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Human cytomegalovirus (HCMV) is the most common opportunistic infection following liver transplantation (LT). This study aimed to identify risk factors for HCMV reactivation early post-transplantation. We retrospectively analyzed data from 150 LT recipients aged ≥14 years who received preemptive therapy in China from July 2017 to December 2018. We performed univariate and multivariate analyses to identify risk factors for HCMV reactivation within the first 90 days post-transplantation. HCMV reactivation occurred in 32 patients (21.33%) within the first 90 days post-LT. Intensive care unit length of stay (odds ratio [OR], 1.055; 95% confidence interval [CI], 1.007-1.104; P = .023), fungal infections (OR, 3.093; 95% CI, 1.092-8.764; P = .034), and non-hepatitis B virus (HBV)-related liver disease (OR, 5.576; 95% CI, 2.137-14.552; P = .000) were significant risk factors for HCMV reactivation within the first 90 days post-LT. The cumulative incidence of HCMV reactivation was significantly higher in patients with non-HBV-related liver diseases (P = .0007) than in those with HBV-related liver diseases. In the former, HCMV reactivation early after transplantation was associated with the pretransplantation hepatitis B surface antibody (HBsAb) serological status (P = .006). Higher HBsAb titers were significantly associated with reduced HCMV reactivation risk (P = .011). This study suggested that HCMV is a common opportunistic infection early after LT. Reducing intensive care unit lengths of stay and preventing fungal infections may reduce the risk of HCMV reactivation early after transplantation. Pretransplantation HBsAb titers might be a useful predictor in patients with non-HBV-related liver diseases.
Kidney transplantation (KT) in patients with bladder augmentation (BA) remains controversial due to concerns about infection, surgical complications, and long-term graft survival rate. We retrospectively evaluated patients who underwent KT after BA. Between January 2010 and August 2025, data from 15 patients with KT and BA were analyzed. Demographic characteristics, underlying urological diagnoses, type of augmentation, surgical details of transplantation, and post-transplant follow-up were evaluated. Fifteen patients underwent kidney transplantation after bladder augmentation. Median interval from augmentation to kidney transplantation was 176 months. Mean age at KT was 25.07 ± 6.8 years. Living kidney donation rate was 93.3%. The mean follow-up after KT was 98.9±57.4 months. Febrile UTI occurred in 8/15 (53.3%) patients (15 episodes), yet no graft loss was directly infection-mediated. Acute rejection occurred in 3/15 (20.0%). Graft survival rate was 100%, 90.9%, and 72.7% at 1, 5, and 10 years, respectively. Median serum creatinine at last follow-up was 1.58 mg/dL. Kidney transplantation in patients with augmented bladders can achieve satisfactory long-term graft survival.
Crigler-Najjar syndrome (CNS) type 1 is a genetic disorder that leads to severe unconjugated hyperbilirubinemia. Auxiliary partial orthotopic liver transplantation (APOLT) is preferred for metabolic liver diseases as a portion of the native liver is retained. Reported here are details of a 32-year-old male who developed bilirubin encephalopathy due to graft failure 27 years after APOLT performed at 5-year-old for CNS type 1. Initially, the bilirubin level was low, which then gradually increased to 7.3 mg/dL at age 12. At the age of 31, the bilirubin level began to rise rapidly and we submitted a request for deceased donor liver transplantation (DDLT) to the Committee for the Evaluation of Indications for DDLT in Japan. However, that was deemed as not indicated, because unconjugated bilirubin-dominant hyperbilirubinemia alone is generally not considered to cause encephalopathy in adults. Despite the high bilirubin level, the patient remained neurologically asymptomatic until occurrence of acute decompensation. At 32 years old, he was admitted on an emergency basis to our hospital with severe hyperbilirubinemia and neurological symptoms. After managing his general condition with intensive care, DDLT was finally performed, resulting in a drastic resolution of various symptoms. The findings in this case show that bilirubin-induced neurotoxicity in adults may be reversible and indicate that the current liver transplantation criteria used in Japan, which limit eligibility for CNS to pediatric patients, may have contributed to delayed transplantation. Re-evaluation of the transplant eligibility criteria is necessary to allow for a more inclusive approach that encompasses adult patients.
