Alveococcosis of the liver – strategy of surgical treatment with special focus on liver transplantation

Patkowski, Waldemar; Kotulski, Marcin; Remiszewski, Piotr; Grąt, Michał; Zieniewicz, Krzysztof; Kobryń, Konrad; Najnigier, B; Ziarkiewicz‐Wróblewska, Bogna; Krawczyk, Marek

doi:10.1111/tid.12574

Cited by 18 publications

(12 citation statements)

References 34 publications

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“…Recentně publikovaná čínská práce popisuje jako možnost léčby AE ex-vivo zemřeli 2 v prvním roce po transplantaci, ale žádné z úmrtí nesouviselo s rekurencí AE. Roční přežití bylo 90 %, 5leté 85 % a 10leté 75 % [22]. Lepší výsledky jsou dány striktnějšími kritérii výběru pa cientů k LTx a také řádnou administrací BZM pa cientům před a po LTx.…”

Section: Autotransplantaceunclassified

Alveolar echinococcis – a rare disease requiring a multidisciplinary approach

Erhartová¹,

Froněk²,

Stejskal³

et al. 2018

Gastroent Hepatol

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Souhrn: Alveolární echinokokóza (AE) je vzácná a potenciálně letální zoonóza způsobená larvami tasemnice Echinococcus multilocularis postihující primárně játra a vyskytující se na severní polokouli. Jedná se o onemocnění, které se pro svůj infiltrativní růst a schopnost zakládat vzdálená satelitní ložiska podobá pomalu rostoucímu zhoubnému nádoru. Dia gnostika je založena na zobrazovacích metodách (UZ, CT, MR) a sérologickém vyšetření. Všichni pa cienti s AE jsou dlouhodobě léčeni benzimidazoly, pokud je to možné, je indikován radikální resekční výkon a ve vybraných případech může být AE i indikací k transplantaci jater (LTx). LTx je zvažována u pa cientů s pokročilým, symp tomatickým a radikálně neresekabilním onemocněním. Rekurence onemocnění úzce souvisí s imunokompetencí jedince. Při potransplantační imunosupresní léčbě je proto riziko rekurence vyšší. V poslední době jsou upřednostňovány ostatní léčebné modality včetně nechirurgických intervenčních metod, které umožňují řešit většinu pozdních komplikací onemocnění. Počet LTx pro AE v Evropě spíše klesá. Klíčová slova: echinokokóza-Echinococcus multilocularis-transplantace jater-benzimidazoly Summary: Alveolar echinoccocosis (AE) is a rare and potentially lethal zoonosis that primarily affects the liver and is caused by larvae of the tapeworm Echinococcus multilocularis, which occurs in the northern hemisphere. AE is an illness with tumor-like characteristics, such as infiltrative growth and metastatic potential. Diagnosis consists of imaging studies (ultrasonography, CT, and magnetic resonance) and serological tests. All patients are treated by long-term benzimidazoles therapy and if possible by radical surgery. In exceptional cases, a liver transplantation (LTx) can be performed. LTx is considered in patients with advanced, symptomatic and radically inoperable disease. Recurrence of AE has been linked with immunocompetence. The risk of recurrence is higher with post-transplant immunosuppressive treatment. Currently, non-surgical interventions, such as percutaneous drainage of bile ducts are preferred, which address most complications. The number of LTx due to AE is diminishing in Europe.

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Section: Autotransplantaceunclassified

Alveolar echinococcis – a rare disease requiring a multidisciplinary approach

Erhartová¹,

Froněk²,

Stejskal³

et al. 2018

Gastroent Hepatol

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“…The safety and success of donor liver recovery is a top priority in organ transplantation [1,2]. Besides that, the liver is resected within healthy tissues in cases of extensive traumatic damage [3,4], during oncological processes [5,6], and the development of metastases [7,8], upon detection of significant benign tumors [9,10] and for the elimination of some parasitic invasions, such as echinococcosis [11,12] and alveococcosis [13,14].…”

Section: Introductionmentioning

confidence: 99%

Some Special Aspects of Liver Repair after Resection and Administration of Multipotent Stromal Cells in Experiment

Maiborodin

Лушникова

Клинникова

et al. 2021

Life

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Changes in rat liver after resection and injection of autologous multipotent mesenchymal stromal cells of bone marrow origin (MSCs) transfected with the GFP gene and cell membranes stained with red-fluorescent lipophilic membrane dye were studied by light microscopy. It was found that after the introduction of MSCs into the damaged liver, their differentiation into any cells was not found. However, under the conditions of MSCs use, the number of neutrophils in the parenchyma normalizes earlier, and necrosis and hemorrhages disappear more quickly. It was concluded that the use of MSCs at liver resection for the rapid restoration of an organ is inappropriate, since the injected cells in vivo do not differentiate either into hepatocytes, into epithelial cells of bile capillaries, into endotheliocytes and pericytes of the vascular membranes, into fibroblasts of the scar or other connective tissue structures, or into any other cells present in the liver.

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“…In such cases the patient requires combined multidrug therapy together with paliative surgical procedures (hemihepatectomy, gastroscopy, biliary tract artificial) [17] and frequent, both parasitological and surgical, follow-up. Sometimes the patient requires the liver transplantation [18,19].…”

Section: Introductionmentioning

confidence: 99%

Portal hypertension as a result of the incomplete surgically treated advanced alveolar echinococcosis: a case description

et al. 2020

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Background: Infection of Echinococcus multilocularis causes in humans the alveolar echinococcosis. Although the infection has worldwide distribution it is rarely detected. Diagnosis of alveococcosis is difficult because of not typical clinical picture and irregular results of radiological examinations suggesting neoplasmatic process which begins in the liver tissue or in the biliary tracts. The parasitic growth is slow, so the illness is quite often established in late invasion period. Treatment of long-lasting and late diagnosed infection is difficult and requires cooperation of parasitologists together with surgeons to avoid life-threatening organ dysfunction. Case presentation: We describe a young male patient, diagnosed, according to the radiological, immunological and histological examination results, infection of Echinococcus multilocularis, who was treated with not radical resection of pathologic mass together with persistent albendazole intake. The right hepatectomy was performed. In addition, visible cysts were removed from the left lobe of the liver in nonanatomical resection and suspicious calcified lesions in hepatoduodenal ligament were also removed. After the operation portal hypertension, with splenomegaly and symptoms of the liver cirrhosis occurred (thrombocytopenia, collateral venous circulation, first degree varices oesophagii). The portal hypertension probably could be a result of incomplete surgery due to extended parasitic infection and liver anathomical changes due to performed procedures, because the portal hypertension and it's further complications had not been observed before the operation. Conclusions: Echinococcus multilocularis should be taken under consideration in differential diagnosis of irregular lesions within the liver. Lon-lasting invasion could be responsible for the irreversible secondary liver changes such as cirrhosis and portal hypertension. The surgery treatment (treatment of choice) is difficult and it's results depends on the invasion period the patient is operated on. After the surgery the patient requires careful followup, to detect early complications.

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Alveococcosis of the liver – strategy of surgical treatment with special focus on liver transplantation

Abstract: In conclusion, LT for E. multilocularis infection is a safe and effective treatment method.

Cited by 18 publications

References 34 publications

Alveolar echinococcis – a rare disease requiring a multidisciplinary approach

Alveolar echinococcis – a rare disease requiring a multidisciplinary approach

Some Special Aspects of Liver Repair after Resection and Administration of Multipotent Stromal Cells in Experiment

Portal hypertension as a result of the incomplete surgically treated advanced alveolar echinococcosis: a case description

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