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1.
J Laparoendosc Adv Surg Tech A ; 34(7): 639-645, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38722056

RESUMEN

Introduction: Urologic complications are thought to be the most common surgical complication of renal transplantation. Ureteral pathology, including stenosis, urine leak, and vesicoureteral reflux, predominates. Although endourologic and interventional radiological management may be utilized, failure rates remain relatively high and surgical reconstruction remains the definitive management. Robotic ureteral reconstruction has been demonstrated to provide patient benefit in nontransplant populations, but the literature on transplant reconstruction is very limited. This study reports an additional series of patients with a focus on surgical technique, as well as reviews the available evidence for robotic reconstruction for post-transplant ureteral complications. Methods: All institutional patients undergoing robotic-assisted reconstruction for post-transplant ureteral complications for the years 2019-2022 were included. Intra- and postoperative variables, patient demographics, and follow-up data were obtained retrospectively from parsing of patient records. Statistics were tabulated descriptively. Results: Eleven patients underwent ureteral reconstruction. Of the 11, 9 (81%) were male with a mean age of 51.9 years (16-70) and BMI of 33.8 (24.3-49.1). The most common (10/11) indication for reconstruction was stricture; the most common (10/11) technique used was Lich-Gregoir reimplantation. Mean operative time was 288 minutes (143-500). There were no intra- or immediate postoperative complications. Median length of stay was 2 days (1-22). There were two incidences of mortality at 2 and 5 months postoperatively unrelated to surgery. There were four readmissions within 30 days, three for urinary tract infection (UTI) and one for a pelvic abscess which required washout. The remainder of the cohort has been followed for a mean of 14.6 months (6-41) without any incidences of graft loss or recurrence of ureteral pathology. Conclusions: Robotic-assisted ureteral reconstruction is a technically challenging but highly feasible technique that may provide the benefits of minimally invasive surgery while still allowing definitive reconstruction. Centers with extensive robotic capabilities should consider the technique.


Asunto(s)
Trasplante de Riñón , Procedimientos Quirúrgicos Robotizados , Enfermedades Ureterales , Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Robotizados/normas , Uréter/cirugía , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía
2.
JSLS ; 27(1)2023.
Artículo en Inglés | MEDLINE | ID: mdl-36818765

RESUMEN

Introduction: Open transplant nephrectomy for failed renal allograft is an invasive procedure associated with significant perioperative morbidity and mortality. Minimally invasive surgical approaches have improved a variety of patient outcomes for many surgeries. Thus, robotic assisted transplant nephrectomy (RATN) potentially offers significant patient benefit. Although previously reported, there remains a paucity of data on RATN outcomes and techniques. Methods: Four perfused, high-fidelity hydrogel models were created using previously described techniques and used for simulated RATN. Subsequently performed institutional cases were included for analysis. Intra- and postoperative variables along with patient demographics were retrospectively obtained through parsing of patient records. Results: Simulated nephrectomy time was 67.33 minutes (35.75 - 98.91). Five patients underwent RATN. There were four male and one female patients. The average age was 47 years. The most common indication was abdominal pain secondary to rejection (3/5). Mean blood loss was 188 mL; mean operative time was 243 minutes, and mean length of stay was 4.5 days. Intraoperatively there were two incidences of small cystotomies. One patient was readmitted within 30 days for intraabdominal abscess. Conclusion: This study adds to the growing literature around RATN, demonstrating the feasibility of the technique and reporting good outcomes for this cohort.


Asunto(s)
Neoplasias Renales , Trasplante de Riñón , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Renales/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Laparoscopía/métodos , Nefrectomía/métodos
3.
BMJ Case Rep ; 15(9)2022 Sep 26.
Artículo en Inglés | MEDLINE | ID: mdl-36162963

RESUMEN

A male in his late 70s with a history of an uncomplicated kidney transplantation 20 years prior was brought to the Emergency Department after experiencing blunt abdominal trauma following a motor vehicle collision. Imaging revealed a large perinephric haematoma, a retroperitoneal haematoma and multiple fractures. He was admitted to the intensive care unit where a renal haematoma was found to be expanding with ultrasonography (US) and developed renal dysfunction including anuria and hyperkalemia. His creatinine rose to twice his baseline and Doppler US showed elevated resistive indices, confirming extrinsic compression and causing a Page phenomenon. An open surgical exploration through the upper aspect of his Gibson incisional scar was performed followed by evacuation of the haematoma. An intraoperative US was done demonstrating good flow in the renal vessels. His postoperative course was uncomplicated and was discharged home with renal function back to baseline. On follow-up, he continued to have a good renal function.


