Publications by authors named "Seyed Ali Malek-Hosseini"

117 Publications

Post liver transplant complications of Budd-Chiari syndrome.

Indian J Gastroenterol 2021 Mar 20. Epub 2021 Mar 20.

Shiraz Transplant Research Center, Shiraz University of Medical sciences, Shiraz, Islamic Republic of Iran.

Background/purpose: Budd-Chiari syndrome (BCS) is a rare, life-threatening disease characterized by hepatic venous outflow obstruction. Liver transplantation (LT) is widely accepted as an effective therapeutic measure for irreversible liver failure due to BCS. There is debate on differences in the post LT course and complications in patients with BCS as compared to non-Budd-Chiari (NBC) patients.

Method: In this retrospective study, data on all patients who received a liver transplant for BCS at the Shiraz Organ Transplantation Center between January 1996 and September 2017 were reviewed and compared to data of a control group who had received liver transplants over the same period but due to other causes (NBC).

Results: Out of 4225 patients who received liver transplants in the study period, 108 had BCS and an age- and gender-matched control group consisted of 108 NBC cases. The mean ± standard deviation (SD) of model for end-stage liver disease (MELD) scores were 19.1 ± 3 and 20 ± 3 for BCS and NBC groups, respectively (p = 0.33). One-, 3-, 5-, and 10-year survival rates in the BCS group were as follows: 82%, 78%, 76%, and 76% compared with the NBC rates of 83%, 83%, 83%, and 76%, respectively (p = 0.556). There was no difference between the two groups in complication rates after 6 months. In the later period, vascular thrombosis was more common in BCS.

Conclusions: Whole-organ LT from deceased donors in patients with BCS had comparable outcomes with LT due to other causes of end-stage liver disease. In most instances, these patients should receive lifelong anticoagulation.
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http://dx.doi.org/10.1007/s12664-020-01139-3DOI Listing
March 2021

Hepatitis E Virus Seroprevalence Among Liver Transplant Recipients with Persistent Elevation of Liver Enzymes: A Single Center Report.

Arch Iran Med 2021 01 1;24(1):22-26. Epub 2021 Jan 1.

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

Background: Chronic hepatitis E infection has been reported in solid organ transplant recipients following acute hepatitis due to the compromised immune status. Almost all reports are from areas where hepatitis E virus (HEV) genotypes 3 and 4 are the dominant genotypes. This study was conducted to investigate the role of hepatitis E infection as an etiology for liver enzymes elevation in liver transplant recipients from the largest liver transplant program in Iran.

Methods: In a prospective study from June to December 2015, in a single liver transplantation center in Iran, all adult liver recipients who were investigated for the etiology of persistent elevation of liver enzymes were tested for HEV serology status.

Results: Of 122 patients included in the study, 19 (15.6%) were positive for HEV serology. Seropositive patients were significantly older than seronegative ones (mean age 43.79 vs. 31.58, P < 0.001); however, they were not different in other characteristics including sex distribution and mean of liver enzymes in each occasion. Liver biopsies were done in 16 HEV seropositive patients and none of the biopsies showed evidence for acute or chronic viral hepatitis.

Conclusion: In this study, with 15.6% rate of HEV seropositivity in liver recipients with persistent elevation of liver enzymes, we were not able to confirm any clinical evidence for active acute or chronic hepatitis E infection. This could theoretically be attributed to the fact that the dominant prevalent HEV genotype in our endemic area is not associated with a chronic form of infection.
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http://dx.doi.org/10.34172/aim.2021.04DOI Listing
January 2021

Diagnosis of Latent Tuberculosis in Liver Transplant Candidates, a Single Center Experience.

Clin Lab 2021 Jan;67(1)

Background: Tuberculosis is an important cause of mortality and morbidity in liver transplant patients, so it is valuable to diagnose latent tuberculosis in liver transplant candidates by an accurate screening test prior to transplantation. Tuberculin skin test (TST) is the standard test for the diagnosis of latent tuberculosis. Currently interferon-gamma release assays (QuantiFERON-TB Gold (QFT)) have been proposed as the best screening test, especially in the geographic areas with widespread BCG vaccination. In this research, we will compare these two tests in the largest liver transplant center in the south of Iran.

Methods: Both TST and QFT were performed in 50 liver transplant patients and 50 normal healthy individuals.

Results: TST was positive in 6 cases and 4 controls. QFT was positive in 5 cases and 9 controls. Sensitivity and negative predictive value were higher in QFT but the specificity and positive predictive value were higher in TST.

Conclusions: There is no significant difference between QFT and TST in evaluation of latent tuberculosis in liver transplant patients, however TST is less expensive and more feasible in Iran.
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http://dx.doi.org/10.7754/Clin.Lab.2020.200451DOI Listing
January 2021

Pure Uterine Lipoma and Focal Nodular Hyperplasia of the Liver: Concurrence of a Rare Tumor and Another Incidental Finding.

Case Rep Pathol 2020 1;2020:8891820. Epub 2020 Nov 1.

