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    P.389: No difference in recurrent hepatocellular carcinoma rates in liver transplanted patients receiving mTOR inhibitors compared to non-mTOR group.
    (Wolters Kluwer, 2024-09-01)
    Anar Ganbold
    ;
    Margad-Erdene Erdenechuluun
    ;
    Bayarmaa Ochirkhuree
    ;
    Urnultsaikhan Ganbold
    ;
    Ulzii-Orshikh Namkhai
    Introduction: A liver transplantation (LT) is a first line therapeutic choice for patients with hepatocellular carcinoma (HCC). Mammalian Target of Rapamycin (mTOR) inhibitors act as immunosuppressant and indicated against HCC recurrence in LT patients. The efficacy of mTOR inhibitors in preventing HCC recurrence remains contentious. Methods: We retrospectively enrolled 45 patients (average age 50, M/F:29/16) who had a history of HCC at the time of LT operation at a single center (2011-2023) and divided into a mTOR and non-mTOR groups. Initial Alfa-fetoprotein (AFP), Protein induced by vitamin K absence-II (PIVKA-II) levels, contrast-enhanced abdominal computer-assisted tomography (CT) scans were compared to most recent results, explant histology was also assessed for HCC extent. Decision to transplant was made based on Milan criteria. Student t-test was used to determine statistical significance (p<0.05). Results: In the mTOR group (n=23, average age 52.7) there were 2 confirmed HCC recurrences with elevated markers and positive CT scans. In the non-mTOR group (n=22, average age 47.4) there was 1 confirmed case of HCC. A recurrence rate of 6.67% was recorded overall, 8.7% and 4.55% for mTOR and non-mTOR (p=0.28), respectively. All three recurrences were detected within 24 months of the operation. For recurrent HCCs, the average levels of PIVKA-II and AFP were 27010mAU/ml and 2842.7ng/ml, respectively. There was no difference in number and mode of pre-LT bridging therapies (TACE or RFA) with regards to recurrence. There were two cases of elevated PIVKA-II without a radiologic confirmation. Conclusion: Adherence to the Milan criteria and application of pre-LT bridging therapies will keep the recurrence rate below 10%. Any possible recurrence will be diagnosed within 24 months of LT. Administration of mTOR inhibitors can be stopped after 2 years as part of the physician-guided minimization of immune suppression regimen.
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    P.402: The role of complement C4 and Alt level for acute rejection after liver transplantation.
    Acute liver graft rejection is still a common complication after liver transplantation. Diagnosis of acute cellular rejection (ACR) requires a liver biopsy with attendant expense, and risk, especially for developing countries. Measurements of serum complement components C3 and C4 are useful in the diagnosis and monitoring of immune complex disease. The normal adult range of C4 is 20-50mg/dl. Low levels of C4 strongly suggest immune complex disease. The combination C4 and ALT levels are highly predictive of acute cellular rejection (ACR) in liver transplant recipients. A lowered concentration or the complete absence of C4 occurs in immunocomplex diseases, systemic lupus erythematosus (SLE), autoimmune thyroiditis and juvenile dermatomyositis. Patients and Methods: Our study has two groups, one group comprised 8 liver transplant recipients, who has predictive diagnosis of ACR. The other group comprised 8 liver transplant recipients, who has not prediction of ACR. Pathologist evaluated the ACR by Banff grading schema. Serum C4 was checked Cobas 6000/c501/ analyzer. Results: ACR patients had an average of C4 ≤ 0.22 gm/L test, ALT ≥ 124 IU/ml. The patients without ACR had an average of C4 ≥0.61 gm/L test, ALT ≤ 87 IU/ml. The ACR patients had done needle biopsy, which showed liver rejection.Conclusion: To detect serum C4 in blood is a relatively non-invasive, inexpensive, easy to measure and quick marker. Especially for developing countries like Mongolia, preliminary diagnosis of ACR, which revealed decreasing C4 and increasing ALT convenient to biopsy results. Organ Transplantation Team of Mongolia.
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    P.367: Outcomes of liver transplantation: A single-center experience. (First Central Hospital of Mongolia).
