ABSTRACT
INTRODUCTION AND AIMS: Orthotopic liver transplant (OLT) is the definitive treatment of most types of liver failure. Transjugular intrahepatic portosystemic shunt (TIPS) and portocaval shunt placement procedures reduce the systemic vascular complications of portal hypertension. TIPS placement remains a "bridge" therapy that enables treatment of refractory symptoms until transplantation becomes available. The aim of the present study was to describe the operative impact of TIPS prior to OLT. MATERIALS AND METHODS: A retrospective review was conducted on patients that underwent liver transplant at the Hospital San José within the timeframe of 1999 and February 2020. RESULTS: We reviewed a total of 92 patients with OLT. Sixty-six patients were male and 26 were female, with a mean age of 52 years. Nine (9.8%) of the 92 patients had a TIPS, before the OLT. Preoperative Child-Pugh class, MELD score, and sodium and platelet levels were similar between groups. We found no difference in the means of intensive care unit stay, operative time, or blood transfusions for liver transplant, with or without previous TIPS. There was no significant difference between groups regarding vascular and biliary complication rates or the need for early intervention. The overall one-year mortality rate in the TIPS group was 11%. CONCLUSIONS: TIPS is an appropriate therapeutic bridge towards liver transplant. We found no greater operative or postoperative complications in patients with TIPS before OLT, when compared with OLT patients without TIPS. The need for transfusion, operative time, and ICU stay were similar in both groups.
ABSTRACT
BACKGROUND: The high cost of tacrolimus is a major problem in Mexico. Ketoconazole increases tacrolimus bioavailability by inhibiting cytochrome P450 3A4 and glycoprotein-p. OBJECTIVE: To demonstrate that the coadministration of tacrolimus and ketoconazole allows a significant dose and cost reduction. PATIENTS AND METHODS: This prospective study administered tacrolimus and ketoconazole to renal transplant recipients with dose adjustment according to tacrolimus blood levels. At 0-1, 1-6, 6-12, and 12-24 months posttransplant demographic, transplant type, immunosuppression, and clinical data were reviewed. The cost of tacrolimus treatment was calculated based on the dose used as compared to the recommended dose (0.15-0.20 mg/kg/d). RESULTS: Eleven patients with an age of 40 years (range, 13-71) were studied from May 2000 to August 2002. Follow-up was 15 +/- 10 months. Graft source was living donor in six patients and cadaveric in five. All patients received tacrolimus + mycophenolate mofetil + prednisone. The mean ketoconazole dose was 87 mg/d. Since the dose of tacrolimus was 0.04 mg/kg/d versus the recommended dose of 0.15-0.20 mg/kg/d, there was a 78% cost reduction (P =.000). Tacrolimus blood levels remained in the therapeutic range. There were no drug-related side effects. CONCLUSIONS: The co-administration of tacrolimus and ketoconazole results in a substantial dose and cost reduction while maintaining therapeutic levels. No adverse metabolic consequences were seen with this combination.
Subject(s)
Ketoconazole/therapeutic use , Kidney Transplantation/immunology , Tacrolimus/economics , Tacrolimus/therapeutic use , Adolescent , Adult , Aged , Antifungal Agents/economics , Antifungal Agents/therapeutic use , Cadaver , Costs and Cost Analysis , Demography , Drug Therapy, Combination , Humans , Immunosuppressive Agents/economics , Immunosuppressive Agents/therapeutic use , Living Donors , Mexico , Middle Aged , Time Factors , Tissue Donors/statistics & numerical dataSubject(s)
Tissue and Organ Procurement/organization & administration , Adult , Aged , Blood Vessels , Bone and Bones , Cadaver , Cornea , Female , Heart , Humans , Kidney , Male , Mexico , Middle Aged , Patient Selection , Spain , Tissue DonorsSubject(s)
Bandages , Blood Loss, Surgical , Hemostasis, Surgical/methods , Intraoperative Complications/therapy , Liver Transplantation/methods , Hemostasis, Surgical/instrumentation , Humans , Liver Transplantation/physiology , Morbidity , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Retrospective StudiesABSTRACT
This is a case report on a 14 year child with a benign mediastinum lipoblastoma examined at the University Hospital "Dr. José E. González", in Monterrey, Nuevo León. This is an infrequent pathology and little has been published especially dealing with patients at this age and the site where it was found. This is a benign tumor which requires complete resection. The patient was submitted to an anterolateral bilateral thoracotomy which allowed for the complete resection of the tumor. It weighed 3.1 kilograms and measured 26 x 21 cm. The patient evolved satisfactorily.