Heterotaxy syndrome is a rare congenital disorder characterized by abnormal arrangement of thoracoabdominal organs. Associated cardiovascular and visceral malformations pose significant anesthetic and surgical challenges during major procedures such as liver transplantation. An eight-month-old female (6.2 kg) with extrahepatic biliary atresia and heterotaxy syndrome was scheduled for living donor liver transplantation. She had situs ambiguous, dextrocardia, right aortic arch, bilateral superior vena cava, and polysplenia. Persistent bradycardia (heart rate 50 bpm) was unresponsive to atropine, with long pauses on Holter monitoring. Isoprenaline infusion maintained a heart rate of 90 bpm preoperatively. On the day of surgery, induction was achieved with fentanyl, propofol, and atracurium. Transvenous pacing via internal jugular veins was unsuccessful due to anatomical variations; hence, left femoral access was used for pacing and central line placement. Intraoperative anesthesia with sevoflurane, fentanyl, and atracurium ensured stability during the 12-hour procedure. Postoperatively, the patient required re-intubation on day 2 for sepsis, which was managed with antibiotics. The pacemaker was removed on day 6 after stable rhythm with isoprenaline and oral orciprenaline. She recovered well and was discharged from ICU on day 20. Successful anesthetic management in heterotaxy syndrome requires detailed preoperative imaging, individualized pacing strategy, and vigilant intraoperative monitoring. Multidisciplinary coordination is key to achieving favorable outcomes in pediatric liver transplantation with complex congenital anomalies.
To investigate the current status and influencing factors of PICC/CVC-related central vascular access device-associated skin impairment (CASI) in patients undergoing hematopoietic stem cell transplantation (HSCT). A convenience sampling method was used to recruit 207 patients undergoing HSCT at our center between August and October 2019. The occurrence of CASI, including noninfectious exudation, puncture-site infection, skin irritation, and skin injury, was recorded, and its influencing factors were analyzed statistically. Among the 207 patients, 80 cases developed CASI, with the an incidence density of 18.3 per 1,000 catheter-days, including 48 cases of exudation (non-infection) (10.9 per 1,000 catheter-days), 13 cases of puncture point infection (3.0 per 1,000 catheter-days), and 1 case of skin injury (0.2 per 1,000 catheter-days) and skin irritation in 18 cases (.1 per 1,000 catheter-days). Logistic regression analysis results showed that the influencing factors of CASI are: compared with PICC, CVC increases puncture-site infection (OR = 17.76, 95% CI: 3.15-100.11, P = 0.001) and skin irritation(OR = 4.68, 95% CI: 1.36-16.08, P = 0.014) risk; compared with catheterization for more than 2 weeks, skin irritation within 2 weeks of catheterization(OR= 0.87,95% CI: 0.86-0.890, P = 0.016)and extravasation (non-infectious) (OR = 1.58, 95% CI: 1.23-11.01, P = 0.045) increased risk, while patients with catheterization for more than 2 weeks had an increased risk of infection (OR = 0.81, 95% CI: 0.810-0.949, P =0.042); exudation (non-infectious) occurred before transplantation (OR = 0.13, 95% CI: 0.06-0.29, P ＜ 0.001), puncture point infection (OR = 0.11,95% CI: 0.04-0.29, P = ＜ 0.001) and skin irritation (OR = 0. 20, 95% CI: 0.08-0.49, P = ＜ 0.001) were higher than those after transplantation. Among HSCT patients, the risk of indwelling PICC to prevent CASI is lower than that of CVC. It is also recommended that medical staff strengthen assessment during the immune deficiency period and within 2 weeks of catheterization, and standardize CVAD maintenance process to reduce the incidence of CASI and improve continuous treatment of patients.
