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Abstract
Liver transplantation is the therapy of choice for many patients with end stage liver disease, liver cancer, fulminant hepatic failure and metabolic liver disease. The viral hepatitis is considered to be an important indication for the liver transplantation. In Egypt, overall HCV antibodies in the population represent 19.3%. In Egypt, the use of cadaveric donor is still prohibited, forcing some capable patients to seek this service abroad and living donor liver transplantation is the only available possible option for end stage liver disease Egyptian patients.
In order to study the impact of pretransplantation status on the outcome during the follow up of patients after transplantation, this retrospective study included 40 male patients who had undergone cadaveric liver transplantation for post-HCV cirrhosis during the period from January 2003 till December 2007. They were followed up for 12 months after transplantation and their data were analyzed. Their age ranged from 41 to 58 years with a mean of 56.3±5.8. None of them died during the study.
Clinically, 38 patients (95%) were suffering from jaundice, 39 patients (97.5%) had manifestations of encephalopathy, and all of them (100%) had ascites.
On endoscopic examination, 5 patients (12.5%) had grade I varices, 12 patients (30%) had grade II varices, 14 patients (35%) had grade III varices, 8 patients (20%) had grade IV varices.
Child-Pugh classification of patients before transplantation was as follows: None of patients was in class A, 8 patients (20%) were class B, and the remaining 32 patients (80%) were class C.
In The current series, clinical recurrent HCV (Evidence of viral replication by PCR post transplantation, elevated transaminases and confirmatory histology) was seen in (52.5%) of patients. Four of them were treated by interferon therapy and finished their course of treatment successfully. Eight of them are still under antiviral or combined therapy, 6 of them stopped after 6 months of treatment due to failure of treatment (persistent positive PCR after 6 months of regular treatment) and 3 patients were non-responding to treatment by combined therapy of interferon with Ribavirin (persistent positive PCR after 3 months of regular treatment).
The biliary complication is the most important factor in morbidity and even responsible for mortality post liver transplantation, accordingly, we found that were 7 (17.5%) patients who experienced biliary complications due to biliary stricture, hepaticojujenostomy, narrowing anastomosis, postoperative leak, absence of biliary flow, biliary peritonitis, dilated main hepatic duct, and stricture of biliary anastomosis which treated either by ERCP in 4 cases, PTC/Drainge in 2 cases and by surgical intervention in 1 case.
One of patients had acute rejection one week postoperatively in the form of mild attack which showed a good response to management. Another patient suffered from chronic rejection and treated by modulation of his immunosuppressant regimen.
All patients were under immunosuppressive regimens during the whole year of follow up. Thirty two patients (80%) were on Tacrolimus (Prograf) therapy, 4 patients (10%) were on Cyclosporine, 2 patients (5%) were on Mycophenolate Mofetil (Cellcept) and 2 patients (5%) were on Sirolmus (Rapamune). Management of rejection was mainly done through increasing the dose of immunosuppression or shifting to other immunosuppressant drug.
On regular ultrasound examination for follow up patients post-transplantation, 2 (5%) patients were discovered accidentally to have hepatic focal lesions, which were proved to be HCC and treated by chemoembolization.
In our studied cases none of them died during the follow up period.