ABSTRACT
A great amount of information is available to be exploited thanks to the use of information technologies. However, the systems that analyze this data lack the ability to alert the right clinical staff to important events, having some of the latest developments centered on the possibility of sending events from specific areas. The following system tries to solve these dependencies and offers a unique system capable of analyzing any data source and communicates the alarms through different means in an effective way.
Subject(s)
Clinical Alarms , Hospital Information Systems/organization & administration , Sentinel Surveillance , HumansABSTRACT
BACKGROUND: There are unresolved issues regarding the security of liver transplantation with non-heart-beating donors (NHBDs). Recently, an increased incidence of biliary complications, mainly intrahepatic ischemic-type biliary strictures, has been described after controlled NHBDs. METHODS: We studied the incidence and risk factors for biliary complications among uncontrolled NHBDs recipients compared with a large population of HBD recipients. RESULTS: Overall, 16.8% of patients in the HBD group and 41.7% of patients in the NHBD group suffered any type of biliary complication (P=0.66). However, the incidence of nonanastomotic biliary strictures was significantly greater in the NHBD group (P<0.001). Multivariate analysis showed that independent risk factors for nonanastomotic strictures were hepatic artery thrombosis (relative risk; 98.7) and receiving a liver from a NHBD (relative risk; 47.1). CONCLUSIONS: If this type of donors is accepted as a source of liver organs, the high incidence of biliary complications should be considered and efforts should be made to decrease ischemic injury.
Subject(s)
Cholestasis, Intrahepatic/etiology , Heart Arrest , Liver Transplantation/adverse effects , Tissue Donors , Tissue and Organ Procurement/classification , Adult , Aged , Graft Survival , Humans , Incidence , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk FactorsABSTRACT
The involvement of the human leukocyte antigen (HLA) in liver graft acceptance is controversial, but the frequency of acute rejection (AR) remains high in spite of the use of the modern immunosuppressive agents. The present study was aimed at determining whether an association exists between liver recipient HLA-C polymorphism and AR development that could influence graft acceptance. Four hundred and forty-six liver recipients and 473 controls were studied within the framework of a collaborative study carried out by the Spanish Transplant Immunotolerance Group (RED-GIT). HLA-A and -B were typed by the standard microlymphocytotoxicity technique, and HLA-C by polymerase chain reaction-sequence-specific oligonucleotide probes (PCR-SSOP). A statistically significant decrease in the HLA-Cw*07 allele frequency was found in liver recipients suffering AR episodes compared to those without AR (NAR). Studies regarding the possible influence of the Asn80 and Lys80 epitopes showed that the Asn80 epitope also could be associated with AR. However, further analysis considering Asn80 alleles others than HLA-Cw*07, confirmed that the apparent protective effect of the Asn80 epitope was actually from the HLA-Cw*07 allele. In conclusion, the HLA-Cw*07 allele carried by the liver recipient is negatively associated with AR development, and could be considered a predictive factor for liver graft acceptance.
Subject(s)
Graft Rejection/immunology , Graft Rejection/prevention & control , HLA-C Antigens/administration & dosage , HLA-C Antigens/genetics , Liver Transplantation/immunology , Acute Disease , Alleles , Female , Graft Rejection/genetics , HLA-C Antigens/physiology , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective StudiesABSTRACT
BACKGROUND: 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. METHODS: The outcome of 20 liver transplants from Maastricht category 2 NHBDs is compared with 40 liver transplants from heart-beating donors (HBDs). After unsuccessful cardiopulmonary resuscitation (CPR), cardiopulmonary support (CPS) with simultaneous application of chest and abdominal compression (n=6), and cardiopulmonary bypass (CPB; n=14), which was hypothermic (n=7) or normothermic (n=7), were used to preserve the organs from NHBDs. Factors that may influence the outcome of livers from Maastricht category 2 NHBDs were also investigated. RESULTS: With a minimum follow-up of 2 years, actuarial patient and graft survivals with livers from Maastricht category 2 NHBDs 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 livers from HBDs. Graft survival was 83% in livers from NHBDs preserved with CPS and 42% in those maintained with CPB. No graft failed if the duration of warm ischemia did not exceed 130 min with CPR or CPS, and if the period of CPB did not surpass 150 min when this method was used after CPR, regardless if it was hypothermic or normothermic. CONCLUSION: Livers from Maastricht type 2 NHBDs may be used for transplantation if the period of warm ischemia during CPR or CPS does not exceed 130 min. Hypothermic or normothermic CPB after CPR preserves liver viability for an additional 150 min.
Subject(s)
Heart Arrest , Liver Transplantation , Tissue Donors , Adult , Aged , Cryopreservation , Follow-Up Studies , Graft Survival , Hot Temperature , Humans , Liver Transplantation/adverse effects , Middle Aged , Myocardial Contraction , Preservation, Biological , Survival Analysis , Time FactorsABSTRACT
Rituximab, a monoclonal antibody directed against the B-cell specific CD20 antigen has been used with success in post-transplant lymphoproliferative disorder (PTLD) of B-cell phenotype. However, the use of such drug in children with liver transplantation and PTLD is very limited. We report a 2-yr-old liver transplant recipient with monomorphic non-Hodgkin lymphoma of B-cell origin. The lymphoma did not respond to immunosuppression withdrawal, with a subsequent allograft rejection. Despite resumption of immunosuppression and rejection treatment, the lymphoma was successfully treated with rituximab.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Liver Transplantation , Lymphoma, B-Cell/drug therapy , Antibodies, Monoclonal, Murine-Derived , Female , Humans , Infant , RituximabSubject(s)
Adrenal Gland Neoplasms/metabolism , Adrenocorticotropic Hormone/metabolism , Hormones, Ectopic/metabolism , Pheochromocytoma/metabolism , ACTH Syndrome, Ectopic/diagnosis , ACTH Syndrome, Ectopic/etiology , Adrenal Gland Neoplasms/pathology , Cushing Syndrome/diagnosis , Cushing Syndrome/etiology , Female , Humans , Middle Aged , Pheochromocytoma/pathologyABSTRACT
In recent years, portal arterialization has been used in liver transplantation to increase the portal flow, as a solution for singular technical problems. We have developed a new auxiliary liver transplantation model in the rat with portal arterialization, so the native hepatic hilium remains untouched, consisting on a graft with a previous 70% hepatectomy. It is sited on the right renal bed, joining the infrahepatic inferior vena cava (IVC) of the graft with the recipient IVC. With an abdominal aortic graft, we connect the recipient aorta with the portal vein from the auxiliary liver. All the animals survived at the seventh day. No thrombosis was seen in any graft and an important rejection was observed in all the fields. We have developed a new experimental model of an auxiliary liver with portal arterialization, avoiding the utilisation of the native hepatic hilium, necessary for the possible recovering of the proper liver in the case of a reversible fulminant hepatitis.