Asunto(s)
Anuria , Enfermedades Renales , Trasplante de Riñón , Anuria/etiología , Creatinina , Hematoma/etiología , Humanos , Riñón/diagnóstico por imagen , Riñón/lesiones , Riñón/fisiología , Enfermedades Renales/complicaciones , Trasplante de Riñón/efectos adversos , Masculino
4.
Prog Transplant ; 32(4): 292-299, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36039516

RESUMEN

Introduction: Despite strong public support, organ donor registration rates (RR) continue to lag while need only grows. In the United States, the traditional registration site is the Department of Motor Vehicles (DMV), however Primary care provider (PCP) offices have been considered as alternate locations for increasing RR. Methods: Twelve PCP offices across 2 New York Counties were subjected to a control week where participants received only a registration opportunity and an intervention week with the addition of a motivational poster and informational brochure. Zip code level sociodemographic data were obtained for each site. RR from the DMV over the same period served as historical control. Results: There were 1292 participants in the control phase and 1099 in the experimental phase. New registration rate for the control was 33.8% (289/897); experimental phase 7.88% (61/769); DMV registration 21.02% (1902/9050). The intervention was associated with a significant decrease in registrations (OR 0.181 (95% CI 0.135-0.244, P < 0.001)). Offices were clustered based on sociodemographic factors and regressed in 2 clusters. Lower educational attainment was associated with lower registration in the first but not second cluster (OR = 0.948 (0.923-0.974, P < 0.001)). Conclusions: This study provided evidence that PCP offices were a feasible site for organ donor registration and calls into question the efficacy of written materials-only interventions for increasing organ donor RR. It reiterated the negative effect of lower educational attainment on registration and suggested future studies focus on more active methods of engagement.


Asunto(s)
Obtención de Tejidos y Órganos , Humanos , Estados Unidos , New York , Sistema de Registros , Donantes de Tejidos , Atención Primaria de Salud
5.
J Endourol ; 34(10): 1088-1094, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32597220

RESUMEN

Introduction and Objective: Despite the adoption of robotic donor nephrectomy, the steep learning curve of robotic recipient transplantation has hindered the implementation of a complete robot-assisted kidney transplantation (RAKT). We sought to develop a high-fidelity perfused full immersion nonbiohazardous platform for RAKT simulation training. Methods: A three-dimensional (3D) computer-aided design (CAD) model consisting of a kidney, pelvicaliceal system, renal artery, and vein was created from a CT scan of a donor patient. 3D printed casts designed from the CAD model were injected with various polyvinyl alcohol hydrogel formulations to fabricate an anatomical kidney phantom and surrounding abdominal cavity. The process was repeated using a recipient's CT scan to create the recipient pelvic model containing a bony pelvis, pelvic musculature, iliac arteries and veins, and bladder. Donor and recipient models each contained structures to simulate the perfused vascular and ureterovesical anastomosis. A board-certified transplant surgeon completed a robotic training curriculum, including four RAKT simulation procedures, from procurement of the donor kidney to final retroperitonealization. Metrics from the simulations (e.g., arterial, venous, ureterovesical, and total anastomosis times) were recorded and compared with surgical times from published data. Results: The average time for the nephrectomies was 67.33 (±31.58) minutes. The average total anastomosis time was 60.85 (±9.73) minutes with 20.37 (±3.87), 20.17 (±4) and 15.1 (±2.35) minutes for arterial, venous, and ureterovesical anastomosis, respectively. The recorded arterial and venous anastomosis times were within published times for competency (Δ = 2.47 and Δ = 2.87, respectively), whereas the uterovesical time was within the mastery range (Δ = 0.45). Conclusions: Using a combination of 3D printing and hydrogel casting technologies, a high fidelity perfused full-immersion nonbiohazardous simulation platform for RAKT was developed. The utilization of this platform has the potential to replace the early cases in a learning curve while decreasing the barriers to utilization for transitioning transplant surgeons.


