RESUMEN
Data comparing long-term effectiveness and safety of once-daily tacrolimus formulations in de novo liver transplantation are scarce. We compared the effectiveness, pharmacokinetic profile, and safety of LCPT (Envarsus) and PR-Tac (Advagraf) for up to 12 months post-transplant. Adult de novo liver transplant recipients who started IR-Tac (Prograf) and were converted to LCPT or PR-Tac 3-5 days post-transplant were included. Data from 163 patients were analyzed, 87 treated with LCPT and 76 with PR-Tac. The incidence of treatment failure was 30.5% in the LCPT group versus 23.0% in the PR-Tac group (p = .291). Biopsy-proven acute rejection (BPAR) was reported in 26.8% of patients in the LCPT group and 17.6% in the PR-Tac group (p = .166). Graft loss was experienced in one patient (1.2%) in the LCPT group and three patients (4.1%) in the PR-Tac group (p = .346). Death was registered in three patients (3.7%) in the LCPT group and three patients (4.1%) in the PR-Tac group (p > .999). Patients in the LCPT group showed 45.7% higher relative bioavailability (Cmin /total daily dose [TDD]; p < .01) with similar Cmin and 33.3% lower TDD versus PR-Tac (p < .01). The evolution of renal function, safety profile, and the incidence of post-transplant renal failure, dyslipidemia, obesity, hypertension, and diabetes mellitus were similar in patients treated with LCPT and PR-Tac. In de novo liver transplant patients, LCPT and PR-Tac showed comparable effectiveness with higher relative bioavailability, similar Cmin and lower TDD in the LCPT group. Renal function, safety, and post-transplant complications were comparable in LCPT and PR-Tac groups.
Asunto(s)
Trasplante de Riñón , Trasplante de Hígado , Adulto , Humanos , Tacrolimus/uso terapéutico , Tacrolimus/farmacocinética , Inmunosupresores/uso terapéutico , Inmunosupresores/farmacocinética , Trasplante de Riñón/efectos adversos , Esquema de Medicación , Estudios Prospectivos , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/etiología , Receptores de TrasplantesRESUMEN
A 62-year-old male presented with severe post-endoscopic retrograde cholangiopancreatography (post-ERCP) acute pancreatitis. He required admission to the Intensive Care Unit (ICU) twice due to respiratory and renal failure and neurological deterioration. On the hospitalization ward, he presented a fluctuating alteration of the level of consciousness, with bradypsychia, disorientation and somnolence, which persisted after hemodynamic, metabolic and renal stabilization. A brain magnetic resonance imaging (MRI) was performed showing focal lesions due to small vessel disease, some with cavitations due to necrosis, and mild to moderate subcortical atrophy. A diagnosis of pancreatic encephalopathy was made given the clinical and radiological findings. The patient recovered full cognitive capacity after one week with adequate nutrition supported by protein supplementation.
Asunto(s)
Encefalopatías , Pancreatitis , Enfermedad Aguda , Encefalopatías/complicaciones , Encefalopatías/etiología , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Páncreas , Pancreatitis/complicaciones , Pancreatitis/diagnóstico por imagenRESUMEN
Paroxysmal nocturnal hemoglobinuria (PNH) is a type of hemolytic anemia acquired by the PIG-A gene mutation. This causes a deficiency of a complement regulatory protein, CD59, which results in hemolysis, hemoglobinuria and thrombosis (due to the release of procoagulant factors). Budd-Chiari syndrome is characteristic in these patients and has classically been considered as a contraindication for liver transplantation (LT) due to post-transplant recurrence. Since the approval of eculizumab for the treatment of PHN, disease control is possible and therefore the post-transplant recurrence of thrombotic phenomena involving the liver is avoided.
Asunto(s)
Síndrome de Budd-Chiari , Hemoglobinuria Paroxística , Trasplante de Hígado , Trombosis , Hemoglobinuria Paroxística/tratamiento farmacológico , Hemólisis , Humanos , Trombosis/etiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Enfermedades Vasculares/complicaciones , Paracentesis/efectos adversos , Hemoperitoneo/diagnóstico por imagen , Embolización Terapéutica/métodos , Paracentesis/métodos , Angiografía/métodos , Cavidad Peritoneal/diagnóstico por imagen , Cavidad Peritoneal/cirugíaRESUMEN
Paracentesis is a common and well accepted technique for its diagnostic-therapeutic profitability. This procedure is considered rapid, minimally invasive and safe, but we must not forget that it can lead to severe complications. In this letter we present two patients with hemorrhagic complications following paracentesis. Both cases were treated by percutaneous transarterial embolization. Likewise, in the absence of consensus on the prevention of complications and on their optimal management, we make some recommendations.
Asunto(s)
Embolización Terapéutica , Paracentesis , Humanos , Paracentesis/efectos adversosRESUMEN
We report the case of a 52-year-old male diagnosed with primary sclerosing colangitis, mainly of the extrahepatic bile duct, with a long evolution. After liver transplantation, the explanted liver showed necrosis of the bile duct wall, with fungal structures inside the bile duct that was compatible with Candida. The patient was treated with mesalazine and ursodeoxycholic acid and does not have a stent in the bile duct.