To evaluate the efficacy and safety of reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) for a salvage therapy of patients with myelofibrosis (MF). We conducted a retrospective study of 17 MF patients with poor performance status, refractory disease, or progressive disease who underwent RIC-allo-HSCT. Overall survival (OS), progression-free survival (PFS), hematopoietic reconstitution, the cumulative incidence of relapse and improvements in myelofibrosis and splenomegaly were analyzed. All 17 patients received RIC regimens. The neutrophil and platelet engraftment rates were 94.1% and 88.2%, respectively, with median engraftment times of 16 days (range, 11-22 days) and 22 days (range, 10-148 days). The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) within 100 days post-transplant was 41.2%, and that of grade III-IV aGVHD was 17.6%. The overall incidence of chronic GVHD (cGVHD) was 35.3%. The reactivation rates of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were 47.1% and 29.4%, respectively. Before transplantation, there were 10 patients (58.8%) with MF-3 and splenomegaly. At six months after transplantation, the proportion of MF-3 decreased to 26.7%, MF-0 increased to 40.0%, and the proportion of splenomegaly decreased to 53.3%. As of the follow-up date, the proportion of MF-3 had decreased to 21.4%, MF-0 had increased to 57.1%, and all eight remaining patients with splenomegaly had shown varying degrees of spleen size reduction. The estimated 1-year OS and PFS were 88.2% (95% CI, 60.6%-96.9%) and 81.9% (95% CI, 53.8%-93.8%), and the estimated 3-year OS and PFS were 70.6% (95% CI, 26.0%-91.4%) and 65.5% (95% CI, 25.7%-87.7%), respectively. RIC-allo-HSCT is a feasible and effective alternative for salvage therapy in MF patients.
Ventilation-perfusion (V/Q) mismatch is common in lung transplant recipients, particularly during the early postoperative period. It may lead to impaired gas exchange and prolong the duration of mechanical ventilation. Electrical impedance tomography (EIT) is a novel bedside imaging modality, facilitating the real-time regional assessment of V/Q mismatch. This pilot study aimed to visualize and quantify V/Q mismatch using EIT in lung transplant recipients during the early postoperative period. This pilot single-center retrospective study included ten recipients following lung transplantation (5 single lung transplantation (SLT) and 5 bilateral lung transplantation (BLT)). During mechanical ventilation, the regional ventilation and perfusion were evaluated using EIT in the first 5 postoperative days. V/Q mismatch was quantified by calculating the percentages of only ventilated units, only perfused units, and unmatched units as well as the fractions of wasted ventilation and wasted perfusion. The SLT recipients exhibited a significantly higher percentage of only ventilated units than the BLT recipients (2.9% [2.8, 3.2] vs. 0.8% [0.0, 1.0], p = .012). In contrast, the BLT recipients showed a numerically higher percentage of only perfused units (28.8% [28.8, 34.1] vs. 19.4% [19.3, 19.4], p = .095). Moreover, the percentages of unmatched units, fractions of wasted ventilation, and fractions of wasted perfusion were comparable between the 2 groups. Distinct V/Q patterns for the SLT and BLT recipients were observed. This highlights the need for individualized ventilatory strategies to optimize postoperative respiratory management in lung transplant recipients.
This study aims to compare the effects of rifaximin and levofloxacin prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT) on the development of graft-versus-host disease (GVHD), length of hospital stay, engraftment duration, initiation of broad-spectrum antibiotics, incidence of febrile neutropenia, relapse rates, readmission periods, and transplant-related mortality. A total of 116 patients aged over 18 who underwent allogeneic HSCT between 2018 and 2022 were included. Exclusion criteria included the use of broad-spectrum antibiotics on the day of transplantation. Of these, 58 patients received rifaximin, and 58 received levofloxacin as prophylaxis. Levofloxacin was associated with a significantly lower incidence of febrile neutropenia in patients with acute myeloid leukemia (AML) compared to rifaximin (P = .017). Among other patient groups, levofloxacin prophylaxis also resulted in a lower fever incidence (P = .031). Levofloxacin demonstrated greater efficacy than rifaximin in reducing the incidence of transition to broad-spectrum antibiotic therapy (P = .008). Among the 116 patients, 54 were readmitted within the first 100 days post-transplantation. Among these, the predominant reason for readmission was infection, followed by graft-versus-host disease (GVHD). The use of levofloxacin prophylaxis was linked to a remarkably lower rate of readmissions (P = .004). In patients with acute lymphoblastic leukemia (ALL), levofloxacin also showed a significant advantage in terms of readmission rates. Moreover, individuals who received levofloxacin for prophylaxis experienced reduced mortality rates (P = .011).
Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation that is strongly associated with Epstein-Barr virus (EBV) infection. Serial monitoring of peripheral blood EBV -DNA is widely used for early detection of PTLD; however, its sensitivity is limited, particularly in cases involving the primary central nervous system. A 23-year-old female patient underwent living-donor kidney transplantation from her mother and was classified as having standard immunological risk. The EBV serostatus was donor-positive/recipient-negative, and serial peripheral blood EBV-DNA monitoring was performed after transplantation. Despite the EBV-DNA levels remaining below 4 log10 IU/mL, the patient developed progressive neurological symptoms. Subsequent neuroimaging and histopathological evaluations led to the diagnosis of central nervous system PTLD (CNS-PTLD). Treatment consisted of immunosuppression reduction, localized radiotherapy, and systemic rituximab-based chemotherapy and resulted in complete metabolic remission. Although EBV-DNA levels over 5 log10 IU/mL indicate an urgent concern for PTLD, this case highlights that CNS-PTLD can develop in high-risk transplant recipients even in the absence of significant EBV-DNAemia. Careful clinical assessment and prompt diagnostic evaluation of neurological symptoms are crucial for early diagnosis and appropriate management, particularly in donor-positive/recipient-negative kidney transplant recipients.
Liver transplantation in critically ill patients with multiple organ dysfunction poses a unique anesthetic challenge due to profound coagulopathy, hemodynamic instability, and metabolic derangements. We describe a 50-year-old male with alcoholic cirrhosis (MELD-Na 27) who underwent 2 consecutive liver transplants within 72 hours. The initial surgery involved aspiration of 15 L of purulent ascites and 8000 mL of blood loss. Advanced hemodynamic monitoring, balanced fluid therapy with albumin, vasopressor support (norepinephrine and vasopressin), goal-directed coagulation management (ROTEM), and strict metabolic control were implemented. Post-reperfusion hypotension and bradycardia were managed with adrenaline and atropine. Twelve hours later, he was reoperated for hemoperitoneum and subsequently underwent urgent retransplantation for hepatic artery thrombosis. Hemodynamic stability was achieved during the second procedure. Despite successful graft perfusion, the patient developed pneumonia and renal failure requiring replacement therapy, leading to a fatal outcome. Physiology-guided anesthesia can sustain intraoperative stability in extreme scenarios, but outcome depends on preoperative physiological reserve and timing of intervention.
Pregnancy after lung transplantation is uncommon and presents significant challenges due to chronic immunosuppression, infection risk, and potential graft dysfunction. We report a 35-year-old woman, 5 years postcadaveric bilateral lobar lung transplantation for non-cystic fibrosis bronchiectasis, who presenting with primary infertility and diminished ovarian reserve. Mycophenolate mofetil was discontinued because of teratogenic risk, and immunosuppression with tacrolimus and prednisolone was continued. Following an unsuccessful assisted reproductive technology (ART) attempt at another center and a second failed cycle complicated by post-transfer pulmonary infection, a third ART cycle was initiated using individualized ovarian stimulation. Piezo-assisted intracytoplasmic sperm injection yielded 3 blastocysts, and preimplantation genetic testing for aneuploidy (PGT-A) identified one euploid embryo. Infection control during treatment was guided by serial C-reactive protein monitoring and close clinical surveillance. A modified natural-cycle frozen embryo transfer resulted in a singleton pregnancy. At 30 weeks, the patient developed hypertension and pneumonia, both managed medically without intensive care. Due to declining pulmonary function, an elective cesarean delivery was performed at 35 weeks and 4 days, resulting in the birth of a healthy male infant (2190 g, Apgar score 10). Both mother and newborn were discharged in good condition, and the patient's pulmonary function improved postpartum with an uneventful follow-up during the past 6 months. This case represents the first documented live birth in Türkiye achieved through ART and PGT-A in a lung transplant recipient and demonstrates that successful pregnancy outcomes are attainable with coordinated multidisciplinary management and individualized reproductive planning.
