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ABSTRACT: Donor scarcity is among the greatest concerns in the transplantation community. Dividing a liver graft theoretically offers a double benefit for candidates on the waiting list. Split liver transplantation entails a higher logistic and technical complexity that is extensively compensated, not only with an increase in the accessibility for child and adult candidates on the liver transplant waiting list, but also acceptable survival results.
Transplantation Proceedings 07/2012; 44(6):1513-6. · 1.00 Impact Factor
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E Álvaro, M Abradelo,
A Fuertes,
A Manrique,
F Colina,
C Alegre,
J Calvo,
M García,
A García-Sesma,
F Cambra,
R Sanabria,
E Moreno,
C Jimenez
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ABSTRACT: Hepatitis C (HCV) is among the most common causes of end-stage liver disease worldwide. The donor shortage leads us to consider alternative organ sources such as HCV-positive donors. The outcomes of these transplants must be evaluated thoroughly since there is universal recurrence of disease among HCV-positive liver transplant recipients.
From January 2005 to April 2011, we performed 143 liver transplants (OLT) to treat end-stage liver disease secondary to HCV infection. Thirteen patients (9,1%) received livers from HCV-positive donors. A control group consisted of 130 HCV-positive patients who underwent OLT during the same period with organs from HCV-negative donors. Donor HCV status was assessed by 2 tests: HCV antibodies and viral load. Not only recipient and graft survivals were analyzed, but also frequency, timing and severity of hepatitis recurrence.
Among 143 transplants performed in HCV-positive recipients during a 6-year period from January 1, 2005, to April 30, 2011, 9.1% of patients received an organ from an anti-HCV-positive donor, 72.7% of whom showed a negative viral load. The vast majority (80%) of our patients suffered hepatitis during their follow-up, 22.4% of which were severe cases.
No significant difference in patient or graft survival was observed between the 2 groups. A high percentage of grafts with initial positive serology for HCV showed no viral replication. Grafts from HCV-positive donors can be considered to be a safe, effective source for liver donation.
Transplantation Proceedings 07/2012; 44(6):1475-8. · 1.00 Impact Factor
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ABSTRACT: Orthotopic liver transplantation (OLT) is the best treatment to restore liver function in liver failure. The low availability of organs has focused interest on the use of cell transplantation to restore liver function. However, this technique is limited because cells can not bind to liver parenchyma and die soon after perfusion. Pretransplant treatment with engraftment enhancers (EE) to increase vascular permeability may increase cell attachment. Using an endothelial cell culture to measure the loss of intercellular endothelial adhesion as a screening test, we evaluated the capacity of 15 monoclonal antibodies against adhesion molecules expressed on endothelial cells to act as EE showing that 3 antibodies (anti-CD54, efalizumab, and abciximab) act as EE by producing disruptions in the cell layer.
Transplantation Proceedings 03/2010; 42(2):671-2. · 1.00 Impact Factor
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ABSTRACT: We assessed whether trough anti-hepatitis B surface antigen (HBs) serum levels considered to be protective (>100 IU/L) were maintained in liver transplanted patients after 6 months of uninterrupted treatment with Niuliva, a new intravenous HBIg.
Twenty patients, aged 18-70 years, who had undergone liver transplantation due to HBV-related liver disease at least 1 year before inclusion were enrolled in a prospective, open-label, uncontrolled, multicenter clinical study. A fixed monthly dose of 5,000 IU of study medication was administered intravenously for 6 months.
After the second infusion, all mean values of anti-HBs and 95% CIs were above the limit of 100 IU/L considered to be protective. The percentages of success ranged between 95% (95% CI 75.1%-99.9%) and 100% (95% CI 86.1%-100%). Mean values and 95% CI of in vivo recovery of anti-HBs at 15-30 minutes after each infusion showed overlaps between all intervals, which indicated that significant differences were not present in the recovery of post infusion anti-HBs in vivo. There were no recurrences of HBV infection during the study. There were no seroconversions in patients previously negative to hepatitis C virus or HIV. No serious adverse events related to the study medication were observed.
