Publications by authors named "Ali Bahador"

65 Publications

Rapid Growth of Hydatid Cyst: A Pediatric Case Report.

Iran J Parasitol 2021 Jan-Mar;16(1):164-167

Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.

Hydatid disease is a parasitic infection caused by with worldwide distribution. The most affected organs are liver and lungs, but it can be detected in any other organs as well. We reported a 5-yr-old boy from Shiraz, southern Iran in 2017 who presented with abdominal discomfort. Imaging revealed multiple liver hydatid cyst and a huge kidney hydatid cyst. This case showed the possible implication of rapid growth of multiple hydatid cyst as well as unusual organ presentation in the pediatric population.
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http://dx.doi.org/10.18502/ijpa.v16i1.5538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988671PMC
March 2021

High accurate lightweight deep learning method for gesture recognition based on surface electromyography.

Comput Methods Programs Biomed 2020 Oct 3;195:105643. Epub 2020 Jul 3.

Faculty of Mechanical Engineering, Islamic Azad University, South Tehran Branch, Tehran 1584743311, Iran.

Background And Objectives: Surface Electromyography (sEMG) is used mostly for neuromuscular diagnosis, assistive technology, physical rehabilitation, and human-computer interactions. Achieving a precise and lightweight method along with low latency for gesture recognition is still a real-life challenge, especially for rehabilitation and assistive robots. This work aims to introduce a highly accurate and lightweight deep learning method for gesture recognition.

Methods: High-density sEMG, unlike sparse sEMG, does not require accurate electrode placement and provides more physiological information. Then we apply high-density sEMG, which, according to previous studies, leads to sEMG images. In this study, we introduce the Sensor-Wise method, which has a higher capability to extract features compared to the sEMG image method due to its high compatibility with the nature of sEMG signals and the structure of convolutional networks.

Results: The proposed method, because of its optimal structure with only two hidden layers and its high compatibility, has shown no sign of overfitting and was able to reach an accuracy of almost 100% (99.99%) when it was evaluated by CapgMyo DB-a database through 96 electrodes. Using this method, even with 16 electrodes, we were able to reach an accuracy of 99.8%, which was higher than the accuracies reported in the previous studies. Additionally, the method was evaluated by the CSL-HDEMG database, where the accuracy reached 99.55%. Previous studies either introduced expensive computational methods with overfitting or reported lower accuracies compared to this study.

Conclusions: The Sensor- Wise method has high compatibility with the nature of sEMG signals and the structure of convolutional networks. The high accuracy and lightweight structure of this method with only two hidden layers make it a proper option for hardware implementation.
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http://dx.doi.org/10.1016/j.cmpb.2020.105643DOI Listing
October 2020

The Largest Single Center Report on Pediatric Liver Transplantation: Experiences and Lessons Learned.

Ann Surg 2021 02;273(2):e70-e72

Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: We described our experiences on pediatric liver transplantation (LT) from the largest LT center in the world termed the Shiraz Transplant Center.

Background: After the first successful pediatric LT in 1967, pediatric LT has become the routine treatment for children with liver failure worldwide.

Methods: Data on a total of 1141 pediatric cases of LT were collected. Specifics on baseline and anthropometric characteristics, clinicopathology, prognosis of recipients of LT, and donor characteristics are reported.

Results: Mean age of patients was 7.83 ± 5.55 years old. Most common etiologies for LT were biliary atresia (15.9%), progressive familial intrahepatic cholestasis (13.4%), and Wilson's disease (13.3%), respectively.Whole organs, living donor grafts, and split grafts were used in 47.9%, 41%, and 11.1% of patients, respectively. In-hospital complications were seen among 34.7% of patients and the most common complications were infections (26.8%), bleeding (23.4%), and vascular complications (18%).Median (interquartile range) model for end stage liver disease score was 20 (15, 25). Main causes of death among patients were sepsis (35.2%), followed by post-transplantation lymphoproliferative diseases (10.5%), and primary nonfunction of liver (9%).Patient survival showed improvement over the years (1-year survival of 73.1%, 83.4%, and 84.4%, 2-year survival of 65.2%, 77.1%, and 78.7%, 5-year survival of 58.2%, 72%, and 77.8% for 1997-2007, 2007-2013, and 2013-2019, respectively; P < 0.001).

Conclusions: This is the largest single-center report on pediatric LT in literature which provides valuable experiences in pediatric LT.
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http://dx.doi.org/10.1097/SLA.0000000000004047DOI Listing
February 2021

Successful Surgical Separation of Thoraco-Omphalopagus Symmetrical Conjoined Twins in Iran: Two Case Reports.

Iran J Med Sci 2020 Mar;45(2):143-147

Student Research Committee, Department of Otorhinolaryngology, Shiraz University of Medical Science, Shiraz, Iran.

