Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Idoso , Feminino , Fluordesoxiglucose F18/administração & dosagem , Fluordesoxiglucose F18/farmacocinética , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Prognóstico , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/farmacocinética , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Carga TumoralRESUMO
This prospective, comparative trial investigated the impact on mean change in height standard deviation score (SDS), acute rejection rate, and renal function of early steroid withdrawal in 96 recipients with 5 years of follow-up. Recipients under basiliximab induction and steroid withdrawal (SW: TAC/MMF; n = 55) were compared with a matched steroid control group (SC: TAC/MMF/STEROID, n = 41). SW received steroids until Day 6, SC decreased to 10 mg/m(2) within 2 months post-transplant. Five years after SW, the longitudinal growth (SDS) gain was 1.4 ± 0.4 vs. 1.1 ± 0.3 for SC group (p < 0.02). Height benefits in prepubertal and pubertal status in both groups were demonstrated in the delta growth trends (mixed model; p < 0.01). Biopsy-proven acute rejection in SW was 11% and 17.5%, SC (p: ns). Mean eGFR (ml/min/1.73 m(2)) at 5 years post-transplant was SW 80.6 ± 27.8 vs. 82.6 ± 25.1 for SC (p: ns). The death-censored graft survival rate at 1 and 5 years was 99 and 90% for SW; 98 and 96% for SC (p = ns). PTLD incidence in SW 3.3 vs. 2.5% in SC (p: ns). Five years post-transplant, early steroid withdrawal showed positive impacts on growth, stable renal function without increased acute rejection risk, and PTLD incidence.
Assuntos
Corticosteroides/administração & dosagem , Estatura , Rejeição de Enxerto/epidemiologia , Imunossupressores/administração & dosagem , Transplante de Rim , Adolescente , Anticorpos Monoclonais/administração & dosagem , Basiliximab , Estatura/efeitos dos fármacos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Proteínas Recombinantes de Fusão/administração & dosagemRESUMO
BACKGROUND: Simultaneous kidney and pancreas transplantation (SKPT) is the best alternative for end stage renal disease among patients with insulin dependent diabetes mellitus. AIM: To report our experience with SKPT. MATERIAL AND METHODS: Retrospective analysis of 12 recipients of SKPT transplanted in one center starting in 1994, with a mean follow-up period of 6.8 years (2-15). RESULTS: Eleven of 12 recipients were in chronic hemodialysis before SKPT. Mean A, B, DR and HLA mismatch was 4.3. Mean preformed anti HLA antibodies was 3.3 %. Mean cold ischemia times for pancreas and kidney were 6 and 10 hours, respectively. In the first eight cases, the pancreas was drained to the bladder, and in the last four, an enteric drainage was performed. Eleven recipients were induced with antibodies, and maintenance immunosuppression consisted of cyclosporin or tacrolimus plus an antiproliferative agent. Ten year patient survival was 70%. Pancreas and kidney survival, defined by insulin and dialysis independence, were 72 and 73% respectively. Fifty percent of recipients experienced acute graft rejection (cellular or humoral), with good response to treatment except in one case. CONCLUSIONS: This experience shows that SKPT is associated with an excellent patient survival associated to insulin and dialysis independence in 70% of patients at 10 years.
Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Falência Renal Crônica/cirurgia , Transplante de Rim/mortalidade , Transplante de Pâncreas/mortalidade , Adulto , Chile , Diabetes Mellitus Tipo 1/fisiopatologia , Métodos Epidemiológicos , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Transplante de Pâncreas/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: The mechanism leading to the development of metabolic complications in obese individuals is not fully understood. Thus, the objective of this study was to examine differences in insulin resistance, inflammation, cytokine and adipokine levels, and expression of selected genes across obese individuals with different number of metabolic syndrome (MetS) components. METHODS: Forty obese individuals who underwent bariatric surgery, divided in three groups based on the number of components of MetS, in addition to abdominal obesity (0, 1, and 2-3 additional components), were studied. Levels of inflammatory proteins, insulin resistance, cytokines, adipokines, and gene expression in subcutaneous (SAT) and visceral adipose tissue (VAT) were compared. RESULTS: There was a significantly higher expression of MYD88 in SAT among those with more components of MetS (P = 0.008). In SAT, but not in VAT, MYD88 expression was significantly correlated with toll-like receptor 4 expression (r = 0.7, P < 0.05). Expression of adipsin in SAT was also associated with the presence of more components of MetS, but with borderline statistical significance (P = 0.05). There were no significant differences in insulin resistance, inflammation, and cytokine and adipokine levels by the number of components of MetS. CONCLUSIONS: Our study suggests that MYD88 expression in SAT of obese subjects could be associated with the development of components of MetS.