Serum levels of anti-HBs after using Niuliva in patients who had undergone liver transplantation were protective in 95%-100% of cases after the study period. This new HBIg showed the expected pharmacokinetic profile and was well tolerated and safe.
Transplantation Proceedings 12/2009; 41(10):4253-8. · 1.00 Impact Factor
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ABSTRACT: Mycophenolate mofetil (MMF) monotherapy has recently been proposed for liver transplant recipients with adverse events (nephrotoxicity, hypertension) related to calcineurin inhibitors. We analyzed the influence of MMF on the clinical course of recurrent hepatitis C.
Among 1038 patients who underwent liver transplantation (OLT) from April 1986 to October 2006, we analyzed 48 adult recipients (4.6%) whose diagnosis was hepatitis C virus (HCV) cirrhosis and who were converted from calcineurin inhibitors to MMF monotherapy.
The 36 men and 12 women, had a mean age at OLT of 52.9 +/- 7.2 years; the time elapsed from OLT to the onset of MMF monotherapy was 72.5 +/- 47.6 months (range = 11-210). The mean follow-up after monotherapy was 19 +/- 16.1 months (range = 2-67). Indications for conversion were: chronic renal dysfunction with HCV in 45 patients; HCV recurrence in two; and hypertension plus HCV recurrence in one subject. When the indication was renal dysfunction (excluding three patients who underwent hemodialysis), the mean creatinine values decreased significantly from baseline to 6 months of monotherapy from 1.63 +/- 0.61 mg/dL to 1.51 +/- 0.78 mg/dL (P < .03). The creatinine clearance only improved significantly from the baseline value of 56.6 +/- 16.8 mL/min to the value at 3 months of monotherapy-63.6 +/- 18.4 mL/min (P < .001). At the last outpatient visit, creatinine and creatinine clearances had not changed significantly. The mean diastolic blood pressure did improve significantly at the end of the study. The mean glucose levels decreased but not significantly at the last outpatient visit. Liver function tests did not change significantly after conversion to MMF monotherapy. The acute rejection rate was 8.3%, and adverse events related to MMF monotherapy were present in 9 patients (18.7%).
Conversion from calcineurin inhibitors to MMF monotherapy in patients who underwent OLT for HCV transiently improved renal function and hypertension. The acute rejection rate was low, and adverse events were usually well tolerated.
Transplantation Proceedings 11/2008; 40(9):2962-4. · 1.00 Impact Factor
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C Jiménez,
A Manrique,
J M Morales,
A Andrés,
T Ortuño, M Abradelo,
A Gimeno,
J Calvo,
F Cambra,
R L Sterup,
E Moreno
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ABSTRACT: We investigated whether hemodialysis or peritoneal dialysis prior to pancreas-kidney transplantation was a risk factor for the development of surgical complications, recipient mortality, or graft loss.
From March 1995 to December 2006, 90 patients with type 1 diabetes underwent pancreas transplantation. Dialysis before transplantation was provides to 81 patients. We compared outcomes of recipients classified as two groups: (A) hemodialysis (n = 49, 60.5%) versus (B) peritoneal dialysis (n = 32, 39.5%) groups.
Donor and recipient characteristics were similar in both groups. Enteric drainage was more frequently used in the hemodialysis group and bladder drainage in the peritoneal dialysis group (P < .05). The rate of intra-abdominal infections was similar in both groups: 10 patients (20.4%) in the hemodialysis group and 9 patients (28.1%) in the peritoneal dialysis group (P = NS). The incidence of enteric or bladder leakage was slightly higher in the peritoneal dialysis group (5 cases, 15.6% vs 4 cases, 8.2% in the hemodialysis group; P = NS). The rate of reoperations was also slightly higher in the peritoneal dialysis group B (15 cases, 46.9% vs 14 cases, 28.6% in the hemodialysis group; P = .07). Pancreas transplantectomy was significantly greater in the peritoneal dialysis (9 cases; 28.1%) than the hemodialysis group (5 cases; 10.2%; P < .05). The actuarial 3-year patient survival was 95.9% in the hemodialysis group and 93.4% in the peritoneal dialysis group (P = NS); actuarial 3-year pancreas graft survival was 79.3% in the hemodialysis group and 68.3% in the peritoneal dialysis group (P = NS).
