Background: An ideal definition of early allograft dysfunction (EAD) after live donor liver transplantation (LDLT) remains elusive. The aim of the present study was to compare the diagnostic accuracies of existing EAD definitions, identify the predictors of early graft loss due to EAD, and formulate a new definition, estimating EADrelated mortality in LDLT recipients. Methods: Consecutive adult patients undergoing elective LDLT were analyzed. Patients with technical (vascular, biliary) complications and biopsy-proven rejections were excluded. Results: There were 19 deaths due to EAD of a total of 304 patients. On applying the existing definitions of EAD, we revealed their limitations of being either too broad with low specificity or too restrictive with low sensitivity in patients with LDLT. A new definition of EAD-LDLT (total bilirubin >10 mg/dL, international normalized ratio [INR] > 1.6 and serum urea >100 mg/dL, for five consecutive days after day 7) was derived after doing a multivariate analysis. In receiver operator characteristics analysis, an AUC for EAD-LDLT was 0.86. The calibration and internal cross-validation of the new model confirmed its predictability. Conclusion: The new model of EAD-LDLT, based on total bilirubin >10 mg/dL, INR >1.6 and serum urea >100 mg/dL, for five consecutive days after day 7, has a better predictive value for mortality due to EAD in LDLT recipients. ( J CLIN EXP HEPATOL xxxx;xxx:xxx)
Hepatoid adenocarcinoma of the stomach is a rare histologic subtype of gastric carcinoma. Morphologically, it shows hepatocyte-like features and the tumor cells can show the expression of alpha-fetoprotein (AFP) in the tumor cells as well as in serum. There are a few AFP-negative hepatoid adenocarcinoma tumors that have been reported in the literature. A 45-year-old male patient presented with abdominal pain. Endoscopy and radiological studies showed an ulceronodular thickening in the antropyloric thickening with lymphadenopathy. He underwent radical subtotal gastrectomy with lymph node dissection. Microscopic examination showed adenocarcinoma with hepatocytic morphology, the presence of lymphovascular and perineural invasion, prominent peritumoral lymphocytic infiltration, multiple metastatic tumor deposit involving regional lymoh nodes and omentum. Adjacent gastric mucosa showed Helicobacter pylori-associated chronic atrophic gastritis with intestinal metaplasia. On immunohistochemistry (IHC), tumor cells were immunopositive for keratin 7, CDX2, and HepPar-1, p53 (focal), and MUC5AC (focal) while immunonegative for AFP, SALL4, MUC2, CD10, and HER2 (ERBB2) was negative. We report this AFP-negative hepatoid adenocarcinoma with its associated uncommon features and discussed the literature review and diagnostic approach.
Von Meyenburg complexes (VMCs), or bile duct microhamartomas, are among the constellation of defects of ductal plate malformation. These present as multiple small intrahepatic cysts and are diagnosed incidentally. Association of intrahepatic VMCs with a bile duct cancer has rarely been reported. We describe a case of a 53-year-old man presenting with obstructive jaundice. Biochemistry and radiology gave a provisional diagnosis of a resectable Klatskin tumour. The patient underwent right hepatectomy with common bile duct and caudate lobe excision. The histopathological examination demonstrated intrahepatic VMCs with complete ductal malformation and malignancy at the hilum.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.