Asunto(s)
Trasplante de Riñón , Procedimientos Quirúrgicos Robotizados , Robótica , Humanos , Hidrogeles , Impresión Tridimensional
6.
Nephrol Dial Transplant ; 34(6): 992-1000, 2019 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-29788425

RESUMEN

BACKGROUND: The size of secondary calciprotein particles (CPP2) and the speed of transformation (T50) from primary calciprotein particles (CPP1) to CPP2 in serum may be associated with vascular calcification (VC) in patients with chronic kidney disease (CKD). METHODS: We developed a high throughput, microplate-based assay using dynamic light scattering (DLS) to measure the transformation of CPP1 to CPP2, hydrodynamic radius (Rh) of CPP1 and CPP2, T50 and aggregation of CPP2. We used this DLS assay to test the hypothesis that a large Rh of CPP2 and/or a fast T50 are associated with VC in 45 participants with CKD Stages 4-5 (22 without VC and 23 with VC) and 17 healthy volunteers (HV). VC was defined as a Kauppila score >6 or an Adragao score ≥3. RESULTS: CKD participants with VC had larger cumulants Rh of CPP2 {370 nm [interquartile range (IQR) 272-566]} compared with CKD participants without VC [212 nm (IQR 169-315)] and compared with HV [168 nm (IQR 145-352), P < 0.01 for each]. More CPP2 were in aggregates in CKD participants with VC than those without VC (70% versus 36%). The odds of having VC increased by 9% with every 10 nm increase in the Rh of CPP2, after adjusting for age, diabetes, serum calcium and phosphate [odds ratio 1.09, 95% confidence interval (CI) 1.03, 1.16, P = 0.005]. The area under the receiver operating characteristic curve for VC of CPP2 size was 0.75 (95% CI 0.60, 0.90). T50 was similar in CKD participants with and without VC, although both groups had a lower T50 than HV. CONCLUSIONS: Rh of CPP2, but not T50, is independently associated with VC in patients with CKD Stages 4-5.


Asunto(s)
Calcio/sangre , Fosfatos/sangre , Fotometría/métodos , Insuficiencia Renal Crónica/sangre , Calcificación Vascular/sangre , Adulto , Estudios Transversales , Diabetes Mellitus , Femenino , Tasa de Filtración Glomerular , Humanos , Hidrodinámica , Luz , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Análisis de Regresión , Insuficiencia Renal Crónica/complicaciones , Dispersión de Radiación , Calcificación Vascular/complicaciones , Adulto Joven
7.
Prog Transplant ; 27(3): 232-239, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-29187096

RESUMEN

INTRODUCTION: Understanding living organ donors' experience with donation and challenges faced during the process is necessary to guide the development of effective strategies to maximize donor benefit and increase the number of living donors. METHODS: An anonymous self-administered survey, specifically designed for this population based on key informant interviews, was mailed to 426 individuals who donated a kidney or liver at our institution. Quantitative and qualitative methods including open and axial coding were used to analyze donor responses. FINDINGS: Of the 141 survey respondents, 94% would encourage others to become donors; however, nearly half (44%) thought the donation process could be improved and offered numerous suggestions. Five major themes arose: (1) desire for greater convenience in testing and scheduling; (2) involvement of previous donors throughout the process; (3) education and promotion of donation through social media; (4) unanticipated difficulties, specifically pain; and (5) financial concerns. DISCUSSION: Donor feedback has been translated into performance improvements at our hospital, many of which are applicable to other institutions. Population-specific survey development helps to identify vital patient concerns and provides valuable feedback to enhance the delivery of care.


Asunto(s)
Trasplante de Riñón/psicología , Trasplante de Hígado/psicología , Donadores Vivos/psicología , Actitud Frente a la Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
8.
J Gastrointest Surg ; 21(10): 1643-1649, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28785937

RESUMEN

PURPOSE: Biliary complications following liver transplantation are a significant source of morbidity, potentially leading to graft failure necessitating retransplantation. We sought to evaluate smoking as an independent risk factor for post-transplant biliary complications. METHODS: The clinical course of all adult primary deceased donor liver transplants at our center from 1992 to 2012 was reviewed. Eligible patients were assigned to cohorts based on their lifetime tobacco exposure: never smokers indicating 0 pack-year exposure and all others were ever smokers. Biliary complications were defined as strictures, leaks, or bilomas requiring intervention. Complication rates were analyzed using univariate regression models correlated with donor and recipient characteristics. Associations found during univariate analysis were included in the final multivariate Cox model. RESULTS: Eight hundred sixty-five subjects were followed for a median of 65 months; 482 (55.7%) of patients had a positive smoking history at the time of transplant. In univariate analysis, positive tobacco smoking history (HR = 1.36; p = 0.037) and increased time from quit date to transplantation (HR = 0.998; p = 0.011) were positive and negative predictors of biliary complication, respectively. Lifetime tobacco exposure remained a significant predictor of biliary complication on multivariate analysis (HR = 1.408; p = 0.023). CONCLUSIONS: Smoking status is an independent predictor of post-transplant biliary complications, and the data presented reinforces the importance of early smoking cessation in the pre-transplantation period.


