Article

Dengue shock syndrome in a renal transplant recipient.

Transplantation (Impact Factor: 3.78). 03/2004; 77(4):634-5.
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    ABSTRACT: In Pakistan, dengue viral infection has become hyper-endemic. Renal transplantation is also expanding. We aimed to study dengue in renal transplant recipients (RTR). We conducted a study of RTR reported to be anti-dengue immunoglobulin-M antibody positive from January 2009 to December 2010 at our institution in Karachi and follow their clinical course and outcome. Median age was 28 years; 75 (73.7%) were males. Clinical presentation included fever in 82 (80.4%), gastrointestinal symptoms in 35 (34.3%), hemorrhagic complications in 9 (8.8%), and thrombocytopenia in 97 (95%), which was of >15 days duration in 24%. Fever was seen less frequently in patients on high-dose (>7.5 mg) steroids as compared with low-dose (≤7.5 mg) steroids. Forty-four patients (43%) had primary and 58 (56.8%) had secondary dengue infection. Dengue fever (DF) occurred in 90 (88%), and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) occurred in 12 (11.7%). DHF/DSS was seen in 3 (6.8%) of those with primary and in 9 (15.5%) of those with secondary infection (P < 0.22). In secondary infection, patients on cyclosporine-containing regimen had less severe disease, with DHF/DSS in 22% as opposed to DF in 59% (P < 0.04). Of 102 RTR, 68 (66.7%) had graft dysfunction, 5 of whom died. Of the remaining 63, in 54 patients (85.7%) creatinine returned to baseline by an average of 12.6 days. Of 102 patients, 95 (93%) recovered and 7 (6.9%) died, 6 of whom had bacteremia with sepsis and 1 had respiratory failure. None died due to dengue infection alone. In conclusion, in RTR without life-threatening co-morbidities, the clinical course of dengue infection is mild, with good recovery and preserved renal function.
    Transplant Infectious Disease 07/2013; · 1.98 Impact Factor
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    ABSTRACT: Living-donor liver transplantation (LDLT) is an excellent option for patients with end-stage liver disease in situations of donor shortage. The aims of this study were to evaluate our experience with left-lobe donor hepatectomy for LDLT and to grade postoperative complications using the 5-tier Clavien classification system. Data from medical records of 60 adult living liver donors (30 men, 30 women) who underwent left-lobe hepatectomy between November 2006 and April 2012 were reviewed. The median donor age was 31.7 ± 8.9 (range, 19-63) years. Sixteen complications were observed in 12/60 (20%) donors. Complications developed in 6/15 (40%) donors who underwent left hepatectomy and in 6/45 (13.3%) donors who underwent left lateral segmentectomy. Seven of 16 (43.7%) complications were Grade I and 2 (12.5%) were Grade II. Major complications consisted of 4 (25%) Grade IIIa and 3 (18.7%) Grade IIIb complications; no Grade IVb or V complications occurred. The most common complication was biliary, occurring in 7 (11.6%) donors and comprising 43.7% of all 16 complications. The mean duration of follow-up was 30 ± 7.1 (range, 2-58) months. No donor mortality occurred. Left-lobe donor hepatectomy for LDLT, which does not benefit the completely healthy donor, was performed safely and with low complication rates, but carries the risk of morbidity. Low morbidity rates following living-donor hepatectomy can be expected when surgical and clinical monitoring and follow-up are adequate and the surgeon has gained increased experience.
    Transplantation Proceedings 04/2013; 45(3):961-5. · 0.95 Impact Factor
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    ABSTRACT: BACKGROUND: Laparoscopic liver resection developed for live liver donors has the advantage of reducing the physical and mental stress in donors. However, its safety and efficacy still remain to be established. We aimed to evaluate the feasibility, safety and efficacy of laparoscopy-assisted hybrid donor hepatectomy (LADH) to obtain left side grafts. PATIENTS AND METHODS: A total of 31 consecutive live liver donors of left side liver grafts underwent LADH, including left lateral segmentectomy (n = 17) and left liver resection with or without the caudate lobe (n = 14) (LADH group). We compared the clinical data between the LADH group and the group of donors in whom traditional open donor hepatectomy was performed to procure the liver graft (open donor hepatectomy [ODH] group, n = 79). RESULTS: Laparoscopy-assisted hybrid donor hepatectomy was feasible in all patients, and there was no mortality over a follow-up period of 13.9 ± 9.8 months. The operative time to procure a left-lobe graft was significantly longer in the LADH group (510 ± 90 min) than in the ODH group (P < 0.001). A large right lobe on CT (RPv distance) was identified as a significant risk factor for prolonged operative time (P = 0.007). Evaluation using the SF36-v2 questionnaire revealed faster recovery of the physical component summary score and bodily pain score in the LADH group than in the ODH group. CONCLUSIONS: Laparoscopy-assisted hybrid donor hepatectomy for procuring left side grafts was safe and effective up to the left liver with the caudate lobe. Left-lobe LADH in donors with a large right lobe should be carefully planned in view of the potential surgical difficulty.
    World Journal of Surgery 06/2013; · 2.23 Impact Factor