We noted an insignificantly greater rate of reoperations but significantly higher incidence of pancreas transplantectomy in the peritoneal dialysis group; however, patient and pancreas graft survivals were similar in both study groups.
Transplantation Proceedings 11/2008; 40(9):2999-3000. · 1.00 Impact Factor
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A Manrique,
C Jiménez,
M L Herrero,
J C Meneu, M Abradelo,
A Moreno,
E González,
E Hernández,
J M Morales,
A Andrés,
J Cortina,
E Moreno
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ABSTRACT: The use of Celsior solution for organ preservation has not been thoroughly studied in pancreas transplantation. The aim of this study was to compare University of Wisconsin and Celsior solutions for preservation of pancreas grafts.
From March 1995 to December 2005, 72 patients with type 1 diabetes underwent pancreas transplantation. There were 42 men and 30 women, with a mean age at transplantation of 38.1 +/- 7.5 years (range: 27 to 55 years), and a mean duration of diabetes of 22.5 +/- 6.6 years. Recipients were classified into two groups according to the preservation solution: (A) Celsior (n = 28, 38.9%) and (B) Wisconsin (n = 44, 61.1%).
The donor and recipient characteristics were similar in both groups. There were five cases of venous thrombosis in the Wisconsin group and two in the Celsior group (P = NS). The venous drainage technique in the former group was portocaval in 19 patients and portoiliac in 25; in the Celsior group, portocaval in 23 patients and portoiliac in five (P = .001). Enteric drainage was used in 19 patients from the Celsior group and 17 patients from the Wisconsin group (P = .01). Actuarial 2-year graft survival was 74.6% in the Wisconsin group and 77.4% in the Celsior group (P = NS).
No differences were observed in venous thrombosis between the two groups. The lower rate of venous thrombosis with the portocaval technique was related to the type of venous drainage rather than the type of preservation solution. Celsior solution may be considered as good as Wisconsin solution for pancreas transplantation.
Transplantation Proceedings 11/2006; 38(8):2582-4. · 1.00 Impact Factor
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F A Gimeno,
J Calvo,
C Loinaz,
J C Meneu,
B Pérez,
R Gomez,
C Jiménez, M Abradelo,
A Moreno,
A Sesma,
I García,
E Moreno
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ABSTRACT: Portal vein thrombosis (PVT), which had been considered an absolute contraindication to orthotopic liver transplantation (OLT), is currently considered a risk factor that increases morbi-mortality. The objective of this study was to compare OLT outcomes in patients with vs without PVT.
Between April 1986 and December 2003, a sample of 83 patients with PVT was compared with another sample of 83 patients without PVT among 962 OLT performed in our department.
Both groups were homogeneous in terms of epidemiological variables, surgical technique, immunosuppression, and donor-related variables. There were no differences with respect to graft function during the first week following surgery. Surgical time and anhepatic phase duration was longer in the PVT group, albeit the differences were not significant. PVT patients also required more transfusions; a strong statistical association was observed with respect to blood (P = .12) and plasma (P = .11) transfusions and statistically significant differences regarding platelet transfusions (P = .02). Time on mechanical ventilation and the length of stay in the ICU were longer but not significant among PVT patients. The only statistically significant difference was the incidence of portal rethrombosis (P = .02). With respect to mean and global patient and graft actuarial survivals after 1, 3, 5, and 10 years, we have observed no significant intergroup differences, although both patient (P = .48; NS) and graft (P = .96, NS) survivals were lower among PVT cases.
PVT should not only cease to be considered a contraindication for OLT, but there were no significant differences between the outcomes despite this finding.
Transplantation Proceedings 12/2005; 37(9):3899-903. · 1.00 Impact Factor
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C Jiménez,
E Marqués,
A Manrique,
C Loinaz,
R Gómez,
J C Meneu, M Abradelo,
B Pérez,
A Moreno,
I García,
E Moreno
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ABSTRACT: Lung tumors have been related to tobacco and alcohol. The incidence increases after orthotopic liver transplantation (OLT) especially when it is performed because of alcoholic cirrhosis.
We analyzed the incidence and risk factors for de novo lung tumors among 701 patients who underwent OLT between April 1986 and July 2004, after exclusion of pediatric recipients and adults who died within 2 months after OLT.
The incidence of de novo lung tumors was 15 patients (2.1%), including 12 (4.3%) who underwent OLT for alcoholic cirrhosis and 3 (0.7%) for nonalcoholic diseases. There were 14 men and 1 woman of mean age at OLT of 50.8 +/- 9.6 years. Mean time from OLT to lung tumor was 83 +/- 43 months (range, 10-184 months). Thirteen patients (86.6%) were heavy smokers before OLT and 8 (61.5%) continued after OLT; 12 patients (80%) were heavy drinkers before OLT. Ten patients were immunosuppressed with CyA and 5 with tacrolimus. Acute rejection episodes before tumor diagnosis occurred in 6 patients (40%). Two patients underwent thoracotomy, but only one was resected. The remaining 13 patients were unresectable because of locally advanced tumor or metastatic disease. Two unresectable patients received palliative chemotherapy. All patients died with a mean survival from tumor diagnosis, of 5.3 months (range, 3 days to 33 months).
A significantly higher incidence of lung tumors was observed among patients who underwent OLT for alcoholic cirrhosis, usually diagnosed in advanced stages of poor prognosis and low survival.
Transplantation Proceedings 12/2005; 37(9):3970-2. · 1.00 Impact Factor
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C Jiménez,
A Manrique,
M L Herrero,
J C Meneu, M Abradelo,
E Gutierrez,
J M Morales,
T Ortuño,
M Praga,
A Andrés,
E Morales,
E Moreno
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ABSTRACT: Pancreas graft thromboses represent more than 70% of all technical failures; multiple risk factors have been implicated. We analyzed the thrombosis rates using portoiliac versus portocaval vein anastomoses.
The series includes 53 patients who underwent pancreas transplantation: 49 simultaneous pancreas-kidney and 4 pancreas after kidney. There were 27 men and 26 women, of mean age of 37.2 +/- 7.0 years. We compared two groups of recipients that were classified according to venous anastomosis: (A) portoiliac (n = 30), and (B) portocaval (n = 23).
The recipients did not show significant differences in age, gender, or duration of diabetes mellitus, but body mass index was significantly higher among the portocaval group. A bladder-drained pancreas technique was more frequently performed in the portoiliac group (93% of patients) versus an enteric-drained pancreas in the portocaval group (81%; P < .001). Heparinization was performed in 12 recipients: 11 (36.6%) in the portoiliac group and 1 (4.3%) in the portocaval group (P < .01). Vascular graft thrombosis (venous in six and arterial in one) developed in seven patients (13.2%) all in the portoiliac group (23%) (P < .02). Two-year patient survival was 93% in the portoiliac group and 94% in portocaval group (P = NS). Two-year graft survival was 66.6% in the portoiliac group and 85.9% in portocaval group (P = .07).
There was no graft thrombosis among patients with a portocaval vein anastomosis.
Transplantation Proceedings 11/2005; 37(9):3977-8. · 1.00 Impact Factor
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E Moreno,
J C Meneu,
J Calvo,
B Pérez,
A G Sesma,
A Manrique,
I Vegh,
A M Aragón,
M Grau,
A Gimeno,
C Jiménez,
R Gómez,
A Moreno, M Abradelo,
I García,
A de la Calle
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ABSTRACT: Partial liver transplantation has been consolidated to be a valid treatment option. We sought to understand the factors that modulate and may be harnessed to accelerate hepatocyte regeneration. We sought to determine the impact of heparin on m-hepatocyte growth factor (HGF) plasma concentrations.
Sixteen rats were assigned to four groups of four animals each: group A, without heparin; group B, 600 IU/kg; group C, 1000 IU/kg, group D, 1400 IU/kg. Blood samples (0.5 mL) were obtained from each rat at baseline and at 30, 60, 120, and 240 minutes. After the samples were centrifuged to separate supernates from the cell phase they were stored at -20 degrees C in the m-HGF reagent and subsequently tested using enzyme-linked immunosorbent assay. Results were analyzed using SPSS 11.5 statistical software.
Among the 16 rats, one died at 110 minutes, just prior to the last extraction. The remaining rats were sacrificed. Mean weight was: 466 +/- 64.24 g with no intergroup differences (P = .149). The comparative results (using Student t test) were: baseline A(1-4) versus A(1-4) 30 minutes: P < .05; baseline A(1-4) versus A(1-4) 60 minutes: P < .05; baseline A(1-4) versus A(1-4) 120 minutes: P = .10 (NS); baseline A(1-4) versus A(1-4) 240 minutes: P = .15 (NS). No significant differences were found among group B: baseline C(1-4) versus C(1-4) 30 minutes and 60 minutes: NS; baseline C(1-4) versus C(1-4) 120 minutes: P < .001; baseline C(1-4) versus C(1-4) 240 minutes: P < .10 (NS). Finally, the results in group D were: baseline D(1-4) versus D(1-4) 30 minutes: NS; baseline D(1-4) versus D(1-4) 60 minutes and 120 minutes: P < .05; baseline D(1-4) versus D(1-4) 240 minutes: P < .0005. When we compared group A to C and D, we detected differences (albeit not when compared to B) with P values = .01. Peak values were obtained at 120 and 240 minutes (225.21 pg/mL and 221.78 pg/mL) among groups C and D.
Heparin has a positive effect to increase serum HGF concentrations among rats. The effect was dependent on the administered dose and the time elapsed.
Transplantation Proceedings 11/2005; 37(9):3943-7. · 1.00 Impact Factor
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ABSTRACT: We evaluate 5-year results of a prospective randomized trial that compared cyclosporine microemulsion (CsA-me) and Tacrolimus (Tac) for primary immunosuppression. One hundred one adult patients undergoing liver transplantation were randomized to receive Tac (n = 50) or CsA-me (n = 51). The most frequent indication for the procedure was cirrhosis due to virus C followed by alcoholism. Survival rates at 1, 3, and 5 years were 86%, 75%, and 72%, respectively; there was no significant difference between CsA-me versus Tac arms. Acute rejection occurred in 30 cases (30%), independent of the type of primary immunosuppression. Serious adverse events were reported significantly more among patients under CsA-me (48 episodes) than under Tac (32 episodes). Nineteen patients were switched to the other calcineurin inhibitor. The switch was much more frequent from CsA-me to Tac (n = 15; 29.4%), mainly because of lack of efficacy (n = 10; 19.6%). There were no cases of chronic rejections in the Tac arm. Four patients were switched from Tac to CsA-me for side effects; only 1 remains alive, after treatment was changed from CsA-me to an antimetabolite. There were no statistical differences in renal dysfunction, diabetes, hypertension, neurologic disorders, new-onset malignancies, or infections. There were no differences in survival or rejection among the intention-to-treat groups. Serious adverse events, total patients with switch of calcineurin inhibitor, as well as switches due to lack of efficacy, were statistically more frequent under CsA-me. Tacrolimus seems to be a more appropriate drug to be used for primary immunosuppression in liver transplantation.
Transplantation Proceedings 06/2005; 37(4):1713-5. · 1.00 Impact Factor
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ABSTRACT: Combined liver-kidney transplantation is safe (low morbidity and acceptable mortality) and effective in patients with end-stage liver disease. Although refinements in surgical technique have resulted in better patient and allograft outcomes, the negative impact of renal insufficiency on survival in patients undergoing liver transplantation has been widely reported, although some aspects are controversial.
Analysis of the clinical characteristics and outcome in the management of patients undergoing combined liver-kidney transplantation. The end points were operative mortality, morbidity, and long-term survival.