Conjoined twins are derived from the division of a single fertilized ovum; a phenomenon accompanied with multiple congenital anomalies. Such twins are identical, of the same sex, and more likely to be female. Most twins die during the embryonic period, and only 18% survive longer than 24 hours. There are complex anomalies in thoraco-omphalopagus twins that makes them unlikely to live long enough to undergo separation. Treatment of this uncommon condition presents both surgical and anesthetic challenges. The management of rare anomalies is difficult even for skilled surgeons. Therefore, it is logical to use the knowledge gained from previous experiences. We herein present the first successful surgical separation of two pairs of thoraco-omphalopagus conjoined twins at the Pediatric Surgery Center of Namazi Hospital (Shiraz, Iran). In both cases, the neonates had separate hearts and common pericardium. Contrast-enhanced computed tomography of two sets of twins showed fusion of sternum, pericardium, diaphragm, and left lobe of liver. Critical steps of the surgical separation were identified and contingency plans were made for possible partial liver donation and cross-circulation between twins. The separation procedure and reconstruction of the abdominal wall were successfully performed. Both pairs of twins, now 6- and 8-year-old, are healthy and have normal growth and are under follow-up.
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http://dx.doi.org/10.30476/ijms.2019.81060.DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071550PMC
March 2020

Effects of partial internal biliary diversion on long-term outcomes in patients with progressive familial intrahepatic cholestasis: experience in 44 patients.

Pediatr Surg Int 2020 May 23;36(5):603-610. Epub 2020 Mar 23.

Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Zand St., 71 32326645, Shiraz, Iran.

Purpose: Progressive familial intrahepatic cholestasis (PFIC) is a hereditary disease characterized by cholestasis, which may cause jaundice, severe pruritus, and cirrhosis in the later stages. By the invention of biliary diversion methods, these patients were prevented from undergoing liver transplant. Using biliary diversion techniques, the entero-hepatic cycle was interrupted. This lowers the bile acid pool and resolves the pruritus. Herein, we report 44 cases of PFIC who underwent partial internal biliary diversion (PIBD) and long-term follow-up of these children. This comprises the largest case series of PIBD.

Methods: All patients were diagnosed by liver biopsy as PFIC before the operation. All underwent cholecysto colic bypass by jejunal interposition due to severe pruritus unresponsive to medication. Laboratory blood tests, sonography, and physical exam were done before and after the operation once every 3 months. Besides, a questionnaire was designed to ask the patients about the symptoms after the operation, and a pruritus score was measured using the 5D-itch scale.

Results: 44 children (25 boys, 19 girls), between 1.75 and 27.5 years (at the time of this study) were followed for a median period of 54 months. Age at operation ranged from 2 months to 18 years, with a median of 29 months. Of these children, 14 were lost to follow up. Results showed a significant decrease in pruritus and sleep disturbance after the surgery (p < 0.001). Also, jaundice decreased from 82.1 before to 7.1% following the surgery. 50% of the patients became medication-free at follow-up.

Conclusion: PIBD is a safe procedure which helps non-cirrhotic children preserve their liver function. Therefore, PIBD prevents them from undergoing liver transplant. Effective results were achieved in terms of severe pruritus and jaundice, and children were able to regain their sleep patterns. It also avoided external stoma, which is more convenient from the patient's point of view.
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http://dx.doi.org/10.1007/s00383-020-04641-zDOI Listing
May 2020

Liver Transplantation Status in Iran: A Multi-center Report on the Main Transplant Indicators and Survival Rates.

Arch Iran Med 2018 07 1;21(7):275-282. Epub 2018 Jul 1.

Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Iran's experience with liver transplantation (LT) began more than two decades ago. The purpose of this article is to present the status of LT in Iran, review specific characteristics of the programs, their outcomes, and their growth to become one of the largest LT programs in the world.

Methods: A questionnaire, asking for data on the number of transplants performed and specifics of the recipients and type of donors with focus on indications and outcomes was sent to LT programs.

Results: During a period of 23 years, 4,485 LTs were performed at 6 centers in the country. Of these, 4106 were from deceased donors and 379 were from living donors. There were 3553 adults and 932 pediatric recipients. Hepatitis B and biliary atresia were the most common etiologies in adult and pediatric patients, respectively. Overall survival rates at 1, 5, and 10 years were 85%, 77%, and 71% for adults and 76%, 67% and 56% for pediatric patients, respectively.

Conclusion: Approval of the brain death law in Iran and coordinated efforts by the transplant centers to build comprehensive LT programs has resulted in the ability to procure more than 700 deceased donors per year with acceptable long-term survival.
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July 2018

Single Center Long-Term Results of Pediatric Liver Transplantation.

Exp Clin Transplant 2020 02 20;18(1):65-70. Epub 2018 Apr 20.

From the Shiraz Organ Transplant Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, I. R. Iran.

Objectives: Liver replacement continues to be the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the rare donor organs, complex surgical demands, and the necessity to prevent long-term complications. Our objectives were to analyze 16 years of experience in the Shiraz University Organ Transplant Center.

