RESUMO
The pharmacokinetics of mycophenolate mofetil (MMF) in liver transplant recipients may change because of pharmacokinetic interactions with coadministered immunosuppressants or because changes in the enterohepatic anatomy may affect biotransformation of MMF to mycophenolic acid (MPA) and enterohepatic recirculation of MPA through the hydrolysis of mycophenolate acid glucuronide to MPA in the gut. In the latter case, the choice of formulation (oral versus intravenous) could have important clinical implications. We randomized liver transplant patients (n = 60) to standard (10-15 ng/mL) or reduced (5-8 ng/mL) trough levels of tacrolimus plus intravenous MMF followed by oral MMF (1 g twice daily) with corticosteroids. Pharmacokinetic sampling was performed after the last intravenous MMF dose, after the first oral MMF dose, and at selected times over 52 weeks. The efficacy and safety of the 2 regimens were also assessed. Twenty-eight and 27 patients in the tacrolimus standard-dose and reduced-dose groups, respectively, were evaluated. No significant differences between the tacrolimus standard-dose and reduced-dose groups were seen in dose-normalized MPA values of the time to the maximum plasma concentration (1.25 versus 1.28 hours), the maximum plasma concentration (15.5 +/- 7.93 versus 13.6 +/- 7.03 microg/mL), or the area under the concentration-time curve from 0 to 12 hours (AUC(0-12); 53.0 +/- 20.6 versus 43.8 +/- 15.5 microg h/mL) at week 26 or at any other time point. No relationship was observed between the tacrolimus trough or AUC(0-12) and MPA AUC(0-12). Exposure to MPA after oral and intravenous administration was similar. Safety and efficacy were similar in the two treatment groups. In conclusion, exposure to MPA is not a function of exposure to tacrolimus. The similar safety and efficacy seen with MMF plus standard or reduced doses of tacrolimus suggest that MMF could be combined with reduced doses of tacrolimus.
Assuntos
Imunossupressores/farmacocinética , Transplante de Fígado , Ácido Micofenólico/análogos & derivados , Tacrolimo/farmacocinética , Administração Oral , Adulto , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/sangue , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/sangue , Ácido Micofenólico/farmacocinética , Tacrolimo/administração & dosagem , Tacrolimo/sangue , Resultado do TratamentoRESUMO
This open-label, randomized study compared the efficacy of a regimen of corticosteroids and tacrolimus (standard therapy group, n = 79) with a regimen of daclizumab induction therapy in combination with mycophenolate mofetil and tacrolimus (modified therapy group, n = 78) in primary liver transplant recipients. The primary endpoint was biopsy-proven acute rejection (BPAR) at 24 weeks. Secondary endpoints included time to rejection and patient and graft survival. The incidence of BPAR was significantly reduced in the modified therapy group compared to the standard therapy group (11.5% versus 26.6%, respectively, P = 0.017). The time to rejection was significantly shorter in the standard therapy group compared with the modified therapy group (P = 0.044). There was no significant difference between groups in patient or graft survival. Hepatitis C virus-positive patients exhibited no differences from hepatitis C virus-negative patients with respect to the incidence of BPAR. A steroid-sparing regimen of daclizumab, mycophenolate mofetil, and tacrolimus was effective and well tolerated in the prevention of BPAR in adult liver transplant recipients in comparison with a standard regimen of tacrolimus and steroids.
