RESUMO
El objetivo del presente trabajo ha sido evaluar la incidencia y las características clínicas de los tumores aparecidos de novo en los pacientes sometidos a trasplante hepático, como así también su supervivencia. Para ello, analizamos en forma retrospectiva los 168 trasplantes hepáticos realizados en 159 pacientes adultos en el período mayo 2006 hasta mayo 2014, encontrando una incidencia de neoplasia de novo de 7.5% (n = 12). La edad media en el momento del diagnóstico fue de 63 ± 7 años. Las neoplasias más frecuentes fueron las de piel no melanoma y adenocarcinomas. El 50% de las neoplasias se desarrollaron en el segundo y tercer año postrasplante. El tipo de inmunosupresión no influyó en el tipo de tumor; sin embargo, debemos destacar que la mayor parte de los pacientes recibieron tacrolimus, micofenolato y/o corticoides. El tiempo medio de seguimiento tras el diagnóstico del tumor fue 25 ± 29 meses (0-76), y la tasa de mortalidad fue de un 41% (5/12 pacientes IC95%,15-72).La supervivencia global luego del trasplante a 1 y 5 años, calculada por análisis de Kaplan-Meier, fue de 83 y 55%, respectivamente. Los tumores de novo son frecuentes luego del trasplante hepático y presentan un patrón evolutivo diferente al de la población general. Teniendo en cuenta esta evolución más agresiva, es fundamental el seguimiento periódico en estos pacientes para realizar un diagnóstico lo más precoz posible.
The aim of the present study was to evaluate the incidence and clinical features of de novo tumors in patients undergoing liver transplantation in our center as well as to assess survival. We retrospectively analyzed 168 liver transplantations (159 patients) performed from May 2006 to May 2014. The incidence of de novo tumors was 7.5% (n = 12). The mean age at diagnosis was 63 ± 7 years. The most frequent neoplasms were non melanoma skin tumors and adenocarcinomas. Fifty percent of the tumors developed in the second and third year after transplantation. Type of immunosuppression did not influence tumoral type, although most patients receive tacrolimus in combination with mycofenolate and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 25 ± 29 months (range 0-76) and the mortality was 41%. The actuarial probability of survival at 1 and 5 years was 83 and 55%, respectively. De novo tumors are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow up of these patients is essential for early diagnosis.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/epidemiologia , Neoplasias do Colo/epidemiologia , Transplante de Fígado/efeitos adversos , Neoplasias da Próstata/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adenocarcinoma/etiologia , Argentina/epidemiologia , Combinação de Medicamentos , Incidência , Imunossupressores/efeitos adversos , Transplante de Fígado/mortalidade , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias Cutâneas/etiologiaRESUMO
The present study reports the effectiveness of the association of a single dose of hepatitis B immunoglobulin (HBIg) associated to entecavir in the prophylaxis of hepatitis B in patients who have undergone liver transplantation. Six patients that had been transplanted because of hepatitis B liver disease were retrospectively evaluated. Three of them developed non-oncological complications related to liver cirrhosis, two had hepatocellular carcinoma and another one had fulminant HBV hepatitis. The mean follow-up was 22 months (range: 7-52 months). The 6 patients received entecavir as prophylactic treatment before transplantation. The pretransplant viral load was undetectable in all patients. HBsAg seroconversion was observed in four of the six patients. Three patients died during follow-up, two because of recurrent hepatocellular carcinoma, none of them had detectable HBV serum viral load. In a small series of patients we could demonstrate that a regimen with a single dose of gamma globulin entecavir is effective in the post-transplant management of patients with liver disease associated with HBV. Future studies will be able to demonstrate the effectiveness of specific gamma globulin-free regimens.
Assuntos
Antivirais/administração & dosagem , Cirrose Hepática/cirurgia , Guanina/análogos & derivados , Hepatite B/prevenção & controle , Imunoglobulinas/administração & dosagem , Transplante de Fígado , Adulto , Argentina , Cirrose Hepática/virologia , Estudos Retrospectivos , Feminino , Guanina/administração & dosagem , Humanos , Idoso , Masculino , Pessoa de Meia-Idade , Prevenção Secundária , Quimioterapia CombinadaRESUMO
UNLABELLED: After the introduction of high active antiretroviral therapy (HAART), the human immunodeficiency virus (HIV) was no longer considered a contraindication for transplantation. Yet, liver disease in this population is characterized by an accelerated course that may impact on the waiting list. OBJECTIVE: To evaluate the experience in Argentina with HIV positive patients listed for liver transplantation. PATIENTS AND METHODS: We analyzed 52 HIV positive patients listed between July 2005 and March 2010 (Group HIV positive). Results were compared with 462 HIV negative patients included during the same period (Group HIV negative). Data were obtained from INCUCAI, the Argentinian procurement organism and from the Transplantation Centers. RESULTS: The etiology of liver disease in the Group HIV positive was hepatitis C 40, HBV 3, fulminant hepatitis 3, alcohol 2, retrasplant 2 and others 2. The mean MELD at the time of listing was 1615 (lower than 19 in 40 cases, higher than 19 in 8, emergency in 3) in the group HIV positive and 16.64 in the group HIV negative (NS). The outcome in the waiting list for HIV positive and negative patients respectively was: death 14 (27
) (NS), mean time from listing to death 270.70 298.11 days vs 267.29 266.53 days (NS), mean time from listing to transplant 70.26 74.05 vs 261 187.6 days (P < 0.01), mean MELD at the time of death 12.54 (13 cases lower than 15, 1 higher than 19) vs 19.6 9.7 (P < 0.05), mean MELD at the time of transplantation 24.33 vs 24.1 7.6 (NS). CONCLUSION: HIV positive patients have high mortality in the waiting list and low access to liver transplantation. MELD score underscores the severity of liver disease in this population when compared to HIV negative patients.