Materials And Methods: We retrospectively analyzed the records of 752 patients (< 18 years old) who underwent orthotopic liver transplant at our center over a 16-year period. Mean age was 90 months, and male-to-female ratio was 1.25. Of the 752 transplants, 354 were whole organs, 311 were from living related donors, and 87 were in situ split liver allografts. Patient and graft survival rates were determined at 1, 3, and 5 years, and results between groups were compared.

Results: Overall mortality was 31.8%. The 1-, 3-, and 5-year patient survival rates were 77%, 69%, and 66%, respectively, whereas the respective graft survival rates were 75%, 68%, and 65%. We observed significant differences in survival according to graft type (log-rank test, P < .001). We also observed significant differences in survival probabilities according to age (log-rank test, P < .001). Cox regression was used to simultaneously analyze effects of age and graft type on survival. Both graft type and age significantly affected survival (P < .001). The 1-, 3, and 5-year survival rates for patients having whole organ transplants were 88%, 81%, and 78%. Patients who received living donor grafts had respective survival rates of 66%, 60%, and 58%, with rates of 65%, 47%, and 47% for patients who received split grafts.

Conclusions: Our results were similar to those observed in the literature in terms of indication for transplant and posttransplant survival.
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http://dx.doi.org/10.6002/ect.2017.0110DOI Listing
February 2020

Perforated Meckel's Diverticulum in a 3-day-old Neonate; A Case Report.

Middle East J Dig Dis 2016 Oct;8(4):323-326

Assistant Professor of Pediatric Gastroenterology, Abuzar Children's Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Perforation of Meckel's diverticulum is a rare complication in neonatal period. A 3-dayold term male neonate was transferred to our emergency room due to bowel perforation. Surgical exploration was done and perforated Meckel's diverticulum was detected. Pathological report of the tissue showed inflamed diverticulum with heterotopic gastric mucosa. This is the first report of Meckel's diverticulum perforation in a neonate in our country.
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http://dx.doi.org/10.15171/mejdd.2016.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5145301PMC
October 2016

Liver transplantation as a definitive treatment for familial hypercholesterolemia: A series of 36 cases.

Pediatr Transplant 2015 Sep;19(6):605-11

Surgery Department, Transplant Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

FH is a genetic disorder characterized by an increase in serum LDL and total cholesterol values. The afflicted patients are at increased risk of premature atherosclerosis and myocardial infarction. Different treatment modalities are present, including pharmacological agents and surgical procedures. The most effective method of therapy in refractive cases is liver transplantation. Herein, we report our experience on 36 cases of patients with FH undergoing liver transplantation in our center, the main referral center of liver transplantation in Iran. The clinical findings, hospital courses, post-operative complications, and patient follow-up are also described.
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http://dx.doi.org/10.1111/petr.12562DOI Listing
September 2015

Prevention of Posttransplant Lymphoproliferative Disorder in Pediatric Patients With a Liver Transplant.

Exp Clin Transplant 2015 Oct 17;13(5):426-9. Epub 2014 Sep 17.

From the Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad; and the Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: This study sought to evaluate in pediatric liver transplant recipients the effects of hybrid antiviral therapy on the rate of posttransplant lymphoproliferative disorder.

Materials And Methods: All pediatric patients (87 cases) who had undergone a liver transplant between April 2011 and March 2012 took part in the study and received hybrid antiviral treatment (case group). Epstein-Barr virus polymerase chain reaction was monitored intermittently. The results were compared to those of a historical control group including 117 pediatric patients who received a liver transplant between April 2009 and March 2011. Follow-up was 27 to 47 months in the control group and 12 to 26 months in the case group.

Results: Posttransplant lymphoproliferative disorder occurred in 12 patients in control group (10.2%) and 5 patients in case group (5.7%) (P = .249). Of 12 cases of posttransplant lymphoproliferative disorder, death occurred in 5 cases in the control group (41.7%), while no posttransplant lymphoproliferative disorder-associated death was seen in the case group (P = .086).

Conclusions: Although hybrid antiviral treatment did not result in a statistically significant decrease in posttransplant lymphoproliferative disorder and posttransplant lymphoproliferative disorder-associated mortality rates, considering the limited number of posttransplant lymphoproliferative disorder cases in this study, this decrease may be interpreted as noticeable, and we advise using this strategy for pediatric patients undergoing a liver transplant.
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http://dx.doi.org/10.6002/ect.2013.0193DOI Listing
October 2015

Nutcrackerlike Phenomenon Is An Unusual Cause for Gross Hematuria After a Kidney Graft.

Exp Clin Transplant 2016 Feb 9;14(1):93-5. Epub 2014 Jun 9.

From the Shiraz Organ Transplant Center, Nemazee Hospital, Shiraz University of Medical Sciences, Nemazee Hospital Zand Ave., Shiraz, Fars 7193711351, Islamic Republic of Iran.