Acute liver failure (ALF) is a life-threatening condition, characterised by serious damage to the liver cells and function. The aetiology of ALF determines the prognosis, and without immediate care or liver transplantation, people with ALF will develop life-threatening complications and die. Liver support systems are used as a bridge therapy to provide detoxification and restore liver function until either functional recovery occurs or a liver becomes available for transplantation. Liver support systems have continued to be used despite conflicting results of randomised clinical trials (RCTs). To assess the benefits and harms of liver support systems plus standard medical care versus standard medical care for adults with acute liver failure. We identified trials through manual and electronic searches in The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and Conference Proceedings Citation Index - Science. We also searched reference lists, trials registers, other sources, and contacted trial authors to identify trials for inclusion in the review. The latest search date was 10 July 2025. We included RCTs (published as abstracts or full-text articles) with a parallel-group design. We included the trials irrespective of the publication language and year, country of performance, or reported outcomes. The trials compared liver support systems plus standard medical care versus standard medical care. We included trials in adults ≥ 18 years old, of any sex, ethnicity, or race, diagnosed with ALF (including previous definitions) and irrespective of aetiology. We excluded trials with mixed populations where participants with ALF were < 10 % of the total number of participants; quasi-randomised trials and other observational studies. Critical outcomes were: all-cause mortality by day 28, all-cause mortality, serious adverse events (measured by the total number of people with one or more events), and the proportion of people with liver transplantation. Important outcomes included health-related quality of life, hepatic encephalopathy, and multi-organ failure (measured by the total number of events, including people who needed liver transplantation). Except for all-cause mortality by day 28, we planned to assess the remaining outcomes at their maximal follow-up. We assessed the risk of bias with the outcome-based RoB 2 tool. We judged the overall bias risk of each outcome result using the intention-to-treat principle. We resolved disagreements through discussion. We followed the Methodological Expectations for Cochrane Intervention Reviews when conducting the review, and PRISMA 2020 for the reporting. We conducted meta-analyses of available data for each outcome at the prespecified time points. We analysed dichotomous data using the risk ratio (RR) and the random-effects model, and calculated the rate ratio from the total number of events in the separate groups of a trial, with a set-up of contrast-level data and the inverse variance method. For both types of analyses, we used a 95% confidence interval (CI). We assessed the certainty of evidence of seven prespecified outcome results using the five GRADE domains (risk of bias, heterogeneity, indirectness, imprecision using a minimally contextualised approach, and publication bias). We included 11 parallel-group RCTs with 681 randomised participants (342 to the experimental group and 339 to the control intervention groups). Two of the trials were only published as abstracts. In the trials reporting on age, there were a few participants (≤ 18 years old) with inseparable data (age range: 10 to 69 years), whom we included in the analyses. The trials compared artificial liver support systems (eight trials) or bioartificial liver support systems (three trials) plus standard treatment and care versus standard treatment and care alone in people with ALF. They were conducted in Europe (Austria, Germany, Denmark, Finland, France, the UK), India, and the USA. The trial participants were treated in intensive care units. The maximal follow-up for all-cause mortality and hepatic encephalopathy was 90 days; for serious adverse events, liver transplantation, and multi-organ failure, it was 360 days. We downgraded the certainty of evidence to very low due to risk of bias and imprecision in all outcome results, and heterogeneity in the two mortality outcome results. Liver support systems may have little to no effect on all-cause mortality by day 28 (RR 0.83, 95% CI 0.58 to 1.19; I² = 66%; 9 studies, 539 participants; very low-certainty evidence), all-cause mortality at maximal follow-up (RR 0.82, 95% CI 0.63 to 1.07; I² = 52%; 11 studies, 681 participants; very low-certainty evidence), on the number of serious adverse events (Rate ratio 0.93, 95% CI 0.81 to 1.07; I² = 0%; 11 studies, 681 participants; very low-certainty evidence), and on the proportion of people with liver transplantation (RR 1.03, 95% CI 0.87 to 1.21; I² = 0%; 5 studies, 519 participants; very low-certainty evidence). No trial included health-related quality of life as an outcome. The evidence is very uncertain about the effect of liver support systems on hepatic encephalopathy (RR 0.40, 95% CI 0.16 to 1.04; I² = 0%; 2 studies, 34 participants; very low-certainty evidence). Liver support systems may have little to no effect on the number of multi-organ failures (Rate ratio 0.92, 95% CI 0.72 to 1.18; I² = 0%; 6 studies, 501 participants; very low-certainty evidence). Five trials had no for-profit funding, four trials declared full or partial for-profit funding and two trials did not declare funding. One study is awaiting classification. We found no ongoing randomised clinical trials. The trials assessed experimental liver support systems in adults with ALF. Based on very low-certainty evidence, we are very uncertain about the effects of liver support systems plus standard treatment and care versus standard treatment and care on all-cause mortality by day 28 and at maximal follow-up, serious adverse events, liver transplantation, hepatic encephalopathy, and multi-organ failure, including liver failure, due to insufficient data. We lack data on health-related quality of life. This Cochrane review had no dedicated funding. The protocol for this review is available via DOI: 10.1002/14651858.CD015059.