Asunto(s)
Enfermedades de las Vías Biliares/etiología , Trasplante de Hígado , Complicaciones Posoperatorias/etiología , Fumar Tabaco/efectos adversos , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
9.
J Vasc Interv Radiol ; 28(5): 714-721, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28190706

RESUMEN

PURPOSE: To investigate whether accessory vein embolization (AVE) improves long-term performance of salvaged nonmaturing arteriovenous fistulae (AVFs). MATERIALS AND METHODS: This retrospective review included 72 patients who underwent percutaneous balloon angioplasty for salvage of nonmaturing AVFs between 2008 and 2014. AVE was performed on 32 patients between 2008 and 2011 (mean age, 59 y [range, 33-85 y]; men, n = 21; women, n = 11; upper arm, n = 17; forearm, n = 15), whereas the procedure was not performed on 40 patients after 2011 (mean age, 62 y [range, 28-85 y]; men, n = 26; women, n = 14; upper arm, n = 26; forearm, n = 14). Endpoints compared between groups included number of procedures required to achieve maturation, time to maturation, number of procedures required to maintain patency, and duration of primary and secondary patency after intervention. RESULTS: There was no statistically significant difference in number of procedures to achieve maturation (2.1 ± 1.4 vs 2.4 ± 1.2; P = .24) or time to maturation (26.1 d ± 56.2 vs 41.1 d ± 54.6; P = .072) between AVE and no embolization groups. Primary (P = .21) and secondary patency (P = .14) after intervention were not significantly different between groups. The number of procedures performed to maintain patency after maturation was significantly greater in the AVE group for patients with forearm AVFs (0.11 ± 0.098 vs 0.04 ± 0.064 per patient year; P = .039) but not for patients with upper arm AVFs. CONCLUSIONS: AVE of AVFs after balloon angioplasty does not lead to significantly improved long-term outcomes. Percutaneous salvage of nonmaturing AVFs in the forearm without AVE resulted in a decreased number of interventions to maintain patency.


Asunto(s)
Angioplastia de Balón , Derivación Arteriovenosa Quirúrgica/rehabilitación , Embolización Terapéutica/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Grado de Desobstrucción Vascular
10.
Adv Radiat Oncol ; 1(1): 35-42, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28799575

RESUMEN

PURPOSE: To evaluate and compare outcome of stereotactic body radiation therapy (SBRT), yttrium-90 radioembolization, radiofrequency ablation (RFA), or transarterial chemoembolization (TACE) as bridge to liver transplant (LT) in patients with hepatocellular carcinoma. METHODS AND MATERIALS: We retrospectively reviewed patients treated at our institution with SBRT, TACE, RFA, or yttrium-90 as bridge to LT between 2006 and 2013. We analyzed radiologic and pathologic response and rate of failure after bridge therapy. Toxicities were reported using Common Terminology Criteria for Adverse Events, 4.0. Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival after LT. RESULTS: Sixty patients with a median age 57.5 years (range, 44-70) met inclusion criteria. Thirty-one patients (50.7%) had hepatitis C cirrhosis, 14 (23%) alcoholic cirrhosis, and 8 (13%) nonalcoholic steatohepatitis cirrhosis. Patients received a total of 79 bridge therapies: SBRT (n = 24), TACE (n = 37), RFA (n = 9), and Y90 (n = 9). Complete response (CR) was 25% for TACE, 8.6% for SBRT, 22% for RFA, and 33% for Y90. Grade 3 or 4 acute toxicity occurred following TACE (n = 4) and RFA (n = 2). Transplant occurred at a median of 7.4 months after bridge therapy. Pathological response among 57 patients was 100% necrosis (n = 23, 40%), >50% necrosis (n = 20, 35%), <50% necrosis (n = 9, 16%), and no necrosis (n = 5, 9%). Pathologic complete response was as follows: SBRT (28.5%), TACE (41%), RFA (60%), Y90 (75%), and multiple modalities (33%). At a median follow-up of 35 months, 7 patients had recurrence after LT. DFS was 85.8% and overall survival was 79% at 5 years. CONCLUSION: All bridge therapies demonstrated good pathological response and DFS after LT. SBRT and Y90 demonstrated significantly less grade ≥3 acute toxicity. Choice of optimal modality depends on tumor size, pretreatment bilirubin level, Child-Pugh status, and patient preference. Such a decision is best made at a multidisciplinary tumor board as is done at our institution.

