Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 17 de 17
Filtrar
Mais filtros










Tipo de estudo
Intervalo de ano de publicação
2.
Transplant Proc ; 42(10): 4578-81, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21168741

RESUMO

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most frequent types of tumor. The aim of this study was to determine the survival of patients who had received liver transplants as a result of the disease. METHODS: This observational follow-up study included 150 patients who received liver transplantations from June 1994 to December 2007. The study considered epidemiological and staging variables, tumor descriptions, and follow-up variables. We employed Kaplan-Meier methodology together with a Cox multivariate regression analysis. RESULTS: The incidence of tumor relapse was 13.3%, with survival rates at 1, 3, and 5 years of 89.3%, 73.1%, and 61.4%, respectively. Variables that showed an independent effect to predict mortality were the degree of histological differentiation and of macrovascular invasion. Patients with poorly differentiated HCC had a 4.03 fold (95% confidence interval [CI]: 1.61-10.06) greater possibility of dying. Macrovascular involvement increased the risk of death (relative risk = 2.23), an effect that was at the limit of significance (95% CI 0.99-5.04). CONCLUSIONS: The survival rate was consistent with the literature. Poor tumor differentiation and macrovascular involvement were independent predictors of mortality.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Feminino , Humanos , Masculino , Prognóstico , Espanha , Análise de Sobrevida
3.
Transplant Proc ; 41(6): 2450-2, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19715948

RESUMO

OBJECTIVE: The objective of this study was to describe by a retrospective analysis the evolution of patients who needed an end-to side cavo-cavostomy in addition to a previous cavo-caval anastomosis, during orthotopic liver transplantation (OLT), caused by hepatic venous outflow obstruction. METHODS: We reviewed 673 consecutive OLT and the treatment and evolution of technique-related complications. RESULTS: This study of 673 consecutive OLT, all with the piggyback modality included 23 cases (22 patients and 23 grafts) who underwent an additional cavo-caval anastomosis for venous outflow problems either perioperatively or during the immediate postoperative period. One patient developed an early and 3 developed a late, caval stenosis that was successfully treated using angioplasty. Five patients died postoperatively. Causes of death were sepsis (n = 3), thrombosis of a mesenteric bypass (n = 1), and massive hemorrhage (n = 1). Long time evolution was as follows: 2 patients died at 7 and 45 months, respectively, (viral relapse) and the other 15 subjects are alive and well.


Assuntos
Síndrome de Budd-Chiari/cirurgia , Transplante de Fígado/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Síndrome de Budd-Chiari/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Sobrevivência de Enxerto , Humanos , Transplante de Fígado/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida
4.
Transplant Proc ; 41(6): 2460-2, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19715951

RESUMO

OBJECTIVE: The objective of this study was to perform a retrospective analysis of the clinical evolution and surgical complications comparing pancreas transplantation with systemic-enteric (SE) drainage versus portal-enteric (PE) drainage. METHODS: This review of 48 consecutive pancreas transplantation includes 39 simultaneous kidney and pancreas (SKP) and 9 pancreas after kidney (PAK) grafts as well as 2 retransplantations. Venous drainage was systemic (n = 29) or portal (n = 19). RESULTS: There were no significant differences in patient, kidney, or pancreas allograft survival rates. There were no significant differences in levels of creatinine, fasting glucose, C-peptide, cholesterol, and homeostatic model assessment (HOMA) of beta cells, namely HOMA-s and HOMA-IR index. HbA1c was lower at 6 months and 1 year in the PE group (P < .05). Twenty-two patients displayed early postoperative complications at a mean time of presentation of 12.8 days. All of these patients but 2 needed relaparotomy. The other two were treated either conservatively (1 enteric fistula) or by interventional radiology (arteriovenous fistula). There were 10 graft losses, 5 in each group, due to thrombosis, pancreatitis, and enteric fistulae. CONCLUSION: Early graft losses were related to pancreatitis and thrombosis. Intermediate-term endocrine function was similar in both groups.