    Methods: This study was conducted in Transplantation Center of the First Central Hospital of Mongolia between September 2011 and May 2023 on a total 200 patients have undergone liver transplantation. Results: There were 105 female patients out of 200, age between 18 months to 62 years old, and the average MELD score was 15±5.5, length of hospital stay were 31±13.94. These transplants were for liver (living donor=189, deceased donor=11, pediatric=7). The most causes of liver transplantation were liver cirrhosis due to HBV/HDV (59.5%), hepatocellular carcinoma (22.5%), primary biliary cirrhosis (5%), and only HBV related cirrhosis, alcoholic cirrhosis. There were 23(11.5%) biliary complication, 17 (8.5%) acute cellular rejection, hepatic artery thrombosis 2 (1%), and 3 cases retransplanted. The five year survival was 87%. Conclusions: This study provides the process of liver transplantation in First Central Hospital of Mongolia, and these positive outcomes support LT as an important therapy for end-stage liver disease and early hepatocellular carcinomas. Introduction: Liver transplantation (LT) is a main treatment of end-stage liver disease. Specially developing country like Mongolia has high prevalence of HBV, HDV, and hepatocellular cancer. Liver transplant is the second-most common solid organ transplant procedure in Mongolia. This study aimed to evaluate the efficacy of liver transplantation in the First Central Hospital of Mongolia.
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    Элэг шилжүүлэн суулгах мэс заслын дараах эрт үеийн бөөрний үйл ажиллагааны алдагдалтай эмчлүүлэгчдийн хүндрэлийг судалсан нь
    (2025-10-20)
    Б.Батсайхан
    ;
    ;
    Б.Цэрэнбат
    ;
    Г.Баярбилэг
    ;
    Үндэслэл: Бөөрний үйл ажиллагааны алдагдал (БҮАА) нь элэгний хатуурал бүхий эмчлүүлэгчдэд түгээмэл тохиолддог нас баралт өндөр хүндрэлүүдийн нэг юм. Элэг шилжүүлэн суулгах мэс засал (ЭШСМЗ)ын дараах эрт үеийн БҮАА-нд нөлөөлдөг эрсдэлт хүчин зүйлсийг судалгааны ажлууд ховор хийгдсэн байгаа ч үр дүн нь харилцан адилгүй байгаа нь энэхүү судалгааны ажлын үндэс боллоо. ЭШСМЗын дараах эрт үеийн хүндрэлүүдийн нэг болох БҮАА-д нөлөөлж буй эрсдэлт хүчин зүйлс болон бусад эрт болон хожуу үеийн хүндрэлүүдийг судлах, БҮАА эмчлүүлэгчийн болон суулгацын амьдрах чадварт хэрхэн нөлөөлж байгааг судлах. Арга, аргачлал: Бид энэхүү эмнэлэгт суурилсан ретроспектив болон проспектив когорт судалгааны ажлыг Улсын Нэгдүгээр Төв Эмнэлэг (УНТЭ)-ийн Эрхтэн шилжүүлэн суулгах төвд 2011 оны 9 сараас 2024 оны 12 сар дуустал хугацаанд амьд болон амьгүй донороос ЭШСМЗ-д орсон, сонгох шалгуурт тэнцсэн тохиолдолыг судалгаанд хамрууллаа. БҮАА-г мэс заслын өмнө, мэс заслын дараах 24 цаг, 72 цаг, 7 хоног, 14 хоног болон 28 дахь хоногийн бөөрний үйл ажиллагааг Кокрофт-Гаултын томъёог ашиглан үнэлэв. ЭШСМЗ-ын дараах эрт болон хожуу үеийн хүндрэлүүдийг олон улсын ангиллалын дагуу ангилж судлав. Анагаахын Шинжлэх Ухааны Их Сургууль (АШУҮИС)-ийн Судалгааны ёс зүйн хяналтын хорооны хурлаар судалгаа хийх ёс зүйн зөвшөөрөл авсан. Үр дүн: Бидний судалгаагаар ЭШСМЗ-ын дараах БҮАА нь 29.7%-д тохиолдож байгаа нь тодорхойлогдлоо. ЭШСМЗ-ын дараах бөөрний үйл ажиллагаанд нөлөөлж буй эрсдэлт хүчин зүйлсийг судлахад эмэгтэй хүйс (OR 3.76; 95% CI 2.17–6.53), Чайлд-Пью ангилалын B болон C шатлалын оноо (OR, 5.57; 95%CI, 1.27-24.52 болон OR, 8.21; 95%CI, 1.87–36.54), их хэмжээний асцит (OR, 3.48; 95%CI, 1.86-6.51), хавсарсан өвчин (OR, 1.92; 95%CI, 1.14-3.23) бие даасан эрсдэлт хүчин зүйл болж байна. Хүндрэлийг судлахад мэс заслын дараах эрт үеийн цочмог цус алдалт (OR, 3.22; 95%CI, 1.22-8.46), давтан мэс засал (OR, 3.12; 95%CI, 1.34-7.28) зэрэг нөлөөлдөг нь статистик үнэн магадтай батлагдав. БҮАА-тай эмчлүүлэгчийн амьдрах чадвар 1 болон 3 жилд 90.7% болон 81.3% байна. Дүгнэлт: 1. Реципиентийн нас өндөр байх (p<0.001), эмэгтэй хүйс (p<0.001), элэгний үйл ажиллагааны алдагдалын оноо өндөр байх (p<0.002), хавсарсан өвчин (p=0.013), асцит (p=0.001), мэс заслын өмнөх эрчимт эмчилгээ (p=0.026) зэрэг нь БҮАА-нд хүргэж буй мэс заслын дараах эрсдэлт хүчин зүйлс болж байна. 2. Мэс заслын дараах цочмог цус алдалт (p=0.003), давтан мэс засал (p=0.006) нь БҮАА үүсэхэд нөлөөлөх бие даасан эрсдэлт хүчин зүйлс болж байна. 3. ЭШСМЗ хийгдсэн реципиентийн мэс заслын тойрны БҮАА нь эмчлүүлэгчийн амьдрах чадвар (Log Rank p=0.522; HR1.3), суулгацын амьдрах чанарт (Log Rank p=0.457; HR1.26) нөлөөлж байна.
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    A decade of liver transplantation in Mongolia: Economic insights and cost analysis
    (Springer Science and Business Media LLC, 2024-07) ; ; ; ;
    Ganbold, Urnultsaikhan
    BACKGROUND: Mongolia introduced liver transplantation 10 years ago, becoming the 46th country globally to successfully perform this procedure. However, the cost of liver transplantation treatment remains expensive in Mongolia, a lower-middle-income country. Thus, the need to calculate the cost of liver transplants, a highly-valued treatment, forms the basis for this study. METHODS: This study employed a retrospective research design with secondary data. The primary dataset comprised 143 cases of liver transplantation performed at the First Central Hospital of Mongolia between 2011 and 2021. RESULTS: The average cost of a liver transplant in Mongolia is $39,589 ± 10,308, with 79.6% being direct costs and 20.4% indirect costs. Of the direct costs, 71% were attributed to drugs, medical equipment, and supplies, while 8.6% accounted for salaries. In terms of the Model of End-Stage Liver Disease (MELD) scores, treatment costs were $39,205 ± 10,786 for patients with MELD ≤ 14 points, $40,296 ± 1,517 for patients with MELD 15-20 points, $39,352 ± 8,718 for patients with MELD 21-27 points, and $39,812 ± 9,954 for patients with MELD ≤ 28 points, with no statistically significant difference (P = 0.953). However, when calculated according to the Child-Turcotte-Pugh (CTP) score classification, treatment cost for CTP-A patients was $35,970 ± 6,879, for CTP-B patients $41,951 ± 12,195, and for CTP-C patients $37,396 ± 6,701, which was statistically significant (Р=0.015). CONCLUSION: The average cost of liver transplantation treatment in Mongolia was $39,589. Despite medical facilities' capacity to treat up to 50 patients annually, the waiting list exceeds 300 individuals, highlighting significant unmet healthcare needs.
    Scopus© Citations 2