Assuntos
Anticorpos Monoclonais/administração & dosagem , Rejeição de Enxerto/tratamento farmacológico , Imunoglobulina G/administração & dosagem , Imunossupressores/administração & dosagem , Transplante de Fígado , Ácido Micofenólico/análogos & derivados , Esteroides/administração & dosagem , Tacrolimo/administração & dosagem , Doença Aguda , Adolescente , Adulto , Idoso , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Daclizumabe , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Imunoglobulina G/efeitos adversos , Imunossupressores/efeitos adversos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/efeitos adversos , Infecções Oportunistas/epidemiologia , Estudos Prospectivos , Esteroides/efeitos adversos , Tacrolimo/efeitos adversos , Adulto JovemRESUMO
Vitamin E (alpha-tocopherol) has demonstrated antioxidant activity and gene-regulatory properties. d-Galactosamine (D-GalN)-induced cell death is mediated by nitric oxide in hepatocytes, and it is associated with hepatic steatosis. The beneficial properties of alpha-tocopherol and their relation to oxidative stress and gene regulation were assessed in D-GalN-induced cell death. Hepatocytes were isolated from human liver resections by a collagenase perfusion technique. alpha-Tocopherol (50 microM) was administered at the advanced stages (10 h) of D-GalN-induced cell death in cultured hepatocytes. Cell death, oxidative stress, alpha-tocopherol metabolism, and NF-kappaB-, pregnane X receptor (PXR)-, and peroxisome proliferator-activated receptor (PPAR-alpha)-associated gene regulation were estimated in the hepatocytes. D-GalN increased cell death and alpha-tocopherol metabolism. alpha-Tocopherol exerted a moderate beneficial effect against apoptosis and necrosis induced by D-GalN. Induction (rifampicin) or inhibition (ketoconazole) of alpha-tocopherol metabolism and overexpression of PXR showed that the increase in PXR-related CYP3A4 expression caused by alpha-tocopherol enhanced cell death in hepatocytes. Nevertheless, the reduction in NF-kappaB activation and inducible nitric oxide synthase expression and the enhancement of PPAR-alpha and carnitine palmitoyl transferase gene expression by alpha-tocopherol may be relevant for cell survival. In conclusion, the cytoprotective properties of alpha-tocopherol are mostly related to gene regulation rather than to antioxidant activity in toxin-induced cell death in hepatocytes.
Assuntos
Antioxidantes/farmacologia , Apoptose/efeitos dos fármacos , Citoproteção , Expressão Gênica/efeitos dos fármacos , Hepatócitos/efeitos dos fármacos , alfa-Tocoferol/farmacologia , Apoptose/genética , Carnitina O-Palmitoiltransferase/genética , Células Cultivadas , Citocromo P-450 CYP3A , Sistema Enzimático do Citocromo P-450/metabolismo , Galactosamina/antagonistas & inibidores , Galactosamina/toxicidade , Regulação da Expressão Gênica , Hepatócitos/metabolismo , Humanos , NF-kappa B/antagonistas & inibidores , NF-kappa B/metabolismo , Óxido Nítrico Sintase Tipo II/antagonistas & inibidores , Óxido Nítrico Sintase Tipo II/genética , PPAR alfa/metabolismo , Receptor de Pregnano X , Espécies Reativas de Oxigênio/metabolismo , Receptores de Esteroides/metabolismo , alfa-Tocoferol/metabolismoRESUMO
BACKGROUND: Prioritizing the liver transplant waiting list (WL) is subject to great variability. We present the experience of four transplant centers in Andalusia (Southern Spain) with a new consensus model of WL management based on the Model for End-Stage Liver Disease (MELD) score. METHODS: The initial criteria for local prioritizing were: a) cirrhosis with MELD score > or =24, and b) all hepatocellular carcinoma (HCC) admitted to the WL. Fourteen months later new criteria were established: a) cirrhosis with MELD score > or =18, and b) uninodular HCC between 3-5 cm or multinodular HCC (2-3 nodules <3 cm). Access to regional priority was scheduled after three months for patients with cirrhosis or six months for patients with HCC. We analyzed the WL mortality rate, posttransplant survival rate, and overall survival rate over three 14-month periods: A (before implementation of priority criteria), B (initial criteria), and C (current criteria). RESULTS: Priority was given to 36% of recipients in period B and 47% in period C. The WL mortality rate (including removals from WL) was 12.9%, 12.9%, and 10.7% in periods A, B, and C, respectively. One-year graft survival was 79.7%, 72.6%, and 81.2% in the same periods. The overall one-year survival rate for new cases on the WL was 74.9% in period A, 68.6% in period B, and 82.2% in period C. CONCLUSIONS: The allocation system and WL management with the current criteria resulted in lower waiting list mortality without reducing posttransplant survival, leading to better survival for all patients listed.