Nutcracker phenomenon is the condition that occurs most commonly at the morphologic type by compression of the left renal vein between the aorta and superior mesenteric artery. The diagnosis is often delayed because of the variability in manifestations and absence of consensus on diagnostic criteria. We report a 30-year-old woman who presented gross hematuria several days after a kidney transplant. Nutcracker syndrome was established intraoperatively during open surgical approach for bladder clot evacuation. Renal repositioning was done with relief in the degree of hematuria intraoperatively. No episode of gross hematuria was observed on follow-up after 8 months.
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http://dx.doi.org/10.6002/ect.2013.0260DOI Listing
February 2016

Living related donor liver transplantation in Iranian children: a 12- year experience.

Gastroenterol Hepatol Bed Bench 2013 ;6(4):183-9

Department of Organ Transplantation Center, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Aim: The aim of this study was to describe our results and investigate the survival of below-18-year-old patients undergoing LRDLT and the factors affecting this.

Background: Living Related Donor Liver Transplantation (LRDLT) has become a good option to provide suitable grafts for children with liver diseases. Using this method, children who have no chance for life can live a much longer life.

Patients And Methods: The present study is a historical cohort study carried on 191 patients below-18-year-sold who had undergone LRDLT for the first time in the Namazi hospital liver transplantation center. Survival rate of the patients was assessed using Kaplan-Meier method. The effect of factors related to the recipients, donors, and the transplantation process on the patients' survival was also investigated.

Results: 1, 3, 5 and 11-year survival of patients was 71%, 66%, 65%, and 65%, respectively. In the univariate analysis, age, weight at transplantation, PELD/MELD score, existence of post-transplant complications were found to be effective factors on the patients' survival. In the multivariate analysis, weight at transplantation, PELD/MELD score, and existence of post-transplant complications were the prognostic variables.

Conclusion: LRDLT is now well established with satisfactory results in our center. Although the survival rate of the patients is lower than the survival rate reported in other studies, but the survival of the patients who had survived 1 month after the transplantation was comparable to other studies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017526PMC
May 2014

Liver Transplant for Children With Hepatocellular Carcinoma and Hereditary Tyrosinemia Type 1.

Exp Clin Transplant 2015 Aug 28;13(4):329-32. Epub 2014 Mar 28.

Department of Surgery, Transplant Ward, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: This study sought to determine the prevalence of hepatocellular carcinoma and other premalignant lesions in children with hereditary tyrosinemia type 1 who had undergone an orthotopic liver transplant at the Shiraz Transplant Center, in Shiraz, Iran.

Materials And Methods: Between September 2006, and June 2011, thirty-six patients with hereditary tyrosinemia type 1 received a liver transplant from a deceased (whole or split) or a living-related donor. Clinical records and pathologic specimens, before and after surgery, for each case were reviewed. In addition, ultrasound, abdominal computed tomographic imaging scan findings, and levels of alpha-fetoprotein were recorded.

Results: Twenty-two patients with hepatic nodules larger than 10 mm underwent a Tru-Cut needle biopsy before their liver transplant. In 2 patients, a diagnosis of hepatocellular carcinoma was made by pathologic examination; in the other 20, cirrhosis was confirmed with no evidence of malignancy. After pathologic examination of the explanted livers, the largest nodules in the 36 patients were 35 mm. Five cases had at least 1 nodule of hepatocellular carcinoma. Three of the other patients had small cell dysplasia in some of nodules. All 5 cases with hepatocellular carcinoma were patients older than 2 years of age (19 patients were older than 2 years of age). All patients with hepatocellular carcinoma received pretransplant nitisinone treatment. All patients with hepatocellular carcinoma after their liver transplant are alive at the time of this writing.

Conclusions: The prevalence of cell dysplasia and hepatocellular carcinoma in children with hereditary tyrosinemia type 1 in our study is not as high as that reported previously, so it appears that patients older than 2 years of age require a liver transplant.
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http://dx.doi.org/10.6002/ect.2013.0158DOI Listing
August 2015

Long-term survival and its related factors in pediatric liver transplant recipients of shiraz transplant center, shiraz, iran in 2012.

Hepat Mon 2013 8;13(7):e10257. Epub 2013 Jul 8.

Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, IR Iran.

Background: Liver transplantation is considered as the standard treatment for both children and adults with end-stage liver diseases. Using this method, children who have no chance for life can live a much longer life .Shiraz Transplant Center is the major pediatric liver transplant center in Iran. Therefore, determining patients' survival and its effective factors can help clinical programming for increasing such patients' survival after liver transplantation.

Objectives: The present study aimed to investigate the survival of patients below-18-years-old undergoing liver transplantation and the factors affecting their survival.

Patients And Methods: The present historical cohort study was conducted on 392 patients below-18-year-sold who had undergone liver transplantation for the first time in the Namazi hospital liver transplant center, Shiraz, Iran between 2000 and 2011. In this study, 1-, 3-, 5-, and 10-year survival of the patients was assessed using Kaplan-Meier and life table methods. The effect of factors related to the recipients, donors, and the transplantation process on the patients' survival was also investigated.

