Experience Using Continuous Veno-Venous Hemofiltration in Patients after Liver Transplant for 2017

( Samat Issakov ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: To evaluate CVVH (Continuous Veno-Venous Hemofiltration) as acute renal replacement treatment in postoperative care of liver transplantation. Retrospective study. Intensive Care Unit, year 2017. 6 OLT performed in 2017, 3 of them underwent acute renal replacement treatment. In the same period, in the ICU were admitted 146 patients, and 16 underwent acute renal replacement treatment (control group). Evaluation with SOFA (Sepsis-related Organ Failure Assessment) score. Methods: CVVH performed heparin free, pump system, polyamide or polysulphone 0.6 mq membrane hemofilter device, blood flow 100-150 ml/min, UF rate 600-1200 ml/h, clearance 16-20 ml/min. Coagulation monitoring (PT as INR, PTT, fibrinogen, antithrombin III, d-dimer, platelet count) was performed 3 times a day or on variation of the clinical conditions. Results: SOFA score did not differ between the two groups. Mortality was higher in the patients treated with CVVH. CVVH was performed from 16 to 18 hrs/day for 9.90 +/- 2.33 days. Three patients developed clinical bleeding before CVVH, 3 during CVVH but 1 of them underwent repeated surgical procedures. Conclusions: We cannot demonstrate that CVVH doesn’t affect bleeding, but we can say that, for the complexity of the post OLT patients, CVVH can be the treatment of choice in case of renal replacement treatment.

Surgical Management of Biliary Complications Following Living Donor Liver Transplantation

( Bekzat Eldesov ),( Samat Issakov ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Biliary complications (BC) account for much of the morbidities seen after living donor liver transplantation (LDLT). Surgical reconstruction might be necessary after the failure of endoscopic or percutaneous procedures. Methods: Between December 2002 and November 20016, a total of 76 LDLTs were performed. Six patients were excluded from statistical analysis because of early graft or patient loss. Results: Of 70, 26 (37.1%) developed BC; 12 (46.2%) were successfully managed by non-surgical procedures, three (11.5%) died from BC-related sepsis, one (3.8%) died from BC-unrelated causes, and 10 (38.5%) underwent surgical reconstruction. Of those 10, four patients had single duct reconstruction, five patients had double ducts reconstruction, and reconstruction was abandoned in one patient because of hepatic artery thrombosis. After a median follow-up period of 4.5 yr (0.1-6), seven (70%) remained well with no recurrent biliary problems, and three (30%) had recurrent BCs that were managed either conservatively or by retransplantation. Patients who underwent surgical reconstruction had significantly fewer hospital admissions, less need for invasive procedures, and shorter cumulative hospital stay (P<0.05). Conclusions: In our experience, BCs after LDLT were frequently resistant to non-surgical procedures. Surgical reconstruction is associated with fewer hospital admissions and less need for invasive procedures leading to reduced resources utilization.

The Outcome of Primary Liver Transplantation from Deceased Donors in Children with Body Weight 10 kg or Less

( Kydyr Nursultan ),( Samat Issakov ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: The aim of this study was to analyze the outcome in terms of patient and graft survival and to search for factors affecting this outcome Methods: Between March 2002 and November 2017, 42 children with body weight 10 kg or less had a primary liver transplantation from deceased donors in our unit. Overall, one-, three-, five-, and 10-yr primary patient and graft survival rates were 73%, 71%, 66%, 63% and 59%, 56%, 53%, 48%, respectively. Fifteen of 42 (36%) children died and in the remaining 14 (33%), the first grafts failed and they were retransplanted. Cox regression analysis revealed that a need for retransplantation and urgent transplantation were important predictors for patient survival (P=0.04 and P=0.001, respectively). To assess whether the need for retransplantation can be influenced, all study variables were compared between surviving grafts and failed grafts Results: Cox regression analysis showed that only donor/recipient (D/R) weight ratio proved to be independent predictor for graft survival (P=0.004). After comparison of graft survival with the long rank test according to different D/R weight ratios (3.0-7.0), the cut-off point for significantly different graft survival approached 4.0. In summary, patient survival in children with body weight < or =10 kg is determined by urgent transplantation and the need for retransplantation. Conclusions: Graft loss and retransplantation in small children can be prevented by adequate size matching of donor and recipient whereby a D/R weight ratio <4.0 seems to offer the favorable outcome

Comparison of two transarterial chemoembolization strategies for hepatocellular carcinoma

Akhnur ASSANOVA,Samat ISSAKOV 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.-

Long-Term Outcomes of Children with Hepatitis C Virus Infection after Kidney Transplantation in Kazakhstan

( Marina Khvan ),( Nazym Nigmatullina ),( Saltanat Rakhimzhanova ),( Samat Issakov ),( Venera Altynova ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Introduction: Hepatitis C virus (HCV) infection is an important co-morbidity in patients after kidney transplantation (KT) affecting patient and graft survival. In the era of Direct Acting Antiviral (DAA) drugs the current standards of management strongly suggest to treat HCV positive patient with end-stage renal disease (ESRD) before KT. However, in the conditions where this treatment is not available, KT remains the only lifesaving option for children with ESRD who is not able to sustain on dialysis any longer. Aim: Currently, there is limited data available about outcomes of pediatric patients with HCV after kidney transplantation. We studied the prevalence, clinical profile and outcome of HCV infection in KT pediatric recipients (KTPR) in Kazakhstan for the first time after the launching the National Pediatric KT Program in 2012. Methods: We studied pediatric patients who underwent KT from January 2012 to December 2018 at the Department of Nephrology, Dialysis and Transplantation, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan. HCV infection was defined as a positive anti-HCV antibody and/or HCV RNA PCR positivity. Control group included KTPRs with no evidence of HCV or hepatitis B virus (HBV) infection. Results: A total of 73 KTPRs were included. The mean age was 10.6 ± 4.5 years, male:female ratio was 1:1 and mean duration of post-transplant follow-up was 32 months. 9 patients (12%) had evidence of HCV infection. All HCV-positive patients underwent KT before DAAs were available in the country. Among them 4 patients were treated with interferon before KT, 4 patients had HCV infection by the time of KT and 1 patient developed de-novo HCV infection after KT. Although there was no statistical significant difference in patient survival (logrank P=0.82) and graft survival (log-rank P=0.416) between HCV-positive group and controls, the only death in HCV group was registered in the patient who had de-novo HCV infection after KT. 2 patients who were treated from HCV infection before KT lost their kidney grafts and returned on dialysis. Among 4 patients with persistent HCV infection by the time of KT, 2 were successfully treated with DAAs 5 years after KT without any side effects or worsening of graft function. 2 KTPRs still have chronic HCV infection Stage 0 - 1 with low viral load, normal liver function tests and normal kidney graft function over the 6 years after KT. Conclusions: In our cohort HCV-positive KTPRs did not have any difference in patient and graft survival comparing to KTPRs without HCV infection. The worst outcome had patient with de-novo developed HCV infection after KT. HCV treatment with DAA after KT was successful without deterioration of kidney graft function. Limitation: low number of HCV-positive KTPRs.