Search

Chollasak Thirapattaraphan,1,2 Prapatsorn Srina,1 Ampaipan Boonthai,1,2 Nuttapon Arpornsujaritkun,2,3 Bundit Sakulchairungrueng,2,3 Worapot Apinyachon,2,4 Suporn Treepongkaruna2,5 1Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Ramathibodi Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Division of Vascular Surgery and Transplantation, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 4Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 5Division of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Suporn TreepongkarunaDivision of Gastroenterology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok 10400, ThailandTel/Fax +6622011446Email suporntr@gmail.comBackground: Pediatric liver transplantation (LT) has been accepted as a definitive treatment for end-stage liver disease. Pleural effusion is a common pulmonary complication following LT in children. The objectives of the study were to identify prevalence of post-LT pleural effusion, risk factors, and the impact on patients’ outcomes.Methods: A retrospective study was conducted in 107 pediatric patients who underwent LT at our center between March 2001 and June 2018. They were categorized into pleural effusion and non-pleural effusion groups. Preoperative and perioperative data, intraoperative findings, liver graft characteristics, and perioperative outcomes were compared between the two groups.Results: Post-LT pleural effusion occurred in 64 (59.8%) patients. There were more patients with PELD score ≥ 18 in the pleural effusion group (68.8 vs 48.8%, P=0.039). Other preoperative and perioperative data were not significantly different. The pleural effusion group had a higher rate of reoperation than non-pleural effusion group (55.6 vs 30.9%, P=0.013). Median oxygen dependence time, length of ICU and hospital stay were significantly longer in the pleural effusion group (18.5 vs 7.0, 10 vs 7 and 48 vs 34 days, respectively, P < 0.05). However, mortality was not significantly different. Among the patients with pleural effusion, median time to extubation, oxygen dependence time, length of ICU and hospital stay were significantly longer in those who required therapeutic interventions than those without interventions (12 vs 3, 31 vs 10, 17 vs 8, and 60 vs 43 days, respectively, P < 0.05).Conclusion: Pleural effusion following pediatric LT is common and its potential risk factor is PELD score at LT ≥ 18. Post-LT pleural effusion is associated with prolonged oxygen dependence time, ICU stay and hospital stay, particularly those who required therapeutic interventions.Keywords: pleural effusion, pediatric liver transplantation, liver transplantation, post-liver transplant pleural effusion, pulmonary complications

Background: Pretransplant desensitization protocols, including plasmapheresis, intravenous immunoglobulin, induction antibody therapy, and intensive maintenance immunosuppression, are generally employed in kidney transplant recipients who have positive status for donor-specific anti-HLA antibody (DSA). To avoid serious infectious complications, the authors designed a novel low-dose protocol in Thai patients undergoing DSA+ living-related kidney transplantation (LRKT)., Methods: A retrospective cohort study of the patients who underwent DSA+ LRKT was conducted. The novel protocol consisted of 3 to 5 sessions of pretransplant double-filtration plasmapheresis (DFPP) with or without low-dose intravenous immunoglobulin together with low-dose anti-thymocyte globulin (ATG) induction (1-1.5 mg/kg/d for 3-4 days) and low-dose tacrolimus (Tac) (trough level 5-10 ng/mL), mycophenolate, and prednisolone., Results: The study included 17 patients. The lymphocyte crossmatch via complement-dependent cytotoxicity was negative in 12 patients and positive for B cell immunoglobulin M in 5 patients. The novel desensitization protocol resulted in a decrease of at least 50% of DSA mean fluorescence intensity from baseline (from 4320 ± 549 before DFPP to 1601 ± 350 before transplantation, P < .005) and successful kidney transplantation with good allograft function in all cases. Early DSA rebound was observed in 3 patients after transplantation, and kidney biopsy revealed subclinical antibody-mediated rejection in 1 patient and diffuse C4d staining without cell infiltration in 2 patients. There were good long-term outcomes in patient and graft survival (100% and 94.1%, respectively). Only 1 allograft loss occurred because of nonadherence. The majority of patients have stable allograft function with serum creatinine less than 1.5 mg/dL. However, infections, including CMV and other organisms, were commonly observed., Conclusions: Desensitization protocol with DFPP, low-dose ATG, and Tac provides excellent outcomes in living donor kidney transplantation in highly sensitized Asian populations., (Copyright © 2020 Elsevier Inc. All rights reserved.)