12.
J Vasc Interv Radiol ; 25(5): 781-3, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24745906

RESUMEN

Patients who receive a left ventricular assist device (LVAD) are prone to develop end-stage renal disease. Primary arteriovenous fistula (AVF) maturation in these patients may be unsuccessful secondary to the nonpulsatile flow with an LVAD. Two patients with LVADs are described in whom assisted maturation aided long-term AVF patency.


Asunto(s)
Derivación Arteriovenosa Quirúrgica/métodos , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar/efectos adversos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/cirugía , Humanos , Fallo Renal Crónico/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Resultado del Tratamiento
13.
BMC Gastroenterol ; 13: 9, 2013 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-23317091

RESUMEN

BACKGROUND: Diabetes mellitus (DM) is identified as a negative prognostic indicator in hepatocellular carcinoma (HCC), though the basis for this is unknown. METHODS: This is a retrospective analysis of a prospectively collected database of 191 HCC patients treated at the University of Rochester Medical Center (URMC) with orthotopic liver transplantation between 1998-2008. Clinical characteristics were compared between patients with and without DM prior to liver transplantation and logistic regression analyses were conducted to assess the effect of DM on clinical outcomes including vascular invasion. RESULTS: Eighty-four of 191 (44%) transplanted patients had DM at time of transplantation. An association of DM with invasive disease was found among transplanted HCC patients where histologically confirmed macrovascular invasion was found in 20.2% (17/84) of diabetics compared to 9.3% of non-diabetics (10/107) (p=0.032). This difference also remained significant when adjusting for tumor size, number of nodules, age, obesity and etiologic risk factors in multivariate logistic regression analysis (OR=3.2, p=0.025). CONCLUSIONS: DM is associated with macrovascular invasion among a cohort of transplanted HCC patients.


Asunto(s)
Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/cirugía , Complicaciones de la Diabetes/complicaciones , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Neovascularización Patológica/epidemiología , Anciano , Carcinoma Hepatocelular/diagnóstico , Estudios de Cohortes , Femenino , Humanos , Incidencia , Neoplasias Hepáticas/diagnóstico , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Pronóstico , Estudios Prospectivos , Análisis de Regresión , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento
14.
Int J Radiat Oncol Biol Phys ; 83(3): 895-900, 2012 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-22172906

RESUMEN

PURPOSE: We sought to determine efficacy, safety, and outcome of stereotactic hypofractionated radiation therapy (SHORT) as a suitable bridging therapy for patients awaiting liver transplantation (LT) for hepatocellular carcinoma (HCC). We also examined histological response to radiation in the resected or explanted livers. METHODS AND MATERIALS: Between August 2007 and January 2009, 18 patients with 21 lesions received SHORT. A median total dose of 50 Gy was delivered in 10 fractions. Three patients underwent either chemoembolization (n = 1) or radiofrequency ablation (n = 2) prior to SHORT. Radiographic response was based on computed tomography evaluation at 3 months after SHORT. Histological response as a percentage of tumor necrosis was assessed by a quantitative morphometric method. RESULTS: Six of 18 patients were delisted because of progression (n = 3) or other causes (n = 3). Twelve patients successfully underwent major hepatic resection (n = 1) or LT (n = 11) at a median follow-up of 6.3 months (range, 0.6-11.6 months) after completion of SHORT. No patient developed gastrointestinal toxicity Grade ≥3 or radiation-induced liver disease. Ten patients with 11 lesions were evaluable for pathological response. Two lesions had 100% necrosis, three lesions had ≥50% necrosis, four lesions had ≤50% necrosis, and two lesions had no necrosis. All patients were alive after LT and/or major hepatic resection at a median follow-up of 19.6 months. CONCLUSIONS: SHORT is an effective bridging therapy for patients awaiting LT for HCC. It provides excellent in-field control with minimal side effects, helps to downsize or stabilize tumors prior to LT, and achieves good pathological response.