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

Background: Fatty uterine tumors, especially pure uterine lipoma, are very rare, but clinically and radiologically, they can mimic other primary benign and malignant uterine neoplasms. . A multipara 61-year-old postmenopausal woman presented with abnormal vaginal bleeding for 3 months. Assessment by ultrasound and magnetic resonance imaging (MRI) revealed a hyperechoic mass in the uterine corpus. Furthermore, during radiologic investigation, there was an incidental isoechoic mass in the left lobe of the liver. Pure uterine lipoma and hepatic focal nodular hyperplasia were diagnosed.

Conclusion: Pure lipoma of the uterus, even though rare, has to be kept in the differential diagnosis of uterine neoplasms, especially in postmenopausal women. Till now, just a few concurrent tumors have been reported with pure uterine lipoma, and among them, FNH is the first extragenital tumor.
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http://dx.doi.org/10.1155/2020/8891820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652630PMC
November 2020

Phylogenetic analysis of Trichostrongylus vitrinus isolates from southwest Iran.

Parasit Vectors 2020 Nov 7;13(1):553. Epub 2020 Nov 7.

Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran.

Background: Trichostrongylus is one of the most important zoonotic trichostrongylid nematodes, infecting mostly livestock. Data on its genetic characteristics are lacking in Iran.

Methods: We determined the phylogenetic relationships of Trichostrongylus species in three counties of Kohgiloyeh and Boyerahmad (K-B) province, southwest Iran. Small intestine and abomasum of 70 sheep and goats were investigated.

Results: A total of 35 isolates of Trichostrongylus worms were detected and all were genetically identified as Trichostrongylus vitrinus. Analysis of 321 bp of the internal transcribed spacer 2 (ITS2) of ribosomal DNA revealed 16 genotypes. All genotypes were single nucleotide polymorphisms, including some hypervariable points. All sequences were trimmed to 170 bp, compared with sequences on GenBank including short sequences from other endemic foci of Iran and other countries and all isolates were used to generate a maximum likelihood phylogenetic tree, which consisted of two clades A and B. Clade A included isolates from Iran, Russia, New Zealand, Australia and the UK; clade B only contained South African isolates. Most clade A isolates (north, southwest and west Iran, Russia, New Zealand, Australia and UK) were in a similar phylogenetic position. One subclade was detected in clade A (isolates from Southwest Iran, New Zealand and UK).

Conclusions: We hypothesize that drug resistant T. vitrinus may account for its exclusive detection in our samples. The high similarity of genotypes from Iran, New Zealand and UK may be due to their close political relationships during the colonial era. More research is needed to understand better the phylogeny of T. vitrinus and its relationship with drug resistance and human transmission.
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http://dx.doi.org/10.1186/s13071-020-04438-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648934PMC
November 2020

COVID-19 in Liver Transplant Patients: Report of 2 Cases and Review of the Literature.

Int Med Case Rep J 2020 31;13:317-321. Epub 2020 Jul 31.

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

Coronavirus 2019 (COVID-19) is caused by a novel coronavirus. Although liver injury is common in patients with COVID-19, little is known about its clinical presentation and management in liver transplantation. This is the first report from Iran that presented two cases of liver transplantation with COVID-19, neither of which had pulmonary signs and symptoms, but after diagnostic imaging, both had lung involvement. We also reviewed some literature on the management of COVID-19 in liver transplant patients. In conclusion, our patients improved after starting hydroxychloroquine and continuing to take all immunosuppressive agents except mycophenolate based on the multidisciplinary team's decision.
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http://dx.doi.org/10.2147/IMCRJ.S265910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410393PMC
July 2020

Hepatic steatosis and liver fat contents in liver transplant recipients are associated with serum adipokines and insulin resistance.

Sci Rep 2020 07 29;10(1):12701. Epub 2020 Jul 29.

Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz, Iran.

Our data about pathogenesis of hepatic steatosis after liver transplantation is scarce. This study aimed to investigate the association between serum adipokines and insulin resistance with hepatic steatosis in liver transplant recipients. We investigated the association between insulin resistance, serum adiponectin, insulin, and leptin with hepatic steatosis in a cohort of liver transplant recipients. Homeostatic model assessment of insulin resistance 2 (HOMA 2-IR) was used for estimation of insulin resistance. Hepatic steatosis was determined using ultrasound and controlled attenuation parameter (CAP). A total of 178 patients were included. 79 patients (44.4%) had hepatic steatosis. Serum adiponectin (OR: 0.912; 95% CI 0.869-0.957; P < 0.001), serum leptin (OR: 1.060; 95% CI 1.017-1.102; P = 0.005), HOMA2-IR (OR: 1.671; 95% CI 1.049-2.662; P = 0.031), and post-transplant diabetes mellitus (PTDM) (OR: 5.988; 95% CI 1.680-21.276; P = 0.006) were independently associated with hepatic steatosis after liver transplantation. CAP values were negatively correlated with serum adiponectin (P = 0.011) and positively correlated with serum insulin (P = 0.001), leptin (P < 0.001) and HOMA2-IR (P < 0.001). Insulin resistance and alterations in adipokines might have central role in pathogenesis of hepatic steatosis after liver transplantation and can be targeted for diagnostic and therapeutic purposes.
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http://dx.doi.org/10.1038/s41598-020-69571-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391625PMC
July 2020

Reduced rate of hospital admissions for liver-related morbidities during the initial COVID-19 outbreak.

