Kidney Dysfunction after Liver Transplantation: Calcineurin Inhibitor Nephrotoxicity

( Abisheva Zhanar ),( Gani Kuttymuratov ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Show the effect of calcineurin inhibitor nephrotoxicity. as a cause of kidney dysfunction after liver transplantation Methods: In our medical center from 2013 to 2017 were performed total 44 liver transplantations. Of these, 31 were from a living donor, the remaining 9 from a cadaver donor. All patients after liver transplantation as basic immunosuppressive therapy received a three-component therapy: tacrolimus, mycophenolic acid and steroid. For induction therapy, Basiliximab was used on days 0 and 4 after surgery at a dose of 20 mg i.v. Tacrolimus was administered on the first day after liver transplantation at a dose of 0.01 mg/kg per day orally. Further, the dose of tacrolimus was increased to 0.05 mg/kg under the control of tacrolimus concentration in the serum. Steroids were administered on the day of the operation i.v., followed by a transfer of the drug per os. Mycophenolic acid preparations were administered on the third day after the operation in a standard dose. Conclusions: Thus, high doses of tacrolimus contribute to impaired renal function, leading to uremia and aggravation of the patient’s condition. Decreased doses of tacrolimus restore the function of the kidneys and, accordingly, normalize the indices of creatinine and urea in the serum of the patient

HSV after LDLT

( Abylaikhan Sharmenov ),( Gani Kuttymuratov ),( Tokan Sultnaliyev ),( Mukazhanov Adilbek ),( Zheksembayev Asan ),( Yermakhan Assylkhanuly ),( Mels Asykbayev ),( Said Abdugafarov ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Viral infection such as HSV, after Living donor liver transplantation (LDLT) is a major cause of morbidity and mortality that result in injury to allograft rejection and opportunistic superinfection. Most patients undergoing liver transplantation are seropositive for HSV. Without antiviral treatments, reactivated HSV infection develops in as many as 40% of these patients. Anogenital lesions are the second most common presentation of HSV disease in LDLT recipients, and are usually due to reactivation of latent HSV-2 in the sacral ganglia. Methods: In our clinical experience, i present a case of a 57-year-old female with hepatocellular carcinoma in the outcome of chronic viral hepatitis C who underwent surgery LDLT. ELISA viral panel before surgery: EBV IgG - positive, IgM - negative, HSV IgG- positive, IgM negative. Her immunosuppressive regimen included - MMF, Tacrolimus, and Prednisone. On the 15th day after the LDLT operation the patient in the pubic region appeared herpes lesion. The level of transaminases in dynamics has increased significantly. Biochemical analysis of blood: ALT - 364 U/l, AST - 98 U/l. GGTP - 159.66 U/l. CRP - 64 ng/ml. Then taken polymerase chain reactions (PCR) analysis for viral infection. PCR for viral panel: HSV DNA 1.2 - detected. CMV DNA - negative. EBV DNA - negative. Given the presence of herpes and PCR data scheduled antiviral therapy - per oral Famvir Famcyklovir) 1500 mg per day and local Acyklovir ointment. Results: After the 2 days on the background of anti-viral therapy transaminase levels started to decline over time. Biochemical analysis of blood: AST - 52.80 U/l, ALT - 204.20 U/l, CRP - 11.04 ng/ml. Post operative day (POD) №22, taken PCR for viral panel: HSV DNA 1.2 - negative. CMV DNA - negative. EBV DNA - negative. Antiviral therapy is continued, the dose of Famvir is reduced to 1000 mg per day. On the background of anti-viral therapy marked regression of herpes lesion, transaminase levels declined. Biochemical analysis of blood: AST - 32.80 U/l, ALT - 104.20 U/l. CRP - 3.96 ng/ml. Conclusions: These Results could help define reasonable indications for transplantation in an era with a shortage of liver grafts related to presented case. Prophylaxis for common infections (HSV and other) in high risk patients improves outcomes in the first year after LDLT. HSV can lead to liver failure after liver transplantation. Antiviral therapy such as Acyclovir, Famcyclavir active against HSV in vitro, and these substances must be used in the treatment of HSV infection after LDLT.