University Hospital 12 de Octubre.
Between May 1986 and December 2001, 820 liver transplantations were performed. There were 16 cases (1.96%) of combined liver-kidney transplantations, which represent the sample of this study.
Mean +/- SD follow-up of 42.2 +/- 29 months: 6 patients died (37.5% mortality rate). There were 4 (25%) hospital deaths within 6 months following surgery and 2 after 6 months (4 sepsis, 1 refractory heart failure, and 1 recurrent hepatitis C virus disease). Univariate analysis related to mortality included age, sex, etiology, preoperative creatinine level, United Network for Organ Sharing status, Child-Pugh score, type of hepatectomy (piggyback), intraoperative blood product administration, and the presence of postoperative complications. The only 2 significant factors were the presence of postoperative complications (P = .01) and the United Network for Organ Sharing status (P = .02). Crude survival rate was 62.5%. Actuarial survival rates were 80%, 71%, and 60% at 1, 3, and 5 years, respectively.
Because end-stage renal disease is not a formal contraindication for liver transplantation, a combined liver-kidney transplantation for adults with end-stage renal disease can be done safely and effectively.
Archives of Surgery 12/2004; 139(11):1189-93. · 4.24 Impact Factor
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ABSTRACT: We report three cases of Kaposi's sarcoma after orthotopic liver transplantation performed for cirrhosis related to hepatitis C virus (one case), ethanol (one case), or both (one case). All patients displayed disease within the first year after liver transplantation, and only in one case was the diagnosis obtained before the patient died. All three patients were on tacrolimus-steroid therapy, and in one case mycophenolate mofetil was added to treat acute persistent rejection.
Transplantation Proceedings 09/2003; 35(5):1898-9. · 1.00 Impact Factor
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E Moreno-Gonzalez,
J C Meneu-Diaz,
García García,
C Jimenez Romero,
C Loinaz Segurola,
R Gomez Sanz, M Abradelo,
F Perez Cerda,
A Moreno Elola-Olaso,
L M Marin,
S Jimenez de los Galanes,
J Calvo Pulido
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ABSTRACT: After the first combined liver-kidney transplantation (CLKT) reported by Margreiter in 1984, it became clear that renal failure was no longer an absolute contraindication.
Our goal was to assess our results with combined liver-kidney transplant. Among 875 liver transplants performed between May 1986 and October 2002, there were 17 cases (1.96%) of combined liver-kidney transplant.
With a mean follow-up of 42.2+/-29 months (range, 1-90), six patients had died (mortality: 37.5%). There were four (25%) operative in-hospital deaths, and two late mortality cases (beyond the month 6 after hospital discharge). The causes were sepsis (four cases, three postoperative and one in later follow-up), refractory heart failure (one postoperative), and recurrent liver disease (HCV-induced severe recurrence) during follow-up one). Actuarial survival (calculated for those who survived the postoperative period) was 80%, 71%, and 60% at 12, 36, and 60 months. Actuarial mean survival time was 60 months (95%IC:47-78). Neither the sex, the UNOS status, the etiology of liver disease, the etiology of renal failure, the type of hepatectomy (piggy back vs others) or the type of immunosuppression (P=.83) were related to long-term survival according to the log-rank test. A control group of 48 patients was constructed with subjects who underwent liver transplantation immediately before or after the combined transplant. A total (two cases after the CLKT and one case prior to). There were no differences in survival.
Combined liver-kidney transplant represents a proper therapeutic option for patients with simultaneously failing organs based on long- and short-term outcomes.
Transplantation Proceedings 09/2003; 35(5):1863-5. · 1.00 Impact Factor
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ABSTRACT: The piggyback technique was first described in adult liver transplantation in 1989, although it has been used in conjunction with venous bypass, with cross-clamping the vena cava, or both. In this study, the inferior vena cava was not occluded at any time during the liver transplant.
We compared the use of intraoperative blood products, fluid requirements, and vasoactive drugs among patients managed with bypass, without bypass, and with the piggyback technique.