Lancet Gastroenterol Hepatol 2020 09 29;5(9):803-804. Epub 2020 Jun 29.

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

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http://dx.doi.org/10.1016/S2468-1253(20)30207-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324093PMC
September 2020

Investigation of Integron-Associated Resistance Gene Cassettes in Urinary Isolates of in Yasuj, Southwestern Iran During 2015-16.

Avicenna J Med Biotechnol 2020 Apr-Jun;12(2):124-131

Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.

Background: Growing antibiotic resistance among urinary opportunistic pathogens such as has created a worrisome condition in the treatment of the Urinary Tract Infections (UTIs) in recent years. Integrons play a significant role in the dissemination of antibiotic resistance genes. The present study was conducted to investigate class 1-3 integrons and the corresponding resistance gene cassettes in urinary isolates.

Methods: In this study, from December 2015 to September 2016, a total of 196 isolates were collected from the patients with UTI referred to medical diagnostic laboratories in Yasouj, Southwestern Iran. Antibiotic susceptibility patterns of isolates were determined using 12 antibiotics by the disc diffusion method. Polymerase Chain Reaction (PCR) was used for detection of integron genes (). The variable regions of integrons were amplified by PCR and sequenced to identify the corresponding gene cassettes.

Results: Thirty-nine different antibiotic resistance profiles were observed among isolates. Only 12.2% of isolates were found to harbor the gene. While 17 (60.7%) out of 28 Multidrug Resistance (MDR) isolates carried the gene, only 4.2% of non-MDR isolates harbored gene. Totally 7 different gene cassette arrays were found in the gene of isolates. The aadA1 was the most prominent gene cassette. Also, high frequency of containing gene cassettes was observed.

Conclusion: Continuous monitoring and characterization of integrons and their associated gene cassettes could be helpful in controlling the rising rate of antibiotic resistance.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229451PMC
May 2020

Bacterial infections in the early period after liver transplantation in adults: A prospective single-center cohort study.

Microbiol Immunol 2020 Jun 18;64(6):407-415. Epub 2020 May 18.

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

Liver transplantation (LT) is a potentially curative treatment for terminal stage hepatic diseases. Bacterial infections are the main causes of mortality and morbidity in the early period after LT. Identifying the risk factors could help in minimizing their development. We prospectively investigated the incidence, characteristics, and risk factors of bacterial infections among the recipients during hospitalization after LT and assigned a predictive score. All 389 consecutive adults who underwent LT at the main referral hospital of LT in Iran during 1 year were enrolled prospectively in a cohort study. Infection group consisted of 143 recipients (36.8%). Urinary tract and surgical site infections were the most frequent ones. Gram-negative bacteria were more prevalent than Gram-positive ones. Independent risk factors were female sex (relative risks = 2.13), age ≤ 43.5 years (3.70), hospital stay ≥ 9.5 days (5.22), abdominal reoperation (3.03), vancomycin-resistant Enterococci colonization (5.52), hospitalization 3 months prior to LT (3.25), mechanical ventilation ≥48 hr (4.93), and renal replacement therapies (13.40). We developed a risk score for the prediction of bacterial infections with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81-0.89) with sensitivity of 88% and specificity of 64%. In the infection group, mortality was higher than in controls (18.9% vs. 2.0%) with longer hospitalization (16 vs. 10 days; P < 0.001). We detected a high rate of bacterial infections leading to longer hospital stay and higher mortality rate. The formulated risk score can help predict bacterial infections; however, it requires clinical validation in further studies.
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http://dx.doi.org/10.1111/1348-0421.12785DOI Listing
June 2020

Longterm Survival After Liver Transplantation for Autoimmune Hepatitis: Results From the European Liver Transplant Registry.

Liver Transpl 2020 07 1;26(7):866-877. Epub 2020 May 1.

I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

The aim of this study was to analyze longterm patient and graft survival after liver transplantation for autoimmune hepatitis (AIH-LT) from the prospective multicenter European Liver Transplant Registry. Patient and liver graft survival between 1998 and 2017 were analyzed. Patients after AIH-LT (n = 2515) were compared with patients receiving LT for primary biliary cholangitis (PBC-LT; n = 3733), primary sclerosing cholangitis (PSC-LT; n = 5155), and alcohol-related cirrhosis (AC-LT; n = 19,567). After AIH-LT, patient survival was 79.4%, 70.8%, and 60.3% and graft survival was 73.2%, 63.4%, and 50.9% after 5, 10, and 15 years of follow-up. Overall patient survival was similar to patients after AC-LT (P = 0.44), but worse than after PBC-LT (hazard ratio [HR], 1.48; P < 0.001) and PSC-LT (HR, 1.19; P = 0.002). AIH-LT patients were at increased risk for death (HR, 1.37-1.84; P < 0.001) and graft loss (HR, 1.35-1.80; P < 0.001) from infections compared with all other groups and had a particularly increased risk for lethal fungal infections (HR, 3.38-4.20; P ≤ 0.004). Excluding patients who died within 90 days after LT, risk of death after AIH-LT was superior compared with AC-LT (HR, 0.84; P = 0.004), worse compared with PBC-LT (HR, 1.38; P < 0.001) and similar compared with PSC-LT (P = 0.93). Autoimmune hepatitis (AIH) patients with living donor liver transplantation (LDLT) showed reduced survival compared with patients receiving donation after brain death (HR, 1.96; P < 0.001). In AIH-LT patients, overall survival is inferior to PBC-LT and PSC-LT. The high risk of death after AIH-LT is caused mainly by early fatal infections, including fungal infections. Patients with LDLT for AIH show reduced survival.
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http://dx.doi.org/10.1002/lt.25739DOI Listing
July 2020

The Status of Liver Transplantation in the Middle East.