Splenic Artery Steal Syndrome after Orthotopic Liver Transplantation

( Saitkarim Abdugafarov ),( Gani Kuttymuratov ),( Tokan Sultnaliyev ),( Mukazhanov Adilbek ),( Zheksembayev Asan ),( Kakharman Yesmembetov ),( Yermakhan Assylkhanuly ),( Aiymkul Ashimkhanova ),( Baizh 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: To present successful treatment of post liver transplant non occlusive hepatic artery hypoperfusion syndrome presented by splenic steal syndrome (SASS) cases managed by splenic artery embolization. SASS is one of possible arterial complications after living donor liver transplantation. Material includes personal experience in diagnostics and treatment of this syndrome. In each case complication was suspected based on laboratory and ultrasound data and proved by angiography. Successful treatment was performed using splenic artery embolization. Methods: From 2014 there are total of 13 liver transplantations were performed and we had 2 cases of SASS. All donor livers undergo biopsy and those biopsy tissues with no more than 10% steatosis could be eligible for transplantation. Results: One of the most threatening complications of liver transplantation from a living donor is hepatic artery thrombosis. There are many possible causes of thrombosis including technical, and coagulation dysfunctions that will lead to the different level of graft disorders. However, in some circumstances other possible factors may induce arterial dysfunction due to functional features of visceral blood flow under established portal hypertension. SASS develops in 1-4% of post-transplant cases at early period after surgery from 2-5 days, and is characterized by re-distribution of blood supply from celiac trunk predominantly to splenic or gastro-duodenal artery. As a result of this phenomenon the linear and volumetric blood flow rates in the hepatic artery decreases leading to arterial ischemia of liver graft and might even lead to thrombosis. During this process the level of transaminases and bilirubin increases along with the Doppler ultrasound changes and CT-angiography data. The most dangerous consequence of SASS is the development of hepatic artery thrombosis (HAT) with the possible loss of transplant. The main reason of SASS development is hyper perfusion of the transplant. The timely diagnosis of the formidable pathologic syndrome is very crucial in order to avoid the loss of the graft. Conclusions: It appears that patients with decompensated cirrhosis with long-time established portal hypertension should be carefully monitored early post-operative time after transplantation for any unexplained liver dysfunction confirmed with Doppler ultrasound, CT-angiography and coagulation abnormalities suggestive of SASS.

Liver Transplantation for Alcoholic Liver Disease

( Yermakhan Assylkhanuly ),( Gani Kuttymuratov ),( Bakhyt Zharkimbekov ),( Mels Asykbayev ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: The most commonly affected organ remains the liver with a risk of alcoholic liver disease (ALD) which can range from asymptomatic to alcoholic hepatitis to alcoholic cirrhosis. Alcoholic liver disease (ALD) is the third most common diagnosis among patients which operation is required liver transplantation (LT) in the Kazakhstan. Pretransplant abstinence broadly achieves two goals; it allows a window window of opportunity for the liver to stabilize, and it allows opportunity to examine the patient’s commitment. Methods: In our center, liver transplant from a living donor to3 recipient with alcoholic liver disease in the outcome of liver cirrhosis. For the 6-8 months prior to the hospitalization of the patient during abstinence, it is important for patients who are prepared for orthotropic liver transplantation (OLT). Results: Indications for OLT was Child-Turcotte-Pugh score >7 with single episode of spontaneous bacterial peritonitis andan estimated 1 year survival without transplantation. Conclusions: ALD is an acceptable indication for liver transplantation as survival of these patients after transplantation is similar to that seen in patients who receive grafts for other causes. Patient selection is important for rationing scarce organs, hence the use of prognostic models for predicting risk of relapse to alcoholism. Rate of graft loss is no greater and rejection of the graft is even less so in patients transplanted for ALD.

