BACKGROUND Recurrent hepatitis C virus (HCV) infection of transplanted liver allografts is universal in patients with detectable HCV viremia at the time of transplantation. Direct-acting antiviral (DAA) therapy has been adopted as the standard of care for recurrent HCV infection in the post-transplant setting. However, there are insufficient data regarding its efficacy in liver transplant (LT) recipients with a history of hepatocellular carcinoma (HCC), and the risk of HCC recurrence after DAA therapy is unknown. AIM To demonstrate predictors of DAA treatment failure and HCC recurrence in LT recipients. METHODS A total of 106 LT recipients given DAAs for recurrent HCV infection from 2015 to 2019 were identified (68 with and 38 without HCC). Descriptive statistics and logistic regression models were used to estimate the multivariate odds ratios and respective 95% confidence intervals for predictors of treatment failure and HCC recurrence. RESULTS Six patients (6%) experienced DAA therapy failure post-LT and 100 (94%) had a sustained virologic response at follow-up week 12. A high alanine transaminase level > 35 U/L at treatment week 4 was a significant predictor of treatment failure. Relapse to pre-LT DAA therapy is a predictor of post-LT HCC recurrence, P = 0.04. DAA relapse post-LT was also associated with post-transplantation HCC recurrence, P = 0.05. CONCLUSION DAAs are effective and safe in the treatment of recurrent HCV infection in LT recipients with history of HCC. Relapse to pre- and post-LT DAA therapy is associated with post-transplantation HCC recurrence.

Background: Liver transplantation is perceived as the only curative treatment for patients with end-stage liver disease. Arterial complications are one of the most serious complications after living donor liver transplantation (LDLT). Aim of the work: To assess the different modalities of management and outcome of early and late arterial complications and to analyze the risk factors of such complications after living donor liver transplantaiton. Patients and Methods: This is a retrospective study in which 293 LDLT operations were done between 2008 and May 2017 at Ain Shams center for organ transplantation (ASCOT). After approval of Ethics committee and the research council, Ain shams university school of medicine, we did this retrospective cohort study that analyzed the incidence, risk factors, management and outcome of HA complications in adults and pediatrics recipients in the period from 2008 to May 2017, where patients were observed from POD 1 until the end 2017 or until death of patients. Results: In our study early arterial complications are more higher and more serious than late arterial complications. Mortality rate in patients with early complications exceeds 50%.In late complications it was 20%. Conclusion: Urgent surgical management is life saving in cases of early hepatic artery thrombosis (HAT). Arterial reconstruction is technically difficult. LD retransplant has been performed in a very small number worldwide. Emergency living donor retransplantation is life saving in cases of early (HAT). Arterial reconstruction using left gastric artery and splenic artery is feasible in LD retransplant and arterial reconstruction after HAT. Early diagnosis and surgical or radiological intervention is the corner stone to save the recipient.

BACKGROUND & AIMS Recurrent hepatitis C virus (HCV) infection of transplanted liver allografts is universal in patients with detectable HCV viremia at the time of transplantation. Directacting antiviral (DAA) therapy has been adopted as the standard of care for recurrent HCV infection in the post-transplant setting. However, there are insufficient data regarding its efficacy in liver transplant (LT) recipients with a history of hepatocellular carcinoma (HCC), and the risk of HCC recurrence after DAA therapy is unknown. In this study, we aimed to demonstrate predictors of DAA treatment failure and HCC recurrence in LT recipients. METHODS A total of 106 LT recipients given DAAs for recurrent HCV infection from 2015 to 2019 were identified (68 with and 38 without HCC). Descriptive statistics and logistic regression models were used to estimate the multivariate odds ratios and respective 95% confidence intervals for predictors of treatment failure and HCC recurrence. RESULTS Six patients (6%) experienced DAA therapy failure and 100 (94%) had a sustained virologic response at follow-up week 12 (SVR12). A high alanine transaminase level >35 U/L at treatment week 4 was a significant predictor of treatment failure. DAA failure at follow-up week 12 was significantly associated with post-transplantation HCC recurrence, (odds ratio, 10.6 [95% confidence interval, 1.0-121.6]; P = .05). CONCLUSIONS DAAs are effective and safe in the treatment of recurrent HCV infection in LT recipients with history of HCC. Lack of SVR12 is a predictor of post-transplantation HCC recurrence.

Background Diabetes is a major health problem that is currently showing an alarming rise in its prevalence, this has recently been estimated at 7.8% in the United States, presenting a > 50% increase over the past 15 years while there exists a large population group in whom diabetes is undiagnosed. Objective To evaluate the effectiveness and rate of healing of autologous PRP gel in treatment of diabetic foot ulcers. Compare the effectiveness of PRP gel with standard treatment (normal saline dressings). Methods 30 patients with non-ischemic DFU were classified into two groups: Group A: Patients with non-ischemic DFU and were treated with a novel modality i.e.: PRP injection in the healing edge and the floor of the targeted ulcer. GroupGroup B B:: Patients with non-ischemic DFU who had usual standard care i.e.: moist dressing with or without collagenase ointment. All cases had a minimal debridement prior to treatment, here in our study the demographic data i.e. Age, sex, medical history were homogenously distributed among both groups. All cases in both groups were non ischemic after successful revascularization either by OR or ER. Results The rate of complete healing for ulcers in group A was achieved in six patients (40%) at the fifth week, while five patients (33.33%) were healed completely by the sixth week and only one patient (6.67%) healed in the ninth week. 26.67% (n = 4 cases) in group B showed complete healing rate by eighth week and 40% (n = 6 cases) were healed by ninth week while 33.33% (n = 5 cases) were healed in the tenth week. P value was statistically significant <0.001 between the groups. Conclusion Activated platelet rich plasma is a novel modality in treatment of diabetic foot ulcers which is feasible, safe and effective with high rate of limb salvage rate and clinical improvement.

BACKGROUND Patients who undergo living donor liver transplantation (LDLT) may suffer complications that require intensive care unit (ICU) readmission. AIM To identify the incidence, causes, and outcomes of ICU readmission after LDLT. METHODS A retrospective cohort study was conducted on patients who underwent LDLT. The collected data included patient demographics, preoperative characteristics, intraoperative details; postoperative stay, complications, causes of ICU readmission, and outcomes. Patients were divided into two groups according to ICU readmission after hospital discharge. Risk factors for ICU readmission were identified in univariate and multivariate analyses. RESULTS The present study included 299 patients. Thirty-one (10.4%) patients were readmitted to the ICU after discharge. Patients who were readmitted to the ICU were older in age (53.0 ± 5.1 vs 49.4 ± 8.8, P = 0.001) and had a significantly higher percentage of women (29% vs 13.4%, P = 0.032), diabetics (41.9% vs 24.6%, P = 0.039), hypertensives (22.6% vs 6.3%, P = 0.006), and renal (6.5% vs 0%, P = 0.010) patients as well as a significantly longer initial ICU stay (6 vs 4 d, respectively, P < 0.001). Logistic regression analysis revealed that significant independent risk factors for ICU readmission included recipient age (OR = 1.048, 95%CI = 1.005-1.094, P = 0.030) and length of initial hospital stay (OR = 0.836, 95%CI = 0.789-0.885, P < 0.001). CONCLUSION The identification of high-risk patients (older age and shorter initial hospital stay) before ICU discharge may help provide optimal care and tailor follow-up to reduce the rate of ICU readmission.