Results: According to the results, 1, 3, 5 and 10-year survival of patients was 73%, 67%, 66%, and 66%, respectively. Besides, 1 ,3, 5, and 10-year survival of the patients who survived 1 and 3 months after the transplantation was 84%, 78%, 77%, and 77% and 89%, 82%, 81%, and 81%, respectively. In the univariate analysis, age, patients' weight at transplantation, initial diagnosis, PELD/MELD score, existence of post-transplant complications, and year of transplantation were found to be effective factors on the patients' survival. In the multivariate analysis, only the type of graft, PELD/MELD score, and existence of post-transplant complications were the prognostic variables.

Conclusions: In this study, the patients' survival rate was 73%, which is quite low compared to the survival rate reported in other studies. Although we only have a 12-year experience with pediatric liver transplantation, the survival rate has increased in our center through the recent years (2008-2011). However, the survival rate of the patients who had survived 3 months after the transplantation was 89% which is comparable to other studies. Overall, cholestatic diseases (biliary atresia was the most prevalent), type of transplantation (split), PELD/MELD score > 20, and existence of post-transplant complications increased the risk of death after the transplantation.
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http://dx.doi.org/10.5812/hepatmon.10257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776561PMC
September 2013

Hepatocellular carcinoma in explanted livers of patients with genotype d HBV cirrhosis: report of the first experience from Iran.

Arch Iran Med 2013 Jun;16(6):348-50

Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: This study was conducted to determine the impact of hepatitis B virus (HBV) as a cause of hepatocellular carcinoma (HCC) in a single liver transplant center in Iran. 

Methods: We included all hepatectomy specimens from patients with HBV-related cirrhosis who underwent transplants from May 1993 until January 2012 in this study. From these, we determined the number that had HBV-induced HCC. Nested PCR results were used to determine the HBV genotype from sections of the hepatectomy pathology specimens.

Results: During this time period there were 1361 cirrhotic livers transplanted in our center. Of these, 249 were attributed to HBV cirrhosis. Overall, HCC was detected in 40 (2.9%) subjects, of which 29 (1.2%) had HBV-related HCC.  Genotype D was only genotype observed in all HBV subjects. 

Conclusions: The results revealed that although HBV-related cirrhosis was the most frequent single cause for liver transplant, the frequency of HBV-induced HCC was very low among transplant recipients. Out of 1361 transplant recipients, only 29 (2.1%) were diagnosed with HBV-related HCC. All HBV subjects had genotype D.
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http://dx.doi.org/013166/AIM.008DOI Listing
June 2013

Human islet cell isolation: the initial step in an islet transplanting program in Shiraz, Southern Iran.

Exp Clin Transplant 2014 Apr 11;12(2):139-42. Epub 2013 Mar 11.

Shiraz Transplant Research Center, Shiraz, Iran.

Objectives: Type 1 diabetes mellitus is an emerging epidemic worldwide and results from autoimmune destruction of insulin-producing β cells. Islet transplanting is a potential treatment for type 1 diabetes mellitus.

Materials And Methods: The Shiraz Organ Transplant Center is a leading center for organ transplants, especially pancreatic transplants, in Iran. For this reason, we want to establish an islet transplanting program. Here, we briefly describe our experience with islet isolation on 6 pancreata from deceased donors. We discussed the necessary equipment required for this procedure, as well as the professionals needed and a specially planned facility.

Results: Islet yield was ≤ 100 000 (islet equivalent), viability 40% to 45%, and the purity was 30% to 45%. We do not have a refrigerated COBE processor for purification; therefore, the yield was low. Our experience shows that we should improve things, so as to acquire more islets for developing clinical grade cell therapy.

Conclusions: Overall, isolation costs are high, and accessing a safer, more economic, and persistent source of material and reagents will improve this technique.
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http://dx.doi.org/10.6002/ect.2012.0306DOI Listing
April 2014

Primary Involvement of Allografted liver in Post-Transplant Lymphoproliferative Disorders, Report of Two Pediatric Cases and Review of the Literature.

Iran Red Crescent Med J 2012 Nov 15;14(11):719-21. Epub 2012 Nov 15.

Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.

Post-transplant lymphoproliferative disorder is a lymphocyte proliferating disease, usually of B cell origin, and rarely of T cell. Involvement of liver itself in liver transplant recipients as the primary organ is not common. Herein we report our experience in two patients who primarily presented in the allografted liver, both of whom were promptly diagnosed after liver biopsy and treated successfully .Now after a few months; both of the patients are alive with normal liver function tests and negative imaging studies.
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http://dx.doi.org/10.5812/ircmj.1134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560542PMC
November 2012

Influence of endothelial nitric oxide synthase gene polymorphisms (-786T/C, 4a4b, 894G/T) on Iranian kidney transplant recipients.

Exp Clin Transplant 2013 Feb;11(1):21-6

Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: Nitric oxide is a major mediator in vascular biology and regulator of regional blood flow. Its production is catalyzed by the enzyme endothelial nitric oxide synthase. Protective actions of nitric oxide in ischemia and reperfusion are due to its potential as an antioxidant and anti-inflammatory agent, along with its inhibitory effects on cell signaling pathways of nuclear proteins, such as NF-kB. The endothelial nitric oxide synthase gene polymorphisms affect endothelial nitric oxide synthase activity and are associated with endothelial dysfunction. This study sought to examine the association between single nucleotide polymorphisms in endothelial nitric oxide synthase gene (rs 2070744, 27VNTR, and rs1799983) and the development of acute rejection in renal transplant patients.

