Ali Bahador

Shiraz University of Medical Sciences, Chimaz, Fārs, Iran

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Publications (135)121.43 Total impact

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    ABSTRACT: So far numerous post-transplant outcome predictors have been studied to decrease the loss of resources and grafts after organ transplantation. The role of education, as a predictor, in liver transplantation outcome has so far been studied in several articles. However, in most of the studies it was evaluated as a surrogate for socioeconomic status or other variants. The absolute impact of parents' education has rarely been studied. Adult patients are their own caregivers whereas pediatric liver transplantation recipients are mostly cared by their parents. To evaluate the effect of level of patients' education on the mortality and morbidity of pediatric liver transplant recipients. We studied a group of 91 children who had undergone liver transplantation in our center from March 21, 2012 to July 21, 2013. In this retrospective study, patients' medical charts and questionnaire were used to collect the necessary data. Post-transplantation mortality and complications were divided into two categories: Early (<6 months after liver transplantation), and late (≥6 months after the transplantation). Parents' educational level was also categorized into 5 groups. Multivariate analysis of all groups showed that paternal education is an independent predictor of the late post-transplantation complications (p=0.024). Educational level of children's mothers had no significant correlation with the late post-transplantation complications (p=0.45). Neither maternal (p=0.59) nor paternal (p=0.607) education had significant effect on the late post-transplantation mortality. Paternal educational level of liver transplanted children is associated with the late post-transplantation complications.
    02/2015; 6(1).
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    ABSTRACT: Objectives: This study sought to evaluate in pediatric liver transplant recipients the effects of hybrid antiviral therapy on the rate of posttransplant lymphoproliferative disorder. Materials and Methods: All pediatric patients (87 cases) who had undergone a liver transplant between April 2011 and March 2012 took part in the study and received hybrid antiviral treatment (case group). Epstein-Barr virus polymerase chain reaction was monitored intermittently. The results were compared to those of a historical control group including 117 pediatric patients who received a liver transplant between April 2009 and March 2011. Follow-up was 27 to 47 months in the control group and 12 to 26 months in the case group. Results: Posttransplant lymphoproliferative disorder occurred in 12 patients in control group (10.2%) and 5 patients in case group (5.7%) (P = .249). Of 12 cases of posttransplant lymphoproliferative disorder, death occurred in 5 cases in the control group (41.7%), while no posttransplant lymphoproliferative disorder-associated death was seen in the case group (P = .086). Conclusions: Although hybrid antiviral treatment did not result in a statistically significant decrease in posttransplant lymphoproliferative disorder and posttransplant lymphoproliferative disorder-associated mortality rates, considering the limited number of posttransplant lymphoproliferative disorder cases in this study, this decrease may be interpreted as noticeable, and we advise using this strategy for pediatric patients undergoing a liver transplant.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 09/2014; DOI:10.6002/ect.2013.0193 · 0.80 Impact Factor
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    ABSTRACT: Objectives: This study sought to evaluate in pediatric liver transplant recipients the effects of hybrid antiviral therapy on the rate of posttransplant lymphoproliferative disorder. Materials and Methods: All pediatric patients (87 cases) who had undergone a liver transplant between April 2011 and March 2012 took part in the study and received hybrid antiviral treatment (case group). Epstein-Barr virus polymerase chain reaction was monitored intermittently. The results were compared to those of a historical control group including 117 pediatric patients who received a liver transplant between April 2009 and March 2011. Follow-up was 27 to 47 months in the control group and 12 to 26 months in the case group. Results: Posttransplant lymphoproliferative disorder occurred in 12 patients in control group (10.2%) and 5 patients in case group (5.7%) (P = .249). Of 12 cases of posttransplant lymphoproliferative disorder, death occurred in 5 cases in the control group (41.7%), while no posttransplant lymphoproliferative disorder-associated death was seen in the case group (P = .086). Conclusions: Although hybrid antiviral treatment did not result in a statistically significant decrease in posttransplant lymphoproliferative disorder and posttransplant lymphoproliferative disorder-associated mortality rates, considering the limited number of posttransplant lymphoproliferative disorder cases in this study, this decrease may be interpreted as noticeable, and we advise using this strategy for pediatric patients undergoing a liver transplant.