Between May 1986 and October 2002, 875 liver transplants included 50 patients divided into three groups (cases considered to be the preliminary series on each group): group A/piggyback (17 patients:34%), group B/ bypass (16 patients: 32%), and group C/no bypass (17 patients:34%). There were no differences in mean age, gender, UNOS or Child-Pugh score, and indications for liver transplantation.
Mean follow up was 134.63+/-32.19 months. At the end of the study, 91.3% of the patients are alive with no operative mortality. There were no differences in postoperative complications, postreperfusion syndrome rate, and postoperative renal failure. However, the number of packed red blood cell units consumed intraoperatively (12+/-7.43 vs 18.03+/-11.46 vs 17.59 +/- 23.8; P =.043), the need for intraoperative crystaloids (3.1 L+/-1.6 vs 6.8+/-4.8 vs 9.1 L+/-3.6; P=.001) and the requirement for vasoactive drugs (18% vs 38% vs 24%; P=.043) was notably lower in group A vs group B vs group C. Operative time was longer in group A (121.54+/-37.77 vs 78.73+/-11.89 vs 87.07+/-14.33 minutes).
The piggyback technique requires a longer operative time but offers the advantages of reducing the red blood cell requirements and preventing severe hemodynamic instability by virtue of reducing the need for vasoactive drugs and for a larger volume of intraoperative fluids.
Transplantation Proceedings 09/2003; 35(5):1918-9. · 1.00 Impact Factor
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E Moreno Gonzalez,
J C Meneu Diaz,
I Garcia Garcia,
C Loinaz Segurola,
C Jimenez,
R Gomez, M Abradelo,
A Moreno Elola,
S Jimenez,
E Ferrero,
J Calvo,
A Manrique,
M L Herrero
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ABSTRACT: Living donor liver transplantation represents a controversial option to increase the donor pool.
Prospective and descriptive clinical study.
(1) To identify risk factors (exclusion criteria) for live donation; (2) to determine the rate of recipients that benefit from a living donor.
Between May 1995 (first adult-to-adult living donor liver transplantation in Spain) and November 2002, we evaluated 74 healthy volunteers and performed 12 living donor liver transplants (no donor mortality).
All actual donors and volunteers are alive and healthy. After a mean time of 3.2+/-0.5 weeks, 72% of potential donors were considered unsuitable for live donation. Exclusion criteria were grouped in three categories: (primary) donor safety reasons (68%); (secondary): ABO mismatch (17%) and (tertiary): cadaveric graft transplantation (15%). Consequently, just 43.7% of the recipients presenting to us with a potential living donor, did finally benefit from these organs. The mortality rate was 8.3% for 43 recipients presenting with a living donor in comparison to 15% for those who did not (321 recipients between May 1995 and November 2001).
ALDLT can benefit a significant number of recipients on the waiting list (43.7% of those presenting with a donor). The most frequent exclusion criteria concern donor safety, namely, unsuspected chronic liver diseases and unsuspected thrombophilic disorders.
Transplantation Proceedings 09/2003; 35(5):1787-90. · 1.00 Impact Factor
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ABSTRACT: Changes in immunosuppression and other factors may have changed the severity of recurrent hepatitis C during recent years. This study sought to establish the changes in incidence and severity of recurrent hepatitis C, and its association with the changes in acute rejection and induction immunosuppressive therapy between 1990 and 1999.
Among 213 liver transplants in HCV-infected recipients, 129 grafts were selected for this study: all grafts with severe recurrent hepatitis C (fibrosis 3-4 in Scheuer's score or fibrosing cholestatic hepatitis), and those grafts without severe recurrence with at least 2 years of follow up. Grafts were divided in 5 groups depending on the year of transplantation to compare recurrent hepatitis C-related variables, AR incidence and induction immunosuppression.
Hepatitis-free survival decreased in recent years (p=0.015). The incidence of fibrosing cholestatic hepatitis was higher among 1996-1997 and the 1998-1999 periods (p=0.019). Survival free of severe hepatitis at 1 year follow up was 95% in 1990-1991 and 80% in 1998-1999; however, in the long-term the survival was similar between groups (p=0.933). HCV-related graft survival at 5 years was 93.5% in the 1990-95 period and 82.5% in 1996-99 (p=0.068). Neither AR nor any regimen of induction immunosuppression was associated with changes in the occurrence of recurrent hepatitis C related survival.