Materials And Methods: Sixty-six renal transplant recipients (33 patients with an episode of acute rejection and 33 recipients an episode of acute rejection), between June 2010 and March 2011, were included. The polymorphism was determined by simple polymerase chain reaction and polymerase chain reaction-restriction fragment-length polymorphism analysis.

Results: There was only a significant association of endothelial nitric oxide synthase -786T allele and acute rejection (P = .03). Recessive model of T-786C alleles (TT vs TC+CC) and acute rejection confirmed a significant association (odds ratio: 3.12; 95% CI: 0.01-9.83; P = .025). Haplotype CbG was higher in recipients without rejection as compared to rejection group (OR: 0.42, 95% CI: 0.16-1.13; P < .05). Respecting the endothelial nitric oxide synthase gene 894G/T single nucleotide polymorphisms and 27VNTR, no significant association between the allele/genotype and acute rejection was seen.

Conclusion: Recipient endothelial nitric oxide synthase gene polymorphisms do not alter the risk of acute rejection after a renal transplant. Rejection is a complex immunologic event. Therefore, finding associated genetic variants demands a multicentric larger sample size.
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http://dx.doi.org/10.6002/ect.2012.0040DOI Listing
February 2013

Liver transplant in a case of arthrogryposis-renal tubular dysfunction-cholestasis syndrome with severe intractable pruritus.

Exp Clin Transplant 2013 Jun 22;11(3):290-2. Epub 2012 Nov 22.

Shiraz Transplant Research Center, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Arthrogryposis-renal tubular dysfunction-cholestasis syndrome (MIM No. 208085) is a rare multisystem disorder involving the liver, kidney, skin, and central nervous and musculoskeletal systems. The syndrome is an autosomal-recessive trait, associated with germ-line mutations in the VPS33B gene. We report an Iranian boy of consanguineous cousin parents who had congenital deformities of the upper and lower extremities, severe ichthyosis, cholestasis, intractable pruritus, metabolic acidosis, and failure to thrive. Owing to cholestasis, severe intractable pruritus, and poor quality of life, he underwent a living-related liver transplant from his mother, and his ichthyosis and pruritus dramatically improved. To the best of our knowledge, this is a first case of someone with arthrogryposis-renal tubular dysfunction-cholestasis syndrome who underwent a liver transplant and is in good condition more than 5 years after surgery.
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http://dx.doi.org/10.6002/ect.2012.0202DOI Listing
June 2013

Clinical experience in organ transplant from the Shiraz Transplant Center: 2011.

Exp Clin Transplant 2012 Aug;10(4):307-9

Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: The Shiraz Organ Transplant Center, the largest transplant center in Iran, has expanded its program of organ transplant during recent years. This article seeks to summarize organ transplantation over the last 2 decades and evaluate its status as of 2011.

Materials And Methods: We retrospectively analyzed the clinical records of all organ transplants performed in our center in 2011. We reviewed the patients' demographics, underlying disease, operation details as well as postoperative complications.

Results: During this period, 655 organ transplants including 345 liver, 297 kidney, 29 pancreas, and 11 intestine and multivisceral transplants were done. Among 345 liver transplants, 291 patients received a deceased-donor graft including 18 cases of split liver transplants while 54 patients received living-donor liver transplants. The 1-year graft and patient survival rates were 90.1% and 91%.

Conclusions: In recent years, our program in organ transplants has expanded in number and variety of organs transplanted. This improvement is related to our multidisciplinary strategies to expand the donor pool and the experiences obtained during our transplant activities.
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http://dx.doi.org/10.6002/ect.2012.0121DOI Listing
August 2012

Evaluation of quality of life in children six months after liver transplantation.

Middle East J Dig Dis 2012 Jul;4(3):158-62

Gastroenterohepatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Liver transplantation (LT) is now performed as a cure for numerous untreatable pediatric liver diseases. Quality of life (QoL) can be affected in pediatric patients with LT. Many factors are responsible for lower scores of QoL. This article aims to detail QoL in liver recipients six months following LT in children.

Methods: WE ASSESSED QOLWITH THE FOLLOWING QUESTIONNAIRES: Child Health Quality-Parent Form 50 (CHQ-PF 50)for parents and Child Health Quality-Child Form 87 (CHQ-CF 87) for children ≥10 years of age in 50 children with LT and their parents.

Results: According to the CHQ-PF 50 questionnaire, QoL was found to be significantly lower in LT children compared with healthy children. According to the CHQ-CF 87 questionnaire, QoL was similar in pediatric liver recipients and the normal population.

