[Basiliximab in the treatment of acute steroid-resistant rejection after liver transplantation]. / Basiliximab en el tratamiento del rechazo celular agudo resistente a los corticoides postrasplante hepático.

We present the case of a liver transplant recipient with alcoholic liver cirrhosis and early-stage hepatocellular carcinoma who developed biopsy-proven acute steroid-resistant rejection 3 months after liver transplantation. After the failure of immunosuppressive therapy with intravenous boluses of 6-methyl-prednisolone and switching of the immunosuppressive regimen to tacrolimus plus mycophenolate mofetil, two doses of intravenous basiliximab were administered four days apart. Clinical, analytical, and biopsy-proven histological response was complete. No basiliximab-related adverse events were detected. Basiliximab may represent an alternative in liver transplantation immunosuppression to treat acute steroid-resistant rejection, without increasing the incidence of infections, neoplasms, or other adverse events, as shown by this case.

Efficacy and safety of sorafenib in combination with mammalian target of rapamycin inhibitors for recurrent hepatocellular carcinoma after liver transplantation.

There is currently no consensus on the most suitable treatment for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation. This open, multicenter, retrospective, uncontrolled cohort study was designed to evaluate the safety and preliminary efficacy of the combined use of a mammalian target of rapamycin (mTOR) inhibitor and sorafenib in this setting. In 31 patients who suffered from HCC recurrence after liver transplantation, the immunosuppressive therapy was changed to mTOR inhibitors, and systemic treatment with sorafenib was initiated. This combination was maintained until symptomatic tumor progression, death, hepatic decompensation, or unacceptable toxicity occurred. Primary treatment efficacy was determined by overall survival and progression-free survival, and secondary efficacy was determined by the overall response rate. Toxicity parameters associated with the use of sorafenib and mTOR inhibitors were also analyzed. The overall response rate according to the Response Evaluation Criteria in Solid Tumors was 3.8% (1/26), and there was sustained stabilization of the disease in 13 additional cases (50.0%). The median overall survival was 19.3 months [95% confidence interval (CI) = 13.4-25.1 months], and the median time to progression was 6.77 months (95% CI = 2.3-11.1 months). Only 2 grade 3/4 cases of hyperglycemia and 1 case of grade 3/4 mucositis were reported, and they were possibly related to mTOR inhibitors. The most common severe adverse event probably related to sorafenib was diarrhea (12.9%). In conclusion, the coadministration of sorafenib and an mTOR inhibitor could be effective despite notable toxicity in patients with post-liver transplant HCC recurrence not suitable for radical therapy. The toxicity and efficacy need to be further evaluated in randomized controlled studies for this combination to be considered a valid option.

[Chronic nephropathy in non-kidney transplantation: [prevention, early diagnosis and management]. / Nefropatía crónica en trasplante no renal: prevención, diagnóstico precoz y manejo.

Transplant from solid nonrenal organ has experienced an important increase in the last decades. It is due to the increasing improvement of the results obtained with the above mentioned transplants. Parallel, many nonrenal transplanted patients have developed a chronic renal failure that has determined, in some cases, the need of beginning the substitution of renal function by means of dialysis and/or transplant. The origin of the same one is multifactorial and the consequences derived from it are very important so much in morbimortality as of economic nature for the set of the system. The present review tries to help to the identification of risk factors of renal insufficiency in the nonrenal transplanted patient and to determine which might be the basic concepts of prevention, early diagnosis and of derivation to the nephrologist expert in transplants and renal dysfunction. Finally, we check the possibilities of managing of the immunosuppressive treatment and substitution of renal function by means of dialysis and/or simple or double transplant.

Sonographic features of liver involvement by lymphoma.

OBJECTIVE: The liver is one of the most frequent extranodal locations of non-Hodgkin lymphoma and Hodgkin disease. Nevertheless, lymphoma constitutes only 6% to 8% of focal lesions of the liver. Few studies have evaluated the sonographic patterns of lymphoma with liver involvement. The purpose of this study was to describe the sonographic features and to evaluate the accuracy of sonography for the diagnosis of lymphoma with liver infiltration. METHODS: The abdominal sonographic findings of 23 consecutive patients with histologically proven diagnosis of lymphoma with liver involvement were reviewed. RESULTS: The most prevalent sonographic features were hepatomegaly and splenomegaly. Abdominal lymphoadenopathies were identified in 34.8% of cases. Liver nodules were seen in half of patients, and the most frequent sonographic appearance was as multiple small focal lesions. Differences in sonographic patterns between high- and low-grade non-Hodgkin lymphoma were not seen. None of the patients with Hodgkin disease had liver nodules. Concordance between sonography and computed tomography for the diagnosis of focal liver lesions was observed. CONCLUSIONS: Sonography may contribute to the diagnosis of liver infiltration by lymphoma. The presence of multiple focal liver lesions associated with splenomegaly and lymphoadenopathies should make us consider the diagnosis of lymphoma with liver involvement. Nevertheless, the low specificity of these findings requires histologic confirmation of lymphomatous infiltration of the liver.

Bilateral adrenal metastases from hepatocellular carcinoma after liver transplantation.

Therapeutic management of hepatocellular carcinoma is a controversial issue. Orthotopic liver transplantation is an alternative for the treatment of hepatocellular carcinoma in a selected group of patients, but recurrence is possible. A 51-year-old patient with liver transplantation due to hepatocellular carcinoma presented bilateral adrenal metastases in a successive manner. A left adrenal gland metastasis was diagnosed five months after liver transplantation, and a left adrenalectomy was carried out. Eight months later, a right adrenal gland metastasis was diagnosed, and a right adrenalectomy was performed. Pathological examination confirmed the diagnosis of a well-differentiated hepatocellular carcinoma. At present, there is no evidence of recurrence 35 months after the second adrenalectomy. Bilateral adrenal gland metastases from hepatocellular carcinoma after liver transplantation have not been previously reported in English literature. Surgical resection of metastases may be indicated in similar patients with successful treatment of the primary tumor, absence of additional metastasic disease, and good performance status.