Incidence, risk factors, and outcomes related with neurological events after liver transplantation in adult and pediatric recipients.

Controversy exists whether NE after LT are more frequently observed in children or adults. We aimed to compare the incidence and outcomes for NE after LT in pediatric and adult recipients. A single-center cohort study, including all LT between 2001 and 2013, was performed. Definition of NE included impaired consciousness, delirium, seizures, focal neurologic deficit, visual impairment, or slurred speech. A cohort of 443 consecutive LT recipients was included: 307 adults and 136 children. Cumulative incidence of NE was similar between adults 15% (n = 41) and children 16% (n = 20; P = .73) with a complete neurological recovery in 62% and 95% of the patients, respectively (P < .0001). Adults with NE had significantly lower survival (70% vs 76%; P = .015) with a HR of 2.36; this was similarly observed in children (45% vs 66%; HR 2.05, CI 0.66; 6.34). Independent risk factors for NE in adults were pre-LT ascites, delta sodium, and post-LT hypomagnesemia, whereas in children pre-LT encephalopathy ≥II and serum albumin were associated with NE. Although a similar incidence of NE after LT was observed, children were more likely to achieve neurological recovery. Risk factors for the development of NE are difficult to assess in both populations.

[Operational tolerance in a pediatric liver transplant recipient. Case report]. / Tolerancia operacional en un receptor pediátrico de trasplante hepático. Caso clínico.

Operational tolerance (absence of allograft rejection and good outcome without immunosuppression) has been object of intense research in pediatric liver transplant in the last years. The morbidity and mortality related to long-term immunosuppressive treatment of these patients are well known. We report a case of operational tolerance of our unit in a pediatric liver transplant recipient who is immunosuppressant-free since 16 month after transplant after progressive withdrawal related to asymptomatic Epstein-Barr virus first infection. He has good histological, clinical and serological outcome after 22 month of follow-up. To our knowledge, this is the first operational tolerance reported case in our country after liver transplant in a pediatric recipient and we believe that the study of these patients is important in order to detect characteristics that allow to identify a potentially tolerant group in which it is possible to withdraw immunosuppressive drugs.

[Human herpesvirus 8 related Kaposi's sarcoma in a pediatric liver transplant recipient: case report]. / Sarcoma de Kaposi por virus del herpes humano de tipo 8 en un receptor de trasplante hepático pediátrico: Caso clínico.

Patients under immunosuppressive treatment are at risk of developing malignant tumors. Primary infection or reactivation of human herpesvirus 8 (HHV-8) may predispose to Kaposi's sarcoma (KS) after solid organ transplantation. KS in pediatric liver transplant recipients has low incidence and poor prognosis. We report the clinical presentation of a KS in lymph node following HHV-8 infection in a pediatric patient presenting four months after liver transplantation. He had a good outcome with suspension of tacrolimus and conversion to sirolimus one month after diagnosis. To our knowledge, this is the frst KS reported case in our country after liver transplant in a pediatric recipient and we believe that this entity should be taken into consideration in the differential diagnosis of post-transplant complications.

[Fulminant hepatic failure due to tuberculostatic drugs: case report]. / Falla hepática secundaria a toxicidad por tuberculostáticos: Caso clínico.

Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for drug hepatotoxicity. We report the case of a 10 year-old patient who presented with acute liver failure requiring orthotropic liver transplant after forty days of tuberculostatic treatment with isoniazid, rifampin and pyrazinamide.

[Rifaximin for hepatic encephalopathy in children. Case report]. / Rifaximina para encefalopatía hepática en niños. Caso clínico.

Rifaximin is an antibiotic recently approved for the treatment of hepatic encephalopathy in adults. In children more than 12 year-old, it has been approved for travelers' diarrhea and it is also widely used in inflammatory bowel disease. We report, to our knowledge, the first case of a pediatric patient who received rifaximin for hepatic encephalopathy with good clinical outcome.

