Attitude of ancillary personnel faced with living kidney donation in a hospital with a living donor kidney transplant program.

Hospital ancillary workers' opinion has credibility among the general public because they work on behalf of a hospital. The objective of this study is to analyze the attitude of ancillary employees toward living kidney donation and the variables that influence such attitude. A random sample of ancillary personnel (n=401) was taken and stratified according to type of service in a transplant hospital. Attitude was evaluated using a survey, which was completed anonymously and self-administered. The completion rate was 94% (n=377). Most (85%) are in favor of related living kidney donation, 7% against, and the 8% undecided. The multivariate analysis found that the variables with more weight affecting attitude are: 1) female sex (odds ratio [OR]=3.75); 2) a respondent's lack of concern about the possible "mutilation" of the body after donation (OR=3.65); 3) a respondent's belief in the possibility of needing a future transplant (OR=2.66); and 4) a respondent's willingness to receive a donated living kidney (OR=10.51).

Severe acute lower gastrointestinal bleeding: risk factors for morbidity and mortality.

BACKGROUND: Many factors can cause morbidity and mortality in patients with severe acute lower gastrointestinal bleeding (LGIB). The objectives of this study are to analyze three aspects related to severe acute LGIB: (1) indications and prognostic factors for urgent surgery, (2) risk factors for morbidity and mortality, and (3) relapse rates. PATIENTS AND METHODS: A retrospective cohort was collected between 1985 and 2002 in a tertiary referral center. One hundred seventy-one patients with severe acute LGIB were reviewed (LGIB is defined as frank rectal bleeding either with a hematocrit decrease >/=10 points or when a transfusion of at least three units of concentrated red blood cells is needed). The main outcome measures are: (1) indications for urgent surgery and results, (2) morbidity and mortality, and (3) relapse. RESULTS: There were 158 (92%) stable patients, and in 61% of these, the bleeding was identified via colonoscopy. Bleeding was identified using urgent colonoscopy in a higher percentage of patients compared to delayed colonoscopy (68% versus 14%; p < 0.001). Urgent surgery was indicated in 24 (14%) patients, and the approach was peri-anal in 5 (21%) patients and abdominal in the rest. Local intestinal resection was performed on the 15 patients in which bleeding was identified, whereas a subtotal colectomy was performed on the remaining 4 patients. The presence of hypotension (p = 0.001; 35 versus 10%) and etiology of LGIB (p < 0.001) are prognostic factors of urgent surgery. Morbidity was 6.4%, and mortality was 4.7%. The only morbidity or mortality risk factors detected were the presence of associated comorbidities (p = 0.008) and the need for urgent surgery (p = 0.002). The most frequent etiology was diverticulosis (25%). After a mean follow-up of 132 +/- 75 months, bleeding relapsed in 30% of patients. CONCLUSIONS: It is difficult to predict which patients are going to need urgent surgery in severe acute LGIB; only the presence of hypotension on arrival at the emergency ward would lead us to suspect a negative outcome for the hemorrhage. In severe acute LGIB, morbidity and mortality is high, and this is mainly due to the high level of associated comorbidity and the need for urgent surgery. It is necessary for strict hemodynamic monitoring of the patients at risk if we want to improve outcomes. The bleeding relapse rate is high in LGIB, although generally, it is not severe.

El personal médico ante la donación hepática de vivo. Estudio de opinión en un hospital español con programa de trasplante hepático de donante vivo / Physicians faced with living liver donation: an attitudinal study in a Spanish hospital with a living donor liver transplant program