Assuntos
Tecido Adiposo/metabolismo , Síndrome Metabólica/genética , Fator 88 de Diferenciação Mieloide/genética , Obesidade Abdominal/genética , Tecido Adiposo/patologia , Adulto , Feminino , Expressão Gênica , Predisposição Genética para Doença , Humanos , Gordura Intra-Abdominal/metabolismo , Gordura Intra-Abdominal/patologia , Masculino , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Fator 88 de Diferenciação Mieloide/metabolismo , Obesidade Abdominal/metabolismo , Obesidade Abdominal/patologia , Fatores de Risco , Gordura Subcutânea/metabolismo , Gordura Subcutânea/patologiaRESUMO
BACKGROUND: Recent interest in cyst fluid analysis (CFA) for carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA), and the introduction of laparoscopic surgery (LS) in the management of hepatic cysts have resulted in sporadic reports of elevated CA 19-9 and CEA levels in intrahepatic biliary cystadenoma (IBC) CFA, and the application of LS in the management of simple cysts. However, the role of CA 19-9 and CEA in the diagnosis of IBC and the role of LS in the management of IBC have not been previously defined. METHODS: We studied 34 patients with IBC at a single institution (8 years). The first 12 patients with IBC were managed with open surgical intervention. We subsequently developed a diagnostic and treatment algorithm for IBC that included, in the last 22 patients, prospective analysis of CFA for CA 19-9 and CEA, and LS for management RESULTS: All patients with IBC who underwent CFA had elevated CA 19-9 (range, 2247-1,757,510; N <33 U/mL) and mildly elevated CEA (range, 3.3-212,; N <3 ng/ml). In all 22 patients the cyst lining consisted of biliary epithelium +/- mesenchymal stroma (MS). In 1/22 patients (highest CA 19-9 level), the cyst epithelium did not contain either MS or intestinal metaplasia. In contrast, control patients (simple cysts, n=8) had normal CFA. In the previous 12 patients managed with laparotomy, 6/12 patients had biliary epithelium alone; the other 6 also contained MS with 1 patient exhibiting intestinal metaplasia and cystadenocarcinoma. CONCLUSIONS: We have proposed a management algorithm for IBC that incorporates CFA and laproscopic surgical management that allows for selective minimally invasive cyst wall sampling for patients with IBC.
Assuntos
Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Colestase Intra-Hepática/patologia , Colestase Intra-Hepática/cirurgia , Cistadenoma/patologia , Cistadenoma/cirurgia , Algoritmos , Antígeno CA-19-9/análise , Antígeno Carcinoembrionário/análise , Estudos de Coortes , Citodiagnóstico , Exsudatos e Transudatos/citologia , Humanos , Laparoscopia/métodos , Estudos Prospectivos , Estudos RetrospectivosRESUMO
Background: Pancreatic cancer is the tenth most prevalent cancer in world, and represents the fourth cause of cancer death. It has a five year-survival of 5%. Aim: To assess the prognostic value of PET/CT in pancreatic cancer. Material and Methods: Sixty-nine patients with pancreatic adenocarcinoma who underwent staging 18F-fluorodeoxyglucose (FDG) PET/CT between December 2008 and July 2016 were selected. Gender, age, body-mass index, laboratory tests (Ca 19-9, hemoglobin, erythrocyte sedimentation rate, liver enzymes, lactate dehydrogenase), histological differentiation of tumor, American Joint Committee on Cancer (AJCC) stage, size and 18F-FDG uptake (maximal stan-dardized uptake value [SUVmax]) of the primary tumor, nodal involvement and distant metastasis detected by PET/CT were registered. Survival was assessed using Kaplan-Meier curves, Log Rank test and Cox multivariable analysis. Results: Mortality was 66.7%, during a mean observation time of 18 months (range 20 days-66 months). Curative surgery, lack of metastases detected by PET/CT, histologically well differentiated tumors, and SUVmax ≤ 4.3 were significantly associated with a better specific survival, determined by the Log Rank test. Histological differentiation was the only variable that had a statistically significant prognostic value in the multivariable analysis. Conclusions: The detection of distant metastases and the intensity of primary tumor 18F-FDG uptake during PET/CT provide useful prognostic information in pancreatic cancer patients.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Pancreáticas/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Prognóstico , Fatores de Tempo , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Análise de Sobrevida , Estudos Retrospectivos , Seguimentos , Compostos Radiofarmacêuticos/administração & dosagem , Compostos Radiofarmacêuticos/farmacocinética , Fluordesoxiglucose F18/administração & dosagem , Fluordesoxiglucose F18/farmacocinética , Carga Tumoral , Gradação de Tumores , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodosRESUMO
We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accommodation opens the possibility of using ABO-incompatible organs as a definitive grafts.
