[An evaluation of a protocol of postoperative nutritional support in patients who have had a liver transplant]. / Valoración de un protocolo de soporte nutricional postoperatorio en pacientes sometidos a trasplante hepático (TxH).

Despite the fact that the incidence of malnutrition in patients subjected to liver transplants is high, there are no definite criteria on the most appropriate postoperative nutritional support characteristics. The present study is a review of our experience with the administering of a diet base on: 1) proteic saving techniques up to enteral nutrition tolerance, and 2) total parenteral nutrition in the event of intolerance (foreseen or proven) to enteral nutrition. The type of nutritional support used and nutritional evaluation data, both during hospitalization in intensive care, were studied over a period of 557 days, in a series of 70 patients subjected to liver transplants. In 61.9% of the study days, parenteral nutritional support techniques had to be used. Enteral nutrition was possible during 18.9% of the study period in patients who had been discharged, compared to 1.8% in patients who needed further transplants or died (p less than 0.001). The elimination of nitrogen gradually increased up to day 9, and then fell. No positive nitrogenated balance was observed until day 13. Glucemia levels remained high during the whole evolutive phase. Seric albumin and transferrin levels were normal at first, and fell during week two. Seric prealbumin levels were within normal limits. Seric Mg and Cu were lower that the reference values during the first 15 days of evolution, where as Zn reached normal levels on day 15. Normal cholesterol values were only observed on day 8. Our results show the level of intolerance to enteral nutrition during the evolution of the patients and the need for using a more aggressive nutritional support.

[Complications of liver transplant in intensive care. Experience in 130 cases]. / Complicaciones del trasplante hepático en Cuidados Intensivos. Experiencia en 130 casos.

Liver transplant is the first therapeutic choice in most of the advanced liver diseases. Nevertheless, its performance originates a number of complications derived from: a) conservation techniques of the organ (in our study a prolonged time of hot ischemia was significantly associated with); b) surgery (all patients who required massive blood transfusions developed metabolic alkalosis); c) the graft itself (all the F 1. degrees were significantly infected), and d) extrahepatic causes (cyclosporin was responsible for high blood pressure and nephrotoxicity which appeared as oliguria with good response to furosemide, as well as hyperglycemia). Some other relevant results in our series were: right pleural effusion and thrombopenia which appeared with a high incidence. Infections were usually originated the staphylococcus which grows in half of the cultures. We also want to highlight the short mean stay and the low mortality incidence in the ICU.

[Massive hemothorax: an exceptional complication of Rendu-Osler-Weber disease]. / Hemotórax masivo: complicación excepcional de la enfermedad de Rendu-Osler-Weber.

Hereditary familial telangiectasis is a vascular dysplasia characterized by a triple syndrome: hereditary character, telangiectasias and hemorrhages. Its association with systemic and/or pulmonary arterio-venous fistulae is frequent and can condition several complications: cerebral abscess, digestive hemorrhages, epistaxis, hemoptysis, hypoxemia, polyglobulia, and rarely the appearance of hemothorax. We describe a patient who was admitted in hospital with a hypovolemic shock secondary to a massive hemothorax; during emergency surgery, which was necessary to perform, a pulmonary A-V fistula was observed in the middle lobe. The studies afterwards performed demonstrated that it was a Rendu-Osler-Weber disease with duodenal, hepatic, and cerebral involvement.

[Infections in the postoperative period of a liver transplant. A comparison of 2 protocols for anti-infectious prophylaxis]. / Infecciones en el postoperatorio del trasplante hepático. Comparación de dos pautas de profilaxis antiinfecciosa.

We discuss the incidence of infection in 198 liver transplants during the immediate post-surgical period. All of them were treated with protocols with anti-infective prophylaxis, and have been divided in two groups regarding the antibiotic scheme used, in the second of said groups we have included parenteral vancomycin. Global incidence of infection was different for both groups (46.9% in group A and 15.3% in group B) (p < 0.01). We stress that the most frequent germ found in the cultures of the group without vancomycin was Staphylococcus aureus, with a great difference between groups (p < 0.01); global incidence of pneumonias was also different between both groups (p < 0.05). After the introduction of vancomycin in the second group the most frequent found germ was Candida but with a low percentage. Gram-negative germs appear preferably in both groups when hospital stay was over 10 days. It is important to stress that transplanted patients who did not show rejection got significantly lesser infected (p < 0.05) than patients who shown rejection. We think that parenteral prophylaxis with ceftazidime and vancomycin, associated with oral-rhino-gastric decontamination, is useful for the control of early infections in patients with liver transplant.

[Antilymphocytic sera versus azathioprine, combined with cyclosporin and steroids, in liver transplant. Comparison of the results at the intensive care unit and 2 years' follow-up]. / Sueros antilinfocitarios frente a azatioprina, en asociación con ciclosporina y esteroides, en el trasplante hepático. Comparación de resultados en UCI y seguimiento de dos años.

The use of anti-lymphocyte globulins (ATG, ALG, OKT3) for the control or organ rejection in humans, has been of major importance both in preventing and treating organ rejection resistant to other treatments. We present here the results of our immunosuppression protocol using two different therapeutic associations. To the first group consisting of 29 patients, low doses of cyclosporine, steroids and anti-lymphocyte globulins were given, and to another group of 11 patients azathioprine was given together with cyclosporine and steroids at the same doses as in the first group. We want to point out that the incidence of acute rejections was similar in both groups (17.2% vs 18.1%) immediately after surgery and a greater incidence of rejections at a later time during the follow up period in the group treated with azathioprine (34.4% vs 54.6%). The incidence of chronic rejections was similar in both groups (10.3% vs 8.9%). During the follow up period, the incidence of infections was higher in the group treated with azathioprine (13.7% vs 36.4%) as well as bacteremia episodes (17.2% vs 45.4%) (p less than 0.1). We also want to highlight that patients with graft complications (primary graft rejection) suffered infections (p less than 0,001) and had a higher mortality rate (p less than 0,05) in association to the infection.