Assuntos
Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Drenagem/efeitos adversos , Drenagem/métodos , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Transplante de Rim/mortalidade , Transplante de Rim/estatística & dados numéricos , Transplante de Pâncreas/imunologia , Transplante de Pâncreas/mortalidade , Transplante de Pâncreas/estatística & dados numéricos , Sistema Porta/cirurgia , Complicações Pós-Operatórias/classificação , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Sobreviventes/estatística & dados numéricos , Resultado do Tratamento
5.
Transplant Proc ; 41(3): 1060-1, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19376427

RESUMO

Vascular complications remain an important cause of postoperative morbidity and mortality in liver transplant patients. There is no elective treatment and the need for retransplantation is common. Herein, we have reported an unusual case of nonanastomotic inferior vena cava thrombosis in a patient with a piggyback caval anastomosis. The conditions was successfully treated with catheter-directed thrombolytic therapy and endovascular stent placement.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/métodos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Hepatite B/complicações , Hepatite C/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Derivação Portocava Cirúrgica/métodos , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Resultado do Tratamento
6.
Transplant Proc ; 39(7): 2335-7, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17889181

RESUMO

UNLABELLED: We performed a retrospective analysis to compare pancreas transplantation with systemic-enteric drainage (SE) or portal-enteric drainage (PE). METHODS: We reviewed 38 consecutive pancreas transplants including 31 simultaneous kidney-pancreas (SKP) and 7 pancreas after kidney (PAK), using either systemic (n = 18) or portal (n = 20) venous drainage. Demographic, clinical, and immunologic variables were similar for both groups. RESULTS: There were no significant differences in patient, kidney, or pancreas allograft survival rates after a mean follow-up of 23 months (range 1-60). The mean length of hospital stay within 3 months was 34 days among the SE group versus 20 days in the PE group (P = ns). The incidences of intraabdominal infection, early relaparotomy, and acute rejection episodes were not different between groups. The blood pressure levels were similar among the SE and PE groups. There was no significant difference in creatinine, or fasting glucose, C-peptide, cholesterol, or triglyceride levels or homeostatic model assessment (HOMA) beta cell, HOMA-S, and HOMA-IR index. HbA1c was lower at 6 and 12 months in the PE group (P < .05). Mean prednisone and mycophenolate mofetil doses as well as tacrolimus levels were identical for both groups. CONCLUSION: The results suggested sustained long-term endocrine function in both groups, showing that in the short term, portal venous drainage did not offer major metabolic or immunologic advantages compared with systemic delivery of insulin.


Assuntos
Drenagem/métodos , Transplante de Rim/métodos , Transplante de Pâncreas/métodos , Veia Porta , Adulto , Glicemia/análise , Peptídeo C/sangue , Creatinina/sangue , Feminino , Seguimentos , Humanos , Insulina/sangue , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Transplant Proc ; 37(3): 1455-6, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15866636

RESUMO

BACKGROUND: For selected patients with type 1 diabetes mellitus and end-stage renal failure, simultaneous kidney-pancreas (SKP) or pancreas after kidney (PAK) transplantation is the treatment of choice. However, it is frequently difficult to start a program for fear of serious intraabdominal complications in an immunosuppressed patient. We review our initial experience with these transplantations. METHODS: Twenty-three patients (20 SKP, 3 PAK) with type 1 diabetes mellitus received transplants between June 2000 and October 2003. All received immunosuppression therapy with thymoglobulin, prednisone, tacrolimus, and mycophenolate mofetil. The operation included portal venous drainage and exocrine enteric drainage. Rejections were biopsy-proved. Cytomegalovirus prophylaxis with gancyclovir was administered. RESULTS: The mean follow-up is 13 months (range, 1-30 months) for recipients of mean age 39 +/- 7 years (17 men, 6 women). Mean cold ischemia time for kidney was 10.2 +/- 3.9 hours, and for pancreas was 10.5 +/- 3 hours. The rate of initial graft function was 100%. Graft rejection rate was 8%. The repeat laparotomy rate was 53% (12 patients), with a mean of 0.8 procedures per patient (range, 0 to 5). At the end of follow-up, patient survival was 95%, kidney survival was 85%, and pancreas survival was 83%. Patients with a functioning graft were insulin-free, with a mean fasting glucose concentration of 79 +/- 7 mg/dL, hemoglobin A1C of 4.5% (range, 4% to 4.9%) C-peptide of 5.9 ng/mL (range, 2.1 to 12 ng/mL), and a mean serum creatinine level of 1.6 mg/dL (range, 0.9 to 4.6 mg/dL). There was 1 death, due to posttransplantation lymphoproliferative disease confined to the pancreatic graft and abdominal sepsis at 3 months posttransplantation. CONCLUSIONS: Our results are similar to those of other series of SPK or PAK transplantations: low acute rejection rates, frequent requirement for repeat laparotomy, and good patient and graft survival, permitting an excellent quality of life.


Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Nefropatias Diabéticas/cirurgia , Falência Renal Crônica/cirurgia , Transplante de Rim/fisiologia , Transplante de Pâncreas/fisiologia , Adulto , Peptídeo C/sangue , Infecções por Citomegalovirus/epidemiologia , Feminino , Seguimentos , Rejeição de Enxerto/epidemiologia , Sobrevivência de Enxerto/fisiologia , Hematoma/cirurgia , Humanos , Imunossupressão/métodos , Falência Renal Crônica/etiologia , Transplante de Rim/imunologia , Masculino , Transplante de Pâncreas/imunologia , Complicações Pós-Operatórias/epidemiologia , Reoperação , Fatores de Tempo
8.
Transplant Proc ; 37(9): 3857-8, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16386562

RESUMO

INTRODUCTION: The aim of this study was to evaluate long-term results after liver transplantation from non-heart-beating donors (NHBD) using the method of chest and abdominal compression-decompression to maintain donors. METHODS: From December 1995 to November 2004, 10 NHBD were identified and maintained by means of the method of chest and abdominal compression-decompression until family and judicial permission were granted. Nine donors were Maastricht type II and one was type IV. RESULTS: The mean age of donors was 40.5 years and the mean time under cardiopulmonary resuscitation (CPR) was 80 minutes. Orthotopic liver transplantation (OLT) was performed using these 10 liver grafts after a mean cold ischemia time of 561.5 minutes. All patients developed good posttransplant function, except for one patient who presented with primary nonfunction corrected with retransplantation. This complication was directly related to a long CPR time (P < .01). After a mean follow-up of 57 months, only one patient died from a hepatitis C virus (HCV) recurrence. The rest of the patients have maintained good graft function over time. CONCLUSIONS: NHBD maintained with the method of chest and abdominal compression-decompression are a valid choice to increase the donor pool. Liver transplantation using these grafts has proven good long-term results, comparable to their heart-beating counterparts.


Assuntos
Descompressão/métodos , Parada Cardíaca , Transplante de Fígado/fisiologia , Fígado , Pressão Negativa da Região Corporal Inferior/métodos , Tórax , Doadores de Tecidos , Adulto , Reanimação Cardiopulmonar/métodos , Humanos , Transplante de Fígado/métodos , Seleção de Pacientes , Resultado do Tratamento
9.
Transplant Proc ; 37(9): 3906-8, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16386580

RESUMO

PURPOSE: To evaluate the usefulness of endovascular procedures for portal vein complications during orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Between May 1994 and November 2004, we performed 504 OLTs in 464 adults. Seventy-eight patients (16.8%) presented with portal vein thrombosis (PVT). This analysis of patients from May 2000 to September 2004 included 10 patients with PVT, who were treated with endovascular techniques due to low portal flow. We compared this group with patients who were treated surgically with attention to rethrombosis and survival rates. If portal vein problems were due to obstruction, a venoplasty and primary stent placement were performed. We also embolized with coils or surgically ligated remaining competitive portosystemic shunts. RESULTS: Perfusion problems in the allograft were solved in all cases. We placed seven stents and embolized six competitive shunts. One anastomotic dysfunction was repaired. None of the patients died or rethrombosed during surgery or follow-up. CONCLUSION: Endovascular techniques during OLT can resolve some liver graft perfusion problems due to PVT and "steal" phenomena, especially with unsatisfactory eversion thromboendovenectomy in patients with grade IV PVT. Although primary permeability of stents has been good, these results need to be confirmed.


