RESUMEN
INTRODUCTION: Because of the shortage of organs available for transplantation, living related sequential transplantation with the use of liver and a kidney from the same donor has emerged as a reasonable therapeutic alternative. However, there is insufficient literature about the complications that living donors experience after simultaneous kidney and liver transplantations. METHODS: From December 2001 to October 2009, 5 living donors provided simultaneous donation of livers and kidneys and 1 living donor donated first her kidney and then her liver. Demographic data of the donors and information concerning the surgery and postoperative observation were collected prospectively. RESULTS: All of the donors were female. The median age was 27.5 (range, 19-36) years. Indications requiring the simultaneous transplantation of livers and kidneys were primary hyperoxaluria type 1 (PH1) in 5 potential recipients and cirrhosis due to chronic hepatitis B infection and idiopathic chronic renal insufficiency in 1 potential recipient. Four recipients underwent right hepatectomy (segments 5-8) and right nephrectomy; 1 recipient underwent left hepatectomy (segments 2-4) and right nephrectomy; and 1 recipient underwent left lobectomy (segments 2-3) and right nephrectomy. There were no complications except in 1 donor (postoperative ileus). No donor developed hypertension or microalbuminuria. CONCLUSIONS: With the right indications, appropriate preoperative evaluation, meticulous surgical technique, proper postoperative care, and long-term close monitoring to minimize morbidity and mortality risks, liver and kidney donation from the same donor can be considered for simultaneous kidney and liver transplantation.
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Trasplante de Riñón , Trasplante de Hígado , Donadores Vivos , Adulto , Femenino , Humanos , Hiperoxaluria Primaria/cirugía , Fallo Renal Crónico/cirugía , Cirrosis Hepática/cirugía , Complicaciones Posoperatorias , Adulto JovenRESUMEN
Gingival overgrowth (GO) is a common side effect following administration of cyclosporin A (CsA). Various case reports have shown that squamous cell carcinomas could arise in GO induced by CsA and phenytoin. It is also known that human telomerase activated in about 90% of cancers is mainly composed of hTR, hTERT, and TPI. The aim of this study was to investigate the potential role of telomerase activity in the pathogenesis of CsA-induced GO. Included in the study were 9 patients on CsA: 4 with and 5 without GO. Gingival tissues were obtained during gingivectomy or flap procedures; gingival fibroblasts were cultured in Dulbecco's modified Eagle's medium (DMEM) supplemented with 10,000 U/mL penicillin, 10 mg/mL streptomycin, 2 mmol/L l-glutamine, and 10% heat-inactivated fetal bovine serum at 37 degrees C under a humidified 95% air virgule 5% CO(2) atmosphere. Quantitative detection of hTERT mRNA was performed with the commercially available LightCycler Telo TAGGG hTERT Quantification Kit using real-time online PCR. The hTERT mRNA expression was positive in one patient, while hTERT mRNA expression was negative in the others. Because results indicated that there may be a relationship between CsA-induced GO and positive telomerase activity, detailed studies should be performed to confirm the present findings.