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Abstracts 21 st Annual Conference of Indian National Association for the Study of Liver (INASL), March 22–24, 2013 Hyderabad International Convention Centre, Hyderabad, India LIVER TRANSPLANTATION TUBERCULOSIS IN LIVER TRANSPLANT RECIPIENTS Arikichenin Olithselvan, Dinesh Jothimani, Vivekanandan Shanmugam, Gomathy Narashimhan, Mohamed Rela Global Hospitals and Health City, Chennai, India Background: Tuberculosis is a signicant infection in transplant recipients worldwide. Post-transplant tubercu- losis remains a life-threatening disease with mortality rang- ing from 18-32% among all Solid Organ Transplants (SOT). Data on the incidence of tuberculosis post-liver transplantation remains scarce in the sub-continent. The incidence of tuberculosis among transplant recipients linked to endemicity. Mycobacterium tuberculosis disease among recipients of SOT in the western world is around 1.2-6.4%; 20-70 times higher than general population and in Liver transplant recipients its 0.7 -2.3%. India has the highest tuberculosis burden in the world (12million). Objectives: To identify the incidence of post-transplant tuberculosis in liver transplant recipients. Methods: A retrospective analysis of the transplant data- base was done to identify the incidence of post-transplant tuberculosis in our liver transplant recipients. Results: A total of 184 liver transplants have been per- formed till date of whom 4(2.1%) developed tuberculosis diagnosed between 2 and 34 months post-transplant. The mean age was 52 years with equal sex ratio. The Indi- cations for transplantation were cryptogenic-1, hepatitis C with hepatoma-1 and Nonalcoholic fatty liver disease in 2 patients. Their MELD score ranged from 13 to 28 and Childs-Pugh score from 10 to 12. All of them were serum IgG positive for cytomegalovirus infection. Two patients presented with Central nervous system involvement, 1 with Fournier's gangrene and the other with Pleural effu- sion. One patient reported recent exposure to tuberculosis and in one the explanted liver showed evidence of active tu- berculosis. There was no obvious pre-transplant risk factor in the remaining 2 patients. Standard protocol immuno- suppression was used in 3 patients and in one the immu- nosuppression was escalated 2 years after transplant due to the diagnosis of de-novo autoimmune hepatitis. Conclusions: The incidence of post-liver transplant tuber- culosis is this study was 2.1% which is consistent with the western data and the high tuberculosis burden in our country does not seem to affect the incidence in this group of immunosuppressed individuals. No signicant risk fac- tors for developing post-transplant tuberculosis could be identied in this small cohort Corresponding author: Arikichenin Olithselvan. E-mail: [email protected] CORRELATION BETWEEN POSTOPERATIVE LIVER FUNCTION TESTS AND SHORT TERM (<1 YEAR) MORTALITY FOLLOWING LIVING DONOR LIVER TRANSPLANTATION H. S. Preetham, K. H. Ismail Siyad, Harikumar R. Nair, V. A. Narayanan, S. Sudhindran Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, Kerala, India Background: Immediately following liver transplantation, standard Liver Function Tests (LFT's) are used routinely to diagnose early problems such as graft preservation injury, rejection, graft dysfunction, technical complications or sepsis. However usefulness of the immediate postoperative LFT's in predicting later graft outcome is not clearly known. Aims: To assess the impact of immediate post-operative Liver function tests in predicting short term (<1 year) mor- tality following Living Donor Liver Transplantation (LDLT) in adult patients. Patients and Methods: Out of 70 consecutive adult pa- tients who underwent LDLT from June 2006 till December 2010, 10 patients died within 28 days. Remaining 60 pa- tients (M: F = 3.6:1) were included in the study. Their post- operative Liver function tests within 28 days were analyzed to ascertain their correlation with one year mortality. Results: Out of 60 patients, mortality within 1 year post- LDLT was found to be 15%. Mortality in these patients was due to septicemia with multi organ dysfunction in 6 patients and hepatic artery thrombosis in 3 patients. No patient was re-transplanted. Both univariate and Multivar- iate analysis of pre and postoperative variables identied © 2013, INASL Journal of Clinical and Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S110S117 Liver Transplantation JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY

Tuberculosis in liver transplant recipients

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Page 1: Tuberculosis in liver transplant recipients

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Abstracts JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY

21st Annual Conference of Indian National Associationfor the Study of Liver (INASL), March 22–24, 2013

Hyderabad International Convention Centre, Hyderabad, India

LIVER TRANSPLANTATION

TUBERCULOSIS IN LIVER TRANSPLANTRECIPIENTS

Arikichenin Olithselvan, Dinesh Jothimani,Vivekanandan Shanmugam, Gomathy Narashimhan,Mohamed Rela

Global Hospitals and Health City, Chennai, India

Background: Tuberculosis is a significant infection intransplant recipients worldwide. Post-transplant tubercu-losis remains a life-threatening disease withmortality rang-ing from 18-32% among all Solid Organ Transplants(SOT). Data on the incidence of tuberculosis post-livertransplantation remains scarce in the sub-continent. Theincidence of tuberculosis among transplant recipientslinked to endemicity. Mycobacterium tuberculosis diseaseamong recipients of SOT in the western world is around1.2-6.4%; 20-70 times higher than general population andin Liver transplant recipients its 0.7 -2.3%. India has thehighest tuberculosis burden in the world (12million).Objectives: To identify the incidence of post-transplanttuberculosis in liver transplant recipients.Methods: A retrospective analysis of the transplant data-base was done to identify the incidence of post-transplanttuberculosis in our liver transplant recipients.Results: A total of 184 liver transplants have been per-formed till date of whom 4(2.1%) developed tuberculosisdiagnosed between 2 and 34 months post-transplant.The mean age was 52 years with equal sex ratio. The Indi-cations for transplantation were cryptogenic-1, hepatitis Cwith hepatoma-1 and Nonalcoholic fatty liver disease in 2patients. Their MELD score ranged from 13 to 28 andChilds-Pugh score from 10 to 12. All of them were serumIgG positive for cytomegalovirus infection. Two patientspresented with Central nervous system involvement, 1with Fournier's gangrene and the other with Pleural effu-sion. One patient reported recent exposure to tuberculosisand in one the explanted liver showed evidence of active tu-berculosis. There was no obvious pre-transplant risk factorin the remaining 2 patients. Standard protocol immuno-suppression was used in 3 patients and in one the immu-nosuppression was escalated 2 years after transplant dueto the diagnosis of de-novo autoimmune hepatitis.

© 2013, INASL Journal of Clinical and

Conclusions: The incidence of post-liver transplant tuber-culosis is this study was 2.1% which is consistent with thewestern data and the high tuberculosis burden in ourcountry does not seem to affect the incidence in this groupof immunosuppressed individuals. No significant risk fac-tors for developing post-transplant tuberculosis could beidentified in this small cohort

Corresponding author: Arikichenin Olithselvan.E-mail: [email protected]

CORRELATION BETWEEN POSTOPERATIVELIVER FUNCTION TESTS AND SHORT TERM(<1 YEAR) MORTALITY FOLLOWING LIVINGDONOR LIVER TRANSPLANTATION

H. S. Preetham, K. H. Ismail Siyad, Harikumar R. Nair,V. A. Narayanan, S. Sudhindran

Department of Gastroenterology, Amrita Institute of Medical Sciences,Kochi, Kerala, India

Background: Immediately following liver transplantation,standard Liver Function Tests (LFT's) are used routinely todiagnose early problems such as graft preservation injury,rejection, graft dysfunction, technical complications orsepsis. However usefulness of the immediate postoperativeLFT's in predicting later graft outcome is not clearlyknown.Aims: To assess the impact of immediate post-operativeLiver function tests in predicting short term (<1 year) mor-tality following Living Donor Liver Transplantation(LDLT) in adult patients.Patients and Methods: Out of 70 consecutive adult pa-tients who underwent LDLT from June 2006 till December2010, 10 patients died within 28 days. Remaining 60 pa-tients (M: F = 3.6:1) were included in the study. Their post-operative Liver function tests within 28 days were analyzedto ascertain their correlation with one year mortality.Results: Out of 60 patients, mortality within 1 year post-LDLT was found to be 15%. Mortality in these patientswas due to septicemia with multi organ dysfunction in 6patients and hepatic artery thrombosis in 3 patients. Nopatient was re-transplanted. Both univariate and Multivar-iate analysis of pre and postoperative variables identified

Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S110–S117