Clin Liver Dis (Hoboken) 2019 Dec 29;14(6):215-218. Epub 2020 Jan 29.

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

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http://dx.doi.org/10.1002/cld.889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988425PMC
December 2019

Retrieving Organs of Executed Prisoners in Iran?

Transplantation 2020 06;104(6):e185

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

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http://dx.doi.org/10.1097/TP.0000000000003116DOI Listing
June 2020

Characterization of biopsy proven non-alcoholic fatty liver disease in healthy non-obese and lean population of living liver donors: The impact of uric acid.

Clin Res Hepatol Gastroenterol 2020 09 11;44(4):572-578. Epub 2019 Oct 11.

Avicenna Center for Medicine and Organ Transplant, Avicenna Transplant Hospital, PO Box: 71994-67985, Shiraz, Iran.

Background: Non-alcoholic fatty liver disease (NAFLD) is frequently seen among non-obese overweight individuals and lean subjects (those with normal body mass index). This study aimed to investigate prevalence and risk factors of biopsy proven NAFLD in a cluster of healthy non-obese and lean individuals.

Methods And Materials: In a retrospective study, adult (>18 years) apparently healthy individuals who had donated liver to pediatric patients between July 2012 and October 2018 were included. Non-obese and lean individuals were defined as BMI<30kg/m and BMI<25kg/m, respectively.

Results: Totally 310 patients were included. Seventy-six individuals (24.5%) had NAFL and 30 patients (9.67%) had non-alcoholic steatohepatitis (NASH) among non-obese population. In multivariate regression analysis, only higher BMI was marginally associated with NASH in non-obese compared to those without NASH (Odds ratio: 2.52, 95% CI: 0.097-6.54; P=0.05). Totally, 246 individuals were lean. 55 individuals (22.3%) had NAFL and 20 individuals (8.2%) had NASH in their liver biopsies. In univariate analysis, serum triglyceride, cholesterol, LDL, ALT, alkaline phosphatase and uric acid were associated with NAFL among lean individuals (P<0.05). In regression analysis, serum uric acid was associated with NAFL (Odds ratio: 1.70, 95% CI: 1.18-2.45; P=0.004) and NASH in lean individuals (Odds ratio: 1.98, 95% CI: 1.27-3.10; P=0.003).

Conclusion: NAFLD/NASH is prevalent even in a healthy lean population when evaluated by liver biopsy. Higher BMI and serum uric acid were two major risks of NAFLD/NASH in non-obese and lean individuals.
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http://dx.doi.org/10.1016/j.clinre.2019.09.002DOI Listing
September 2020

Incidence, Risk Factors, and Follow-Up of Diabetes Mellitus After Liver Transplant: A Prospective Study From Iran.

Exp Clin Transplant 2019 Oct 1. Epub 2019 Oct 1.

From the Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: Diabetes mellitus is one of the metabolic consequences of solid-organ transplant. Most reports on this condition are from cross-sectional or retrospective studies. In this prospective study, we evaluated the incidence, risk factors, and short-term follow-up of diabetes mellitus in recipients of liver transplant at the Shiraz Liver Transplant Center (Shiraz, Iran).

Materials And Methods: Recipients of liver transplant who were ≥ 16 year old and were seen from February 2017 until February 2018 were included. Anthropologic measurements and diabetes history were taken between 2 and 4 weeks after transplant. Fasting blood sugar and 75-g oral glucose tolerance test were measured. We diagnosed patients with diabetes mellitus and patients with impaired fasting glucose or impaired glucose tolerance test based on American Diabetes Association criteria. These patients were promptly followed for at least 6 months.

Results: Of the 397 recipients who were included in this study, 35.5% were female and 64.5% were male. Overall, the most common reason for transplant was primary sclerosing cholangitis (22.5%). We had 42 living donors and 355 deceased donors, with none being unrelated donors. At first visit (3.8 ± 1.6 wk posttransplant), 20.4% of recipients did not have diabetes, 24.2% were diagnosed with preexisting diabetes mellitus, 31.2% had impaired fasting blood sugar or oral glucose tolerance test, and 24.2% were determined to have posttransplant diabetes mellitus. At last visit (13.6 ± 4.9 mo posttransplant), prevalence for posttransplant diabetes mellitus was 10.8%. Multivariate regression analysis showed that age correlated with development of impaired glucose tolerance test or posttransplant diabetes mellitus (odds ratio 1.060; 95% confidence interval, 1.026-1.095; P < .001).