Introducción: La mortalidad de los pacientes en lista de espera para el trasplante hepático es elevada, por lo que se buscan alternativas, como la donación de vivo. Por ello, uno de los aspectos que se debe mejorar es la actitud de los profesionales sanitarios hacia dicha donación para crear un clima favorable al respecto. El objetivo es analizar la actitud hacia la donación hepática de vivo entre los médicos de un hospital con programa de trasplante hepático de donante vivo, y analizar las variables que influyen en dicha opinión. Pacientes y método: Muestra aleatorizada y estratificada por tipo de servicio (n = 369) entre el personal médico del hos-pital. La actitud se valoró mediante una encuesta validada en nuestro medio. Para su distribución se contactó con cada jefe de servicio, o un médico adjunto en su defecto, al cual se le explicó el estudio y fue el responsable del reparto de la encuesta en los turnos seleccionados. La encuesta fue cumplimentada de forma anónima y autoadministrada. Para el análisis estadístico se emplearon las pruebas de la *2 y de la t de Student, así como un análisis de regresión logística. Resultados: El grado de cumplimentación del cuestionario fue del 93% (n = 345). Entre los encuestados, el 15% (n = 52) está a favor de la donación hepática de vivo tanto relacionada como no relacionada. Dicho porcentaje asciende hasta el 85% (n = 292) si la donación está relacionada. Del resto, el 8% (n = 27) no acepta la donación hepática de vivo y el 7% (n = 26) restante está indeciso. Dicha actitud se ha asociado sólo a 2 factores: a) considerar la posible necesidad de un futuro trasplante (p = 0,003), de tal manera que los individuos que creen que pueden necesitarlo están a favor en un 90%, y b) aceptar en el futuro, si fuera necesario, un hígado de donante vivo de un familiar o amigo (p = 0,000). Quien así lo acepta está a favor de esta donación de vivo en un 96%. En el análisis multivariante persisten ambas variables: que el encuestado considere la posibilidad de necesitar un trasplante en un futuro (odds ratio [OR] = 2,36) y, en dicho caso, la aceptación de un hígado de donante vivo (OR = 7,11). Conclusiones: La actitud hacia la donación hepática de vivo entre el personal médico de un hospital trasplantador es muy favorable, por lo que actualmente puede ser una pieza importante de promoción, cuando se está intentando potenciar dicha donación para evitar la mortalidad de pacientes en lista de espera

Introduction: Mortality on the waiting list for liver transplants is high. Consequently, alternatives such as living donation are being sought. Therefore, one of the aspects that should be improved is the attitude of healthcare professionals toward this type of donation in order to create a favorable climate. The objective of this study was to identify attitudes toward living liver donation among physicians in a hospital with a living donor liver transplant program and to analyze the variables that affect these attitudes. Patients and methods: A random sample stratified by type of service (n = 369) was performed among physicians in the hospital. Attitudes were evaluated using a survey validated in our geographical area. In each service, the head of service, or in their absence, an attending physician, was contacted. This person was given an explanation of the study and was made responsible for distributing the questionnaire in selected work shifts. The questionnaire was completed anonymously and was self-administered. Statistical analysis consisted of *2 test, Student's t-test, and a logistic regression analysis. Results: The survey completion rate was 93% (n = 345). Of those surveyed, 15% (n = 52) were in favor of living liver donation whether related or unrelated. This percentage increased to 85% (n = 292) if donation was related. Of the remainder, 8% (n = 27) did not accept living liver donation and the remaining 7% (n = 26) were undecided. This attitude was associated with only two factors: the respondent's belief that he or she might need a transplant in the future (p = 0.003) ­90% of those who believed that they might need a transplant at some point in the future were in favor­, and the respondent's acceptance (if transplantation were necessary at some point in the future) of a living donated liver from a family member or a friend (p = 0.000). Thus, 96% of those who would be prepared to accept a living organ were in favor. In the multivariate analysis, both variables remained significant: the respondent's belief that he or she might need a transplant in the future (odds ratio [OR] = 2.36) and, if this were the case, the respondent's acceptance of a living donated liver (OR = 7.11). Conclusions: Attitudes toward living liver donation among physicians in a hospital with a living donor transplant program were highly favorable. Consequently, these health professionals may be a key element for the promotion of living donation at the present time when this form of donation is being encouraged to avoid mortality on waiting lists

[Physicians faced with living liver donation: an attitudinal study in a Spanish hospital with a living donor liver transplant program]. / El personal médico ante la donación hepática de vivo. Estudio de opinión en un hospital español con programa de trasplante hepático de donante vivo.

