survival but was associated with higher CCI scores (p = 0.001) and prolonged intensive care unit length of stay (p = 0.028). Conclusions: FHH is a common radiological finding after NMP. Although it does not affect graft loss, its association with a higher complication burden warrants further attention. Whether avoiding NMP in very heavy grafts could reduce the incidence of FHH remains to be determined....
Liver transplant can significantly improve survival in patients with isolated colorectal liver metastases (CRLMs) not amenable to surgical resection. The use of evolving strict selection criteria to identify patients with CRLM best suited for transplant has greatly prolonged disease-free survival and resulted in a post-transplant overall survival similar to that of other established indications for transplant such as advanced cirrhosis or hepatocellular carcinoma. While recurrence of colorectal cancer is still seen in the majority of patients after transplant, lesions are typically slow-growing and treatable without significant mortality. Further profiling of patients’ tumor molecular and biologic activity before transplant can help risk-stratify them for aggressive recurrence. Our current understanding of recurrence after liver transplant for CRLM is based on only a small number of prospective studies but further trials are underway. Novel surgical approaches which could expand the pool of patients eligible for transplant are also being evaluated. We summarize and discuss the current state of the literature describing the patterns, risk factors, and treatment of recurrence after liver transplant for isolated CRLM....
Background/Objectives: Salvage hepatectomy with a prolonged anhepatic phase represents a potential life-saving strategy in patients with toxic liver syndrome (TLS) following orthotopic liver transplantation (OLT). Available evidence is limited to small case series. Methods: We retrospectively analyzed all patients undergoing OLT between 2014 and 2024 at a German transplant center. Among 497 patients, 33 required retransplantation, including four patients who underwent salvage hepatectomy due to refractory TLS. Clinical trajectories were analyzed descriptively. Additionally, a structured narrative review of the literature was performed. Results: Median age was 63 years (range 62–67), and median anhepatic time was 38.4 h (range 14.39–71.55). No patient died during the anhepatic phase. One patient died during retransplantation, and another during the postoperative course. Two patients survived long-term without neurological impairment. A literature review identied 30 relevant studies with reported mortality rates exceeding 50%. Conclusions: Salvage hepatectomy with subsequent retransplantation may serve as a life-saving bridge in selected patients with TLS. However, outcomes remain heterogeneous, and evidence is limited. This study provides detailed insights into perioperative physiological trajectories and clinical decision-making, which are insuciently described in the current literature....
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