Assuntos
Falência Hepática/mortalidade , Transplante de Fígado/mortalidade , Doadores de Tecidos/provisão & distribuição , Obtenção de Tecidos e Órgãos/métodos , Listas de Espera , Feminino , Humanos , Falência Hepática/cirurgia , Masculino , Modelos Biológicos , EspanhaRESUMO
The pre-administration of PGE(1) reduced inducible nitric oxide synthase (NOS-2) expression and cell death induced by d-galactosamine (d-GalN) in cultured rat hepatocytes. The present study evaluated the role of nitric oxide (NO) during PGE(1) treatment in fully established d-GalN-induced cytotoxicity in cultured human hepatocytes. Human hepatocytes were isolated from liver resections by classic collagenase perfusion. PGE(1) (1 microM) was administered at 2 h before d-GalN (40 mM), or 2 or 10 h after d-GalN in cultured hepatocytes. The production of NO was inhibited by N-omega-nitroso-l-arginine methyl ester (l-NAME) (0.5 mM). Various parameters related to oxidative and nitrosative stress, mitochondrial dysfunction, NF-kappaB activation, NOS-2 expression and cell death were evaluated in hepatocytes. NO mediated mitochondrial disturbances, nitrosative stress and cell death in d-GalN-treated hepatocytes. The administration of PGE(1) 10 h after d-GalN enhanced NF-kappaB activation, NOS-2 expression and nitrosative stress. Although PGE(1) administered at 2 h before or 2h after d-GalN reduced apoptosis and necrosis, its administration 10 h after d-GalN had no beneficial effect on cell death. In conclusion, the administration of PGE(1) during advanced d-GalN cytotoxicity induced nitrosative stress and lost its cytoprotective properties in cultured human hepatocytes.
Assuntos
Alprostadil/farmacologia , Galactosamina/toxicidade , Hepatócitos/metabolismo , Óxido Nítrico/metabolismo , Morte Celular/efeitos dos fármacos , Células Cultivadas , Indução Enzimática/efeitos dos fármacos , Feminino , Galactosamina/antagonistas & inibidores , Hepatócitos/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Mitocôndrias Hepáticas/efeitos dos fármacos , Mitocôndrias Hepáticas/metabolismo , NF-kappa B/genética , NF-kappa B/metabolismo , NG-Nitroarginina Metil Éster/metabolismo , NG-Nitroarginina Metil Éster/farmacologia , Óxido Nítrico Sintase Tipo II/biossínteseRESUMO
INTRODUCTION: Long-term steroid administration may predispose liver transplant recipients to infectious and metabolic complications. Maintaining effective immunoprophylaxis while minimizing the negative consequences of steroid therapy could be a key factor in improving clinical outcomes. METHODS: Six hundred two patients were randomized to receive tacrolimus (TAC) immunosuppression with a single-steroid bolus and two doses of daclizumab (DAC) or mycophenolate mofetil (MMF). RESULTS: The incidence of biopsy-proven acute rejection was 19.7% in the TAC/DAC group and 16.2% in the TAC/MMF group (ns). Three-month patient and graft survival were similar. Steroid use at month-3 was low at 5.5% in the TAC/DAC group and 3.9% in the TAC/MMF group. Significantly higher incidences of causally related adverse events (AEs) and significantly more dose modifications, interruptions, or discontinuations due to an AE were reported with TAC/MMF. Study withdrawal due to leucopenia was significantly higher with TAC/MMF (0.0% vs. 1.7%. P
Assuntos
Anticorpos Monoclonais/uso terapêutico , Imunoglobulina G/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Fígado/imunologia , Ácido Micofenólico/análogos & derivados , Tacrolimo/uso terapêutico , Sistema ABO de Grupos Sanguíneos , Doença Aguda , Corticosteroides/uso terapêutico , Adulto , Anticorpos Monoclonais Humanizados , Daclizumabe , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Cirrose Hepática/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado/mortalidade , Transplante de Fígado/patologia , Masculino , Ácido Micofenólico/uso terapêutico , Seleção de Pacientes , Análise de Sobrevida , Resultado do TratamentoRESUMO
Hepatic artery aneurisms are infrequent and most are asymptomatic. Clinical presentation is variable but the most frequent form is rupture, complicated by hemoperitoneum and shock. We present the case of a patient who, 2 years after undergoing surgery for a dissecting aortic aneurysm, presented to the emergency room with obstructive jaundice, caused by a hepatic artery aneurism.
