Management of Large Hepatic Hemangiomas: The Single Center Experience of Treatment

( Marlen Doskali ),( Zhaksylyk Doskaliyev ),( Yerlan Nurgaliyev ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Hepatic hemangiomas are benign tumors, and they are usually asymptomatic with normal liver function. Surgical resection and surgical enucleation are the treatments of choice in the management of hepatic hemangiomas. In recent period transcatheter arterial embolization (TAE) has become as routine method to manage tumor growth. However, we use definition as large hemangiomas when hepatic tumors reach 4 cm. The aim of this study was to find applicable solutions for patients with large hepatic hemangiomas due to detailed observation of tumor diameter and liver function. Methods: In our study we retrospectively reviewed the patient charts of 21 patients with large hepatic hemangiomas treated with several methods at National Scientific Medical Research Center, Astana. Results: The median age was 41 years (37-51) and 85% were female. The median hemangioma size was 6.5 cm (6-12.1). Abdominal ultrasound was conclusive in 66.7% (13/21) and four-phase computed tomography (CT) in 82.6% (17/21) of patients. The indication for treatment was progressive abdominal pain in 78.6% (18/21). All patients were observed and showed no complications related to the liver hemangioma during follow-up. Conclusions: A large hemangioma resection can be safely performed at highly specialized institutions. The main indication for surgical procedures remains abdominal pain symptoms. Both surgical resection, enucleation and TAE are safe and are well admitted by patients.

Experience of Managment of Large Liver Hemangiomas

( Aidos Kulmagambetov ),( Marlen Doskali ),( Zhaksylyk Doskaliyev ),( Abai Baigenzhin ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Hepatic hemangiomas are benign tumors, and they are usually asymptomatic with normal liver function. The aim of this study was to find applicable solutions for patients with large hepatic hemangiomas due to detailed observation of tumor diameter and liver function. Methods: In our study we retrospectively reviewed the patient charts of 21 patients with large hepatic hemangiomas treated with several methods at National Scientific Medical Research Center, Astana. Clinical Features: - The commonest liver tumor - 5% of autopsies - Usually single small - Well demarcated capsule - Usually asymptomatic Results: The median age was 41 years (37-51) and 85% were female. The median hemangioma size was 6.5 cm (6-12.1). Abdominal ultrasound was conclusive in 66.7% (13/21) and four-phase computed tomography (CT) in 82.6% (17/21) of patients. The indication for treatment was progressive abdominal pain in 78.6% (18/21). All patients were observed and showed no complications related to the liver hemangioma during follow-up. A large hemangioma resection - 3 cases - safely performed at highly specialized surgeon. The main indication for surgical procedures remains abdominal pain symptoms. Both surgical resection, enucleation and TAE are safe and are well admitted by patients. Conclusions: Surgical resection and surgical enucleating are the treatments of choice in the management of hepatic hemangiomas. In recent period transcatheter arterial embolization (TAE) has become as routine method to manage tumor growth. However, we use definition as large hemangiomas when hepatic tumors reach 4 cm.

Self-Experience of Surgical Management of Bile Duct Strictures after Liver Transplantation

( Yerkin Turdiyev ),( Marlen Doskali ),( Abai Baigenzhin ),( Zhaksylyk Doskaliyev ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Bile duct (BD) stricture is one of the most common complication following liver transplant surgery and its challenging clinical condition requires a multidisciplinary approach for management. Methods: We analyzed the outcome of 6 patients who hospitalized in our center with BD strictures and underwent traditional surgery. In all patients biliary strictures are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, itching and cholangitis. Results: Traditional reconstructive surgery on bile duct remains as the mainstay of treatment, even it is associated with significant morbidity and variable long-term outcome. In our center an outcome of surgical management depended on both the etiology and location of stricture. Our data shows successful long-term results in patients with conventional surgery on BD. Conclusions: In conclusion, bile duct strictures often due to surgical inexperience, failure to recognize abnormal biliary anatomy and congenital anomalies, misplacement of clips, excessive use of cautery, and excessive dissection around the major bile ducts. Surgeons should be confident to avoid these causes and minimize an ischemic injury of BD.

Liver Transplantation for Patient with Emergency Indication

( Aidos Kulmagambetov,),( Marlen Doskali,),( Zhaksylyk Doskaliyev ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Decompensate liver cirrhosis is often accompanied by hepatorenal syndrome (HRS) with mortality up to 80%. The aim is improving the results of critical cases of decompensate liver cirrhosis in terminal phase. Methods: Patient S., 32 years old, female, enrolled with decompensated Primary Liver Cirrhosis, Child-Pugh class C, portal hypertension, esophageal varices II degree, ascites and hydrothorax, secondary coagulopathy and hepatic encephalopathy - III. MELD was 38. In inpatient ward his condition become worse as marked dyspnea, itching, ascites, oliguria. The total bilirubin increasedto critical levels (571 mcmol/L), hepatocellular, kidney (Cre 220mcmol/L) and respiratory failure progression and growing of ascites tense. MARS-therapy was ineffective. Despite significant coagulopathy, the continuous renal replacement procedure was performed safely and without incident. Cadaveric donor liver transplantation was indicated and performed by standard method. Results: In postoperative period intensive care and triple immunosuppression therapy (calcineurin inhibitor started on the 4th day, because of HRS) were done. In our patient, our treatment strategy resulted in resolution of ascites and edema, and improvement of renal function and hemodynamics. Patient discharged after 42 days after transplantation operation. Conclusions: Thus, in this emergency case just organized and undertaken by highly qualified emergency medical care to a patient in a terminal state would save lives.