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    ABSTRACT: Nutcracker phenomenon is the condition that occurs most commonly at the morphologic type by compression of the left renal vein between the aorta and superior mesenteric artery. The diagnosis is often delayed because of the variability in manifestations and absence of consensus on diagnostic criteria. We report a 30-year-old woman who presented gross hematuria several days after a kidney transplant. Nutcracker syndrome was established intraoperatively during open surgical approach for bladder clot evacuation. Renal repositioning was done with relief in the degree of hematuria intraoperatively. No episode of gross hematuria was observed on follow-up after 8 months.
    Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation 06/2014; DOI:10.6002/ect.2013.0260 · 0.80 Impact Factor
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    ABSTRACT: Mesenchymal hamartoma and hepatoblastoma are common causes of hepatic masses in pediat-ric population; they have similar radiologic and pathologic features. Herein, we present a case of mesenchymal hamartoma that was preoperatively diagnosed as hepatoblastoma. The mass was completely resected instead of being treated with preoperative chemotherapy. Postopera-tive pathological evaluation revealed mesenchymal hamartoma with free margins; the patient incidentally received the standard treatment. If we would have measured serum AFP in our patient, we could make the correct diagnosis preoperatively, because AFP increases largely in hepatoblastoma. When suspicious exists, serum AFP is a good guide in differentiating hepato-blastoma from mesenchymal hamartoma.
    05/2014; 5(2):78-80.
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    ABSTRACT: This study sought to determine the prevalence of hepatocellular carcinoma and other premalignant lesions in children with hereditary tyrosinemia type 1 who had undergone an orthotopic liver transplant at the Shiraz Transplant Center, in Shiraz, Iran. Between September 2006, and June 2011, thirty-six patients with hereditary tyrosinemia type 1 received a liver transplant from a deceased (whole or split) or a living-related donor. Clinical records and pathologic specimens, before and after surgery, for each case were reviewed. In addition, ultrasound, abdominal computed tomographic imaging scan findings, and levels of alpha-fetoprotein were recorded. Twenty-two patients with hepatic nodules larger than 10 mm underwent a Tru-Cut needle biopsy before their liver transplant. In 2 patients, a diagnosis of hepatocellular carcinoma was made by pathologic examination; in the other 20, cirrhosis was confirmed with no evidence of malignancy. After pathologic examination of the explanted livers, the largest nodules in the 36 patients were 35 mm. Five cases had at least 1 nodule of hepatocellular carcinoma. Three of the other patients had small cell dysplasia in some of nodules. All 5 cases with hepatocellular carcinoma were patients older than 2 years of age (19 patients were older than 2 years of age). All patients with hepatocellular carcinoma received pretransplant nitisinone treatment. All patients with hepatocellular carcinoma after their liver transplant are alive at the time of this writing. The prevalence of cell dysplasia and hepatocellular carcinoma in children with hereditary tyrosinemia type 1 in our study is not as high as that reported previously, so it appears that patients older than 2 years of age require a liver transplant.
    03/2014; DOI:10.6002/ect.2013.0158
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    02/2014; 5(1):34-37.