Surgical Treatment of Liver Alveococcosis

( Dzhussubaliev Yerbol ),( Gani Kuttymuratov ),( Tokan Sultnaliyev ),( Mukazhanov Adilbek ),( Zheksembayev Asan ),( Yermakhan Assylkhanuly ),( Mels Asykbayev ),( Sharmenov Abylaikhan ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Alveococcosis - a parasitic disease caused by echinococcus multilocularis larvae and proceeding with the formation of the primary liver tumor. Alveococcosis complications may include festering parasitic tumor, a rupture in the formation of peritoneal or pleural cavity, jaundice, portal hypertension, alveococcus metastasis into brain and lungs. In terms of surgical tactics at liver alveococcosis, the most difficult issues are the choice of the optimal variant of surgical intervention and liver resection volume. Methods: Experience of observation over 36 patients with alveococcosis within 2 years is the basis for this presentation. Radical liver resection is performed on 30 patients, the other 6 patients had the unresectable alveococcosis volume. After radical liver resection alveococcosis relapse was observed on 1 patient. At the impossibility to execute radical surgery, resection - bone removal and palliative interventions remain the only surgery options. Results: During intrasurgical audit, mainly right lobe impairment has been revealed on 28 (93,3%) patients, 5 (17,8%) of them had parasitic knots crossed to segments of the left lobe of a liver. 2 (6,7%) patients had tumor generally localized separately in the left lobe of a liver without spreading to the adjacent organs. Germination in the adjacent organs was observed at 2 (7,1%) patients in the 1st group (to a diaphragm). In the same group one patient had lymph nodes of colon impaired, and 2 (7,1%) patients had the remote metastasises of abdominal cavity settled down in retroperitoneum (in the lower hollow vein and a tail of a pancreas). Often, parasitic impairment of an alveococcosis is massive which in some observations demands non-standard approach to treatment of such patients. Separate attention should be given to some clinical observations. Two-stage surgical treatment carried out for 25 years old patient. First, right-sided hemihepatectomia was performed (first phase), then, 12 months later atypical resection of segments II and III was performed (the second phase). In order to achieve a radical intervention for a 42 year-old patient, the resection of the V-VI liver segments, an atypical resection of the VII segment and a bisegmentectomy of the II-III segments were augmented with a radio-frequency ablation of two small (diameter to 1 cm) centers in the VII liver segment. During 2 years of treatment she had been receiving chemotherapy with albendazole, in 2 years after surgery CT of an abdominal cavity in the VII segment will reveal postablation lesions; no signs of disease recurrence present. Conclusions: Thus, alveococcosis remains surgicai- dependent disease. Radical resection during alveococcosis is abie to heal completely majoriti of patients and brings good results in the further perspective. I wonder alveococcosis liver surgery because I was ill alveococcosis liver and underwent surgical treatment. Now I``m alive and well.

Transplant Program Development in Kazakhstan: Experience of 6 Years

( Mels Assykbayev ),( Gani Kuttymuratov ),( Lyazzat Abdrakhmanova ),( Yermakhan Assylkanuly ),( Aiymkul Ashimkhanova ),( Kakharman Yesmembetov ),( Saitkarim Abdugaffarov ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: The aim of this analysis was to present the overall results of transplant service development in Kazakhstan. Background: Kazakhstan as the one of the fast developing countries in Central Asia has been improving the development of organ transplantation since 2010. There are 9 national and city level hospitals performing kidney, liver and heart transplantations in two major cities Almaty and Astana. A coordination center for organ transplantation was established in 2013 with the purpose of developing cadaveric donation service in Kazakhstan. In all 16 regions of our country we have transplant coordinators who work on finding potential donors, talking to their relatives, and making organ preservation. Considering the huge territory of the country there is a sanitary aviation service specially prepared for organ transportation, the special team for organ harvesting and for recipients. Methods: Prospective study started from 2010 at our center included all performed liver transplants and other organ transplants to analyze and follow up their results. Numbers are shown in percentages in Figure 1. The quantitative characteristics of all organ transplants in Kazakhstan. Results: Overall, 760 patients had undergone transplantations of kidneys, liver and heart for the last 5 years. The first kidney transplantation from a cadaveric donor performed in 1979, and this date considered as a beginning of the organ transplantation development in the Republic of Kazakhstan (RK). For the first time in our country, the multi-organ harvesting of organs: kidneys and the heart from cadaveric donor was performed in 2012. Our national center became a pioneer in performing liver transplantation from a cadaveric donor since 2013. The same year, the first pediatric liver transplantation from a living donor was carried out for a 6-year-old child. Starting from 2013 in collaboration with transplant surgeons from Turkey and South Korea many hospitals started to develop living donor liver transplant programs. Figure 1 illustrates the quantitative characteristics of organ transplants carried out in the Republic of Kazakhstan for the period from 2010 (including) to 2015. Conclusion: Our experience of Transplant program development highlights the demands of our population in organ donors with high mortality on a waiting list (72%). Thus, the development of living donor transplantation and overall transplant service will increase survival and quality of life of patients with end stage diseases.