Conclusion: According to parents' judgments, childhood liver recipients have impaired QoL. This may be due to multiple factors that include concern about the long term outcome of LT, comparing their child with other children, and complications of LT. On the other hand, older children and adolescents believe their QoL is similar to healthy children. It seems that by decreasing risk factors, we can reduce stress on families and improve QoL.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990120PMC
July 2012

Comparison of immediate renal dysfunction in split and partial liver transplantation versus full size liver transplantation in Shiraz transplant centre.

Ann Transplant 2011 Apr-Jun;16(2):36-42

Transplant Research Centre, Shiraz University of Medical Sciences, Iran.

Background: Renal dysfunction (RD) is a common complication following liver transplantation. Postoperative renal function after split liver transplant (SLT) and (partial living related liver transplant) (LRLT) has not been well studied yet.

Material/methods: Renal function immediately after surgery was analyzed retrospectively in 32 patients that received SLT and LRLT. Serum creatinine (SCr) was measured before surgery, and, after transplantation daily during the first week and at 14, 21, and 28 days after transplantation. Patient's medical records were reviewed to find clinical data;Model for end-stage liver disease (MELD) score, Child-Turcotte-Pugh score (CTP) class, the length of surgery, length of anhepatic phase, hospital and ICU admission, incidence of acute rejection, renal dysfunction, and sepsis. These data compared between groups.

Results: Length of surgery and anhepatic phase was longer in SLT and LRLT group (P<0.05). The incidence of acute rejection, reoperation, and complication such as sepsis was higher in SLT and LRLT group than FSLT group (P<0.05). There were no significant difference between groups with respect to MELD, CTP score, the need for transfusions, the length of admission to the hospital and ICU. Immunosuppression regimens were similar in both groups. RD developed in 25.8% of SLT and LRLT patients, but in only 9.5% of FSLT patients (p=0.063). The requirement for RRT in SLT and LRLT group (12.5%) was greater than that in the FSLT group (2.3%); P=0.20.

Conclusions: Although the number of patients studied was small, our data suggests a higher incidence of RD in patients receiving SLT and LRLT.
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http://dx.doi.org/10.12659/aot.881863DOI Listing
October 2011

Liver abscess in children: a 10-year single centre experience.

Saudi J Gastroenterol 2011 May-Jun;17(3):199-202

Trauma Research Center, Shiraz, Iran.

Background/aim: Although liver abscess is more prevalent in developing countries than in developed countries, there is scant data about the characteristics of pediatric liver abscess in our region. We aimed to analyze the characteristics of pediatric liver abscess in our region and compare these with those of developed countries.

Materials And Methods: The clinical features, laboratory, imaging, microbiologic findings, management strategy, and final outcome were extracted from the patients' records retrospectively.

Results: There were 18 cases of liver abscess including 16 pyogenic liver abscess, one amebic liver abscess and one candida liver abscess. Fever and abdominal pain were the most common clinical findings and leukocytosis was the most common laboratory finding. The most predisposing factors of liver abscess were immune deficiency, minor thalassemia. Origin of liver abscess was appendicitis in two patients, the rest were considered as cryptogenic. While one patient was treated with antibiotics alone, five cases were taken for open drainage, and 12 cases were treated with percutaneous aspiration. Percutaneous aspiration failed in two patients who were later taken for open drainage, with an overall mortality rate of 5.5%.

Conclusion: The overall characteristics of liver abscess in children in our society are not so different from developed countries. However, in contradiction to cases reported in developed countries, most cases of liver abscess were seen in healthy patients in our centre. Moreover, liver abscess was reported in our patients at a younger age and was more commonly seen in male children. Mortality rate was similar to that of developed countries.
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http://dx.doi.org/10.4103/1319-3767.80384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122091PMC
September 2011

Postrenal transplant urinary leakage caused by segmental infarction of a renal allograft treated by partial nephrectomy.

Exp Clin Transplant 2011 Apr;9(2):153-5

Organ Transplant Center, Shiraz University of Medical Science, Shiraz, Fras, Iran.

Kidney transplant is the final treatment for patients with end-stage renal disease. Urinary leakage is the most-common surgical complication early after transplant. Another complication in the early posttransplant period is segmental allograft infarction. We report a kidney recipient who developed urinary leakage secondary to a segmental infarction of the upper pole of the transplanted kidney 2 months after transplant. The patient was treated successfully by a partial nephrectomy of the infracted upper lobe of the kidney. Three months after the partial nephrectomy of the allograft, serum blood urea nitrogen and creatinine were normal, and the patient was able to partake in her daily activities. Partial nephrectomy in the context of infarction of a kidney allograft is safe and can be used in similar cases.
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April 2011

The application of a new cyanoacrylate glue in pediatric surgery for fistula closure.