INTRODUCTION: Mortality on the waiting list for liver transplants is high. Consequently, alternatives such as living donation are being sought. Therefore, one of the aspects that should be improved is the attitude of healthcare professionals toward this type of donation in order to create a favorable climate. The objective of this study was to identify attitudes toward living liver donation among physicians in a hospital with a living donor liver transplant program and to analyze the variables that affect these attitudes. PATIENTS AND METHODS: A random sample stratified by type of service (n = 369) was performed among physicians in the hospital. Attitudes were evaluated using a survey validated in our geographical area. In each service, the head of service, or in their absence, an attending physician, was contacted. This person was given an explanation of the study and was made responsible for distributing the questionnaire in selected work shifts. The questionnaire was completed anonymously and was self-administered. Statistical analysis consisted of chi2 test, Student's t-test, and a logistic regression analysis. RESULTS: The survey completion rate was 93% (n = 345). Of those surveyed, 15% (n = 52) were in favor of living liver donation whether related or unrelated. This percentage increased to 85% (n = 292) if donation was related. Of the remainder, 8% (n = 27) did not accept living liver donation and the remaining 7% (n = 26) were undecided. This attitude was associated with only two factors: the respondent's belief that he or she might need a transplant in the future (p = 0.003) -90% of those who believed that they might need a transplant at some point in the future were in favor-, and the respondent's acceptance (if transplantation were necessary at some point in the future) of a living donated liver from a family member or a friend (p = 0.000). Thus, 96% of those who would be prepared to accept a living organ were in favor. In the multivariate analysis, both variables remained significant: the respondent's belief that he or she might need a transplant in the future (odds ratio [OR] = 2.36) and, if this were the case, the respondent's acceptance of a living donated liver (OR = 7.11). CONCLUSIONS: Attitudes toward living liver donation among physicians in a hospital with a living donor transplant program were highly favorable. Consequently, these health professionals may be a key element for the promotion of living donation at the present time when this form of donation is being encouraged to avoid mortality on waiting lists.

Cirugía urgente en las hemorragias digestivas bajas graves / Emergency surgery in severe lower gastrointestinal hemorrhage

Introducción. No hay estudios concluyentes que permitan distinguir los pacientes que precisaran cirugía urgente de los que no en la hemorragia digestiva baja grave. Objetivo. Determinar los factores clinicoepidemiológicos que permitan diferencian las hemorragias digestivas bajas graves que precisan cirugía urgente respecto a los que se autolimitan, y analizar el abordaje quirúrgico en dichos casos. Material y métodos. Se revisan 175 hemorragias digestivas bajas graves (rectorragia franca con descenso del hematocrito ≥ 10 puntos, o al menos transfusión de tres unidades de concentrados de hematíes) tratadas entre 1980 y 2002, y se seleccionaron las 28 (16%) que precisaron cirugía urgente. Grupo control: hemorragias digestivas bajas graves que no precisaron cirugía. Se aplicó el test de la t de Student, y el de la χ2. Resultados. Al comparar las hemorragias digestivas bajas graves que precisaron cirugía urgente con las que no, se obtienen 3 variables que nos pueden orientar a la hora de diferenciarlas: la edad inferior a 80 años (p = 0,013); la presencia de hipotensión a la llegada a urgencias (p < 0,0001) y la etiología del sangrado (p < 0,0001). En los casos con cirugía urgente, en 9 (32%) el origen fue anorrectal, por lo que el abordaje fue perianal. En el resto (n = 19) el abordaje fue abdominal. En 10 casos no se tenía un diagnóstico etiológico en el momento de la intervención, y la hemorragia se localizó durante el acto quirúrgico en 6 de ellos. En los 4 restantes sin localización de la hemorragia se realizó una colectomía subtotal, y en el resto una resección local de la zona afecta (3 hemocolectomías derechas, 9 resecciones de intestino delgado y 3 resecciones de un divertículo de Meckel). La morbilidad fue del 18% y la mortalidad, del 7%. Conclusión. En la hemorragia digestiva baja grave es difícil determinar cuál será cataclísmica y cuál autolimitada. En nuestra serie sólo son factores predictivos de cirugía urgente la inestabilidad hemodinámica a la llegada a urgencias y la edad menor de 80 años. La etiología del sangrado no es valorable, pues generalmente esta etiología se desconoce al inicio del cuadro (AU)