Assuntos
Fístula Arteriovenosa/patologia , Artéria Hepática/patologia , Fístula Arteriovenosa/cirurgia , Evolução Fatal , Artéria Hepática/cirurgia , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
Steroid-free immunosuppressive regimens reduce corticosteroid-related side effects in liver transplant recipients although their efficacy is very variable. We evaluated the efficacy and safety of a steroid-free regimen in a 6-month, open-label, multicenter, pilot study, which involved 102 liver transplant patients treated with daclizumab (2 mg/kg within 6 h following transplant and 1 mg/kg on day 7), mycophenolate mofetil (MMF, 1 g b.i.d) and tacrolimus (trough levels of 5-15 ng/ml in the first month and 5-10 ng/ml thereafter). One intra-operative dose of methylprednisolone was administered. At 6 months, the acute rejection rate was 9.8%, and patient and graft survival rates were 96% and 95%, respectively. Acute rejection rates were similar for hepatitis C-positive patients (8.6%) and hepatitis C-negative patients (10.4%). Infections occurred in 22% of patients; most cases were considered mild or moderate. Post-transplantation hypertension and diabetes mellitus developed in 37% and 14% of patients, respectively, during the study period, but were markedly less frequent (8% and 6%, respectively) at 6 months. Hypercholesterolemia was observed in only 2% of patients. In conclusion, the steroid-free immunosuppressive regimen of daclizumab, MMF, and tacrolimus effectively prevents acute rejection after liver transplantation without decreasing safety.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunoglobulina G/uso terapêutico , Terapia de Imunossupressão/métodos , Transplante de Fígado/imunologia , Ácido Micofenólico/análogos & derivados , Tacrolimo/uso terapêutico , Doença Aguda , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Daclizumabe , Feminino , Humanos , Hipertensão/etiologia , Imunoglobulina G/efeitos adversos , Terapia de Imunossupressão/efeitos adversos , Infecções/etiologia , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Ácido Micofenólico/uso terapêutico , Projetos Piloto , Segurança , Tacrolimo/efeitos adversosRESUMO
BACKGROUND: This article describes the presence of antibodies against glutathione S-transferase T1 (GSTT1) in a group of patients who never received a solid organ graft. These antibodies have been previously detected in liver and kidney transplant subjects with donor-recipient mismatch for this enzyme at the genetic level. In liver-grafted subjects, the appearance of these antibodies correlated with de novo immune hepatitis. STUDY DESIGN AND METHODS: To obtain some insights in this phenomenon, the clinical records of these patients were reviewed, and the possible causes leading to the production of these antibodies and possible clinical consequences were analyzed. RESULTS: The clinical situation of these patients was very heterogeneous, but they had in common the need for transfusions or a previous pregnancy. GSTT1 antigen is present in red blood cells, liver, kidney, and other tissues. Because the presence of the GSTT1-null allele in seven of these patients has been demonstrated, it can be hypothesized that both GSTT1-positive transfusions or pregnancy of a GSTT1-positive fetus could induce these antibodies. Because the recipient is allele-null, no adverse effects in the host are expected to occur. The longest follow-up (5 years) shows no antibody-derived diseases. CONCLUSION: It is concluded that anti-GSTT1 can appear in a context different from the previously published alloreactivity after liver and kidney transplantation, as a consequence of transfusions and pregnancies. So far, no adverse clinical outcomes in our patients have been observed.
Assuntos
Transfusão de Eritrócitos , Glutationa Transferase/imunologia , Isoanticorpos/biossíntese , Isoantígenos/imunologia , Transplante Homólogo/imunologia , Adulto , Idoso , Alelos , Feminino , Seguimentos , Glutationa Transferase/genética , Humanos , Isoanticorpos/sangue , Isoanticorpos/imunologia , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Doadores de Tecidos , Resultado do TratamentoRESUMO
BACKGROUND/AIMS: Hepatic injury by d-galactosamine (d-GalN) is a suitable experimental model of hepatocellular injury. The induction of oxidative and nitrosative stress participates during d-GalN-induced cell death in cultured rat hepatocytes. This study aimed to identify protein expression changes during the induction of apoptosis and necrosis by d-GalN in cultured human hepatocytes. METHODS: A proteomic approach was used to identify the proteins involved and those altered by tyrosine nitration. A high dose of d-GalN (40 mM) was used to induce apoptosis and necrosis in primary culture of human hepatocytes. Cellular lysates prepared at different times after addition of d-GalN were separated by two-dimensional electrophoresis. Gel spots with an altered expression and those matching nitrotyrosine-immunopositive proteins were excised and analyzed by mass spectrometry. RESULTS: d-GalN treatment upregulated microsomal cytochrome b5, fatty acid binding protein and manganese superoxide dismutase, and enhanced annexin degradation. d-GalN increased tyrosine nitration of four cytosolic (Hsc70, Hsp70, annexin A4 and carbonyl reductase) and three mitochondrial (glycine amidinotransferase, ATP synthase beta chain, and thiosulfate sulfurtransferase) proteins in human hepatocytes. CONCLUSIONS: The results provide evidences that oxidative stress and nitric oxide-derived reactive oxygen intermediates induce specific alterations in protein expression that may be critical for the induction of apoptosis and necrosis by d-GalN in cultured human hepatocytes.