Severity of recurrent hepatitis C and HCV-related graft loss after liver transplantation were higher in the second half of the 1990s; however, there was no association with AR or induction immunosuppression.
Transplantation Proceedings 09/2003; 35(5):1836-7. · 1.00 Impact Factor
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A Moreno,
J C Meneu,
E Moreno,
M Fraile,
I García,
C Loinaz, M Abradelo,
C Jiménez,
R Gomez,
A García-Sesma,
A Manrique,
A Gimeno
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ABSTRACT: Describe the results of liver transplantation after installing Transjugular Intrahepatic Portosystemic Shunt (TIPS) and compare them with those of a control group in a comparative, longitudinal, retrospective study.
Between April 1986 and October 2002, we performed 875 liver transplantations. Between January 1996 and October 2002, 26 transplantations were performed on TIPS carriers. This group was compared with a control cohort of 50 randomly selected patients who underwent transplantation in this period (non-TIPS carriers). Both groups were homogeneous with no significant differences between age, sex United Network for Organ Sharing (UNOS) score, Child stage, or etiology.
Actuarial survival rates at 1 and 3 years: TIPS group 96.15% and 89.29% versus control cohort 87.8% and 81%, respectively. In 73.9%, the TIPS was clearly effective; in 88.9%, a postoperative Doppler revealed normal flow. There were no statistically significant differences compared with time on the waiting list for transplant, duration of the operation, ischemia times, intraoperative consumption of hemoderivates, vascular or nonvascular postoperative complications, duration of stay in the intensive care unit, hospital stay, or retransplantation rate.
In our experience, TIPS insertion does not affect either the intraoperative or postoperative evolution and is not associated with an increased time on the liver transplant waiting list.
Transplantation Proceedings 09/2003; 35(5):1869-70. · 1.00 Impact Factor
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A Moreno,
J C Meneu,
E Moreno,
I Garcia,
C Loinaz,
C Jimenez,
R Gómez, M Abradelo,
J Calvo,
Y Fundora,
C Ortiz
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ABSTRACT: The shortage in cadaveric grafts has prompted the development of alternative surgical techniques to expand the donor pool.
To evaluate the feasibility of split liver transplantation using an observational, retrospective, and longitudinal study.
Between April 1986 and October 2002 we performed 875 liver transplants. From April 1991 to date, we performed 18 split liver transplantations in patients of mean age 42.27+/-25.65 years; five children and 13 adults; and 83.3% women. Urgent transplants accounted for 38.9%. Mean patient weight was 52.29+/-20.87 kg. Ex situ splitting was performed in 33%. The mean cold ischemia time was 460+/-265.69 minutes with a mean warm time of 64.33+/-11.78 minutes. Mean consumption of packed blood was 5.59+/-4.87 units; of frozen fresh plasma, 11.56+/-7.42 units; and of platelets 4.89+/-4.99 units.
After a mean follow-up of 10.83+/-12.51 months, 55.56% of the recipients are alive. Actuarial patient and graft survival rates at 1 year are 55.6% and 44.12%, respectively. Actuarial patient and graft survival rates at 1 year, excluding operative mortality were 77% and 68%, respectively. Actuarial patient and graft survival rates at 1 year, comparing urgent and elective transplantations are: 14.29 and 14%, respectively, for urgent cases and 90.91 and 90% for elective ones. Operative mortality was 16.6% while mortality during follow-up was 26.6%. The late complications included arterial thrombosis (n=2): of whom the first needed liver retransplantation 4 months after split liver transplantation; chronic rejection (n=2), recurrence of hepatitis (n=1).
Split liver transplantation is a useful way to expand the graft pool and shows better results in elective liver transplantation.
Transplantation Proceedings 09/2003; 35(5):1810-1. · 1.00 Impact Factor