Passenger lymphocyte syndrome (PLS) is a graft-versus-host immune complication after solid organ or hematopoietic stem cell transplantation, typically arising from minor ABO or Rh incompatibility. It is caused by the transfer of viable donor B lymphocytes that produce alloantibodies against recipient red blood cell (RBC) antigens. The syndrome presents as delayed, immune-mediated hemolysis and can be clinically significant. We report a 51-year-old woman (blood group B/Rh-positive) who underwent liver transplantation from a blood group O/Rh-positive donor. On postoperative day 9, she developed jaundice and a significant drop in hemoglobin, with no overt clinical signs of hemorrhage. Liver biopsy revealed moderate T-cell mediated rejection and laboratory workup confirmed immune-mediated hemolysis, consistent with PLS. Management included donor compatible red blood cell transfusion, corticosteroids, intensified immunosuppression, and monoclonal antibodies (rituximab), which resulted in stabilization and subsequent resolution of hemolysis. Although rare, PLS should be considered in the differential diagnosis of early post-transplant anemia. Prompt recognition and appropriate transfusion strategy, with immunomodulatory therapy in severe cases, are crucial for favorable outcomes.
Kidney transplant recipients (KTRs) face high cardiovascular risk, but the benefit of statin therapy for preventing major adverse cardiovascular events (MACE) in this population remains unclear. We conducted a retrospective, single-center cohort study of adult KTRs between 2015 and 2024. Patients were categorized by statin use at the time of kidney transplantation (statin use [STN] vs no statin use [NoSTN]). We also conducted a separate analysis of patients with no known cardiovascular disease. The primary outcome was a composite of all-cause mortality and MACE. Cox proportional-hazards models were performed, adjusting for confounders identified from logistic regression. A total of 518 patients (202 STN vs 316 NoSTN) were included (mean age 54.3 vs 53.1 years. The STN group had significantly more patients with a history of smoking (73.5% vs 62.1%), whereas in the NoSTN group, diabetes mellitus was more prevalent (40.2% vs 30.7%). Statin use was not associated with a significant difference in MACE (13.8% vs 15.5%, P = .62), all-cause mortality (10% in both), or the composite outcome. Similar findings were observed in the primary prevention subgroup. Statin therapy at the time of kidney transplantation was not associated with a significant reduction in MACE or all-cause mortality in patients with and without known atherosclerotic cardiovascular disease. These results support a review of routine statin use in KTRs and highlight the need for further analysis.
Liver transplantation is a life-saving treatment for end-stage liver disease and acute liver failure. This study examines infections that develop within 1 year after liver transplantation, their risk factors, and patient prognoses. This study retrospectively reviewed the follow-up files and hospital computer records of patients who underwent liver transplantation at our hospital between 2010 and 2024. Patients information were recorded. After data analysis, statistical significance was accepted as p < .05. Of the 106 patients included in the study, the mean age at transplantation was 47.61 ± 12.17 (20-67), and 56 (52.8%) were male. The most common indication for transplantation was cryptogenic liver cirrhosis (26.4%). Nineteen (17.9%) patients died within the first 48 hours after transplantation. Of the 87 patients who survived after transplantation, 68 (78.2%) experienced at least 1 episode of infection, resulting in a total of 135 infections. Intra-abdominal infection (28.1%) was the most common post-transplantation infection. In the 1-year post-transplant period, the most common infections were bacterial (57.8% Gram-negative microorganisms) in 71.5% of cases, followed by fungal (16.5%), viral (6.5%), parasitic (5.5%), and M. tuberculosis (0.9%). Klebsiella spp. was the most common bacterial agent in 32 (29.3%) cases, and carbapenem resistance was detected in 64.9%. Enterococcus spp. was the most common Gram-positive microorganism in 12 (11%) cases. The duration of surgical prophylaxis was longer in patients who did not develop infection than in patients who did (p = .014). The length of intensive care unit stays in patients who developed infection was longer than in patients who did not (p = .033). Five patients (8.9%) died due to infection. Although bacterial infections are the most common, opportunistic viral, fungal, and parasitic infections can also occur in liver transplant patients. Because these infections can lead to patient death, rapid diagnosis and early initiation of treatment are crucial.
