Nephrological indications in combined liver-kidney transplantation.

In isolated liver transplantation pretransplant renal failure is a major mortality risk, there are no guidelines at the moment to establish the indications for a combined liver-kidney transplantation (LKT). In irreversible chronic renal failure (CRF) not on dialysis, nephrological evaluation is required to assess the need for a simultaneous kidney transplantation. There are no experiences about the functional contribution of native kidneys post-LKT. Herein we have reported the case of two patients who underwent LKT in 2004 due to CRF, not yet on dialysis. At the moment of LKT, the first patient (polycystic kidney disease) had a glomerular filtration rate (GFR) = 29 mL/min, and the second recipient (vascular nephropathy and diabetes), a GFR = 33 mL/min. In both cases we did not observe delayed graft function. At discharge the serum creatinine was 1.1 and 1.0 mg/dL, respectively, which was maintained during follow-up. In both cases renal scintigraphy with Tc-99 DMSA was performed to evaluate the functional contributions of transplanted versus native kidneys. In the first case scintigraphy at 9 months after LKT demonstrated an 81% contribution from the transplanted kidney, 9% from the right and 10% from the left native kidneys. In the second case, at 3 months after LKT, the functional contributions were 76%, 10%, and 14%, respectively. The transplanted kidney nephron mass may avoid the need for hemodialysis in the early posttransplant period; in the midterm it may help to maintain residual renal function. As in other combined transplant programs (heart-kidney, kidney-pancreas) with irreversible CRF, a GFR < or = 30 to 35 mL/min may be an indication for LKT, but we need more experience.

Influence of breeding systems on pH and histochemical properties of muscle fibres in porcine M. semimembranosus.

The purpose of this study was to investigate pH values, fibre type frequency and histological features of Semimembranosus muscle of 15 pigs subjected to three breeding systems. The A group was raised in a large paddock; the B group animals were raised in a collective pen until they reached a live weight of 120 kg and then in the same paddock as the A group; the C group was raised in a collective pen. Breeding systems had no significant effect on pH values and fibre type frequency. Histopathological changes in muscle fibres and connective tissue were observed in 12 of the animals studied regardless of the group. However, analysis of the incidence of alterations showed a higher frequency of lesions in the B group, followed by the C group. Except for one case of DFD meat, muscle alterations were not associated with an adverse pH. In addition, regenerating fibres, with strong reactivity for neonatal serum, were observed both in apparently healthy and in pathological muscle samples.