Tolerancia operacional en un receptor pediátrico de trasplante hepático: Caso clínico / Operational tolerance in a pediatric liver transplant recipient: Case report

La tolerancia operacional (ausencia de rechazo del injerto y buena evolución sin inmunosupresión) ha sido objeto de intensa investigación en trasplante hepático pediátrico en los últimos años. La morbimortalidad relacionada con la exposición a drogas inmunosupresoras a largo plazo en estos pacientes es bien conocida. Reportamos un caso de tolerancia operacional de nuestro centro en un receptor pediátrico de trasplante hepático libre de inmunosupresión desde los 16 meses postrasplante luego de una progresiva disminución a partir de su primoinfección asintomática por virus de Epstein-Barr, con buena evolución histológica y clínico-humoral en 22 meses de seguimiento. De acuerdo con nuestro conocimiento, este es el primer caso de tolerancia operacional en un receptor pediátrico de trasplante hepático reportado en nuestro país y creemos que debería profundizarse el estudio de estos pacientes para detectar características que permitan identificar una población potencialmente tolerante en la cual es posible disminuir y suspender la inmunosupresión.

Operational tolerance (absence of allograft rejection and good outcome without immunosuppression) has been object of intense research in pediatric liver transplant in the last years. The morbidity and mortality related to long-term immunosuppressive treatment of these patients are well known. We report a case of operational tolerance of our unit in a pediatric liver transplant recipient who is immunosuppressant-free since 16 month after transplant after progressive withdrawal related to asymptomatic Epstein-Barr virus first infection. He has good histological, clinical and serological outcome after 22 month of follow-up. To our knowledge, this is the first operational tolerance reported case in our country after liver transplant in a pediatric recipient and we believe that the study of these patients is important in order to detect characteristics that allow to identify a potentially tolerant group in which it is possible to withdraw immunosuppressive drugs.

Tolerancia operacional en un receptor pediátrico de trasplante hepático: Caso clínico / Operational tolerance in a pediatric liver transplant recipient: Case report

La tolerancia operacional (ausencia de rechazo del injerto y buena evolución sin inmunosupresión) ha sido objeto de intensa investigación en trasplante hepático pediátrico en los últimos años. La morbimortalidad relacionada con la exposición a drogas inmunosupresoras a largo plazo en estos pacientes es bien conocida. Reportamos un caso de tolerancia operacional de nuestro centro en un receptor pediátrico de trasplante hepático libre de inmunosupresión desde los 16 meses postrasplante luego de una progresiva disminución a partir de su primoinfección asintomática por virus de Epstein-Barr, con buena evolución histológica y clínico-humoral en 22 meses de seguimiento. De acuerdo con nuestro conocimiento, este es el primer caso de tolerancia operacional en un receptor pediátrico de trasplante hepático reportado en nuestro país y creemos que debería profundizarse el estudio de estos pacientes para detectar características que permitan identificar una población potencialmente tolerante en la cual es posible disminuir y suspender la inmunosupresión.(AU)

Operational tolerance (absence of allograft rejection and good outcome without immunosuppression) has been object of intense research in pediatric liver transplant in the last years. The morbidity and mortality related to long-term immunosuppressive treatment of these patients are well known. We report a case of operational tolerance of our unit in a pediatric liver transplant recipient who is immunosuppressant-free since 16 month after transplant after progressive withdrawal related to asymptomatic Epstein-Barr virus first infection. He has good histological, clinical and serological outcome after 22 month of follow-up. To our knowledge, this is the first operational tolerance reported case in our country after liver transplant in a pediatric recipient and we believe that the study of these patients is important in order to detect characteristics that allow to identify a potentially tolerant group in which it is possible to withdraw immunosuppressive drugs.(AU)

Sarcoma de Kaposi por virus del herpes humano de tipo 8 en un receptor de trasplante hepático pediátrico: Caso clínico / Human herpesvirus 8 related Kaposi's sarcoma in a pediatric liver transplant recipient: Case report

Los pacientes que reciben tratamiento inmunosupresor están en riesgo de desarrollar tumores malignos. La infección primaria o reactivación del virus del herpes humano de tipo 8 (HHV-8) puede predisponer al sarcoma de Kaposi después del trasplante de un órgano sólido. En los receptores de trasplantes pediátricos, este sarcoma tiene baja incidencia y mal pronóstico. Se informa la presentación clínica de un sarcoma de Kaposi en un ganglio linfático luego de una infección por HHV-8 en un niño a los 4 meses del trasplante hepático. El paciente tuvo buena evolución con suspensión del tacrolimus y conversión a sirolimus un mes después del diagnóstico. En nuestro conocimiento, este es el primer caso de sarcoma de Kaposi en un receptor pediátrico de trasplante hepático informado en nuestro país y creemos que esta entidad debería considerarse como diagnóstico diferencial en las complicaciones postrasplante.