Asunto(s)
Conductos Biliares Extrahepáticos/microbiología , Candidiasis/microbiología , Colangitis Esclerosante/microbiología , Conductos Biliares Extrahepáticos/patología , Candida/aislamiento & purificación , Colangitis Esclerosante/patología , Humanos , Trasplante de Hígado , Masculino , Persona de Mediana EdadRESUMEN
Segmental arterial mediolysis is an uncommon arterial disease that primarily involves splanchnic arteries; abdominal pain is the most common clinical manifestation. We report the case of a 53-year-old male with postprandial diffuse abdominal pain of one month's standing. Physical examination was uneventful, and laboratory tests revealed no abnormal findings. Abdominopelvic CT/Angio-CT showed an increased caliber of the superior mesenteric artery resulting from eccentric circumferential wall thickening. The patent lumen had a segment with fusiform aneurysmal dilatation, 7 x 26 mm long. These vascular changes extended along a number of distal jejunal branches, which also presented complete lumen obliteration. Abdominal arteries were free from signs of arteriosclerotic disease. Findings were consistent with segmental arterial mediolysis.
Asunto(s)
Dolor Abdominal/etiología , Enfermedades Vasculares/complicaciones , Vísceras/irrigación sanguínea , Arterias , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/diagnóstico por imagen , Vísceras/diagnóstico por imagenRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Cirrosis Hepática/cirugía , Enfermedad del Almacenamiento de Glucógeno/complicaciones , Carcinoma Hepatocelular/complicaciones , Trasplante de HígadoRESUMEN
Type III glycogen storage disease (GSD-III) is an autosomal recessive disorder due to the deficiency of the glycogen debrancher enzyme. 80% of the patients have hepatic and muscular involvement (IIIa), compared to 15% with only liver involvement (IIIb). As the life expectancy improves in these patients, the possible liver complications are better understood.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Enfermedad del Almacenamiento de Glucógeno Tipo III/cirugía , Cirrosis Hepática/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Adulto , Enfermedad del Almacenamiento de Glucógeno Tipo III/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de NeoplasiaRESUMEN
Advances in surgical technique, as well as in medical management and immunosuppression (IS), have represented a significant improvement in the survival of patients undergoing liver transplantation (LT), with 1-year, 5-year, and 10-year survival rates of 86%, 73%, and 62%, respectively, according to the Spanish liver transplant registry.
Asunto(s)
Terapia de Inmunosupresión , Trasplante de Hígado , Humanos , Sistema de Registros , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Anciano , Encefalopatía Hepática/etiología , Trasplante de Hígado , Derivación Esplenorrenal Quirúrgica/efectos adversos , Complicaciones Posoperatorias , Cirrosis Hepática/cirugíaRESUMEN
Splenorenal shunts are a rare cause of hyperammonemia and hepatic encephalopathy in the absence of cirrhosis. We report the case of a woman, who presented hepatic encephalopathy, with a normal functioning graft, after 14 years of liver transplantation, confirmed by liver biopsy.
Asunto(s)
Encefalopatía Hepática/etiología , Trasplante de Hígado , Complicaciones Posoperatorias/etiología , Venas Renales/anomalías , Vena Esplénica/anomalías , Malformaciones Vasculares/diagnóstico por imagen , Anciano , Angiografía por Tomografía Computarizada , Femenino , Encefalopatía Hepática/diagnóstico por imagen , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Venas Renales/diagnóstico por imagen , Vena Esplénica/diagnóstico por imagen , Malformaciones Vasculares/complicacionesRESUMEN
Los fármacos inhibidores de la mTOR, everolimus (EVL) y sirolimus, son inmunosupresores con muy poco efecto nefrotóxico, limitado al desarrollo de proteinuria en algunos casos. En la prevención del rechazo agudo EVL combinado con tacrolimus a dosis reducidas tiene una eficacia y seguridad comparables a la inmunosupresión estándar con tacrolimus. La aplicación temprana de una inmunosupresión basada en EVL con minimización de la exposición al inmunosupresor calcineurínico en trasplantados hepáticos permite mejorar los resultados de la función renal, con tasas similares de eficacia y seguridad, tanto en el período de novo como de mantenimiento. En pacientes con disfunción renal establecida la introducción de EVL permite minimizar la exposición al inmunosupresor calcineurínico, con la consiguiente mejoría en la función renal. Aunque no hay evidencia suficiente para recomendar su uso para prevenir la recurrencia del hepatocarcinoma y la progresión de tumores de novo, es práctica clínica habitual utilizarlos en este contexto (AU)
Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice (AU)
Asunto(s)
Humanos , Trasplante de Hígado/métodos , Everolimus/uso terapéutico , Terapia de Inmunosupresión/métodos , Inmunosupresores/uso terapéutico , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/prevención & control , Insuficiencia Renal/complicaciones , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/inmunología , Estudios ProspectivosRESUMEN
Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice.
Asunto(s)
Everolimus/uso terapéutico , Inmunosupresores/uso terapéutico , Trasplante de Hígado , Everolimus/efectos adversos , Rechazo de Injerto/prevención & control , Humanos , Inmunosupresores/efectos adversos , Enfermedades Renales/inducido químicamente , Enfermedades Renales/prevención & control , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/prevención & control , Guías de Práctica Clínica como AsuntoRESUMEN
Hepatocellular Carcinoma (HCC) is an aggressive tumor entity, with the only curative options being surgical resection or orthotopic liver transplantation (OLT). The presence of one single tumor nodule of less than 5 centimeters diameter or a maximum of 3 nodules, with the largest of these not exceeding 3 centimeters (Milan criteria) constitute the clinical situation in which the best results for OLT in patients with HCC have been achieved. The survival of patients fulfilling the Milan criteria after transplantation is comparable to patients with similar tumor stages without cirrhosis, undergoing hepatic resection. The application of PET in oncology has become increasingly common in the last decade as it is a non-invasive tool that also gathers information about the degree of the biological aggressiveness of the tumor. The objective of this study was to perform a review of the literature, identifying the strengths and weaknesses of the PET as a prognostic tool in patients with HCC after OLT.