Iran J Med Sci 2011 Mar;36(1):54-6

Department of General surgery, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Surgical glues have been used in pediatric surgery because of the fragility of tissue, and to prevent major surgeries. The present report describes our experience with using a new cyanoacrylate Glubran 2 (Viareggio, Italy) in the treatment of five cases of tracheoesophageal atresia with fistula (one fistula protection, three recurrent fistula, and one unstable patients), two cases of hypospadias, one case of vesicutanouse fistula after bladder extrophy, and one case of cloacal extrophy from January-December 2008. Three cases of recurrent tracheoesophageal atresia with fistula were treated by bronchoscpic glue injection. The other two cases benefited from glue through its ability to plug the fistula and to act as a protecting layer on anastomosis. In two cases with hypospadias excessive use of the glue caused skin necrosis, which was repaired. The wounds of cloacal extrophy were protected from nearby colostomy contamination and infection, and the vesicocutanouse fistula was closed by deepithelialization and sealing with glue. Based on the outcomes of the cases, it may be possible to suggest that Glubran 2 may be used safely in Pediatric Surgery as a sealant for the prevention and treatment of fistulas.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559118PMC
March 2011

Hepatic angiosarcoma of childhood: a case report and review of literature.

J Pediatr Surg 2011 Jan;46(1):e9-11

Transplant Research Center, Iran.

Angiosarcomas are rare tumors that predominantly affect adults. Hepatic angiosarcoma in a child is an extremely rare event and is associated with a poor prognosis. Herein, we report our experience in a case of hepatic angiosarcoma in a child who presented with a huge unresectable mass that underwent liver transplantation.
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http://dx.doi.org/10.1016/j.jpedsurg.2010.09.005DOI Listing
January 2011

Commemoration of 1000(th) liver transplantation in Shiraz Center.

Authors:
Ali Bahador

Int J Organ Transplant Med 2011 ;2(3):148

Congress Executive Secretary.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089261PMC
July 2014

Outcomes of kidney transplantation in patients with systemic lupus erythematosus: a single-center study.

Iran J Kidney Dis 2011 Jan;5(1):53-6

Shiraz Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Sciences, Iran.

INTRODUCTION. This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus (SLE) and a matched control group of non-SLE kidney recipients. MATERIALS AND METHODS. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. RESULTS. In each group, 12 patients (36.4%) received a kidney from a deceased donor, 15 (45.4%) from a living unrelated donor, and 6 (18.2%) from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 ± 18.1 days in the SLE group, while it was 13.0 ± 7.3 days in the controls (P = .006). One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients (P = .17). One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls (P = .26). Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications (P = .59). CONCLUSIONS. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys.
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January 2011

Hyponatremia a valuable predictor of early mortality in patients with cirrhosis listed for liver transplantation.

Clin Transplant 2011 Jul-Aug;25(4):638-45. Epub 2010 Nov 16.

Department of Internal Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

The current policy for organ allocation in liver transplantation is to give priority to the sickest patients mostly using model for end-stage liver disease (MELD) score in ranking. However, other factors as serum sodium may be of value in predicting early mortality. In this single-center study, patients with cirrhosis over age 14 on the liver transplant wait-list from September 1998 to June 2007 were followed for six months from the time of listing to evaluate the value of hyponatremia on mortality. Of 612 listed patients, 51 were transplanted who were excluded from survival analysis and 55 died without transplantation within the first three months. The numbers of transplanted and dead patients during months 3-6 were 29 and 24, respectively. Both MELD score and serum sodium at the time of listing were independent predictors of early mortality. On bivariate analysis, serum sodium of <130 mEq/L beside MELD was a significant predictor of mortality within 90 and 180 d. Serum sodium level <135 mEq/L masked the difference in mortality between patients with refractory and non-refractory ascites. Serum sodium level of <130 mEq/L and an increased MELD score are significant predictors of early mortality in patients listed for liver transplantation.
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http://dx.doi.org/10.1111/j.1399-0012.2010.01350.xDOI Listing
January 2012

Post-transplantation lymphoproliferative disorder after liver transplantation: report of 5 cases among more than 550 liver transplants in Iran.

Arch Iran Med 2010 Sep;13(5):417-9

Transplant Center, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Post-transplantation lymphoproliferative disorders (PTLD) are a spectrum of diseases defined as polyclonal or monoclonal proliferations of lymphocytes which occur after solid organ transplants. In this study, we report our first experiences with PTLD following liver transplantation in Iran.

Methods: We retrospectively analyzed five cases of PTLD which followed liver transplantation among more than 550 liver transplants in our center. Of these, three were pediatric cases and two were adults. The underlying causes were tyrosinemia, autoimmune hepatitis, and progressive familial intrahepatic cholestasis (PFIC) in the three pediatric cases. HCV hepatitis was the primary cause for cirrhosis in one of the adults and the other adult was labeled as cryptogenic cirrhosis. All cases, except for one, developed PTLD during the first year following liver transplantation.

Results: Patients were diagnosed as PTLD, B-cell, MALT and Hodgkin-like (according to the WHO classification of PTLD). The three pediatric patients died despite discontinuation of immunosuppressive drugs and chemotherapy. Fortunately both adult patients, until now, are still alive.

Conclusion: The incidence of PTLD in our center is lower than previous reports from other centers (0.9%), with a 60% mortality rate and worse prognosis in the pediatric age group.
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http://dx.doi.org/010135/AIM.009DOI Listing
September 2010