Assuntos
Apoptose/efeitos dos fármacos , Galactosamina , Hepatócitos/metabolismo , Proteínas/metabolismo , Proteômica , Morte Celular/efeitos dos fármacos , Células Cultivadas , Hepatócitos/efeitos dos fármacos , Humanos , Necrose , Nitratos/metabolismo , Estresse Oxidativo , Tirosina/análogos & derivados , Tirosina/metabolismoRESUMO
Cytomegalovirus (CMV) infection remains an important complication of transplantation. The last decade has been characterized by improvements to management that has reduced its morbidity and mortality. The advance has been particularly important in the diagnosis and prevention. Several techniques have been developed that allow the increasingly rapid and sensitive diagnosis. The different preventive strategies include use of appropriate blood products, immune globulin, and antiviral agents either as prophylaxis or pre-emptive therapy. The development of effective oral drugs as valganciclovir also represents a new advance. It is necessary to summarize these advances to facilitate the development of local policies reflecting recent changes. The Group of Study of Infections in Transplantation (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) has therefore produced actual recommendations in the management of CMV infection after transplantation.
Assuntos
Infecções por Citomegalovirus/prevenção & controle , Transplante de Células-Tronco Hematopoéticas , Hospedeiro Imunocomprometido , Infecções Oportunistas/prevenção & controle , Transplante de Órgãos , Antivirais/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Humanos , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/virologia , Fatores de RiscoRESUMO
A new form of autoimmune hepatitis referred to as de novo, has been reported after liver transplantation during the past 5 years. The features are identical to those of classical autoimmune hepatitis (AIH), but the facts involved in the onset and outcome of this type of graft dysfunction are still unclear. The identification of antibodies directed to glutathione S-transferase T1 (GSTT1) in the sera of patients with de novo immune hepatitis led us to the description of an alloimmune reaction due to a GSTT1 genetic incompatibility between donor and recipient. We analyzed a cohort of 110 liver transplant patients treated in the liver transplant unit of our hospital during a period of 1 year, from September 2002 to October 2003. We found the following distribution of the GSTT1 genotypes (recipient/donor): +/+ = 66, +/- = 23, -/+ = 15, -/- = 6. Six of these patients were diagnosed with de novo immune hepatitis; all of them belong to the group of negative recipients with positive donors, and all produced anti-GSTT1 antibodies. This genetic combination is associated with a statistically significant increased risk of de novo immune hepatitis (IH) in liver transplant patients (P < .0001 by the Fisher exact test). In conclusion, our results clearly establish the importance of the GSTT1 genotype from donor and recipient of a liver transplant as a predictive marker for de novo IH. At the same time, we confirmed our initial results that only this particular donor/recipient combination triggers the anti-GSTT1 antibody production.
Assuntos
Glutationa Transferase/genética , Hepatite Autoimune/genética , Transplante de Fígado/fisiologia , Adolescente , Adulto , Alelos , Autoanticorpos/análise , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Glutationa Transferase/imunologia , Hepatite Autoimune/metabolismo , Humanos , Transplante de Fígado/imunologia , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético/fisiologia , Fatores de RiscoRESUMO
Recipient portal vein thrombosis in liver transplantation is a contingency that increases surgical difficulty as well as patient morbidity and mortality. The aim of this paper is to demonstrate a surgical technique for reconstruction of portal blood flow in emergency situations of portal vein thrombosis with inadequate blood flow and a poor vascular bed for re-vascularization.