Conclusions: In this prospective cohort study, we followed recipients posttransplant and reevaluated the prevalence of posttransplant diabetes mellitus. We found significant recovery for this type of diabetes mellitus. Further larger and multicenter studies are necessary to monitor and manage diabetes mellitus posttransplant.
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http://dx.doi.org/10.6002/ect.2019.0158DOI Listing
October 2019

Nonalcoholic Steatohepatitis Is the Most Rapidly Growing Indication for Liver Transplantation in Iranian Patients.

Exp Clin Transplant 2019 Oct 1. Epub 2019 Oct 1.

From the Avicenna Transplant Hospital, Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: Nonalcoholic fatty liver disease is a rapidly growing disease and is hypothesized to become the most common cause of liver cirrhosis in the near future. This study aimed to investigate trends of nonalcoholic steatohepatitis as an indication for liver transplant in Iranian patients.

Materials And Methods: Liver transplant data from all adult patients (age > 18 y) who had undergone liver transplant between 1993 and 2017 at the Shiraz Organ Transplant Center (Shiraz, Iran) were reviewed. Underlying liver diseases leading to liver transplant were stratified according to year of transplant, and trends of increase or decline were analyzed. Kaplan-Meier curves were used for analysis of posttransplant survival of patients with nonalcoholic steatohepatitis and patients with modified nonalcoholic steatohepatitis.

Results: We evaluated 3184 liver transplant patients. Of these, 112 patients with biopsy-proven nonalcoholic steatohepatitis underwent liver transplant up to the end of 2017. Mean age of patients was 52.86 ± 9.01 years in those with nonalcoholic steatohepatitis and 51.73 ± 7.91 years in those with modified nonalcoholic steatohepatitis (P > .05).The prevalence of nonalcoholic steatohepatitis as an indication for liver transplant was 0.8% in 2011, 0.36% in 2012, 1.9% in 2013, 4.01% in 2014, 2.89% in 2015, 6.65% in 2016, and 9.97% in 2017. The prevalence of modified nonalcoholic steatohepatitis was 2.4% in 2011, 2.88% in 2012, 2.71% in 2013, 2% in 2014, 2.17% in 2015, 2.13% in 2016, and 2.28% in 2017. We found that nonalcoholic steatohepatitis as a cause of liver transplant increased significantly during recent years (P < .001).

Conclusions: Nonalcoholic steatohepatitis is a rapidly growing indication for liver transplant among Iranian patients. Health care providers should consider programs for prevention and early diagnosis of patients with nonalcoholic steatohepatitis for proper treatment.
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http://dx.doi.org/10.6002/ect.2019.0205DOI Listing
October 2019

Liver Transplant for Primary Hyperoxaluria Type 1: Results of Sequential, Combined Liver and Kidney, and Preemptive Liver Transplant.

Exp Clin Transplant 2019 Oct 1. Epub 2019 Oct 1.

From the Avicenna Transplant Hospital, Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: Primary hyperoxaluria type 1 is an autosomal recessive disorder that causes overproduction and urinary excretion of oxalate. Liver transplant has been suggested as a treatment for primary hyperoxaluria type 1 since the defective enzyme is expressed in the liver. This study aimed to investigate results of combined liver and kidney, sequential, and preemptive livertransplantin patients with primary hyperoxaluria type 1.

Materials And Methods: In this cohort study, we followed patients with primary hyperoxaluria type 1 who underwent liver transplant at our centerin Shiraz, Iran. Clinical and laboratory data of patients were gathered, and major outcomes, including renal failure after liver transplant, rejection, and mortality were recorded. Survival of patients was analyzed by the Kaplan-Meier method.

Results: Our study included 24 patients. There were 16 male (66.6%) and 8 female (33.33%) patients. Thirteen patients were in the pediatric age group (age < 18 y), and 11 patients were adults (age ≥ 18 y). Thirteen patients underwent sequential transplant, 8 patients underwent combined liver and kidney transplant, and 3 patients underwent preemptive transplant. All patients received organs from deceased donors. There were no statistically significant differences in mortality, rejection, and hemodialysis after transplant between those with sequential transplant and those with combined liver and kidney transplant (P > .05).

Conclusions: Liver transplant can be considered a treatment for patients with primary hyperoxaluria type 1. Combined liver and kidney transplant and preemptive liver transplant could be proper options for these patients.
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http://dx.doi.org/10.6002/ect.2019.0150DOI Listing
October 2019

Large cystic lymphangioma of pancreas mimicking mucinous neoplasm: case report with a review of histological differential diagnosis.

Int Med Case Rep J 2019 3;12:297-301. Epub 2019 Sep 3.

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

Purpose: Cystic lymphangioma of the pancreas was first recognized in 1913 as a form of benign cyst. It is extremely rare, accounting for less than 1% of the lymphangiomas.

Case Report: Herein, we report a case of cystic pancreatic lymphangioma diagnosed in a 51-year-old female patient who was hospitalized for a colicky upper abdominal pain for a month. Radiological imaging revealed a large multiloculated cystic pancreatic mass with enhancing septations. The patient underwent distal pancreatectomy, and the histological examination showed cystic lymphangioma.

