Document Detail


Should possible recurrence of disease contraindicate liver transplantation in patients with end-stage alveolar echinococcosis? A 20-yr follow-up study.
MedLine Citation:
PMID:  21455928     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND AIMS.: Liver transplantation (LT) is currently contraindicated in patients with residual or metastatic lesions of alveolar echinococcosis (AE). We evaluated the long- term course of such patients who underwent LT and were subsequently treated with benzimidazoles. METHODS.: Clinical, imaging, serological and therapeutic data were collected from 5 patients with residual/recurrent lesions of AE who survived for more than 15 years; these patients were from a cohort of 23 with AE who underwent LT at 2 LT/AE referral centers and were subsequently followed up prospectively. Since 2004, images of FDG-positron emission tomography (FDG-PET) were available, and levels of serum antibodies against Echinococcus (E.) multilocularis-recombinant antigens were evaluated. RESULTS.: Median survival of the 5 patients after LT was 21 years. Four of 8 patients with residual/recurrent AE versus 4 of 9 patients without residual/recurrent AE were alive in September 2009. High doses of immunosuppressive drugs, late introduction of therapy with benzimidazoles, withdrawal of such therapy because of side-effects or non-adherence to such therapy, adversely affected prognosis. Administration of appropriate doses of benzimidazoles inhibited the growth of residual/recurrent E. multilocularis. Anti-Em2(plus) and anti-rEm18 antibody levels and standard FDG-PET enabled the efficacy of therapy with benzimidazoles to be assessed. However, meaningful variations in levels of antibodies were observed below diagnostic cut-off values, and images of the uptake of FDG 3 hours after its injection were more sensitive than those obtained 1 hour after its injection in monitoring the metabolic activity of parasitic lesions. CONCLUSIONS.: Benzimidazoles can control residual/recurrent lesions of AE after LT. Monitoring levels of anti-rEm18 or anti-Em2(plus) antibodies and delayed acquisition of FDG-PET images can improve the functional assessment of disease activity. Potential recurrence of disease, especially in patients with residual or metastatic lesions of AE, should not be regarded as a contraindication to LT, even when AE is considered to be lethal in the short-term. Liver Transpl, 2011. © 2011 AASLD.
Authors:
Bresson-Hadni Solange; Blagosklonov Oleg; Knapp Jenny; Grenouillet Frédéric; Sako Yasuhito; Delabrousse Eric; Brientini Marie-Pascale; Richou Carine; Minello Anne; Antonino Anca-Teodora; Gillet Michel; Ito Akira; Mantion Georges André; Vuitton Dominique Angèle
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-31
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  -     ISSN:  1527-6473     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-4-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 American Association for the Study of Liver Diseases.
Affiliation:
WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis; University Hospital (Dept of Digestive Surgery/Liver Transplantation Unit; Dept of Hepatology; Dept of Nuclear Medicine; Dept of Parasitology, Dept of Radiology and Dept of Clinical Pharmacology) and University of Franche-Comté (Joint Research Unit UFC/CNRS/INRA, UMR6249 "Chrono-Environment" and EA3181); 25030 Besançon, France.
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