Severe hypertension after liver transplantation in alpha-1 antitrypsin deficiency

Article Abstract:

The transplantation of the liver is used to treat various potentially fatal liver conditions. Survival of liver transplantation has improved in children, but complications after surgery may be frequent and severe. Hypertension (high blood pressure) may result from treatment with cyclosporin, a drug used to suppress the immune system and thereby help to prevent rejection of the transplanted organ. One study showed that hypertension developed after liver transplantation in nine of 40 children with biliary atresia (closure or absence of the major bile ducts) and 10 of 14 children with alpha-1 antitrypsin deficiency (the lack of a compound that inhibits enzymes that break down proteins). A deficiency in alpha-1 antitrypsin may lead to the development of emphysema, the distention of lung tissue due to collection of air and gas within tissue spaces; hepatitis, or inflammation of the liver; and glomerulonephritis, the inflammation of the kidney tissue. Cases are described of five children with alpha-1 antitrypsin deficiency who underwent liver transplantations and biopsy of the kidney. All children developed hypertension after surgery, including four who developed brain disease related to the hypertension. The children had evidence of kidney disease before surgery, and this was confirmed by microscopic examination of the kidney tissue specimens. In four cases, a decrease in creatinine clearance, which is a measure of kidney function, had decreased before the development of hypertension. The development of glomerulonephritis in children with alpha-1 antitrypsin deficiency occurs more frequently than previously recognized. Patients with this kidney disorder are at increased risk of developing hypertension after liver transplantation, and complications due to kidney disease may affect the long-term outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Alpha 1-antitrypsin, Renal hypertension

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Cerebral aspergillosis in liver transplantation

Article Abstract:

Liver transplantation is often a last resort in treating end-stage liver disease. To prevent rejection of the donated organ, transplant patients receive immunosuppressive agents, such as steroids. There appears to be an increasing incidence of neurologic disease following liver transplant surgery, but the causes of this problem are poorly understood. Systemic fungal infection due to Aspergillus is a complication of immunosuppression; Aspergillus infection of the brain results in various symptoms and is difficult to diagnose in live patients. The authors suggest that aspergillosis is underdiagnosed in liver transplant patients. To explore the incidence and clinical presentation of cerebral aspergillosis in this patient population, they examined 44 brains at autopsy. Invasive cerebral aspergillosis was detected in nine brains, either by culture or tissue examination. In all cases, the primary focus of infection was the lungs; one case of pulmonary aspergillosis did not have cerebral involvement. Only two cases of cerebral aspergillosis were diagnosed prior to death. No specific neurologic findings were noted. Systemic aspergillosis infection appeared to occur soon after transplantation and in association with high doses of steroids. In addition, there appeared to be seasonal variation in the occurrence of this infection, with more cases in winter and spring. Liver transplant patients frequently require breathing support and ventilation. These procedures may increase the immunosuppressed patient's vulnerability to nosocomial (hospital-acquired) infection and pulmonary aspergillosis, in particular. Aggressive antifungal therapy should be initiated when systemic steroids are administered to transplant patients, and at the first indication of fungal infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Risk factors, Demographic aspects, Disease transmission, Brain, Aspergillus, Aspergillosis, Immunosuppression

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Viral and Toxoplasma gondii infections in children after liver transplantation

Article Abstract:

Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and adenovirus infections are common causes of mortality and morbidity in patients after organ transplantation. CMV can be transferred with the donor organ which, along with the other viruses, can cause significant disease after transplantation. Toxoplasma gondii (TG) can also be transmitted with the donor organ to produce a fatal, disseminated disease. The incidence and morbidity of TG infection, as well as viral infections, in children who underwent liver transplants was the focus of this study. Forty children, 14 boys and 26 girls, constituted the study group. CMV seroconversion occurred in 19 percent and reactivated CMV was detected in 47 percent of the children. New episodes of EBV infection occurred with mild disease; no reactivation of EBV was noted. Seven adenovirus infections occurred, with one fatal case of pneumonia, one case of hepatitis, and the remainder with mild respiratory involvement. Only one case TG infection was noted. Herpes simplex, varicella-zoster viruses, and respiratory syncytial virus were also implicated in disease. CMV virus is the most common and significant viral disease associated with post-transplantation morbidity and mortality. Surveillance and follow-up for all of the post-transplant diseases and viruses should be continued for an extended postoperative period. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Causes of, Cytomegalovirus infections, Toxoplasma

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