Introduction. There are no conclusive studies that would allow us to distinguish between patients with severe lower gastrointestinal hemorrhage (LGIH) who require emergency surgery and those who do not. The aim of the present study was to determine the clinical and epidemiological factors that would allow us to distinguish between severe LGIH requiring emergency surgery and self-limiting LGIH and to analyze the surgical management of these patients. Material and methods. We reviewed 175 patients with LGIH (severe rectal bleeding with a decrease in hematocrit > 10 points or transfusion of at least three units of packed red blood cells) treated between 1980 and 2002 and selected 28 patients (16%) who required emergency surgery. The control group consisted of patients with LGIH who did not require surgery. Student's t-test and the Chi-squared test were used in the statistical analysis. Results. Comparison of severe LGIH requiring emergency surgery with self-limiting LGIH revealed three variables that could serve as a guide to differentiating between these entities, namely: age less than 80 years (p = 0.013), the presence of hypotension on arrival at the emergency department (p < 0.0001), and cause of bleeding (p < 0.0001). Among patients requiring emergency surgery, the origin was ano-rectal in nine (32%) and consequently the approach used was perianal. In the remaining patients (n = 19) the abdominal approach was used. In 10 patients, etiologic diagnosis was not available before surgery and the source of bleeding was identified during the intervention in 6 of these patients. In the four remaining patients without etiological diagnosis before surgery, subtotal colectomy was performed. In the remaining patients, local resection of the affected area was performed (3 right hemicolectomies, 9 small bowel resections, and 3 resections of Meckel's diverticulum). Morbidity was 18% and mortality was 7%. Conclusion. Distinguishing between self-limiting LGIH and LGIH requiring emergency surgery is difficult. In our series, the only factors predictive of emergency surgery were hemodynamic instability on arrival at the emergency department and age less than 80 years. Cause of bleeding is not a predictive factor as it generally unknown at symptom onset (AU)

Surgical treatment of multinodular goiter in young patients.

The objectives of this study were to analyse the results of surgical treatment of multinodular goiter (MG) in a population with under 30 yr of age; (2) to determine the incidence and evolution of related thyroid carcinomas; and (3) to evaluate the rate of relapse. Eighty-one patients operated for MG and under 30 yr of age were analyzed. The control group used consisted of 510 patients between 30 and 60 yr of age, operated on for MG. Cervical surgery for thyroidectomy was performed in all patients. The main outcome measures were postoperative morbidity and mortality; related thyroid carcinoma (number, type and evolution); remission of symptoms; and relapse of goiter. There were neither cases of hypoparathyroidism nor definitive recurrent lesions. In patients with symptoms, there was total remission of these. Although more than half were treated on suspicion of malignancy, only 9% were related to a carcinoma and most were papillary microcarcinomas. The average follow-up was 124 +/- 68 mo. Of the 48 patients with partial surgery, 40% had relapse (n=19). After 5 yr, the rates of relapse were 11% for the Dunhill technique, 20% for bilateral subtotal thyroidectomy, 17% for hemithyroidectomy, and 50% for unilateral subtotal hemithyroidectomy. These rates increased by 25%, 50%, 44%, and 60% respectively, after 10 yr, and up to 33%, 50%, 62%, and 70% after 15 yr; 89% of the cases of relapse were operated on-there were two hypoparathyroidisms and two recurrent lesions, one of the cases of recurrent lesion becoming definitive. MG in young people is mainly treated because of the suspicion of malignancy, although this occurs in less than 10% of cases. Surgery can be carried out with a low rate of morbidity, although the results are only definitive with total thyroidectomy, with a high level of relapse when partial techniques are used given that these are patients with long life expectancy.

Acute lower gastrointestinal hemorrhages in geriatric patients.

Age is a risk factor in acute lower gastrointestinal hemorrhages (LGIH). The objectives here were to analyze: (1) diagnostic and therapeutic handling, (2) related morbidity and mortality, (3) the indications for surgery, and (4) the evolution of acute LGIH in patients > or =80 years. Forty-three patients >80 years with acute LGIH were reviewed retrospectively. In 86% (n = 37) related comorbidities were found, in 9% (n = 4) there had been prior colorectal surgery, 19% (n = 8) were antiaggregated, and 7% (n = 3) were anticoagulated. One hundred thirty-two cases of acute LGIH in patients <80 years were used as a control group. Student's t test and the chi-square test were applied. On arrival at the emergency ward 11 cases (26%) had hemodynamic instability and 8 of these were stabilized using conservative measures. In 39 cases an endoscopy was performed, allowing for an etiological diagnosis in 59% (n = 23) of cases, above all in those carried out in an urgent or semiurgent way. The arteriography permitted an etiological diagnosis in two of the four cases in which it was carried out. In seven patients (16%) urgent surgery was indicated: three were hemorrhoidectomies, three were subtotal colectomies, and one was a resection of the small intestine. The morbidity rate was 10% (n = 4) in the patients who were not treated and 14% (n = 1) in those treated, with a mortality rate of 8% (n = 3) and 14% (n = 1), respectively. The rate of relapse of bleeding after discharge from hospital was 42% (n = 18), with nine of these needing to be readmitted into hospital. In comparison with the control group, they present a different bleeding etiology (diverticulosis as opposed to the benign anal-rectal and small intestinal pathology in the younger population; P = 0.017), surgery is indicated with less frequency (9 versus 33%; P = 0.007), and there is a higher relapse rate (42 versus 26%; P = 0.045). Acute LGIH in geriatric patients relents in most cases with the use of conservative measures, although there is a high percentage of related morbidity and mortality, and of relapse of bleeding.

