[Association between the use of blood components and the five-year mortality after liver transplant]. / Asociación entre el uso de hemocomponentes y lamortalidad en cinco años después de transplante hepático.

BACKGROUND AND OBJECTIVES: Liver transplant (LT) surgery is associated with significant bleeding in 20% of cases, and several authors have demonstrated the risks related to blood components. The objective of the present study was to evaluate the impact of using blood components during hospitalization in five-year survival of patients undergoing LT. METHODS: One hundred and thirteen patients were evaluated retrospectively. Several variables, including the use of blood components intraoperatively and throughout hospitalization, were categorized and evaluated by univariate analysis using Fisher's test. A level of significance of 5% was adopted. Results with p < 0.2 underwent multivariate analysis using multinomial logistic regression. RESULTS: Parenchymal diseases, preoperative renal dysfunction, and longer stay in hospital and ICU are associated with greater five-year mortality after LT (p < 0.05). Unlike the intraoperative use of blood components, the accumulated transfusion of packed red blood cell, frozen fresh plasma, and platelets during the entire hospitalization was associated with greater five-year mortality after liver transplantation (p < 0.01). CONCLUSIONS: This study emphasizes the relationship between the use of blood components during hospitalization and increased mortality in five years after LT.

HIV testing strategies: test performance is important, but not sufficient.

Minimum accuracy of HIV diagnostic tests is considered the pillar on which testing strategies for all settings must be based. Systematic reviews and meta-analyses have shown that performance of the same test in different settings may vary according to several factors, resulting in different confidence intervals for sensitivity and specificity. Prevalence of HIV infection may influence observed test accuracy. The purpose of this article is to use the knowledge from meta-analyses of general diagnostic tests to inform the specific field of HIV diagnostic strategies. We propose the 'Bayesian' thinking: considering the pretest probability (i.e., prevalence, risk factors) and understanding test limitations to estimate a post-test probability of HIV diagnosis. Cost-effectiveness analysis, patient preferences and ethical issues must also be considered in HIV testing strategies.

Life-threatening thrombocytopenia and nephrotic syndrome due to focal segmental glomerulosclerosis associated with pegylated interferon alpha-2b and ribavirin treatment for hepatitis C.

BACKGROUND: Interferon-alpha (IFN-alpha)and ribavirin combination therapy for chronic infection with hepatitis C virus produces a number of well-described side effects. Combination therapy with pegylated interferon (PEG-IFN) yields an adverse event profile similar to that observed with the standard IFN, although the frequency of certain adverse events may vary according to the preparation. CASE REPORT: We report the case of a 44-year-old man who was treated with ribavirin and PEG-IFN-alpha-2b for chronic hepatitis C and developed two rare side effects simultaneously on the 16th week of therapy: severe thrombocytopenia and nephrotic syndrome due to focal segmental glomerulosclerosis. The antiviral treatment was immediately interrupted and the patient received immunosuppressive therapy. He promptly recovered from the thrombocytopenia and partially and slowly from the nephrotic syndrome. To our knowledge, this is the first case reported of the development of such complications at the same time.