ABSTRACT
Resumen La Sociedad Española de Trasplante Hepático tiene como objetivo la promoción y elaboración de documentos de consenso sobre temas de actualidad en trasplante hepático de abordaje multidisciplinario. Para ello, en noviembre de 2022 se celebró la 10.ª Reunión de Consenso, con la participación de representantes de los 26 programas de trasplante hepático españoles autorizados. En esta edición se abordó la recuperación intensificada tras el trasplante hepático y se dividieron las acciones en 3 periodos, preoperatorio, intraoperatorio y postoperatorio. Se exponen a continuación las evidencias evaluadas y las consecuentes recomendaciones consensuadas. Abstract The goal of the Spanish Society for Liver Transplantation (Sociedad Española de Trasplante Hepático) is to promote and create consensus documents about current topics in liver transplantation with a multidisciplinary approach. To this end, in November 2022, the 10th Consensus Document Meeting was held, with the participation of experts from the 26 authorized Spanish liver transplantation programs. This edition discusses enhanced recovery after liver transplantation, dividing needed actions into 3 periods: preoperative, intraoperative and postoperative. The evaluated evidence and the consensus conclusions for each of these topics are described (AU)
Subject(s)
Humans , Societies, Medical , Liver Transplantation , Waiting Lists , Consensus , SpainABSTRACT
The goal of the Spanish Society for Liver Transplantation (Sociedad Española de Trasplante Hepático) is to promote and create consensus documents about current topics in liver transplantation with a multidisciplinary approach. To this end, in November 2022, the 10th Consensus Document Meeting was held, with the participation of experts from the 26 authorized Spanish liver transplantation programs. This edition discusses enhanced recovery after liver transplantation, dividing needed actions into 3periods: preoperative, intraoperative and postoperative. The evaluated evidence and the consensus conclusions for each of these topics are described.
Subject(s)
Liver Neoplasms , Liver Transplantation , Humans , Consensus , Liver Neoplasms/surgerySubject(s)
Humans , Female , Middle Aged , Hepatic Veins/surgery , Liver Neoplasms/surgery , Portal Vein/surgery , HepatectomySubject(s)
Hepatectomy , Liver Neoplasms , Hepatic Veins/surgery , Humans , Liver Neoplasms/surgery , Portal Vein/surgeryABSTRACT
Fundamento y objetivo: La polineuropatía amiloidótica familiar (PAF) constituye el tipo más prevalente de amiloidosis sistémica hereditaria. Es una enfermedad autosómica dominante que se caracteriza por el depósito de una variante anómala de la transtiretina. Tiene una distribución mundial, con zonas endémicas localizadas en Portugal, Suecia y Japón. En España hay un foco endémico, localizado en Mallorca. El trasplante hepático es la única opción curativa para los pacientes con PAF. El objetivo de este estudio fue describir las características clínicas y demográficas de los pacientes trasplantados con diagnóstico de PAF. Material y método: Se evaluaron 6 pacientes trasplantados por PAF entre abril de 1986 y diciembre de 2012. Resultados: La edad media fue de 57,7 + 16 años, los pacientes de origen español eran mayores de 60 años. Todos los pacientes presentaban síntomas progresivos en forma de polineuropatía mixta. En 2 pacientes se realizó un doble trasplante hepatocardiaco secuencial, efectuándose en primer lugar el trasplante hepático. La supervivencia del paciente y del injerto fue del 80% a los uno, 3 y 5 años. Conclusiones: El único tratamiento etiológico eficaz para la PAF es el trasplante hepático. Una detección temprana es la clave para el tratamiento y el control, evitándose el daño orgánico irreversible (AU)
Background and objective: Familial amyloid polyneuropathy (FAP) is the most prevalent type of hereditary systemic amyloidosis. It is an autosomal dominant disease characterized by the deposition of an abnormal variant transthyretin. It has a worldwide distribution, with localized endemic areas in Portugal, Sweden and Japan. In Spain there is an endemic focus, located in Mallorca. Liver transplantation is the only curative option for patients with FAP. The aim of this study was to describe the clinical and demographic characteristics of patients transplanted with a diagnosis of PAF. Material and method: Six patients with PAF underwent liver transplantation between April 1986 and December 2012. Results: The mean age was 57.7 + 16 years, patients of Spanish origin were older than 60 years. All patients had progressive symptoms as mixed polyneuropathy. In 2 patients, combined heart-liver transplants sequentially were performed. Patient survival and graft was 80% at one, 3 and 5 years. Conclusions: The only effective treatment for etiologic PAF is liver transplantation. Early detection is the key to the treatment and control, avoiding the irreversible organ damage (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Amyloid Neuropathies, Familial/surgery , Liver Transplantation , Chromosome Disorders/complications , Early Diagnosis , Treatment Outcome , Time-to-Treatment , Age Factors , Retrospective StudiesABSTRACT
BACKGROUND AND OBJECTIVE: Familial amyloid polyneuropathy (FAP) is the most prevalent type of hereditary systemic amyloidosis. It is an autosomal dominant disease characterized by the deposition of an abnormal variant transthyretin. It has a worldwide distribution, with localized endemic areas in Portugal, Sweden and Japan. In Spain there is an endemic focus, located in Mallorca. Liver transplantation is the only curative option for patients with FAP. The aim of this study was to describe the clinical and demographic characteristics of patients transplanted with a diagnosis of PAF. MATERIAL AND METHOD: Six patients with PAF underwent liver transplantation between April 1986 and December 2012. RESULTS: The mean age was 57.7+16 years, patients of Spanish origin were older than 60 years. All patients had progressive symptoms as mixed polyneuropathy. In 2 patients, combined heart-liver transplants sequentially were performed. Patient survival and graft was 80% at one, 3 and 5 years. CONCLUSIONS: The only effective treatment for etiologic PAF is liver transplantation. Early detection is the key to the treatment and control, avoiding the irreversible organ damage.