Patients under immunosuppressive treatment are at risk of developing malignant tumors. Primary infection or reactivation of human herpesvirus 8 (HHV-8) may predispose to Kaposi's sarcoma (KS) after solid organ transplantation. KS in pediatric liver transplant recipients has low incidence and poor prognosis. We report the clinical presentation of a KS in lymph node following HHV-8 infection in a pediatric patient presenting four months after liver transplantation. He had a good outcome with suspension of tacrolimus and conversion to sirolimus one month after diagnosis. To our knowledge, this is the frst KS reported case in our country after liver transplant in a pediatric recipient and we believe that this entity should be taken into consideration in the differential diagnosis of post-transplant complications.

Sarcoma de Kaposi por virus del herpes humano de tipo 8 en un receptor de trasplante hepático pediátrico: Caso clínico / Human herpesvirus 8 related Kaposis sarcoma in a pediatric liver transplant recipient: Case report

Los pacientes que reciben tratamiento inmunosupresor están en riesgo de desarrollar tumores malignos. La infección primaria o reactivación del virus del herpes humano de tipo 8 (HHV-8) puede predisponer al sarcoma de Kaposi después del trasplante de un órgano sólido. En los receptores de trasplantes pediátricos, este sarcoma tiene baja incidencia y mal pronóstico. Se informa la presentación clínica de un sarcoma de Kaposi en un ganglio linfático luego de una infección por HHV-8 en un niño a los 4 meses del trasplante hepático. El paciente tuvo buena evolución con suspensión del tacrolimus y conversión a sirolimus un mes después del diagnóstico. En nuestro conocimiento, este es el primer caso de sarcoma de Kaposi en un receptor pediátrico de trasplante hepático informado en nuestro país y creemos que esta entidad debería considerarse como diagnóstico diferencial en las complicaciones postrasplante.(AU)

Patients under immunosuppressive treatment are at risk of developing malignant tumors. Primary infection or reactivation of human herpesvirus 8 (HHV-8) may predispose to Kaposis sarcoma (KS) after solid organ transplantation. KS in pediatric liver transplant recipients has low incidence and poor prognosis. We report the clinical presentation of a KS in lymph node following HHV-8 infection in a pediatric patient presenting four months after liver transplantation. He had a good outcome with suspension of tacrolimus and conversion to sirolimus one month after diagnosis. To our knowledge, this is the frst KS reported case in our country after liver transplant in a pediatric recipient and we believe that this entity should be taken into consideration in the differential diagnosis of post-transplant complications.(AU)

Falla hepática secundaria a toxicidad por tuberculostáticos: Caso clínico / Fulminant hepatic failure due to tuberculostatic drugs: Case report

La toxicidad hepática por isoniacida, sobre todo asociada a rifampicina, es un raro efecto adverso de la terapia antituberculosa. En EE.UU., es la causa de 0,2% de los trasplantes hepáticos pediátricos y del 14% de los trasplantes por toxicidad medicamentosa. Comunicamos el caso de una paciente de 10 años de edad con falla hepática fulminante que requirió trasplante hepático luego de cuarenta días de tratamiento tuberculostático con isoniacida, rifampicina y pirazinamida.

Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for drug hepatotoxicity. We report the case of a 10 year-old patient who presented with acute liver failure requiring orthotropic liver transplant after forty days of tuberculostatic treatment with isoniazid, rifampin and pyrazinamide.