Conclusion: Although very uncommon, cystic lymphangioma should be placed in the differential diagnosis list of pancreatic cystic lesions, at least about the multi-septated ones in asymptomatic female patients which are discovered incidentally.
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http://dx.doi.org/10.2147/IMCRJ.S218056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731960PMC
September 2019

Non-alcoholic fatty liver disease after liver transplantation in patients with non-alcoholic steatohepatitis and cryptogenic cirrhosis: the impact of pre-transplant graft steatosis.

HPB (Oxford) 2020 04 17;22(4):521-528. Epub 2019 Aug 17.

Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Nonalcoholic fatty liver disease (NAFLD) may occur in liver transplant recipients. This study aimed to investigate the prevalence and risk factors of NAFLD after liver transplantation in patients with NASH and cryptogenic cirrhosis, focusing on the impact of graft steatosis.

Methods: Patients with NASH and cryptogenic cirrhosis who had undergone liver transplantation in Shiraz transplant center between March 2010 and March 2017 were included. NAFLD was diagnosed after liver transplantation using ultrasonography and transient elastography.

Results: 73 patients with NASH and 389 with cryptogenic cirrhosis were included. NAFLD was diagnosed in 33 patients (56.9%) in NASH group and 96 patients (26.7%) in cryptogenic group (OR: 3.61; CI: 2.04-6.39; P-Value < 0.001), using ultrasound. Obesity and post-transplant hyperlipidemia were independent predictors of NAFLD after liver transplantation (P < 0.05). NAFLD was diagnosed in 32.9% of patients with graft macrosteatosis compared to 29.9% in patients without graft macrosteatosis (OR: 1.51; 95%CI: 0.755-1.753). 28% of the patients with macrosteatosis ≥30% had NAFLD after liver transplantation compared to 31.4% with macrosteatosis <30% (OR: 1.175; 95% CI: 0.346-2.091).

Conclusion: Liver graft steatosis before transplantation was not associated with the occurrence of NAFLD after liver transplantation.
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http://dx.doi.org/10.1016/j.hpb.2019.07.015DOI Listing
April 2020

Shiraz Organ Transplant Center: The Largest Liver Transplant Center in the World.

Transplantation 2019 08;103(8):1523-1525

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

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http://dx.doi.org/10.1097/TP.0000000000002581DOI Listing
August 2019

Outcomes of liver transplantation for non-alcoholic steatohepatitis: A European Liver Transplant Registry study.

J Hepatol 2019 08 7;71(2):313-322. Epub 2019 May 7.

Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.

Background & Aims: Little is known about outcomes of liver transplantation for patients with non-alcoholic steatohepatitis (NASH). We aimed to determine the frequency and outcomes of liver transplantation for patients with NASH in Europe and identify prognostic factors.

Methods: We analysed data from patients transplanted for end-stage liver disease between January 2002 and December 2016 using the European Liver Transplant Registry database. We compared data between patients with NASH versus other aetiologies. The principle endpoints were patient and overall allograft survival.

Results: Among 68,950 adults undergoing first liver transplantation, 4.0% were transplanted for NASH - an increase from 1.2% in 2002 to 8.4% in 2016. A greater proportion of patients transplanted for NASH (39.1%) had hepatocellular carcinoma (HCC) than non-NASH patients (28.9%, p <0.001). NASH was not significantly associated with survival of patients (hazard ratio [HR] 1.02, p = 0.713) or grafts (HR 0.99; p = 0.815) after accounting for available recipient and donor variables. Infection (24.0%) and cardio/cerebrovascular complications (5.3%) were the commonest causes of death in patients with NASH without HCC. Increasing recipient age (61-65 years: HR 2.07, p <0.001; >65: HR 1.72, p = 0.017), elevated model for end-stage liver disease score (>23: HR 1.48, p = 0.048) and low (<18.5 kg/m: HR 4.29, p = 0.048) or high (>40 kg/m: HR 1.96, p = 0.012) recipient body mass index independently predicted death in patients transplanted for NASH without HCC. Data must be interpreted in the context of absent recognised confounders, such as pre-morbid metabolic risk factors.

Conclusions: The number and proportion of liver transplants performed for NASH in Europe has increased from 2002 through 2016. HCC was more common in patients transplanted with NASH. Survival of patients and grafts in patients with NASH is comparable to that of other disease indications.

Lay Summary: The prevalence of non-alcoholic fatty liver disease has increased dramatically in parallel with the worldwide increase in obesity and diabetes. Its progressive form, non-alcoholic steatohepatitis, is a growing indication for liver transplantation in Europe, with good overall outcomes reported. However, careful risk factor assessment is required to maintain favourable post-transplant outcomes in patients with non-alcoholic steatohepatitis.
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http://dx.doi.org/10.1016/j.jhep.2019.04.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656693PMC
August 2019

Liver Transplantation for High-Grade Primary Hepatic Neuroendocrine Tumor with Diffuse Liver Metastasis.

J Gastrointest Cancer 2020 Mar;51(1):304-306

Avicenna Transplant Hospital, Avicenna Center for Medicine and Organ Transplant, Shiraz, Iran.

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http://dx.doi.org/10.1007/s12029-019-00244-7DOI Listing
March 2020

Metastatic Tumors to the Pancreas, a Single Center Study.