Subject(s)
Amyloid Neuropathies, Familial/surgery , Liver Transplantation , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Liver Transplantation/rehabilitation , Graft Survival , Heart Arrest , Tissue Donors , Brain DeathSubject(s)
Graft Survival , Heart Arrest , Liver Transplantation/mortality , Tissue Donors/statistics & numerical data , Tissue and Organ Harvesting/methods , Tissue and Organ Procurement/methods , Adult , Humans , Liver Transplantation/methods , Liver Transplantation/statistics & numerical data , Outcome Assessment, Health Care , Spain , Tissue and Organ Harvesting/statistics & numerical data , Tissue and Organ Procurement/statistics & numerical dataABSTRACT
La presión en lista de espera de trasplante hepático obliga a la exploración de nuevas fuentes de donación, siendo la utilización de injertos procedentes de donantes después de muerte cardiocirculatoria una de las que reúnen un potencial más prometedor e interesante. Inicialmente, este recurso ha sido utilizado en España a través de la llamada categoría II de Maastricht, previamente denominada asistolia no controlada tipo II . Diferentes motivos han conducido a reconsiderar la donación después de la llamada muerte cardiocirculatoria controlada en el territorio nacional. El fenómeno distintivo en este tipo de donación es el estrés isquémico al que se exponen los órganos del donante con sus importantes implicaciones sobre los resultados. Los aspectos particulares de esta modalidad de trasplante hepático son el objeto de este trabajo (AU)
An increasing pressure on the liver transplant waiting list, forces us to explore new sources, in order to expand the donor pool. One of the most interesting and with a promising potential, is donation after cardiac death (DCD). Initially, this activity has developed in Spain by means of the Maastricht type II donation in the uncontrolled setting. For different reasons, donation after controlled cardiac death has been reconsidered in our country. The most outstanding circumstance involved in DCD donation is a potential ischemic stress, that could cause severe liver graft cell damage, resulting in an adverse effect on liver transplant results, in terms of complications and outcomes. The complex and particular issues related to DCD Donation will be discussed in this review (AU)
Subject(s)
Humans , Liver Transplantation/methods , Tissue and Organ Procurement/methods , Heart Arrest , Tissue Donors , Brain Death , Waiting ListsABSTRACT
An increasing pressure on the liver transplant waiting list, forces us to explore new sources, in order to expand the donor pool. One of the most interesting and with a promising potential, is donation after cardiac death (DCD). Initially, this activity has developed in Spain by means of the Maastricht type II donation in the uncontrolled setting. For different reasons, donation after controlled cardiac death has been reconsidered in our country. The most outstanding circumstance involved in DCD donation is a potential ischemic stress, that could cause severe liver graft cell damage, resulting in an adverse effect on liver transplant results, in terms of complications and outcomes. The complex and particular issues related to DCD Donation will be discussed in this review.
Subject(s)
Heart Arrest , Liver Transplantation , Tissue and Organ Procurement/methods , Decision Trees , Humans , Patient Selection , Postoperative Complications/etiology , Warm IschemiaABSTRACT
We evaluate the 5-year results of a single-centre prospective randomized trial that compared cyclosporine microemulsion (CyA-me) in triple therapy (plus steroids and azathioprine) and Tacrolimus (Tac) in double therapy (plus steroids) for primary immunosuppression. One hundred adult patients undergoing liver transplantation were randomized to receive Tac (n=51) or CyA-me (n=49). Ten patients in group A, and thirty-one patients in group B had their main immunosuppressive agent switched. The switch was much more frequent from CyA-me to Tac (n=31; 62.3%), mainly because of lack of efficacy (n=12; 38.7%). Six of 10 patients were shifted from Tac to CyA-me for side effects. The clinical course of the majority of patients converted from CyA-me to Tac improved clearly after conversion. Donor age and acute rejection (number, severity and rejection free days) had a significative association with lack of efficacy in group B. In these series, the conversion to Tac from CyA-me could be accomplished safely, with an excellent long-term outcome.
Subject(s)
Immunosuppressive Agents/administration & dosage , Liver Transplantation , Liver/physiopathology , Adult , Aged , Azathioprine/administration & dosage , Cyclosporine/administration & dosage , Female , Humans , Male , Middle Aged , Prospective Studies , Tacrolimus/administration & dosageABSTRACT
No disponible
