Small bowel obstruction caused by a bezoar following an adult simultaneous liver-kidney transplantation:A case report

BACKGROUND Small bowel obstructions(SBOs)are common following a large intra-abdominal operation;however,SBOs caused by bezoars are unreported in patients following liver-kidney transplantation procedures,particularly in adults.CASE SUMMARY A 65-year-old Caucasian female presented with nausea and nonbilious emesis during her postoperative course following a simultaneous liver-kidney transplantation.She developed worsening nausea and vomiting with significant abdominal distension and obstipation.Computed tomography imaging showed a marked abnormal dilation of multiple small bowel loops with a distinct transition point that was suggestive of a small bowel obstruction.An exploratory laparotomy revealed a foreign body in the intestinal track approximately 30 cm from the ileocecal valve.The foreign body was extracted and identified as a bezoar with hair follicles and old digestive contents.Following the operation,the patient demonstrated rapid clinical improvement with resolution of nausea,emesis,and progress in bowel motility.CONCLUSION SBOs caused by bezoars can occur immediately following a liver-kidney transplantation and should not be discounted as a diagnosis.

Combined liver-kidney transplantation for rare diseases

Combined liver and kidney transplantation(CLKT)is indicated in patients with failure of both organs,or for the treatment of end-stage chronic kidney disease(ESKD)caused by a genetic defect in the liver.The aim of the present review is to provide the most up-to-date overview of the rare conditions as indications for CLKT.They are major indications for CLKT in children.However,in some of them(e.g.,atypical hemolytic uremic syndrome or primary hyperoxaluria),CLKT may be required in adults as well.Primary hyperoxaluria is divided into three types,of which type 1 and 2 lead to ESKD.CLKT has been proven effective in renal function replacement,at the same time preventing recurrence of the disease.Nephronophthisis is associated with liver fibrosis in 5%of cases and these patients are candidates for CLKT.In alpha 1-antitrypsin deficiency,hereditary C3 deficiency,lecithin cholesterol acyltransferase deficiency and glycogen storage diseases,glomerular or tubulointerstitial disease can lead to chronic kidney disease.Liver transplantation as a part of CLKT corrects underlying genetic and consequent metabolic abnormality.In atypical hemolytic uremic syndrome caused by mutations in the genes for factor H,successful CLKT has been reported in a small number of patients.However,for this indication,CLKT has been largely replaced by eculizumab,an anti-C5 antibody.CLKT has been well established to provide immune protection of the transplanted kidney against donor-specific antibodies against class I HLA,facilitating transplantation in a highly sensitized recipient.

Simultaneous liver-kidney transplantation:Single-center study

Objective To analyze the curative effect of simultaneous liver and kidney transplantation ( SLKT) for patients with end - stage liver and kidney diseases and liver cirrhosis patients with hepatorenal syndrome. Methods All SLKTs ( n = 21) performed at our center from January 1999 to December 2010 were reviewed and

Orthotopic liver transplantation in treatment of 77patients with end-stage hepatic disease

Objective: To summarize the experience of human or-thotopic liver transplantation(OLTx) in treatment ofpatients with end-stage hepatic disease and their peri-operative management.Methods: A retrospective analysis was made on OLTxperformed in 77 patients from April 1993 to September2001 in our department included combined liver-kid-ney transplantation (6 patients) and living related livertransplantation (2). Among them, 76 were adults and1 was infant (67 males and 10 females) . The donors in-cluded 7S non-heart beating donors and 2 living re-lated donors. Veno-venous bypass was used only in 45cases during the operation. Immunosuppressive agentsconsisted of cyclosporine, cellcept, ALG corticosteroidsand FK506.Results: The one-year survival rates of grafts and re-cipients with benign hepatic disease were 75%. Therecipients this year are surviving with good function ofgrafts.Conclusion: Liver transplantation is the best therapeu-tic method for a large number of patients with end-stage hepatic disease in China.

Combined liver and kidney transplantation in children and long-term outcome

Combined liver-kidney transplantation(CLKT)is a rarely performed complex surgical procedure in children and involves transplantation of kidney and either whole or part of liver donated by the same individual(usually a cadaver)to the same recipient during a single surgical procedure.Most common indications for CLKT in children are autosomal recessive polycystic kidney disease and primary hyperoxaluria type 1.Atypical haemolytic uremic syndrome,methylmalonic academia,and conditions where liver and renal failure co-exists may be indications for CLKT.CLKT is often preferred over sequential liver-kidney transplantation due to immunoprotective effects of transplanted liver on renal allograft;however,liver survival has no significant impact.Since CLKT is a major surgical procedure which involves multiple and complex anastomosis surgeries,acute complications are not uncommon.Bleeding,thrombosis,haemodynamic instability,infections,acute cellular rejections,renal and liver dysfunction are acute complications.The long-term outlook is promising with over 80%5-year survival rates among those children who survive the initial six-month postoperative period.

Revisiting the liver’s role in transplant alloimmunity

The transplanted liver can modulate the recipient immune system to induce tolerance after transplantation.This phenomenon was observed nearly five decades ago.Subsequently,the liver’s role in multivisceral transplantation was recognized,as it has a protective role in preventing rejection of simultaneously transplanted solid organs such as kidney and heart.The liver has a unique architecture and is home to many cells involved in immunity and inflammation.After transplantation,these cells migrate from the liver into the recipient.Early studies identified chimerism as an important mechanism by which the liver modulates the human immune system.Recent studies on human T-cell subtypes,cytokine expression,and gene expression in the allograft have expanded our knowledge on the potential mechanisms underlying immunomodulation.In this article,we discuss the privileged state of liver transplantation compared to other solid organ transplantation,the liver allograft’s role in multivisceral transplantation,various cells in the liver involved in immune responses,and the potential mechanisms underlying immunomodulation of host alloresponses.

大鼠原位肝肾联合移植模型的建立

目的建立一种简易、可靠、成功率高的大鼠肝肾联合移植模型。方法建立210例大鼠原位肝肾联合移植模型。SD大鼠作同品系异体移植的供、受体。自制部分手术小器械;整块切取供鼠肝、肾,受体手术采取腹部横切口,并改进肝上下腔静脉及肾动脉吻合方法;术后采取复温、补液、抗感染等综合措施。结果供体手术时间(38±5)min,受体无肝期(20±3)min,受体手术时间(81±13)min。供体器官热缺血时间≤4s,冷缺血时间≤83min,手术成功率87.1%(183/210),术后门静脉栓塞等近期并发症的发生率12.9%(27/210)。结论本模型具有操作相对简单、重复性好、成功率高、并发症少等优点,是良好的肝肾联合移植动物模型。