Arch Iran Med 2019 01 1;22(1):50-52. Epub 2019 Jan 1.

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

Background: Most pancreatic masses are primary ductal adenocarcinomas; however, with the advent of new imaging studies and increasing survival of cancer patients, there are more cases with the diagnosis of secondary metastatic cancer to the pancreas. There is no study regarding cancer metastases to the pancreas from Iran. In this study, we retrieved all of the cases with the diagnosis of secondary cancer of pancreas in the affiliated hospitals of Shiraz University of Medical Sciences.

Methods: In 5 years (2012-2017), we evaluated all cases with the diagnosis of any pancreatic tumors and extracted all of the demographic and clinicopathologic findings of the cases with the diagnosis of metastatic pancreatic tumors from the clinical charts and pathology reports.

Results: For the duration of 5 years in our center, there were 131 cases of pancreatic tumors with different diagnoses, 9 of which were diagnosed as metastatic cancers from other organs. Two cases were diagnosed with gastric adenocarcinoma, 2 cases were colonic adenocarcinoma, one case was lung small cell carcinoma, 2 cases were renal cell carcinoma (RCC) and one case was gastrointestinal stromal tumor (GIST). The mesenchymal metastatic cancer to the pancreas has been a case of pleomorphic sarcoma of retroperitoneum.

Conclusion: Pancreas is not a common location for metastases; however, colon, stomach, kidney and lung seem to be the most common primary tumors with metastases to the pancreas. Our report is the first study about pancreatic metastatic tumors from Iran.
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January 2019

Portal vein thrombosis in patients with liver cirrhosis and its impact on early and long-term outcomes after liver transplantation.

Int J Clin Pract 2018 Dec 28:e13309. Epub 2018 Dec 28.

Avicenna Center for Medicine and Organ Transplant, Shiraz University of Medical Sciences, Shiraz, Iran.

Aim: Portal vein thrombosis (PVT) is a common complication amongst patients with liver cirrhosis. The PVT risk factors and its impact on post liver transplant outcome has not been well defined, yet. This study aimed to investigate PVT prevalence, its risk factors and influence on early and long-term outcomes after liver transplantation.

Methods: Adult (>18 years) patients with liver cirrhosis undergoing liver transplantation between March 2013 to March 2015 were included. Presence or absence of PVT was recorded at transplant. PVT risk factors in patients with liver cirrhosis and its impact on early and long-term outcomes were analysed.

Results: Portal vein thrombosis was diagnosed in 174 patients (17.3%). Large oesophageal varices (grade II and III vs grade I) (OR: 2.5; 95% CI: 1.46-4.26; P = 0.001), diabetes mellitus before transplantation (OR: 2.03; 95% CI: 1.13-3.64; P = 0.017) and cryptogenic-NASH (OR: 1.36; 95% CI: 1.08-1.72; P = 0.008) as a cause of underlying liver disease were the independent risk factors for PVT. PVT (OR: 2.05; 95% CI: 1.10-3.81; P = 0.023) was an independent predictor of early (within 90 days) posttransplant mortality, but did not influence long-term survival.

Conclusion: Portal vein thrombosis prevalence is high in pretransplant period. NASH related cirrhosis and diabetes mellitus might be risk factors for PVT. More intense screening of these patients for PVT is warranted.
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http://dx.doi.org/10.1111/ijcp.13309DOI Listing
December 2018

Evaluation of Interleukin-21, 23 and 27 mRNA Expression and Protein Level in Liver Transplant Patients.

Iran J Allergy Asthma Immunol 2018 Aug 12;17(4):298-307. Epub 2018 Aug 12.

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

Cytokines have prominent roles in activating of different T cells and shifting the immune response, in this study the role of three cytokines (IL-21, IL-23 and IL-27) is investigated in the liver transplant rejection. Three EDTA-treated blood samples were collected from each liver transplanted patient in 1st, 4th and 7th day of post-transplantation. The expression level of the mentioned cytokines was determined using real-time PCR for all samples. Also, the serum levels of cytokines were determined using ELISA tests. In acute rejection (AR) group (51 patients), mRNA expression pattern of IL-21and IL-23 showed a steady increase, but this pattern was converse for IL-27. Our results in non-acute rejection (non-AR) group (54 patients) showed an elevation in day 4 and then a decrease in day 7 for IL-21 and IL-23 genes. This pattern was converse again for IL-27 gene. In comparison between the two groups, in all 3 sampling times the mean of mRNA expression level of IL-21 and IL-23, showed an increase in AR group which this increase was significant for IL-21 in the 3rd (p=0.007) and for IL-23 in 2nd (p=0.048) and 3rd (p=0.049) sampling time, but the pattern of mRNA expression for IL-27 was contrary to the results of IL-21 and IL-23. Furthermore, ELISA technique also, showed the serum level changes the same as cytokines. In this study IL-21 and IL-23 showed pro-inflammatory properties in the liver transplant rejected patients. Also, IL-27 having different expression pattern, showed anti-inflammatory behavior which needs more considerations in future.
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http://dx.doi.org/10.18502/ijaai.v17i4.89DOI Listing
August 2018

Determination of antibiotic resistance pattern and virulence genes in Escherichia coli isolated from bovine with subclinical mastitis in southwest of Iran.