Asunto(s)
Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Radiocirugia/métodos , Anciano , Carcinoma Hepatocelular/patología , Fraccionamiento de la Dosis de Radiación , Femenino , Humanos , Hígado/anatomía & histología , Hígado/efectos de la radiación , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Necrosis , Tamaño de los Órganos , Radiocirugia/efectos adversos , Estudios Retrospectivos , Resultado del Tratamiento , Carga Tumoral , Listas de Espera
15.
Transplantation ; 92(4): 453-60, 2011 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-21799468

RESUMEN

BACKGROUND: Hepatitis C virus (HCV) recurrence is universal after liver transplantation (LT). Whether the progression of recurrent HCV is faster after live-donor LT (LDLT) compared with deceased-donor LT (DDLT) is debatable. METHODS AND RESULTS: We retrospectively examined 100 consecutive LTs (65 DDLTs and 35 LDLTs) performed between July 2000 and July 2003. A total of 147 liver biopsies were performed between 6 months post-LT and last follow-up. Mean donor age and model for end-stage liver disease (MELD) score were significantly lower in LDLT (P<0.01). On a mean follow-up of 86.6±6.8 months, overall patient and graft survivals were 61% (51% DDLT vs. 77.1% LDLT; P=0.026) and 56% (46.2% DDLT vs. 71.4% LDLT; P=0.042), respectively. Eight of 39 (20.5%) deaths (7 DDLT and 1 LDLT) and two of nine (22.2%) retransplants (one in each group) were related to recurrent HCV. Mean fibrosis scores for DDLT and LDLT were 1.9±1.7 and 1.6±1.4, respectively (P=0.01). When donor age less than 50 years and MELD score less than 25 were matched among 64 patients (32 DDLT and 32 LDLT), the overall patient and graft survivals were 73.4% (68.8% DDLT vs. 78.1% LDLT; P=0.439) and 71.9% (71.9% DDLT vs. 71.9% LDLT; P=0.978), respectively. CONCLUSIONS: Long-term survival rates were better, and fibrosis scores were lower for LDLT. The survivals between LDLT and DDLT were comparable for patients with MELD score less than 25 and donor age less than 50 years.


Asunto(s)
Hepatitis C Crónica/etiología , Trasplante de Hígado/efectos adversos , Donadores Vivos , Donantes de Tejidos , Adulto , Anciano , Antivirales/uso terapéutico , Cadáver , Progresión de la Enfermedad , Enfermedad Hepática en Estado Terminal/etiología , Enfermedad Hepática en Estado Terminal/cirugía , Femenino , Estudios de Seguimiento , Supervivencia de Injerto , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Estimación de Kaplan-Meier , Trasplante de Hígado/métodos , Trasplante de Hígado/mortalidad , Trasplante de Hígado/patología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos
17.
Clin Transplant ; 25(2): 213-21, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-20331690

RESUMEN

Acute renal failure is a significant risk factor for death in patients with liver failure. The goal of this study was to analyze the impact of peri-transplant dialysis on the long-term mortality of liver transplant recipients. We performed a single-center, retrospective cohort study of 743 adult liver transplants; patients who received first liver transplants were divided into four groups: those who received more than one dialysis treatment (hemodialysis [HD], continuous veno-venous hemodialysis [CVVH]) pre-orthotopic liver transplantation (OLT), post OLT, pre- and post OLT, and those not dialyzed. There was no statistically significant difference in the mean survival time for patients who were not dialyzed or dialyzed only pre-OLT. Mean survival times were markedly reduced in patients dialyzed post OLT or both pre- and post OLT compared with those never dialyzed. Mortality risk in a Cox proportional hazards model correlated with hemodialysis post OLT, intra-operative vasopressin or neosynephrine, donor age >50 yr, Cr >1.5 mg/dL at transplant, and need for subsequent retransplant. Risk of post-OLT dialysis was correlated with pre-OLT dialysis, intra-operative levophed, pre-OLT diabetes, African American race, pre-OLT Cr >1.5, and male gender. We conclude that renal failure requiring hemodialysis post liver transplant, irrespective of pre-transplant dialysis status, is a profound risk factor for death in liver transplant recipients.