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    ABSTRACT: Liver transplantation is considered as the standard treatment for both children and adults with end-stage liver diseases. Using this method, children who have no chance for life can live a much longer life .Shiraz Transplant Center is the major pediatric liver transplant center in Iran. Therefore, determining patients' survival and its effective factors can help clinical programming for increasing such patients' survival after liver transplantation. The present study aimed to investigate the survival of patients below-18-years-old undergoing liver transplantation and the factors affecting their survival. The present historical cohort study was conducted on 392 patients below-18-year-sold who had undergone liver transplantation for the first time in the Namazi hospital liver transplant center, Shiraz, Iran between 2000 and 2011. In this study, 1-, 3-, 5-, and 10-year survival of the patients was assessed using Kaplan-Meier and life table methods. The effect of factors related to the recipients, donors, and the transplantation process on the patients' survival was also investigated. According to the results, 1, 3, 5 and 10-year survival of patients was 73%, 67%, 66%, and 66%, respectively. Besides, 1 ,3, 5, and 10-year survival of the patients who survived 1 and 3 months after the transplantation was 84%, 78%, 77%, and 77% and 89%, 82%, 81%, and 81%, respectively. In the univariate analysis, age, patients' weight at transplantation, initial diagnosis, PELD/MELD score, existence of post-transplant complications, and year of transplantation were found to be effective factors on the patients' survival. In the multivariate analysis, only the type of graft, PELD/MELD score, and existence of post-transplant complications were the prognostic variables. In this study, the patients' survival rate was 73%, which is quite low compared to the survival rate reported in other studies. Although we only have a 12-year experience with pediatric liver transplantation, the survival rate has increased in our center through the recent years (2008-2011). However, the survival rate of the patients who had survived 3 months after the transplantation was 89% which is comparable to other studies. Overall, cholestatic diseases (biliary atresia was the most prevalent), type of transplantation (split), PELD/MELD score > 20, and existence of post-transplant complications increased the risk of death after the transplantation.
    Hepatitis Monthly 07/2013; 13(7):e10257. DOI:10.5812/hepatmon.10257 · 1.80 Impact Factor
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    ABSTRACT: BACKGROUND: This study was conducted to determine the impact of hepatitis B virus (HBV) as a cause of hepatocellular carcinoma (HCC) in a single liver transplant center in Iran. METHODS: We included all hepatectomy specimens from patients with HBV-related cirrhosis who underwent transplants from May 1993 until January 2012 in this study. From these, we determined the number that had HBV-induced HCC. Nested PCR results were used to determine the HBV genotype from sections of the hepatectomy pathology specimens. RESULTS: During this time period there were 1361 cirrhotic livers transplanted in our center. Of these, 249 were attributed to HBV cirrhosis. Overall, HCC was detected in 40 (2.9%) subjects, of which 29 (1.2%) had HBV-related HCC. Genotype D was only genotype observed in all HBV subjects. CONCLUSIONS: The results revealed that although HBV-related cirrhosis was the most frequent single cause for liver transplant, the frequency of HBV-induced HCC was very low among transplant recipients. Out of 1361 transplant recipients, only 29 (2.1%) were diagnosed with HBV-related HCC. All HBV subjects had genotype D.
    06/2013; 16(6):348-350.
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    ABSTRACT: OBJECTIVES: Type 1 diabetes mellitus is an emerging epidemic worldwide and results from autoimmune destruction of insulin-producing β cells. Islet transplanting is a potential treatment for type 1 diabetes mellitus. MATERIALS AND METHODS: The Shiraz Organ Transplant Center is a leading center for organ transplants, especially pancreatic transplants, in Iran. For this reason, we want to establish an islet transplanting program. Here, we briefly describe our experience with islet isolation on 6 pancreata from deceased donors. We discussed the necessary equipment required for this procedure, as well as the professionals needed and a specially planned facility. RESULTS: Islet yield was ≤ 100 000 (islet equivalent), viability 40% to 45%, and the purity was 30% to 45%. We do not have a refrigerated COBE processor for purification; therefore, the yield was low. Our experience shows that we should improve things, so as to acquire more islets for developing clinical grade cell therapy. CONCLUSIONS: Overall, isolation costs are high, and accessing a safer, more economic, and persistent source of material and reagents will improve this technique.