Falla hepática secundaria a toxicidad por tuberculostáticos: Caso clínico / Fulminant hepatic failure due to tuberculostatic drugs: Case report

La toxicidad hepática por isoniacida, sobre todo asociada a rifampicina, es un raro efecto adverso de la terapia antituberculosa. En EE.UU., es la causa de 0,2% de los trasplantes hepáticos pediátricos y del 14% de los trasplantes por toxicidad medicamentosa. Comunicamos el caso de una paciente de 10 años de edad con falla hepática fulminante que requirió trasplante hepático luego de cuarenta días de tratamiento tuberculostático con isoniacida, rifampicina y pirazinamida.(AU)

Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for drug hepatotoxicity. We report the case of a 10 year-old patient who presented with acute liver failure requiring orthotropic liver transplant after forty days of tuberculostatic treatment with isoniazid, rifampin and pyrazinamide.(AU)

Falla hepática secundaria a toxicidad por tuberculostáticos: Caso clínico / Fulminant hepatic failure due to tuberculostatic drugs: Case report

La toxicidad hepática por isoniacida, sobre todo asociada a rifampicina, es un raro efecto adverso de la terapia antituberculosa. En EE.UU., es la causa de 0,2% de los trasplantes hepáticos pediátricos y del 14% de los trasplantes por toxicidad medicamentosa. Comunicamos el caso de una paciente de 10 años de edad con falla hepática fulminante que requirió trasplante hepático luego de cuarenta días de tratamiento tuberculostático con isoniacida, rifampicina y pirazinamida.(AU)

Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for drug hepatotoxicity. We report the case of a 10 year-old patient who presented with acute liver failure requiring orthotropic liver transplant after forty days of tuberculostatic treatment with isoniazid, rifampin and pyrazinamide.(AU)

Rifaximina para encefalopatía hepática en niños: Caso clínico / Rifaximin for hepatic encephalopathy in children: Case report

La rifaximina es un antibiótico recientemente aprobado para el tratamiento de la encefalopatía hepática en adultos. En niños mayores de 12 años se aprobó su uso en la diarrea del viajero y se lo emplea ampliamente en la enfermedad infamatoria intestinal. Comunicamos el primer caso del que tenemos conocimiento, de un paciente en edad pediátrica que recibió rifaximina para tratar la encefalopatía hepática, con buena respuesta clínica.

Rifaximin is an antibiotic recently approved for the treatment of hepatic encephalopathy in adults. In children more than 12 year-old, it has been approved for travelers' diarrhea and it is also widely used in infammatory bowel disease. We report, to our knowledge, the frst case of a pediatric patient who received rifaximin for hepatic encephalopathy with good clinical outcome.

Sarcoma de Kaposi por virus del herpes humano de tipo 8 en un receptor de trasplante hepático pediátrico: Caso clínico. / [Human herpesvirus 8 related Kaposis sarcoma in a pediatric liver transplant recipient: case report].

Patients under immunosuppressive treatment are at risk of developing malignant tumors. Primary infection or reactivation of human herpesvirus 8 (HHV-8) may predispose to Kaposis sarcoma (KS) after solid organ transplantation. KS in pediatric liver transplant recipients has low incidence and poor prognosis. We report the clinical presentation of a KS in lymph node following HHV-8 infection in a pediatric patient presenting four months after liver transplantation. He had a good outcome with suspension of tacrolimus and conversion to sirolimus one month after diagnosis. To our knowledge, this is the frst KS reported case in our country after liver transplant in a pediatric recipient and we believe that this entity should be taken into consideration in the differential diagnosis of post-transplant complications.

Tolerancia operacional en un receptor pediátrico de trasplante hepático: Caso clínico. / [Operational tolerance in a pediatric liver transplant recipient: Case report].

Operational tolerance (absence of allograft rejection and good outcome without immunosuppression) has been object of intense research in pediatric liver transplant in the last years. The morbidity and mortality related to long-term immunosuppressive treatment of these patients are well known. We report a case of operational tolerance of our unit in a pediatric liver transplant recipient who is immunosuppressant-free since 16 month after transplant after progressive withdrawal related to asymptomatic Epstein-Barr virus first infection. He has good histological, clinical and serological outcome after 22 month of follow-up. To our knowledge, this is the first operational tolerance reported case in our country after liver transplant in a pediatric recipient and we believe that the study of these patients is important in order to detect characteristics that allow to identify a potentially tolerant group in which it is possible to withdraw immunosuppressive drugs.