Asunto(s)
Rechazo de Injerto/mortalidad , Fallo Renal Crónico/mortalidad , Trasplante de Riñón/mortalidad , Trasplante de Hígado/efectos adversos , Diálisis Renal/mortalidad , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
18.
J Gastrointest Surg ; 14(9): 1362-9, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20617395

RESUMEN

INTRODUCTION: Autoimmune hepatitis and cholestatic liver diseases have more favorable outcomes after liver transplantation as compared to viral hepatitis and alcoholic liver diseases. However, there are only few reports comparing outcomes of both living donor liver transplants (LDLT) and deceased donor liver transplants (DDLT) for these conditions. AIM: We aim to study the survival outcomes of patients undergoing LT for autoimmune and cholestatic diseases and to identify possible risk factors influencing survival. Survival outcomes for LDLT vs. DDLT are also to be compared for these diseases. PATIENTS AND METHODS: A retrospective analysis of the UNOS database for patients transplanted between February 2002 until October 2006 for AIH, PSC, and PBC was performed. Survival outcomes for LDLT and DDLT patients were analyzed and factors influencing survival were identified. RESULTS: Among all recipients the estimated patient survival at 1, 3, and 5 years for LDLT was 95.5%, 93.6%,and 92.5% and for DDLT was 90.9%, 86.5%, and 84.9%, respectively (p = 0.002). The estimated graft survival at 1, 3, and 5 years for LDLT was 87.9%, 85.4%, and 84.3% and for DDLT 85.9%, 80.3%, and 78.6%, respectively (p = 0.123). On multivariate proportional hazard regression analysis after adjusting for age and MELD score, the effect of donor type was not found to be significant. CONCLUSION: The overall survival outcomes of LDLT were similar to DDLT in our patients with autoimmune and cholestatic liver diseases. It appears from our study that after adjusting for age and MELD score donor type does not significantly affect the outcome.


Asunto(s)
Hepatitis Autoinmune/cirugía , Cirrosis Hepática Biliar/cirugía , Trasplante de Hígado/métodos , Donadores Vivos , Adulto , Colangitis Esclerosante/mortalidad , Colangitis Esclerosante/cirugía , Femenino , Estudios de Seguimiento , Hepatitis Autoinmune/mortalidad , Humanos , Cirrosis Hepática Biliar/mortalidad , Trasplante de Hígado/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Resultado del Tratamiento , Estados Unidos/epidemiología
20.
Exp Clin Transplant ; 8(1): 4-8, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20199364

RESUMEN

OBJECTIVES: Alpha 1 antitrypsin (A1A) is a 52 kD glycoprotein that is mainly synthesized in the liver. As a major protease inhibitor, it binds to and neutralizes neutrophil elastase, thereby limiting the damage to the normal tissues after an inflammatory response. A deficiency in A1A leads to end-stage liver disease, both in children and in adults. In addition, the deficiency also has a detrimental effect in the lungs of the adult population. Alpha 1 antitrypsin deficiency is corrected with hepatic replacement; however, the changes in pulmonary functions have not been studied before and after liver transplant. The purpose of this study was to observe the changes in the pulmonary functions of patients who underwent liver transplant for the treatment of A1A deficiency. MATERIALS AND METHODS: Nine patients underwent liver transplant for A1A deficiency. Seven patients (5 men, 2 women; mean age, 49.95 -/+ 7.09 years) had their pulmonary function tests available before the liver transplant (mean, 5.6 -/+ 3.4; range, 0.9-10.1 months) and after the liver transplant (mean, 30.3 -/+ 18.4, range 7.8-48.1 months) for analysis. RESULTS: The mean, preliver, transplant, FEV1 was 2.69 -/+ 0.9 L, which was nearly unchanged after the liver transplant to a mean of 2.7 -/+ 1.2 L. During the mean total interval of nearly 3 years, an estimated decline of 250 mL in FEV1 was expected. CONCLUSIONS: It appears from the results of our study that liver transplant probably prevented the progression of pulmonary disease in A1A-deficient patients. Further study and close, postliver, transplant follow-up is warranted to support our initial findings.


Asunto(s)
Fallo Hepático/cirugía , Trasplante de Hígado/fisiología , Pulmón/fisiopatología , Deficiencia de alfa 1-Antitripsina/complicaciones , Deficiencia de alfa 1-Antitripsina/cirugía , Adulto , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado/fisiología , Humanos , Fallo Hepático/etiología , Fallo Hepático/fisiopatología , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/fisiopatología , Masculino , Persona de Mediana Edad , Derrame Pleural/fisiopatología , Pruebas de Función Respiratoria , Estudios Retrospectivos , Fumar/fisiopatología , Deficiencia de alfa 1-Antitripsina/fisiopatología
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