    03/2013; 12(2). DOI:10.6002/ect.2012.0306
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    ABSTRACT: Nitric oxide is a major mediator in vascular biology and regulator of regional blood flow. Its production is catalyzed by the enzyme endothelial nitric oxide synthase. Protective actions of nitric oxide in ischemia and reperfusion are due to its potential as an antioxidant and anti-inflammatory agent, along with its inhibitory effects on cell signaling pathways of nuclear proteins, such as NF-kB. The endothelial nitric oxide synthase gene polymorphisms affect endothelial nitric oxide synthase activity and are associated with endothelial dysfunction. This study sought to examine the association between single nucleotide polymorphisms in endothelial nitric oxide synthase gene (rs 2070744, 27VNTR, and rs1799983) and the development of acute rejection in renal transplant patients. Sixty-six renal transplant recipients (33 patients with an episode of acute rejection and 33 recipients an episode of acute rejection), between June 2010 and March 2011, were included. The polymorphism was determined by simple polymerase chain reaction and polymerase chain reaction-restriction fragment-length polymorphism analysis. There was only a significant association of endothelial nitric oxide synthase -786T allele and acute rejection (P = .03). Recessive model of T-786C alleles (TT vs TC+CC) and acute rejection confirmed a significant association (odds ratio: 3.12; 95% CI: 0.01-9.83; P = .025). Haplotype CbG was higher in recipients without rejection as compared to rejection group (OR: 0.42, 95% CI: 0.16-1.13; P < .05). Respecting the endothelial nitric oxide synthase gene 894G/T single nucleotide polymorphisms and 27VNTR, no significant association between the allele/genotype and acute rejection was seen. Recipient endothelial nitric oxide synthase gene polymorphisms do not alter the risk of acute rejection after a renal transplant. Rejection is a complex immunologic event. Therefore, finding associated genetic variants demands a multicentric larger sample size.
    02/2013; 11(1):21-6. DOI:10.6002/ect.2012.0040
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    ABSTRACT: Background: Despite all efforts in medical community, health staff and medical technology progress, the rate of dissatisfaction and complaining among patients has been increased. In one hand, this might be due to the medical mistakes, on the other hand; it could be due to the dissertation between physician and patient, improvement of general information of patients about their legal rights or the other factors may be involved. Aims: In this study, we looked at all complaining that received to Fars province (South of Iran) Legal Medicine Department in 2008 to 2011. Materials and Methods: In this study, the entire complaints documents against physicians gathered into Fars Legal Medicine Department in 2008 to 2011, according to income-outcome factors investigated. All data were written by “SPSS - version 16” software and analyzed by “T-test” and “Chi-square” statistical tests. Results: In these records, 370 doctors or treatment staff is accused. The gender ratio of complainants was 60.3% men to 39.7% women. The most complainants’ job with 27.3% was freelance and the most complain with 78.6% was about professional medical crews. Among the 370 accused personnel, 170 personnel were sentenced and the others were acquitted. Under current study, in physician community, the most mistakes are happened in the following fields: Plastic surgery, general surgery, gynecology and orthopedics. Conclusion: The study providing better and advanced training program for these groups of doctors and health staffs like; holding legal medicine and low seminars will reduce medical crime commitments. Keywords: Complaints, Medical Malpractice, Southern Iran
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    ABSTRACT: The aim of this study was to describe our results and investigate the survival of below-18-year-old patients undergoing LRDLT and the factors affecting this. Living Related Donor Liver Transplantation (LRDLT) has become a good option to provide suitable grafts for children with liver diseases. Using this method, children who have no chance for life can live a much longer life. The present study is a historical cohort study carried on 191 patients below-18-year-sold who had undergone LRDLT for the first time in the Namazi hospital liver transplantation center. Survival rate of the patients was assessed using Kaplan-Meier method. The effect of factors related to the recipients, donors, and the transplantation process on the patients' survival was also investigated. 1, 3, 5 and 11-year survival of patients was 71%, 66%, 65%, and 65%, respectively. In the univariate analysis, age, weight at transplantation, PELD/MELD score, existence of post-transplant complications were found to be effective factors on the patients' survival. In the multivariate analysis, weight at transplantation, PELD/MELD score, and existence of post-transplant complications were the prognostic variables. LRDLT is now well established with satisfactory results in our center. Although the survival rate of the patients is lower than the survival rate reported in other studies, but the survival of the patients who had survived 1 month after the transplantation was comparable to other studies.