Retrograde reperfusion of renal grafts to reduce ischemic-reperfusion injury

Myltykbay Rysmakhanov,Aibolat Smagulov,Nadiar Mussin,Asset Kaliyev,Bazylbek Zhakiyev,Yerlan Sultangereyev,Gani Kuttymuratov 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.4

Background: During transplantation, a kidney graft undergoes a cascade of pathological changes, referred to as ischemia-reperfusion injury (IRI), as it is incorporated into the bloodstream. Various studies have reported that retrograde reperfusion (RRP) leads to improved myocardial recovery and could reduce IRI in liver transplantation. This study investigated the effect of RRP in renal transplantation with a focus on reduction of kidney IRI. Methods: Between December 2019 and July 2022, 15 consecutive kidney transplants were performed with retrograde venous reperfusion. To conduct a comparative study and to recruit a control group, 15 kidney transplants that had been performed in the same center by the same two surgeons were retrospectively analyzed. Differences between the two groups were considered statistically significant at P<0.05. Results: The baseline characteristics of the two groups were statistically comparable (P>0.05). The surgical technique for kidney transplantation was the same in both groups. On the first postoperative day, polyuria was less pronounced in the RRP group (P<0.01). Serum creatinine and urea levels and estimated glomerular filtration rates on postoperative days 1, 4, 7, and 30 were lower in the RRP group (P<0.05). Conclusions: Retrograde venous reperfusion of a kidney transplant, preceding antegrade arterial reperfusion, reduced the effects of renal parenchyma IRI. To validate the results of this study, it is necessary to conduct further studies on a larger cohort of patients with a longer follow-up period.

PE-102: Treatment of End-stage Liver Disease in the JSC National Scientific Center for Oncology and Transplantology, Astana, Kazakhstan: Views and Perspectives

( Kulpash Kaliaskarova ),( Yuriy Prokopenko ),( Zhansaya Muratova ),( Sergey Borovskiy ),( Tokan Sultanaliyev ),( Adilbek Mukazhanov ),( Bakhyt Zharkimbekov ),( Assan Zhexembayev ),( Gani Kuttymuratov 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: End-stage liver disease represents a major healthcare problem worldwide and in Kazakhstan, carrying a high risk for mortality. Around 1000 patients with end-stage liver disease need liver transplantation in Kazakhstan, more than 50 of them dying yearly without being transplanted. The aim of this paper was review treatment methods for end-stage liver cirrhosis in our center. Methods: Results of various treatment options for end-stage liver disease patients, treated in JSC National Scientific Center for oncology and transplantology since June 2013 so far, were reviewed. Results: Total of 18 liver transplantations, including 6 from cadaveric and 12 from live donors, were performed in our clinic since June 2013, so far. Etiology of liver disease was as follows: HCC (due to nonalcoholic steatohepatitis in 2, hepatitis B in 1) 3 patients, liver cirrhosis (due to alcoholic liver disease in 3, hepatitis C in 2, hepatitis B+D in 6, autoimmune hepatitis in 1, primary biliary cirrhosis in 2 and autoimmune hepatitis and hepatitis B in 1) 14 patients, remaining was 7-year old pediatric patient with biliary atresia. Out of 18 transplanted patients, 2 have succumbed in the early post-operative period due to hemorrhage, remaining 16 are followed-up, counting up to 32 months of disease and rejection-free survival. Since the establishment of hepatology beds at department of general therapy in June 2015, total of 122 patients with liver cirrhosis and hepatocellular carcinoma were treated so far up to February 2016. Methods of treatment of hepatocellular carcinoma included transarterial chemoembolisation used 10 times in 6 patients, 1 patient has succumbed after 3 months of being diagnosed. Treatment options for portal hypertension in 113 liver cirrhosis patients included: esophageal varices ligation and sclerotherapy in 45 patients, splenic artery and esophageal varices embolisation in 22 patients with no complications dated and treatment with beta blockers in the rest of the patients. Out of 113 patients, 1 has succumbed due to the disease progression since start of follow-up in June 2015. Conclusions: Liver transplantation is the only viable option for end-stage liver disease patients. Portal hypertension treatment options using endoscopic and endovascular methods may provide sufficient short-term effect with good safety profile while being waitlisted, thus making liver transplantation available for more patients.