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1.
Am J Transplant ; 16(10): 2816-2835, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27273869

RESUMO

The Banff Working Group on Liver Allograft Pathology reviewed and discussed literature evidence regarding antibody-mediated liver allograft rejection at the 11th (Paris, France, June 5-10, 2011), 12th (Comandatuba, Brazil, August 19-23, 2013), and 13th (Vancouver, British Columbia, Canada, October 5-10, 2015) meetings of the Banff Conference on Allograft Pathology. Discussion continued online. The primary goal was to introduce guidelines and consensus criteria for the diagnosis of liver allograft antibody-mediated rejection and provide a comprehensive update of all Banff Schema recommendations. Included are new recommendations for complement component 4d tissue staining and interpretation, staging liver allograft fibrosis, and findings related to immunosuppression minimization. In an effort to create a single reference document, previous unchanged criteria are also included.


Assuntos
Rejeição de Enxerto/etiologia , Rejeição de Enxerto/patologia , Isoanticorpos/imunologia , Transplante de Fígado/efeitos adversos , Aloenxertos , Humanos , Relatório de Pesquisa
2.
Am J Transplant ; 13(5): 1327-35, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23463950

RESUMO

In contrast to traditional static cold preservation of donor livers, normothermic machine perfusion may reduce preservation injury, improve graft viability and potentially allows ex vivo assessment of graft viability before transplantation. We have studied the feasibility of normothermic machine perfusion in four discarded human donor livers. Normothermic machine perfusion consisted of pressure and temperature controlled pulsatile perfusion of the hepatic artery and continuous portal perfusion for 6 h. Two hollow fiber membrane oxygenators provided oxygenation of the perfusion fluid. Biochemical markers in the perfusion fluid reflected minimal hepatic injury and improving function. Lactate levels decreased to normal values, reflecting active metabolism by the liver (mean lactate 10.0 ± 2.3 mmol/L at 30 min to 2.3 ± 1.2 mmol/L at 6 h). Bile production was observed throughout the 6 h perfusion period (mean rate 8.16 ± 0.65 g/h after the first hour). Histological examination before and after 6 h of perfusion showed well-preserved liver morphology without signs of additional hepatocellular ischemia, biliary injury or sinusoidal damage. In conclusion, this study shows that normothermic machine perfusion of human donor livers is technically feasible. It allows assessment of graft viability before transplantation, which opens new avenues for organ selection, therapeutic interventions and preconditioning.


Assuntos
Sobrevivência de Enxerto , Precondicionamento Isquêmico/métodos , Transplante de Fígado , Fígado/irrigação sanguínea , Preservação de Órgãos/métodos , Perfusão/métodos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Temperatura
3.
Clin Exp Rheumatol ; 27(6): 945-51, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20149310

RESUMO

OBJECTIVES: Despite the important role of the transcription factor HIF-1alpha in angiogenesis and inflammation, only a few studies on HIF-1alpha expression have been performed in RA patients. The aim of the present study was to identify the layer in synovial tissue of RA patients where HIF1a is expressed and to find out whether HIF-1alpha expression is related to both angiogenesis and inflammation in synovium from RA patients. METHODS: A reproducible staining method for HIF-1alpha was developed. HIF-1alpha -positive cells were quantified in synovial tissue from patients with RA. As control we used synovial tissue from patients with osteoarthritis (OA). The number of HIF-1alpha-positive cells was compared with the number of blood vessels present and was correlated with the amount of inflammation. The amount of inflammation was determined by counting inflammatory cells, by estimating the proliferation marker Ki67 in inflamed tissue, and by using a recently published synovitis score which gives an accurate estimate of the amount of inflammation present. RESULTS: HIF-1alpha was expressed weakly in the lining layer and strongly in the sublining layer in RA synovial tissue. In contrast, HIF-1alpha was only weakly expressed in OA synovial tissue. The number of HIF-1alpha -positive cells correlated strongly with the number of blood vessels in RA synovial tissue and with inflammatory endothelial cell infiltration (blood vessels), cell proliferation (Ki67) and the synovitis score. CONCLUSIONS: HIF-1alpha expression is strongest in the sub-lining layer of RA synovium and is related to both angiogenesis and inflammation in synovium from RA patients. These results thus suggest that HIF-1alpha could serve as an important new therapeutic target in RA, targeting both angiogenesis and inflammation.


Assuntos
Artrite Reumatoide/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Inflamação/metabolismo , Neovascularização Patológica/metabolismo , Membrana Sinovial/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vasos Sanguíneos/metabolismo , Contagem de Células , Proliferação de Células , Células Cultivadas , Endotélio Vascular/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/metabolismo , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Sinovite/metabolismo
4.
Neth J Med ; 73(5): 247-52, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26087805

RESUMO

We present a case about a 25-year-old male patient suffering from a rare genetic disorder called Mizuho haemoglobin. He was admitted to the Intensive Care Unit with acute liver and renal failure. During admission he also developed a cardiac tamponade twice. Finally he received a liver transplantation. Hereafter the patient stabilised and his liver and renal functions improved. His symptoms could not be explained solely by his known disease. After searching the literature, similarities between his symptoms and a rare complication of sickle cell disease were found. Molecular diagnostics showed that the patient also suffered from Gilbert's syndrome. Due to his chronic haemolysis, symptoms of this other disease were masked. This stresses the importance of always looking for other causes if symptoms or changes cannot be explained by a known rare disorder.