Assuntos
Sistema ABO de Grupos Sanguíneos/imunologia , Incompatibilidade de Grupos Sanguíneos/imunologia , Sobrevivência de Enxerto/imunologia , Falência Hepática Aguda/sangue , Transplante de Fígado , Adulto , Feminino , Humanos , Falência Hepática Aguda/cirurgia , Transplante de Fígado/imunologia , Transplante de Fígado/métodos , Resultado do TratamentoRESUMO
Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.
Assuntos
Veias Hepáticas/cirurgia , Hiperbilirrubinemia/cirurgia , Transplante de Fígado/efeitos adversos , Anastomose Cirúrgica/métodos , Veias Hepáticas/fisiopatologia , Humanos , Hiperbilirrubinemia/etiologia , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , SíndromeRESUMO
Liver transplantation is an excellent therapeutic option for terminal liver disease. During the last decades the results of liver transplantation have improved significantly with a patient survival rate of nearly 90% at one year and 80% at 5 years of follow-up. The main indications for liver transplantation include: end-stage liver disease associated to cirrhosis, acute liver failure, and hepatic tumors (mainly hepatocarcinoma). The absolute contraindications for a transplant are less frequent than in the past, and include: severe co-morbidity (cardiac or pulmonary), sepsis, advanced HIV disease and extra-hepatic malignancy. This document presents a Consensus of the main groups performing liver transplantation in Chile, about its indications and contraindications. It also reviews general aspects of liver transplantation, including the selection and referral of liver transplant candidates, allocation of organs and the evaluation of severity of liver disease.
Assuntos
Carcinoma Hepatocelular/cirurgia , Cirrose Hepática/cirurgia , Falência Hepática Aguda/cirurgia , Neoplasias Hepáticas/cirurgia , Transplante de Fígado , Chile , Doença Crônica , Contraindicações , Seleção do Doador , Acessibilidade aos Serviços de Saúde , Humanos , Transplante de Fígado/mortalidade , Transplante de Fígado/patologia , Seleção de Pacientes , Reoperação , Índice de Gravidade de Doença , Taxa de Sobrevida , Listas de EsperaRESUMO
Steroids have been a cornerstone in renal transplant immunosuppression. New immunosuppressive drugs have led to protocols using early steroid withdrawal or complete avoidance. A prospective protocol in 23 pediatric renal transplant (ages 2-14 yr) who received decreasing steroid doses stopping at day 7 post-Tx, FK, and MMF were compared with a CsA, AZT, historically matched steroid-based control group. Basiliximab was used in two doses. Anthropometric, biochemical variables, AR rates, and CMV infection were evaluated and compared using Student's t-test and regression analysis. A better growth pattern was seen in steroid withdrawal group. GFR rate and serum glucose were similar in both groups. Total serum cholesterol levels were significantly lower in steroid withdrawal group. The incidence of AR at 12 months was 4.3% in steroid withdrawal group vs. 8.6% in steroid-based group (p = ns). No difference in CMV infection was observed. Hemoglobin levels were low during the first months in both groups; reached normal values after six months. SBP became higher at 12 months in steroid-based group. Patient and graft survival was 98% in both groups at one-yr post-transplant. Early steroid withdrawal was efficacious, safe, and did not increase risk of rejection, preserving optimal growth, renal function, and reducing cardiovascular risk factors.
Assuntos
Corticosteroides/uso terapêutico , Esquema de Medicação , Imunossupressores/uso terapêutico , Transplante de Rim/imunologia , Adolescente , Corticosteroides/administração & dosagem , Anticorpos Monoclonais/uso terapêutico , Basiliximab , Criança , Pré-Escolar , Rejeição de Enxerto/epidemiologia , Humanos , Estudos Prospectivos , Puberdade , Proteínas Recombinantes de Fusão/uso terapêutico , Fatores de Tempo , Resultado do TratamentoRESUMO
Background: Simultaneous kidney and páncreas transplantation (SKPT) is the best alternative for end stage renal disease among patients with insulin dependent diabetes mellitus. Aim: To report our experience with SKPT. Material andMethods: Retrospective analysis ofl2 recipients of SKPT transplanted in one center starting in 1994, with a meanfollow-upperiod of6.8years (2-15). Results: Eleven ofl2 recipients were in chronic hemodialysis before SKPT. Mean A, B, DR and HLA mismatch was 4.3. Mean preformed anti HLA antibodies was 3.3 percent. Mean cold ischemia times for páncreas and kidney were 6 and 10 hours, respectively. In the first eight cases, the páncreas was drained to the bladder, and in the last four, an enteric drainage was performed. Eleven recipients were induced with antibodies, and maintenance immunosuppression consisted ofCyclosporine or Tacrolimusplus an antiproliferative agent. Ten year patient survival was 70 percent. Páncreas and kidney survival, defined by insulin and dialysis independence, were 72 and 73 percent respectively. Fifty percent of recipients experienced acute graft rejection (cellular or humoral), with good response to treatment except in one case. Conclusions: This experience shows that SKPT is associated with an excellent patient survival associated to insulin and dialysis independence in 70 percent of patients at 10 years.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 1/cirurgia , Falência Renal Crônica/cirurgia , Transplante de Rim/mortalidade , Transplante de Pâncreas/mortalidade , Chile , Diabetes Mellitus Tipo 1/fisiopatologia , Métodos Epidemiológicos , Falência Renal Crônica/fisiopatologia , Transplante de Rim/efeitos adversos , Transplante de Pâncreas/efeitos adversos , Resultado do TratamentoRESUMO
We report a girl with a chronic hepatitis caused by C virus diagnosed at the age of nine, unsuccessfully treated with interferon and ribavirine. Two years later, she was subjected to a liver transplantation. She maintained elevated viral loads with a normal pathological study of the liver until 22 months after transplantation. She was treated again with combined antiviral therapy, for 6 months, without response and experienced a progressive deterioration liver function, dying three years after transplantation.
Assuntos
Hepatite C Crônica/complicações , Cirrose Hepática/virologia , Transplante de Fígado , Antivirais/uso terapêutico , Criança , Quimioterapia Combinada , Evolução Fatal , Feminino , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/patologia , Humanos , Interferons/uso terapêutico , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/patologia , Ribavirina/uso terapêutico , Carga ViralRESUMO
Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the "small-for-size syndrome" one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Veias Hepáticas/cirurgia , Hiperbilirrubinemia/cirurgia , Transplante de Fígado/efeitos adversos , Anastomose Cirúrgica/métodos , Veias Hepáticas/fisiopatologia , Hiperbilirrubinemia/etiologia , Transplante de Fígado/métodos , Fluxo Sanguíneo Regional/fisiologia , SíndromeRESUMO
We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accomodation opens the possibility of using ABO-incompatible organs as a definitive grafts.
Assuntos
Adulto , Feminino , Humanos , Sistema ABO de Grupos Sanguíneos/imunologia , Incompatibilidade de Grupos Sanguíneos/imunologia , Sobrevivência de Enxerto/imunologia , Falência Hepática Aguda/sangue , Transplante de Fígado , Falência Hepática Aguda/cirurgia , Transplante de Fígado/imunologia , Transplante de Fígado/métodos , Resultado do TratamentoRESUMO
Liver transplantation is an excellent therapeutic option for terminal liver disease. During the last decades the results of liver transplantation have improved significantly with a patient survival rate of nearly 90 percent at one year and 80 percent at 5 years of follow-up. The main indications for liver transplantation include: end-stage liver disease associated to cirrhosis, acute liver failure, and hepatic tumors (mainly hepatocarcinoma). The absolute contraindications for a transplant are less frequent than in the past, and include: severe co-morbidity (cardiac or pulmonary), sepsis, advanced HIV disease and extra-hepatic malignancy. This document presents a Consensus of the main groups performing liver transplantation in Chile, about its indications and contraindications. It also reviews general aspects of liver transplantation, including the selection and referral of liver transplant candidates, allocation of organs and the evaluation of severity of liver disease.