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

Abstract

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

The Role of Delayed 18F-FDG PET Imaging in the Follow-up of Patients with Alveolar Echinococcosis

“…The treatment interruption was followed by a reincrease in specific Em21 serology, confirmed by a reincrease in specific antiEm18 serology. The disease course of this patient has been published elsewhere (21). One year after the treatment interruption, 18 F-FDG PET showed clear 18 F-FDG uptake at the delayed acquisition, and albendazole treatment was resumed in this patient.…”

“…Serologic tests for diagnostic and therapeutic evaluation were also performed for all patients. All patients underwent serologic follow-up using Em2-plus -ELISA (Bordier Affinity Products; cutoff index, 0.8), which contains purified Em2 antigen localized in the laminated layer and recombinant EmII/3-10 antigen localized in the tegument of the protoscolex and the germinal layer and considered to be a relevant marker of disease activity (19)(20)(21). Follow-up Therapeutic efficiency was evaluated by clinical and ultrasound examinations, liver tests, blood counts, and serology every 6 mo.…”

Novel techniques and preliminary results of ex vivo liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis: A study of 31 cases

“…Liver transplantation has provided a life‐saving technique for patients with “unresectable” but not metastatic HAE lesions 11, 13, 14, 31, 32, 33, 34, 35. Several centers had reported their work, which was summarized in Table 4.…”

“…Liver transplantation (LT) has been applied as the last‐resort therapy and as the only opportunity for radical cure of HAE since 1985 7, 11. This application has been expanded through living donor liver transplantation (LDLT)12, 13; however, the limitations are obvious: post‐LT complications, recurrence associated with the management of immunosuppressive drugs, the shortage of organ donations, and the intolerably high expense of treatment have impaired the wide application of LT 7, 14…”

Development of a Real-Time PCR for a Sensitive One-Step Coprodiagnosis Allowing both the Identification of Carnivore Feces and the Detection of Toxocara spp. and Echinococcus multilocularis

“…Carnivores become infected after predation of contaminated rodents and release eggs into the environment via their feces. Alveolar echinococcosis in humans remains a lethal disease in untreated cases (10). In contrast, Toxocara cati is found mainly in cats, and Toxocara canis is found in dogs.…”