Post Living Donor Liver Transplant Research Articles

Down-Regulation of microRNA-26a Promotes Mouse Hepatocyte Proliferation during Liver Regeneration

BackgroundInadequate liver regeneration (LR) is still an unsolved problem in major liver resection and small-for-size syndrome post-living donor liver transplantation. A number of microRNAs have been shown to play important roles in cell proliferation. Herein, we investigated the role of miR-26a as a pivotal regulator of hepatocyte proliferation in LR.Methodology/Principal FindingsAdult male C57BL/6J mice, undergoing 70% partial hepatectomy (PH), were treated with Ad5-anti-miR-26a-LUC or Ad5-miR-26a-LUC or Ad5-LUC vector via portal vein. The animals were subjected to in vivo bioluminescence imaging. Serum and liver samples were collected to test liver function, calculate liver-to-body weight ratio (LBWR), document hepatocyte proliferation (Ki-67 staining), and investigate potential targeted gene expression of miR-26a by quantitative real-time PCR and Western blot. The miR-26a level declined during LR after 70% PH. Down-regulation of miR-26a by anti-miR-26a expression led to enhanced proliferation of hepatocytes, and both LBWR and hepatocyte proliferation (Ki-67+ cells %) showed an increased tendency, while liver damage, indicated by aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (T-Bil), was reduced. Furthermore, CCND2 and CCNE2, as possible targeted genes of miR-26a, were up-regulated. In addition, miR-26a over-expression showed converse results.Conclusions/SignificanceMiR-26a plays crucial role in regulating the proliferative phase of LR, probably by repressing expressions of cell cycle proteins CCND2 and CCNE2. The current study reveals a novel miRNA-mediated regulation pattern during the proliferative phase of LR.

Hepatic arterial embolization for massive bleeding from an intrahepatic artery pseudoaneurysm using N-butyl-2-cyanoacrylate after living donor liver transplantation

Parenchymal pseudoaneurysm of the hepatic arteries with massive intraperitoneal bleeding is rare but a serious life-threatening complication when it occurs following liver transplantation. We report a case of an adult postliving donor liver transplant recipient who developed massive subcapsular bleeding combined with massive right pleural effusion from ruptured multiple small intrahepatic arteries, which developed from a pseudoaneurysm that was treated by hepatic arterial embolization. Successful embolization was performed via a percutaneous trans-catheter approach by depositing 20-25%N-butyl-2-cyanoacrylate (NBCA) through the multiple small intrahepatic arteries into the pseudoaneurysm. Complete occlusion of the feeding arteries and pseudoaneurysm cavity resulted to immediate cessation of bleeding. There was no re-bleeding; and normal liver graft function was noted postembolization. Hepatic arterial embolization with NBCA can be used as treatment for postliver transplant peripheral intrahepatic artery pseudoaneurysm bleeding.

Effective and safe immunizations with live-attenuated vaccines for children after living donor liver transplantation

Immunizations using live-attenuated vaccines are not recommended for post-liver transplant children due to its theoretical risks. However, they will encounter vaccine-preventable viral diseases upon returning to real-life situations. We performed a total of 70 immunizations with four individual live-attenuated vaccines to 18 pediatric post-living donor liver transplant (LDLT) recipients who fulfilled a clinical criteria including humoral and cell-mediated immunity. The seroconversion rates at the first dose for measles (strain AIK-C), rubella (strain TO-336), varicella (strain Oka), and mumps (strains Hoshino) were 100% (15/15), 100% (15/15), 82% (9/11), and 82% (9/11), respectively. During observed period (−5 years 11 months), a few cases with waning immunity (antibodies were once produced but the levels fell over time) were seen except after rubella immunization. Clinical diseases after seroconversion or definite serious adverse effects due to immunization were not observed. Immunizations using selected live-attenuated vaccines were safe and effective for post-LDLT children who were not severely immunosuppressed.

Percutaneous transhepatic biliary drainage may serve as a successful rescue procedure in failed cases of endoscopic therapy for a post–living donor liver transplantation biliary stricture

Although a biliary stricture is one of the most important complications that develop after living donor liver transplantation (LDLT), a standard approach has not yet been established. The aim of this study was to evaluate the usefulness of nonoperative management in repairing a post-LDLT biliary stricture. A total of 60 patients were referred, from July 2004 to July 2007, for management of a post-LDLT biliary stricture. The patients had ERCP if the hepatic arterial flow was patent on a Doppler sonography. If endoscopic therapy failed, then percutaneous transhepatic drainage (PTBD) was performed to dilate the stricture. If the percutaneous approach also failed, then a repeated PTBD was performed after a 3-dimensional abdominal CT (3D-CT). Division of Gastroenterology, Department of Internal Medicine, Yongdong Severance Hospital. Sixty patients were referred from Catholic University Hospital of Korea for ERCP. ERCP was performed on all 60 patients, and 38 (63%) were successfully treated. When the shape of the distal side of the bile-duct anastomosis was classified into 3 categories (pouched, triangular, and intermediate), the pouched shape showed the lowest success rate of endoscopic therapy (25% [4/16]). Fifteen of 22 patients in whom endoscopic therapy failed were treated by using PTBD. Nine of the 15 patients were successfully managed in the first PTBD attempt, and 4 of the 6 patients in whom the first attempt of PTBD failed had repeated PTBD after a 3D-CT. Four patients were successfully treated with repeated PTBD of the alternative branch approach after a 3D-CT. ERCP is a feasible first modality in the treatment of a post-LDLT biliary stricture, but, in failed cases, especially in the pouched shape, PTBD can be attempted. When initial PTBD trial fails, a biliary-tract examination, such as a 3D-CT, can be useful for a repeated PTBD trial.

1026: Ultrasound of post-living donor liver transplantation complications

1026: Ultrasound of post-living donor liver transplantation complications