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ABSTRACT: Hepatocellular carcinoma (HCC) is one of the most frequent types of tumor. The aim of this study was to determine the survival of patients who had received liver transplants as a result of the disease.
This observational follow-up study included 150 patients who received liver transplantations from June 1994 to December 2007. The study considered epidemiological and staging variables, tumor descriptions, and follow-up variables. We employed Kaplan-Meier methodology together with a Cox multivariate regression analysis.
The incidence of tumor relapse was 13.3%, with survival rates at 1, 3, and 5 years of 89.3%, 73.1%, and 61.4%, respectively. Variables that showed an independent effect to predict mortality were the degree of histological differentiation and of macrovascular invasion. Patients with poorly differentiated HCC had a 4.03 fold (95% confidence interval [CI]: 1.61-10.06) greater possibility of dying. Macrovascular involvement increased the risk of death (relative risk = 2.23), an effect that was at the limit of significance (95% CI 0.99-5.04).
The survival rate was consistent with the literature. Poor tumor differentiation and macrovascular involvement were independent predictors of mortality.
Transplantation Proceedings 12/2010; 42(10):4578-81. · 1.00 Impact Factor
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M G Crespo-Leiro,
O Robles,
M J Paniagua,
R Marzoa,
C Naya,
X Flores, F Suárez,
M Gómez,
Z Grille,
J J Cuenca,
A Castro-Beiras,
F Arnal
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ABSTRACT: Irreversible hepatic cirrhosis greatly increases the risks attending heart transplantation (HT), and is accordingly considered to be an absolute contraindication for HT unless combined heart and liver transplantation can be performed. It is now recognized that hepatic cirrhosis can undergo regression if the source of insult is removed, but no cases of post-HT regression of cirrhosis of cardiac origin have hitherto been reported. Here we report a case of cardiac cirrhosis that underwent complete regression following orthotopic HT, and we discuss the implications of this case.
American Journal of Transplantation 07/2008; 8(6):1336-9. · 6.39 Impact Factor
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J I Herrero,
S Benlloch,
A Bernardos,
I Bilbao,
L Castells,
J F Castroagudin,
L González,
I Irastorza,
M Navasa,
A Otero, [......],
A Rimola, F Suárez,
T Casanovas,
E Otero,
M Rodríguez,
T Serrano,
S Otero,
I López,
M Miras,
M Prieto
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ABSTRACT: Liver transplant recipients frequently suffer gastrointestinal (GI) complications but their prevalence and their influence on quality of life remain unknown.
The objective of this study was to asses the prevalence, impact on quality of life, and management of GI complications in liver transplant recipients.
This was an epidemiologic, cross-sectional, multicenter study. Four hundred seventeen liver recipients were recruited in 14 centers. A questionnaire was filled for every patient.
The median age of the patients was 55 years. The median time since transplantation was 4.1 +/- 4 years. Whereas 19.2% presented some GI disease before transplantation, 49.4% showed this type of complication after transplantation. Diarrhea was the most prevalent GI complication, and anorexia was the GI disorder that affected patients daily activities the most frequently. GI complications were more frequent among female patients, subjects with pretransplantation hiatal hernia, and those readmitted after transplantation. Of the patients with GI complications, 70.9% received pharmacological treatment (89.7% with gastric protectors). Immunosuppressive therapy was also modified because of GI complications. Immunosuppressive drug dose was reduced in 18.1%, transiently stopped in 3.4%, and definitively stopped in 3.4% of cases. The drug most frequently changed was mycophenolate mofetil: dose reduction, 23.6%; transient withdrawal, 5.7%; and definitive withdrawal, 6.6%.
The prevalence of GI complications in the liver transplant population was approximately 50%. GI complications showed a significant impact on the quality of life of the patients. They were related to female gender, to pretransplantation GI pathology, and posttransplantation hospital admission. These complications were frequently managed with pharmacological therapy or with changes in immunosuppressive therapy.
Transplantation Proceedings 10/2007; 39(7):2311-3. · 1.00 Impact Factor
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ABSTRACT: Simultaneous pancreas-kidney transplantation is presently a well-accepted procedure for patients with type 1 diabetes mellitus and renal failure. However, experiences with combined pancreas and liver transplantation are scarce, a few data are available about the best immunosuppression for these patients. We report our experience with two patients who received a pancreas after liver transplantation for long-standing insulin-dependent diabetes mellitus, with steroid-free immunosuppression based on daclizumab, tacrolimus, and mycophenolate mofetil. Short- and long-term evolution was uneventful. Currently, both patients are insulin free with appropriate metabolic control after 12 and 6 months follow-up. Considering our preliminary results, we suggest a steroid-free immunosuppressive regimen as an option for pancreas-after-liver transplantation.
Transplantation Proceedings 12/2005; 37(9):3975-6. · 1.00 Impact Factor
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ABSTRACT: The aim of this study was to evaluate long-term results after liver transplantation from non-heart-beating donors (NHBD) using the method of chest and abdominal compression-decompression to maintain donors.
From December 1995 to November 2004, 10 NHBD were identified and maintained by means of the method of chest and abdominal compression-decompression until family and judicial permission were granted. Nine donors were Maastricht type II and one was type IV.
The mean age of donors was 40.5 years and the mean time under cardiopulmonary resuscitation (CPR) was 80 minutes. Orthotopic liver transplantation (OLT) was performed using these 10 liver grafts after a mean cold ischemia time of 561.5 minutes. All patients developed good posttransplant function, except for one patient who presented with primary nonfunction corrected with retransplantation. This complication was directly related to a long CPR time (P < .01). After a mean follow-up of 57 months, only one patient died from a hepatitis C virus (HCV) recurrence. The rest of the patients have maintained good graft function over time.