    01/2013; 6(4):183-9.
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    ABSTRACT: Arthrogryposis-renal tubular dysfunction-cholestasis syndrome (MIM No. 208085) is a rare multisystem disorder involving the liver, kidney, skin, and central nervous and musculoskeletal systems. The syndrome is an autosomal-recessive trait, associated with germ-line mutations in the VPS33B gene. We report an Iranian boy of consanguineous cousin parents who had congenital deformities of the upper and lower extremities, severe ichthyosis, cholestasis, intractable pruritus, metabolic acidosis, and failure to thrive. Owing to cholestasis, severe intractable pruritus, and poor quality of life, he underwent a living-related liver transplant from his mother, and his ichthyosis and pruritus dramatically improved. To the best of our knowledge, this is a first case of someone with arthrogryposis-renal tubular dysfunction-cholestasis syndrome who underwent a liver transplant and is in good condition more than 5 years after surgery.
    11/2012; 11(3). DOI:10.6002/ect.2012.0202
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    ABSTRACT: Post-transplant lymphoproliferative disorder is a lymphocyte proliferating disease, usually of B cell origin, and rarely of T cell. Involvement of liver itself in liver transplant recipients as the primary organ is not common. Herein we report our experience in two patients who primarily presented in the allografted liver, both of whom were promptly diagnosed after liver biopsy and treated successfully .Now after a few months; both of the patients are alive with normal liver function tests and negative imaging studies.
    11/2012; 14(11):719-21. DOI:10.5812/ircmj.1134
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    ABSTRACT: Caroli disease is a rare congenital disorder characterized by multifocal, segmental dilatation of intrahepatic bile ducts. Patients with Caroli disease who have recurrent bouts of biliary infection, particularly those who also have complications related to portal hypertension may require liver transplantation. In liver transplant ward of Shiraz University of Medical Science we had 4 patients with Caroli disease who were transplanted. Herein, we describe the demographic characteristics and post-transplant course of the patients. These patients presented with liver failure, recurrent cholangitis and portal hypertension sequelae unresponsive to medical treatment. The mean age of patients was 24.5 (range: 18–36) years, the mean MELD score was 17.5 (range: 11–23), three patients were female; one was male. All of the patients had good post-transplantation course except for one patient who developed post-operative biliary stricture for whom biliary reconstruction was done.
    11/2012; 3(4):189-91.
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    ABSTRACT: Background: Kidney transplantation is the best available treatment for patients with end-stage renal disease. Objective: To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). Methods: From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively. Results: Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2–6 months of post-operation follow up. Conclusion: Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time.
    08/2012; 3(3).
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    ABSTRACT: The Shiraz Organ Transplant Center, the largest transplant center in Iran, has expanded its program of organ transplant during recent years. This article seeks to summarize organ transplantation over the last 2 decades and evaluate its status as of 2011. We retrospectively analyzed the clinical records of all organ transplants performed in our center in 2011. We reviewed the patients' demographics, underlying disease, operation details as well as postoperative complications. During this period, 655 organ transplants including 345 liver, 297 kidney, 29 pancreas, and 11 intestine and multivisceral transplants were done. Among 345 liver transplants, 291 patients received a deceased-donor graft including 18 cases of split liver transplants while 54 patients received living-donor liver transplants. The 1-year graft and patient survival rates were 90.1% and 91%. In recent years, our program in organ transplants has expanded in number and variety of organs transplanted. This improvement is related to our multidisciplinary strategies to expand the donor pool and the experiences obtained during our transplant activities.
    08/2012; 10(4):307-9. DOI:10.6002/ect.2012.0121