Kartagener syndrome (KS) is a rare genetic disorder inherited in an autosomal recessive manner. Bronchiectasis is a major contributor to the morbidity associated with this syndrome. In end-stage cases of KS, bilateral lung transplantation (DLuTx) is considered a viable treatment option. This case report presents a 7-year follow-up of a KS patient who developed end-stage respiratory failure and subsequently underwent DLuTx. The case includes both surgical and postoperative challenges, ultimately resulting in a significant improvement in the patient's quality of life.
Simultaneous pancreas-kidney transplantation (SPK) is a definitive treatment for end-stage kidney disease (ESKD) and type 1 diabetes mellitus. However, even with careful perioperative control of hemostasis, SPK carries a high risk of postoperative bleeding, which is exacerbated in patients with hemophilia A. Here, we report the first known successful SPK in a patient with congenital hemophilia A. A 52-year-old man was diagnosed with hemophilia A at 2 years of age. He developed type 1 diabetes mellitus at 25 years of age, which progressed to ESKD at 43 years of age. A comprehensive preoperative FVIII replacement protocol was applied during the perioperative period, using continuous infusion with bolus supplementation to maintain target VIII activity levels (100% intraoperatively, 80% during the first postoperative week, and ≥30% thereafter). This case demonstrates that SPK transplantation can be safely performed in patients with congenital hemophilia A, by implementing appropriate FVIII replacement strategies and close multidisciplinary collaboration.
We aimed to study the quality of life and self-care behavior of patients undergoing heart transplantation. We conducted a retrospective, descriptive study among recipients of heart transplants at Ramathibodi Hospital between 2017 and 2024. The study included 20 surviving patients, consisting of 17 adult patients and 3 pediatric patients aged 14 to 17 years, and elderly patients were defined as those aged 60 years and older. Patients who were unwilling to participate were excluded. The study utilized a 5-section questionnaire as a data collection instrument: Section1 Personal Data; Section2 Self-Care Behavior Questionnaire; Section3 Thai SF-36 QoL Questionnaire; Section4 Thai EQ-5D-5L QoL Questionnaire; and Section5 Satisfaction Score Assessment. Most patients were male (71%) and had at least a high school education. Physical self-care behaviors were generally good to very good, with high adherence to medication, infection prevention, and dietary guidelines. Exercise levels were moderate, and emotional well-being was favorable, with low levels of sadness or anxiety. The Thai SF-36 results showed mean scores of 75.03 for the physical component and 80.31 for the mental component. The EQ-5D-5L assessment indicated that most patients reported no problems with self-care (94%), anxiety/depression (90%), pain/discomfort (87%), usual activities (87%), and mobility (81%). The mean health state score from the VAS was 73.71. Satisfaction with QoL significantly improved after transplantation (P < .001). Recipients of heart transplants demonstrated improved QoL across physical and mental dimensions and maintained strong self-care behaviors. Continued support from health care teams is essential to sustain long-term outcomes and address remaining limitations in mobility and daily activities.
Liver transplantation (LT) is the main treatment for liver cirrhosis and other conditions. Hepatic artery thrombosis (HAT) is a complication described in up to 15% of LTs in adults. To evaluate the characteristics of patients who developed HAT, describe the different treatments performed in a tertiary center, and compare outcomes. This study is a retrospective cohort study based on medical record review of patients who underwent LT between January 2013 and December 2023. A total of 548 LTs were evaluated, of which 88 patients (16.05%) developed HAT. The proposed treatments were: expectant management in 7 patients (7.95%); endovascular treatment in 14 patients (15.90%); and LrT in 59 patients (67.05%). All patients in the expectant management group died, with a mean survival of 672.8 days (range 93-1583); 1- and 5-year mortality 40% and 100%, respectively. In the endovascular treatment group, 9 patients (69.23%) died, with a mean survival of 132 days (range 4-571); 1- and 5-year survival rates were 38.46% and 30.76%, respectively. Among patients indicated for LrT, 23 (26.13%) died before undergoing the procedure; thus, LrT was performed in 36 patients (40.9% of diagnosed HAT and 61.01% of those listed for re-LT). Of these, 22 (61.11%) died, with a post-LrT mean survival of 1290.45 days (range 1-4184); 1- and 5-year survival rates were 55.55% and 38.88%, respectively. HAT after LT represents a therapeutic challenge. Endovascular management was associated with positive outcomes; however, Lrt demonstrated the greatest long-term survival benefit.