Trop Anim Health Prod 2019 Mar 23;51(3):575-580. Epub 2018 Oct 23.

Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.

The aims of the present study were to investigate the prevalence of some virulence genes and also determine the antimicrobial resistance pattern of E. coli isolated from bovine with subclinical mastitis. The milk of 502 cows was collected from 8 dairy herds in the southwest of Iran. Conventional biochemical tests were used for identification of E. coli at the species level. Antimicrobial susceptibility patterns of E. coli isolates were determined by disc agar diffusion method and polymerase chain reaction (PCR) was used for detection of seven virulence genes including f17A, afaE-8, afaD-8, eaeA, cnf1, cnf2, and iucD. Seventy (13.94%) isolates of E. coli were identified in 502 milk samples. The highest rate of resistance was observed against tetracycline (18.6%), while none of the isolates were resistant to streptomycin. Eight (11.5%) out of 70 E. coli isolates carried at least one of the virulence genes. The afaD-8 was the most prevalent gene detected in 5 (7.1%) isolates. The afaE-8, iucD, and eaeA were detected in 3, 3, and 2 isolates respectively. Low prevalence of virulence factors may be indicating that most of the E. coli isolates originated from the commensal flora of cows and enter to the udders via environment contamination with feces.
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http://dx.doi.org/10.1007/s11250-018-1726-0DOI Listing
March 2019

Significance of Occult Hepatitis C Virus Infection in Liver Transplant Patients With Cryptogenic Cirrhosis.

Exp Clin Transplant 2020 04 19;18(2):206-209. Epub 2018 Oct 19.

>From the Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: Investigations into the viral causes of end-stage liver disease in liver transplant patients with cryptogenic underlying disease remain of interest. Hepatitis C virus infection, especially in its silent (occult) form, may play a key role in the introduction and development of cryptogenic cirrhosis. We aimed to determine the prevalence of occult hepatitis C virus infection in liver transplant recipients with cryptogenic cirrhosis.

Materials And Methods: In this cross-sectional study, 127 liver transplant recipients confirmed to have cryptogenic cirrhosis were included. Plasma samples of the patients underwent evaluation for hepatitis C virus antibody using the enzyme-linked immunosorbent assay method. Plasma samples and paraffin-embedded liver tissue samples were tested for hepatitis C virus RNA using nested reverse transcriptase-polymerase chain reaction.

Results: Hepatitis C virus RNA was detected in liver tissue sections of 10 patients (7.9%). However, none of the cryptogenic patients had hepatitis C virus RNA or antibody in their plasma samples. None of the patients had hepatitis C or G virus coinfection, but simultaneous detection of hepatitis B and hepatitis C virus was diagnosed in 4 liver tissue samples.

Conclusions: A finding of hepatitis C virus RNA in liver tissue samples of transplant recipients presents the historical possibility of occult hepatitis C virus infection as underlying disease in our patients with cryptogenic cirrhosis. Results present an important and determinative role of occult hepatitis C virus infection in the pathogenesis of cryptogenic cirrhosis, which needs further confirmation in additional studies.
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http://dx.doi.org/10.6002/ect.2017.0332DOI Listing
April 2020

Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran.

Transpl Infect Dis 2019 Feb 2;21(1):e13001. Epub 2018 Oct 2.

Shiraz Organ Transplant Center, Abu-Ali Sina Hospital, Shiraz, Iran.

Background: Bacterial infection in early period after liver transplant (LT) is the main cause of morbidity and mortality; however, data on children is limited.

Methods: To investigate the frequency, characteristics, and the associated factors of bacterial infection during hospitalization after LT, we prospectively enrolled all consecutive children with LT for a one-year, case-control study at the unique referral center of pediatric LT in Iran.

Results: Eighty-five events of bacterial infection were detected among 51 out of 94 LT recipients (54.3%) (infection group). Forty-three patients without bacterial infection constituted the control group. The frequency of bacterial infection based on the 51 microbiologically documented events was 31.9% (30 out of 94 patients). Major site of bacterial isolation were abdomen (43.6%). The following variables were associated with bacterial infection in univariate analysis: younger age (5.6 vs 8.9 years old), longer duration of JP Drain (13.4 vs 6.3 days), central venous catheter (14.6 vs 7.6 days), and Foley catheter insertion (7.3 vs 4.5 days), reoperation (57% vs 12% of patients), mean frequency of reoperation (1.1 vs 0.1 times), and intensive care unit stay (12.1 vs 6.5 days). In multivariate analysis, only longer hospital stay after transplant (23.6 vs 10.9 days) was independently associated with bacterial infection. All ten deaths occurred within the infection group and half of which directly caused by infection.

Conclusions: These infections were associated with longer hospital stay and higher mortality rate. Conducting further studies with larger sample size and investigating more effective prophylactic measures should be considered in future studies.
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http://dx.doi.org/10.1111/tid.13001DOI Listing
February 2019

The Situation of Liver Transplantation Programs in Iran.

Middle East J Dig Dis 2018 Jul 24;10(3):194-195. Epub 2018 Jun 24.

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

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http://dx.doi.org/10.15171/mejdd.2018.111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119831PMC
July 2018