Assuntos
Transplante de Fígado/métodos , Veia Porta/diagnóstico por imagem , Trombose/diagnóstico por imagem , Trombose/terapia , Humanos , Período Intraoperatório , Cirrose Hepática Alcoólica/cirurgia , Monitorização Intraoperatória , Veia Porta/cirurgia , Derivação Portossistêmica Cirúrgica , Radiografia , Reoperação , Estudos Retrospectivos , Stents , Trombose/cirurgia , Resultado do Tratamento
10.
Transplant Proc ; 37(9): 3919-21, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16386584

RESUMO

INTRODUCTION: Recombinant activated factor VII (rFVIIa, NovoSeven, NovoNordiskA/S, Bagsvaerd, Denmark) has shown benefits in hemophilic patients and recently in transplant recipients. This study presents our experiences with rFVIIa in complicated liver transplant recipients. METHODS: From May 2001 to August 2004, rFVIIa was administered to 7 patients undergoing liver transplantation. All treatments were made on emergency bases, except for 1 case with hemophilia A, who received prophylactic treatment. The drug was delivered when severe bleeding with coagulopathy persisted despite the usual treatment with blood products. The drug doses were 60-90 mug/kg; the results were evaluated clinically and analytically. RESULTS: Seven patients undergoing liver transplantation were treated with FVIIa. Mean prothrombin times before and after treatment were 17.5 and 10.9 seconds, respectively, with a mean reduction of 7.2 seconds (P = .03). Mean thromboplastin times before and after treatment were 38.1 and 29.4 seconds, respectively, with a mean reduction of 8.7 seconds (P = .034). The average dose was 83.6 mug/kg, leading to decreased consumption of blood products (P < .01). In all cases, rFVIIa allowed sufficient hemostasis to carry on definitive treatment. There was no mortality in this series. CONCLUSIONS: These results provide new evidence on the potential benefits of rFVIIa in liver transplantation, especially for rescue therapy in cases of severe bleeding.


Assuntos
Fator VIIa/uso terapêutico , Hemofilia A/cirurgia , Transplante de Fígado , Humanos , Cirrose Hepática Alcoólica/cirurgia , Tempo de Protrombina , Proteínas Recombinantes/uso terapêutico , Trombopoetina/análise
11.
Transplant Proc ; 37(9): 3975-6, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16386601

RESUMO

Simultaneous pancreas-kidney transplantation is presently a well-accepted procedure for patients with type 1 diabetes mellitus and renal failure. However, experiences with combined pancreas and liver transplantation are scarce, a few data are available about the best immunosuppression for these patients. We report our experience with two patients who received a pancreas after liver transplantation for long-standing insulin-dependent diabetes mellitus, with steroid-free immunosuppression based on daclizumab, tacrolimus, and mycophenolate mofetil. Short- and long-term evolution was uneventful. Currently, both patients are insulin free with appropriate metabolic control after 12 and 6 months follow-up. Considering our preliminary results, we suggest a steroid-free immunosuppressive regimen as an option for pancreas-after-liver transplantation.


Assuntos
Imunossupressores/uso terapêutico , Transplante de Fígado/imunologia , Transplante de Pâncreas/imunologia , Corticosteroides , Carcinoma Hepatocelular/cirurgia , Hemocromatose/complicações , Humanos , Falência Hepática/etiologia , Falência Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Transplant Proc ; 36(3): 747-50, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15110650

RESUMO

INTRODUCTION: The demand for liver transplantation has increasingly exceeded the supply of cadaver donor organs. Non-heart-beating donors (NHBDs) may be an alternative to increase the cadaver donor pool. The outcome of 20 liver transplants from Maastricht category 2 NHBD was compared with that of 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support with simultaneous application of chest and abdominal compression (CPS; n = 6) or cardiopulmonary bypass (CPB; n = 14) was used to maintain the donors. RESULTS: At a minimum follow-up of 2 years, actuarial patient and graft survival rates with livers from Maastricht category 2 NHBD were 80% and 55%, respectively. Transplantation of organs from these donors was associated with a significantly higher incidence of primary nonfunction, biliary complications, and more severe initial liver dysfunction compared with organs from HBDs. The graft survival rates was 83% for livers from NHBDs preserved with CPS and 42% in those maintained with CPB.


Assuntos
Parada Cardíaca , Transplante de Fígado/fisiologia , Fígado , Doadores de Tecidos/classificação , Adolescente , Adulto , Reanimação Cardiopulmonar , Seguimentos , Sobrevivência de Enxerto , Frequência Cardíaca , Hepatectomia/métodos , Humanos , Fígado/citologia , Fígado/patologia , Transplante de Fígado/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Doadores de Tecidos/provisão & distribução , Coleta de Tecidos e Órgãos/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA