https://www.giejournal.org/article/S0016-5107(02)00006-8/pdf

Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis

Plastic anemia, which is pancytopenia with a fatty or “empty” bone marrow, is remarkable for the simplicity of its pathologic picture and the direct derivation of its clinical manifestations.1 Although it is not a common disease, the drama of an individual case and the larger consequences of its associations give it considerable interest. That aplastic anemia is perhaps the most dreaded idiosyncratic complication of drug treatment has serious and often expensive consequences for drug development, for risk assessment, for approval by regulatory agencies, and in legal actions. Aplastic anemia, first described by Paul Ehrlich in 1888 from an autopsy of . . .

The pathophysiology of acquired aplastic anemia.

Primary sclerosing cholangitis.

https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.1840220511

Primary sclerosing cholangitis and ulcerative colitis: Evidence for increased neoplastic potential

AGA Technical Review on the Diagnosis and Management of Colorectal Neoplasia in Inflammatory Bowel Disease

http://d-scholarship.pitt.edu/4441/1/31735062110972.pdf

Development of Colon Cancer After Liver Transplantation for Primary Sclerosing Cholangitis Associated with Ulcerative Colitis

Aplastic anemia developed in 9 of 32 patients (28 percent) undergoing orthotopic liver transplantation for acute non-A, non-B hepatitis, at one to seven weeks after the procedure. No patient previously had evidence of hematologic dysfunction or conditions known to be associated with aplastic anemia. No other cases of aplastic anemia were identified among 1463 patients undergoing liver transplantation for all other indications at the four centers participating in the study (chi-square = 415, P less than 0.001; 95 percent confidence interval for the incidence of aplastic anemia after transplantation for non-A, non-B hepatitis, 13 to 44 percent, vs. 0.00 to 0.13 percent for all other indications). The operative and postoperative treatment of these patients was not otherwise different, indicating that the aplastic anemia was a complication of the hepatitis, not of the transplantation procedure. Four of the nine patients died of complications due to infections. Three of the surviving patients have been followed for less than six months, one for one year, and one for two years. The two patients followed the longest have recovered marrow function to an appreciable degree, and two of the others have evidence of early recovery. We conclude that patients undergoing orthotopic liver transplantation for non-A, non-B hepatitis are at a high risk for the development of aplastic anemia.

Aplastic Anemia Complicating Orthotopic Liver Transplantation for Non-A, Non-B Hepatitis

A tension mucocele was created in three hepatic homografts by ligating a low-lying cystic duct during transplant cholecystectomy and by incorporating its outflow end into the anastomosis of the common hepatic duct to the recipient common duct or Roux limb of jejunum. The consequent complication of obstruction of the biliary tract that necessitated reoperation and excision of the mucocele in all three patients can be avoided by the simple expedient of completely removing the cystic duct when feasible or providing egress to the secretion of the cystic duct as described.

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Obstructing mucocele of the cystic duct after transplantation of the liver.

Xenograft transplantation is perhaps the most immunologically difficult problem in transplantation today. An overwhelming hyperacute rejection reaction (HAR) occurs within minutes of organ implantation. Preformed antibodies are thought to initiate this process. We used a pig-to-dog renal xenograft transplant model and investigated methods of decreasing the severity of hyperacute rejection. Female pigs weighing 15–20 kg were used as donors. Recipients were mongrel dogs weighing 15–25 kg. Experimental dogs were all given a number of treatments of IgG depletion using an antibody removal system (Dupont-Excorim). This machine immunoadsorbs plasma against a column containing immobilized staphylococcal protein A, which is known to bind the IgG Fc receptor. An 84% reduction in the IgG levels and a 71% reduction in IgM levels was achieved. Postoperative assessment was made of urine output, time to onset of HAR, and histopathological examination of the rejected kidneys. Although cross-matches between donor lymphocytes and recipient sera remained strongly positive in the treated dogs, there was a two- to fourfold reduction in the titers. The time to onset of HAR was prolonged in the experimental group, and the urine output was increased slightly. The histopathologic changes in the experimental group generally showed signs of HAR, but of less intensity than in the nonimmunodepleted control group.

/pdf/immunodepletion-in-xenotransplantation-pj7u41qm0c.pdf

Immunodepletion in xenotransplantation.

Hepatic artery thrombosis (HAT) is a dreadful complication of orthotopic liver transplantation (OLT). This complication occurred in 27 grafts (68% = 27/393 grafts) in 25 patients (9% = 25/313 patients). HAT was responsible for a high mortality (64% = 16/25 patients) despite a high retransplantation rate (70% = 19/27 grafts). HAT should be suspected in case of fulminant liver failure, delayed bile leak or unexplained fever of sepsis of unknown etiology occurring after liver transplantation. Pulsed doppler examination and arteriogram are the decisive diagnostic procedures. Patients presenting HAT can only be rescued by early diagnosis and retransplantation. Aneurysms of the hepatic arterial supply must also be treated urgently, either by conventional vascular repair if possible or by retransplantation, because or the high incidence of fatal rupture (3/4 patients = 75%).

Ag G. Tzakis

Papers

Development of Colon Cancer After Liver Transplantation for Primary Sclerosing Cholangitis Associated with Ulcerative Colitis

Aplastic Anemia Complicating Orthotopic Liver Transplantation for Non-A, Non-B Hepatitis

Obstructing mucocele of the cystic duct after transplantation of the liver.

Immunodepletion in xenotransplantation.

The hepatic artery in orthotopic liver transplantation