NHBD maintained with the method of chest and abdominal compression-decompression are a valid choice to increase the donor pool. Liver transplantation using these grafts has proven good long-term results, comparable to their heart-beating counterparts.
Transplantation Proceedings 11/2005; 37(9):3857-8. · 1.00 Impact Factor
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ABSTRACT: Recombinant activated factor VII (rFVIIa, NovoSeven, NovoNordiskA/S, Bagsvaerd, Denmark) has shown benefits in hemophilic patients and recently in transplant recipients. This study presents our experiences with rFVIIa in complicated liver transplant recipients.
From May 2001 to August 2004, rFVIIa was administered to 7 patients undergoing liver transplantation. All treatments were made on emergency bases, except for 1 case with hemophilia A, who received prophylactic treatment. The drug was delivered when severe bleeding with coagulopathy persisted despite the usual treatment with blood products. The drug doses were 60-90 mug/kg; the results were evaluated clinically and analytically.
Seven patients undergoing liver transplantation were treated with FVIIa. Mean prothrombin times before and after treatment were 17.5 and 10.9 seconds, respectively, with a mean reduction of 7.2 seconds (P = .03). Mean thromboplastin times before and after treatment were 38.1 and 29.4 seconds, respectively, with a mean reduction of 8.7 seconds (P = .034). The average dose was 83.6 mug/kg, leading to decreased consumption of blood products (P < .01). In all cases, rFVIIa allowed sufficient hemostasis to carry on definitive treatment. There was no mortality in this series.
These results provide new evidence on the potential benefits of rFVIIa in liver transplantation, especially for rescue therapy in cases of severe bleeding.
Transplantation Proceedings 11/2005; 37(9):3919-21. · 1.00 Impact Factor
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ABSTRACT: INTRODUCTION: The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. The outcome of 20 liver transplants from Maastricht category 2 NHBD was compared with that of 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support with simultaneous application of chest and abdominal compression (CPS; n = 6) or cardiopulmonary bypass (CPB; n = 14) was used to maintain the donors. RESULTS: At a minimum follow-up of 2 years, actuarial patient and graft survival rates with livers from Maastricht category 2 NHBD were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with organs from HBDs. The graft survival rates was 83% for livers from NHBDs preserved with CPS and 42% in those maintained with CPB.
Transplantation Proceedings 05/2004; 36(3):747-50. · 1.00 Impact Factor
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ABSTRACT: INTRODUCTION: Because of an increased organ shortage, one of the most controversial questions is whether hepatic retransplantation should be offered to transplant recipients with hepatitis C virus (HCV)-related graft failure because of their worse survival and the inevitable denial of other patients to access to primary transplantation. The objective of the present study was to review our experience with HCV-infected transplant recipients undergoing re-orthotopic liver transplantation (OLT) for HCV graft cirrhosis and receiving pegylated interferon and ribavirin on a prophylactic basis. RESULTS: With a median follow-up of 26 months, all 5 patients are alive with stable graft function. Four patients are still receiving pegylated interferon at a mean duration of 20 months (range, 15-32 months). Although none of the patients has cleared HCV RNA by polymerase chain reaction the mean serum levels have decreased significantly when compared with pre-retransplantation amounts. One year after re-OLT, both grade and fibrosis stage had significantly decreased; the rate of post-retransplantation fibrosis progression was significantly lower than that pre-retransplantation (3.4 +/- 0.2 vs 0.6 +/- 0.3; P <.05).
Transplantation Proceedings 04/2004; 36(3):775-7. · 1.00 Impact Factor
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M Gómez,
J M Garcia-Buitrón,
A Fernandez-Garcia,
D Vilela,
C Fernández-Selles,
R Corbal,
J Fraguela, F Suárez,
A Otero,
J Alvarez,
R Mánez
Transplantation Proceedings 01/1998; 29(8):3478-9. · 1.00 Impact Factor
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ABSTRACT: A case of chronic hepatitis in a 20-year-old patient in whom hepatitis C virus infection markers and type 1 liver and kidney antimicrosome antibodies (anti-LKM 1) were detected, thereby allowing diagnosis of autoimmune type 2b hepatitis, is reported. The different types of autoimmune hepatitis (AIH) and the type 2a and 2b AIH are discussed as are the rejection of this terminology by some authors followed by their proposals and the therapeutic strategy to be used in these patients.
Gastroenterología y Hepatología 05/1996; 19(4):203-5. · 0.73 Impact Factor
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ABSTRACT: Eight patients with Caroli's Disease are presented, studied by Endoscopic Retrograde Cholangiopancreatography (ERCP) from January 1976 through January 1990. In this period of time 1,525 procedures were carried out, this entity thus representing 0.52% of patients submitted to ERCP in our population. Six patients were females, being female: male ratio 3:1. Mean age was 52 years (range: 40-75). All patients presented a clinical history of recurring episodes of abdominal pain and/or crisis of cholangitis. In the ERCP carried out in these eight patients, cystic dilatation of intrahepatic left lobe bile ducts were confirmed in five patients, dilatation generalized to both lobes in two, and affecting exclusively the right lobe in one patient.
Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 08/1991; 80(1):35-40. · 1.55 Impact Factor
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Transplantation Proceedings 33(1-2):1064-5. · 1.00 Impact Factor