[Emergency surgery in severe lower gastrointestinal hemorrhage]. / Cirugía urgente en las hemorragias digestivas bajas graves.

INTRODUCTION: There are no conclusive studies that would allow us to distinguish between patients with severe lower gastrointestinal hemorrhage (LGIH) who require emergency surgery and those who do not. The aim of the present study was to determine the clinical and epidemiological factors that would allow us to distinguish between severe LGIH requiring emergency surgery and self-limiting LGIH and to analyze the surgical management of these patients. MATERIAL AND METHODS: We reviewed 175 patients with LGIH (severe rectal bleeding with a decrease in hematocrit > or = 10 points or transfusion of at least three units of packed red blood cells) treated between 1980 and 2002 and selected 28 patients (16%) who required emergency surgery. The control group consisted of patients with LGIH who did not require surgery. Student's t-test and the Chi-squared test were used in the statistical analysis. RESULTS: Comparison of severe LGIH requiring emergency surgery with self-limiting LGIH revealed three variables that could serve as a guide to differentiating between these entities, namely: age less than 80 years (p = 0.013), the presence of hypotension on arrival at the emergency department (p < 0.0001), and cause of bleeding (p < 0.0001). Among patients requiring emergency surgery, the origin was ano-rectal in nine (32%) and consequently the approach used was perianal. In the remaining patients (n = 19) the abdominal approach was used. In 10 patients, etiologic diagnosis was not available before surgery and the source of bleeding was identified during the intervention in 6 of these patients. In the four remaining patients without etiological diagnosis before surgery, subtotal colectomy was performed. In the remaining patients, local resection of the affected area was performed (3 right hemicolectomies, 9 small bowel resections, and 3 resections of Meckel's diverticulum). Morbidity was 18% and mortality was 7%. CONCLUSION: Distinguishing between self-limiting LGIH and LGIH requiring emergency surgery is difficult. In our series, the only factors predictive of emergency surgery were hemodynamic instability on arrival at the emergency department and age less than 80 years. Cause of bleeding is not a predictive factor as it generally unknown at symptom onset.

Utility of fine-needle aspiration for diagnosis of carcinoma associated with multinodular goitre.

BACKGROUND: Fine-needle aspiration (FNA) is a useful method for evaluating a solitary thyroid nodule; however, this is not an agreed method for a multinodular goitre (MNG). The aim of this study was to assess the utility of preoperative FNA for detecting malignancy in MNG. PATIENTS AND METHOD: We analysed operated MNGs in which FNA had been performed. Puncture was carried out on the dominant nodule and any other nodules with features suggesting malignancy. The diagnosis was classed as colloid, follicular or Hurthle proliferation, suggestive of malignancy, haematic and inadequate. The thyroid FNA results, grouped into suggestive of malignancy (positive result) and other diagnoses (negative result), were compared to those of the final histological study in order to calculate the value of the test in diagnosing malignancy. RESULTS: FNA was performed in 432 MNGs, of which 42 (9.7%) were associated with carcinoma. Overall, the results of the test were poor, revealing a sensitivity of 17%, specificity of 96% and diagnostic accuracy of 88%, with a positive predictive value of 32% and negative predictive value of 88%. When the values were recalculated with the exclusion of microcarcinomas--considering their minor clinical importance--there was a slight improvement in the results: the sensitivity increased to 26%, diagnostic accuracy to 93% and negative predictive value to 96%. However, the specificity remained at 96%, and the positive predictive value fell from 32% to 25%. The results of the test improved in multifocal carcinomas. CONCLUSIONS: Thyroid fine needle aspiration is not useful for differentiating MNG with malignant degeneration from benign MNG, as more than 80% of carcinomas go unnoticed; it provides a sensitivity of 17% for detecting carcinomas, rising to 26% if microcarcinomas are excluded. We therefore suggest that clinical criteria should prevail over FNA.