Portal Vein Thrombosis after Liver Transplantation: Prevention and Treatment

( Zhaksylyk Doskaliyev ),( Marlen Doskali ),( Abay Baigenzhin ),( Nurbek Ilyassov ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Among complications after liver transplantation the vascular causes of graft dysfunction remains as a devastating complication and its challenging clinical condition requires a multidisciplinary approach for management. Methods: From January 2013 to January 2017, 38 LDLTs were performed in our center. Operation procedures were performed by standard methods in donor and recipients. In all donors right hepatectomies were performed. Risk factors and variables associated with the transplant and the post-transplant period were analyzed. Results: At a median follow up of 3 years, both the patient and graft survival were 82%. The main causes of transplantation were primary biliary cirrhosis (50%), viral hepatitis (30%) and other liver diseases. The median age of the recipients at the time of LDLT was 43.9±17.2 (19-65 years). Recipients average hospital stay was 30±5 days (23-38 days, median 30 days) found. Vascular and biliary complications were the leading cause of reoperation, graft loss and retransplantation. Conclusions: Portal vein thrombosis is an awkward problem to treat after liver transplantation because a different portal inflow is difficult to establish. We successfully applied the heparin-based treatment in 3 patients, but graft loss were found in 2 patients. It is reliable to use a local delivery of thrombolytic therapy compare to systemic therapy because of a high risk of systemic bleeding in post-liver transplant patients. Survival rate depends on presence of PVT in cirrhotic liver before surgery.

The Severity of Condition and Mortality of Patients with the Hepatorenal Syndrome to Prevent the Organ Failure by the Treatment with Cell Mediators

( Saule Kushenova,),( Marlen Doskali,),( Zhaksylyk Doskaliyev ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Hepatorenal Syndrome (HRS) plays an important role in patients with liver cirrhosis. To determine the dynamics of the severity of the condition and prediction of the estimated risk of mortality (ERM) patients with HRS using cellular mediators. Methods: The study included a group of 11 patients with HRS in ages from 18 to 70 years. 6 patients of the main group received cell mediators. The severity of the condition and prognosis of hospital mortality was evaluated on a scale APACHE III. Inside the main group investigated patients were divided into 3 groups (moderate, severe and very severe) depending on the number of points. Assessment of the dynamics of flow multiple organ failure (MOF) performed before treatment, 3-5 days and 7-10 days of treatment. Results: According to the results of intragroup analysis revealed statistically significant dynamic changes in the main group for the subgroup of moderate severity. Decrease in the average scores in the subgroup indicates positive patient outcomes. Comparison between subgroups and control group showed no statistical differences in the dynamics of APACHE III. The exception were two subgroups moderate groups where there was a statistically significant difference in the initial state - prior to treatment. This is due to the small sample of patients, where the average score was higher APACHE III in the study group than in the control. At subsequent stages of observation for 3-5 and 7-10 day these differences offset due to the patients. The dynamics of the estimated risk of death in 1 and 2 subgroup of the main group shows a statistically significant decrease of this indicator. Conclusions: The use of cell mediators may be considered appropriate in someone the complex therapy of patients to prevent the MOF. The positive trend in the state of patients with of severity for inclusion in the comprehensive treatment by cellular mediators. The appropriate use of cell mediators in patients with HRS remains controversial and requires further evidence by the researchs.

Features of Care the Pregnant Woman after Liver Transplantation

( Aibolat Smagulov ),( Doskali Marlen ),( Rysmakhanov Myltykbai ),( Taganova Aliya ),( Kulmaganbetov Aidos ),( Seidakhmetov Akhmet ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: As known the first case of pregnancy after liver transplantation has been in 1978 (Armenti VT1 et. al., Liver Transpl. 2000). During three years 127 living donor liver transplantations has carried out in Kazakhstan and our report represents the first successful pregnancy and childbirth after liver transplantation. Methods: Our patient is 27 years old for long period suffered from liver cirrhosis caused by autoimmune hepatitis. In December 2013 orthotopic transplantation of right liver lobe from a living related donor was performed. The donor was her elder brother. Results: In postoperative period it was portal vein thrombosis which treated by heparin monotherapy. No other complications found in late period after transplantation. The standard third-component immunosuppressive therapy (CI + MMF + GCS) was applied during the first year after transplantation. One year later it was suddenly known that patient is pregnant and it was 2 week of pregnancy when MMF application was canceled. First signs of liver rejection was appeared on 18-20 weeks where sensitization of HLA class 1 was 0% and HLA class 2 consisted 91%. As a main therapy pulse therapy with GCS and plasmapheresis were performed. During observation all signs of rejection and laboratory data decreased in 4 weeks and patientperformed a screening of fetus where no pathological alterations were found. On 40 weeks delivery was successfully done by Cesarean section. The child was male with weight - 2830 g, and height - 54.3 cm and without no visible any defects. Conclusions: In our case, it was an acceptable outcome for both mother and baby, although considered a high risk pregnancy. Regarding our data there is no evidence of specific structural malformations among children born to female liver transplant recipients, but it is still under observation when it should be decided with immunosuppressive therapy alterations.