Alveolar Echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease

Haider, Hani H.; Nishida, Seigo; Selvaggi, Gennaro; Levi, David; Tekin, Akin; Moon, Jang; Tzakis, Andreas G.

doi:10.1111/j.1399-0012.2008.00821.x

Cited by 16 publications

(10 citation statements)

References 12 publications

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“…WHO‐IWGE recommendations in 19963 and 201022 proposed that LT be contraindicated in patients with residual lesions and/or metastatic disease. Since the mid 1990s, the number of patients who have undergone LT for AE has decreased substantially, especially in European countries in which the disease is endemic; only isolated examples of LT for AE in China, Turkey, and the United States have been published 23‐25. Our prospective study shows that patient survival rates after LT were similar for patients who had residual foci and were subsequently treated with ABZ (whether or not the lesions were recognized by the surgeons at LT) and for patients who were considered to have undergone curative LT.…”

Section: Discussionmentioning

confidence: 71%

Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study

et al. 2011

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Liver transplantation (LT) is currently contraindicated in patients with residual or metastatic alveolar echinococcosis (AE) lesions. We evaluated the long-term course of such patients who underwent LT and were subsequently treated with benzimidazoles. Clinical, imaging, serological, and therapeutic data were collected from 5 patients with residual/recurrent AE lesions who survived for more than 15 years. Since 2004, [ 18 F]-2-fluoro-2-deoxyglucose (FDG)-positron emission tomography (PET) images were available, and the levels of serum antibodies (Abs) against Echinococcus multilocularis-recombinant antigens were evaluated. Median survival time after LT was 21 years. These patients were from a prospective cohort of 23 patients with AE who underwent LT: 5 of 8 patients with residual/recurrent AE and 4 of 9 patients without residual/recurrent AE were alive in September 2009. High doses of immunosuppressive drugs, the late introduction of therapy with benzimidazoles, its withdrawal due to side effects, and nonadherence to this therapy adversely affected the prognosis. Anti-Em2 plus and anti-rEm18 Ab levels and standard FDG-PET enabled the efficacy of therapy on the growth of EA lesions to be assessed. However, meaningful variations in Ab levels were observed below diagnostic cutoff values; and in monitoring AE lesions, images of FDG uptake taken 3 hours after its injection were more sensitive than images obtained 1 hour after its injection. In conclusion, benzimidazoles can control residual/recurrent AE lesions after LT. Using anti-rEm18 or anti-Em2 plus Ab levels and the delayed acquisition of FDG-PET images can improve the functional assessment of disease activity. The

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Section: Discussionmentioning

confidence: 71%

Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study

et al. 2011

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“…The World Health Organization (WHO) recommends that all operable cases should undergo radical surgery followed by chemotherapy for a minimum of 2 years. In severe cases such as biliary septicemia, bleeding from portal hypertension caused by portal vein invasion, invasion of both liver lobes, and chronic Budd‐Chiari syndrome secondary to invasion of the suprahepatic veins, LT may represent the only possibility of survival and cure . LT should be considered in patients with very severe hilar extension, leading to uncontrolled biliary infections, symptomatic secondary biliary cirrhosis with ascites, and/or severe variceal bleeding because of portal hypertension .…”

mentioning

confidence: 99%

“…LT should be considered in patients with very severe hilar extension, leading to uncontrolled biliary infections, symptomatic secondary biliary cirrhosis with ascites, and/or severe variceal bleeding because of portal hypertension . Transplantation is also suggested especially for patients with involvement at the liver hilum (hepatic pedicle) and PNM stage IIIa, IIIb, and IV patients who could not undergo liver resection …”

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confidence: 99%

Liver transplantation for alveolar echinococcosis in an endemic region

et al. 2015

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Alveolar echinococcosis (AE) is a chronic disease caused by ingestion of the eggs of the parasitic cestode Echinococcosis multilocularis (EM). In severe cases, liver transplantation (LT) may represent the only possibility of survival and cure. Patients undergoing LT associated with hepatic AE at our institution between April 2011 and October 2014 were investigated retrospectively. The clinical findings of the 27 patients who participated in the study were noted. Kaplan-Meier and chi-square tests were used to investigate the effect of these characteristics on survival and mortality. Living donor LT was performed on 20 patients (74.1%), and deceased donor LT was performed on 7 patients (25.9%). Hilar invasion was the most common indication (14 patients, 51.9%) for transplantation. The patient follow-up was 16.1 6 11.4 months, and the overall survival rate was 77.8%. Primary nonfunction developed only in 2 patients in the posttransplantation period. Six patients died during monitoring, the most common cause of death being sepsis (3 patients). The relationship between the mortality rate of the patients and the invasion of the bile duct and/or portal vein by alveolar lesions was found to be statistically significant (P 5 0.024 and P 5 0.043, respectively). According to PNM staging, when the AE disease exceeds the resectability limits, the only alternative for the treatment of the disease is LT. However, different from LT due to cirrhosis, it is extremely difficult to perform a transplantation for AE disease because of the invasive characteristics of it. In order to decrease the difficulty of the operation and the postoperative mortality, the intracystic abscess and cholangitis which occur because of AE must be treated via medical and percutaneous methods before transplantation.

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“…The result suggests OLT may benefit the advanced HAE patients with parasitic BuddChiari syndrome or when resection techniques have been exhausted and those with end-stage functional disorders caused by secondary biliary cirrhosis, secondary sclerosing cholangitis, and postnecrotic cirrhosis. [33][34][35][36][37] In summary, our study suggests aggressive treatment with a multimodality strategy could result in prolonged survival in patients with advanced HAE. Palliative resection may be beneficial for those with advanced HAE.…”

Section: Discussionmentioning

confidence: 67%

Management of Advanced Hepatic Alveolar Echinococcosis: Report of 42 Cases

Qu¹,

Guo²,

Sheng³

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract. Radical resection is the first choice for hepatic alveolar echinococcosis (HAE). However, many patients with advanced HAE have no chance to be treated with curative resection owing to the long clinical latency. This study aimed to evaluate the necessity of aggressive operations, like palliative resection and orthotopic liver transplantation (OLT), in the management of advanced HAE. A retrospective study analyzed 42 patients with advanced HAE treated with palliative resection (N = 15), palliative nonresective procedures (N = 13), OLT (N = 3), or albendazole therapy alone (N = 11). The patients' condition before treatments was comparable among all the four groups. The overall 1-year, 3-year, and 5-year survival rates of the 42 cases were 81.0%, 45.2%, and 23.8%, respectively. No event occurred to end the follow-up during the 5-year observation period except death. The survival time (median ± standard error) of the palliative resection group (3.6 ± 1.4 years) was longer than that of the palliative nonresective procedures group (1.5 ± 0.2) and the albendazole therapy-alone group (1.0 ± 0.4). The 5-year survival rates after palliative resection and liver transplantation were 40.0% and 66.7%, compared with only 7.7% and 9.1% after palliative nonresective procedures or albendazole therapy alone. Therefore, we concluded that aggressive treatment with a multimodality strategy could contribute to prolonged survival in patients with advanced HAE. Moreover, the prognosis of the patients who received albendazole therapy alone or palliative nonresective procedures is poor.

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Alveolar Echinococcosis induced liver failure: salvage by liver transplantation in an otherwise uniformly fatal disease

Cited by 16 publications

References 12 publications

Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study

Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-year follow-up study

Liver transplantation for alveolar echinococcosis in an endemic region

Management of Advanced Hepatic Alveolar Echinococcosis: Report of 42 Cases

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