Assuntos
Circulação Hepática , Transplante de Fígado/métodos , Veia Porta/cirurgia , Trombose Venosa/cirurgia , Humanos , Veia Ilíaca/transplante , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/cirurgiaRESUMO
OBJECTIVE: To assess the real utility of orthotopic liver transplantation (OLT) in patients with cholangiocarcinoma, we need series with large numbers of cases and long follow-ups. The aim of this paper is to review the Spanish experience in OLT for hilar and peripheral cholangiocarcinoma and to try to identify the prognostic factors that could influence survival. SUMMARY BACKGROUND DATA: Palliative treatment of nondisseminated irresectable cholangiocarcinoma carries a zero 5-year survival rate. The role of OLT in these patients is controversial, due to the fact that the survival rate is lower than with other indications for transplantation and due to the lack of organs. METHODS: We retrospectively reviewed 59 patients undergoing OLT in Spain for cholangiocarcinoma (36 hilar and 23 peripheral) over a period of 13 years. We present the results and prognostic factors that influence survival. RESULTS: The actuarial survival rate for hilar cholangiocarcinoma at 1, 3, and 5 years was 82%, 53%, and 30%, and for peripheral cholangiocarcinoma 77%, 65%, and 42%. The main cause of death, with both types of cholangiocarcinoma, was tumor recurrence (present in 53% and 35% of patients, respectively). Poor prognosis factors were vascular invasion (P < 0.01) and IUAC classification stages III-IVA (P < 0.01) for hilar cholangiocarcinoma and perineural invasion (P < 0.05) and stages III-IVA (P < 0.05) for peripheral cholangiocarcinoma. CONCLUSIONS: OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.
Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Adulto , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/patologia , Colangiocarcinoma/mortalidade , Colangiocarcinoma/secundário , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
Los aneurismas de la arteria hepática son lesiones infrecuentes, la mayoría asintomáticas. Su presentación clínica es variable, aunque la forma más habitual es la rotura aneurismática complicada con hemoperitoneo y shock. Presentamos el caso clínico de un paciente intervenido previamente de un aneurisma disecante de aorta que ingresó de urgencias por un cuadro de ictericia obstructiva, cuya causa fue un aneurisma de la arteria hepática (AU)
Hepatic artery aneurisms are infrequent and most are asymptomatic. Clinical presentation is variable but the most frequent form is rupture, complicated by hemoperitoneum and shock. We present the case of a patient who, 2 years after undergoing surgery for a dissecting aortic aneurysm, presented to the emergency room with obstructive jaundice, caused by a hepatic artery aneurism (AU)
Assuntos
Masculino , Pessoa de Meia-Idade , Humanos , Aneurisma/diagnóstico , Artéria Hepática/fisiopatologia , Aneurisma Aórtico/complicações , Icterícia Obstrutiva/etiologia , Necrose , HepatectomiaRESUMO
La infección por citomegalovirus (CMV) es una complicación importante del trasplante. La última década se ha caracterizado por los avances en su tratamiento, reduciendo su morbilidad y la mortalidad. Estos avances han sido decisivos en el diagnóstico y prevención. Se han desarrollado técnicas de diagnóstico rápidas y sensibles. Entre las estrategias de prevención destaca el uso correcto de los productos sanguíneos, las inmunoglobulinas y los fármacos antivirales, empleados en profilaxis o en terapia anticipada. El reciente desarrollo de fármacos eficaces por vía oral como el valganciclovir permitirá el tratamiento ambulatorio de los pacientes infectados. Es necesario trasladar este conocimiento a la práctica clínica diaria. Con este objetivo el Grupo de Estudio de la Infección en el Trasplante (GESITRA) de la Sociedad Española de Microbiología Clínica y Enfermedades Infecciosas (SEIMC) ha desarrollado este documento de consenso que incluye las últimas recomendaciones en el tratamiento de la infección por CMV postrasplante (AU)
Cytomegalovirus (CMV) infection remains an important complication of transplantation. The last decade has been characterized by improvements to management that has reduced its morbidity and mortality. The advance has been particularly important in the diagnosis and prevention. Several techniques have been developed that allow the increasingly rapid and sensitive diagnosis. The different preventive strategies include use of appropriate blood products, immune globulin, and antiviral agents either as prophylaxis or pre-emptive therapy. The development of effective oral drugs as valganciclovir also represents a new advance. It is necessary to summarize these advances to facilitate the development of local policies reflecting recent changes. The Group of Study of Infections in Transplantation (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) has therefore produced actual recommendations in the management of CMV infection after transplantation (AU)