Assuntos
Colestase Intra-Hepática/diagnóstico , Doença de Gilbert/diagnóstico , Hemoglobinas Anormais/genética , Insuficiência Renal/diagnóstico , Adulto , Bilirrubina/sangue , Tamponamento Cardíaco , Colangiopancreatografia Retrógrada Endoscópica , Ecocardiografia , Doença de Gilbert/genética , Doença de Gilbert/cirurgia , Hemólise , Humanos , Transplante de Fígado , Masculino , Polimorfismo de Nucleotídeo Único , Insuficiência Renal/genética , Insuficiência Renal/cirurgia
5.
Neth J Med ; 61(9): 300-3, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14692445

RESUMO

A 51-year-old patient is described who presented with locomotor pain and highly significant positive ANA due to p53 antibodies, which appeared to be associated with primary hepatic carcinoma.


Assuntos
Anticorpos Antinucleares/análise , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Proteína Supressora de Tumor p53/análise , Carcinoma Hepatocelular/imunologia , Feminino , Imunofluorescência , Humanos , Neoplasias Hepáticas/imunologia , Pessoa de Meia-Idade
6.
Ned Tijdschr Geneeskd ; 148(36): 1788-92, 2004 Sep 04.
Artigo em Holandês | MEDLINE | ID: mdl-15495944

RESUMO

A few months after birth two sisters aged 5 and 9 years had developed cholestasis and abnormal liver functions with symptoms including itching and jaundice. The younger sister also developed rickets and clotting disorders. On clinical, biochemical and immunohistopathological grounds the diagnosis of 'progressive familial intrahepatic cholestasis (PFIC) type 2' was made. Medical treatment was not succesfull in reducing symptoms. An ileocolonic bypass in the younger child was not effective. Subsequently, both patients underwent partial external biliary diversion (PEBD). Except for a period of intermittent itching in the younger child, both patients remained free of symptoms 2 years after PEBD. In cases where an early diagnosis is made, PEBD could delay or even prevent the necessity of liver transplantation.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Colestase Intra-Hepática/genética , Colestase Intra-Hepática/cirurgia , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Transplante de Fígado , Fatores de Tempo , Resultado do Tratamento
7.
Am J Transplant ; 6(11): 2660-71, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16952301

RESUMO

The finer branches of the biliary tree (FBBT) contain a regenerative compartment. We hypothesized that preservation of the FBBT together with its microvasculature will lead to recovery of biliary damage and prolonged preservation of bile ductules during the development of chronic liver allograft rejection. The interlobular bile ducts, portal bile ductules and extraportal biliary cells with and without microvessels were studied in sequential biopsies in five patients who fulfilled the Banff criteria of early chronic rejection (CR) (imminence group). Biopsies of CR patients (n = 12) served as controls. Biopsies were double immunostained with CD34 (microvessels) and cytokeratin 7 (biliary structures). Proliferation and proangiogenic activity were assessed with Ki67 and VEGF-A immunostaining. Severe damage of bile ducts in the imminence group did not progress to significant bile duct loss. This was associated with a high proliferative activity in all biliary structures and preservation of the microvascular compartment. VEGF-A expression was increased in all but the reperfusion biopsies. In conclusion, both regenerative activity of the FBBT and an intact microvascular compartment are associated with less damage of the biliary tree and could therefore be prerequisites for biliary regeneration.


Assuntos
Ductos Biliares Extra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/patologia , Transplante de Fígado/patologia , Adolescente , Adulto , Ductos Biliares Extra-Hepáticos/fisiopatologia , Ductos Biliares Intra-Hepáticos/fisiopatologia , Divisão Celular , Criança , Pré-Escolar , Humanos , Recém-Nascido , Testes de Função Hepática , Transplante de Fígado/fisiologia , Preservação de Órgãos , Regeneração
8.
Scand J Gastroenterol ; 37(12): 1473-4, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12523601

RESUMO

The search for an unknown primary tumour is often time-consuming, costly and unrewarding. Positron emission tomography might be an effective method for screening the body for malignant deposits. We present the case of a woman with a symptomatic liver tumour of unknown origin. Several investigations did not reveal a primary tumour, but PET scanning showed a hot spot in the pelvis, suggesting either a primary tumour or a metastatic deposit. During operation, a primary Fallopian tube carcinoma was detected. Histopathological examination of the resected liver tumour revealed a metastasis of the Fallopian tube carcinoma. This case report demonstrates that PET scanning can be useful in the diagnostic process in patients with unknown primary tumour, and that a symptomatic liver tumour can be the first sign of Fallopian tube carcinoma.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Neoplasias das Tubas Uterinas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Tomografia Computadorizada de Emissão , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Pessoa de Meia-Idade
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