Diverticulopexia asociada a miotomía delcricofaríngeo en el tratamiento del divertículo de Zenker. Presentación de 21 casos / Diverticulopexy with cricopharyngeal myotomy in zenker's diverticulum. Presentation of 21 cases

Introducción. El divertículo de Zenker consiste en la herniación de la mucosa esofágica a través del triángulo de Killian. En la actualidad persiste la controversia sobre qué técnica quirúrgica se debe realizar en el tratamiento del divertículo de Zenker, la diverticulopexia o la diverticulectomía y si es necesario o no asociar una miotomía del cricofaríngeo. El objetivo de este trabajo es analizar de forma retrospectiva los resultados clínicos y radiológicos obtenidos en un grupo de 21 pacientes intervenidos por divertículo de Zenker. Pacientes y métodos. Entre 1985 y 2001, 21 pacientes diagnosticados de divertículo de Zenker fueron intervenidos en nuestro servicio de cirugía, se realizó una miotomía del cricofaríngeo en todos ellos, y se asoció una diverticulopexia en 19 casos y una diverticulectomía en otro paciente. Resultados. El diagnóstico se realizó, en todos los casos, mediante tránsito esofágico baritado, que mostró la presencia del divertículo con un tamaño mediano de 4 cm. El estudio manométrico se realizó en 14 pacientes, se apreció una asinergia faringoesfinteriana en 3 casos, y el estudio cricofaríngeo fue normal en el resto. Además, se objetivaron cuatro casos de trastorno motor esofágico primario. Tras la intervención quirúrgica, ningún paciente falleció a consecuencia de la misma, y presentaron complicaciones 4 pacientes. Tras una mediana de seguimiento de 5,5 años (rango, 1-16), los resultados clínicos fueron excelentes en 19 pacientes y buenos en 2. Desde el punto de vista radiológico, no se observó ningún caso de recidiva del divertículo, ni de malignización del saco herniario. Conclusiones. Según nuestra experiencia, la diverticulopexia asociada a la miotomía del cricofaríngeo es una buena opción quirúrgica en el tratamiento del divertículo de Zenker (AU)

Estudio clínico e inmunólogico del xenorrechazo en el xenotrasplante ortotópico de hígado de cerdo a babuino / Clinical and immunological study of xenorejection in orthotopic liver xenotransplantation from pig to baboon

Introducción. La experiencia de xenotrasplante hepático (Xtoh) de cerdo a primate no humano es muy limitada. Nuestros objetivos han sido: a) comprobar si el hígado de un cerdo transgénico h-DAF evita el rechazo hiperagudo; b) estudiar las funciones metabólicas del hígado porcino tras el Xtoh; y c) analizar el perfil clínico, bioquímico e inmunológico del rechazo vascular agudo retardado. Animales y métodos. Se realizaron 6 Xtoh de cerdo a babuino, 4 de cerdos no modificados y dos de cerdos transgénicos para h-DAF. Se llevaron a cabo determinaciones hematológicas, de coagulación, de xenoanticuerpos y del complemento. En el babuino que sobrevivió 8 días, se estudiaron durante los mismos las poblaciones linfocitarias y la actividad lítica de los linfocitos. Resultados. Los valores de xIgG e IgM descendieron drásticamente a los 3 min de la reperfusión, sobre todo del CH50, C3 y C4. En los hígados no modificados genéticamente apareció una coagulación intravascular diseminada por rechazo hiperagudo, con una supervivencia inferior a 12 h. Con los hígados h-DAF, la coagulación se normalizó, con una supervivencia de 8 y 4 días, falleciendo ambos por insuficiencia respiratoria, sin rechazo hiperagudo. El babuino que sobrevivió 8 días presentó a las 36 h un rechazo vascular agudo retardado, detectándose una estimulación de las HLA clase I sobre los linfocitos CD3+ y CD19+, que respondió al tratamiento. Conclusiones. El hígado transgénico h-DAAF previene el rechazo hiperagudo y mantiene la coagulación en rangos normales en el babuino. El rechazo vascular agudo provoca el cese en la producción de bilis y un patrón mixto de citólisis y colostasis. Los valores de expresión de HLA clase I en los linfocitos podrían ser útiles para diagnosticarlo (AU)