Subject(s)
Liver Transplantation , Warm Ischemia , Bile Ducts , Death , Humans , Thrombolytic Therapy , Tissue DonorsABSTRACT
Donation after circulatory death (DCD) liver transplantation (LT) reportedly yields inferior survival and increased complication rates compared with donation after brain death (DBD). We compare 100 consecutive DCD LT using a protocol that includes thrombolytic therapy (late DCD group) to an historical DCD group (early DCD group n = 38) and a cohort of DBD LT recipients (DBD group n = 435). Late DCD LT recipients had better 1- and 3-year graft survival rates than early DCD LT recipients (92% vs. 76.3%, p = 0.03 and 91.4% vs. 73.7%, p = 0.01). Late DCD graft survival rates were comparable to those of the DBD group (92% vs. 93.3%, p = 0.24 and 91.4% vs. 88.2%, p = 0.62). Re-transplantation occurred in 18.4% versus 1% for the early and late DCD groups, respectively (p = 0.001). Patient survival was similar in all three groups. Ischemic-type biliary lesions (ITBL) occurred in 5%, 3%, and 0.2% for early DCD, late DCD, and DBD groups, respectively, but unlike in the early DCD group, in the late DCD group ITBL was endoscopically managed and resolved in each case. Using a protocol that includes a thrombolytic therapy, DCD LT yielded patient and graft survival rates comparable to DBD LT.
Subject(s)
Bile Duct Diseases/etiology , Donor Selection , Liver Transplantation/adverse effects , Thrombolytic Therapy , Tissue Donors , Tissue and Organ Procurement/methods , Vascular Diseases/etiology , Adult , Aged , Death , Female , Follow-Up Studies , Graft Rejection/etiology , Graft Survival , Humans , Male , Middle Aged , Postoperative Complications , Prognosis , Retrospective Studies , Risk Factors , Survival Rate , Young AdultSubject(s)
Calciphylaxis/diagnosis , Kidney Transplantation , Liver Transplantation , Female , Humans , Male , Middle AgedABSTRACT
UNLABELLED: Survival outcomes for liver retransplantation (LRTx) after graft loss in HCV patients (HCV-LRTx) are generally considered inferior to those after non-HCV-LRTx. Between January 1, 2005 and June 30, 2011, our center performed 663 LTx, including 116 (17.5%) LRTx, 41 (35.3%) of which were more than 90 d after the LTx. Twenty-nine (70.7%) LRTx were performed in HCV antibody-positive individuals. We compared patient demographics, baseline characteristics and outcomes of our HCV-LRTx group with the HCV-LRTx patients from the most recent OPTN database covering the same time period. Our Kaplan-Meier HCV-LRTx one-, three-, and five-yr HCV-LRTx patient survival rates were 86.2%, 79.0%, and 72.4%, respectively compared with the OPTN one-, three-, and five-yr HCV-LRTx survival rates of 73.3%, 59.0%, and 51.3% respectively. Likewise, our graft survival rates were higher than OPTN rates at all time points studied. We performed a higher percentage of HCV-LRTx as simultaneous liver/kidney transplants (SLK) (37.9% vs. 21.8%) and recorded shorter warm (30 ± 4 vs. 45 ± 23 min) and cold ischemic times (5:44 ± 1:53 vs. 7:36 ± 3:12 h:min). CONCLUSION: In our experience, HCV-LRTx patient and graft survival rates are comparable to LTx survival rates and are higher than the rates described by OPTN.
Subject(s)
Hepacivirus/pathogenicity , Hepatitis C/surgery , Liver Failure/virology , Liver Transplantation/mortality , Postoperative Complications , Reoperation , Adult , Aged , Female , Follow-Up Studies , Graft Rejection/etiology , Graft Rejection/prevention & control , Graft Survival , Hepatitis C/etiology , Hepatitis C/mortality , Humans , Liver Failure/complications , Liver Failure/surgery , Male , Middle Aged , Prognosis , Retrospective Studies , Survival RateSubject(s)
Laparoscopy/methods , Living Donors , Nephrectomy/methods , Obesity, Morbid/surgery , Body Mass Index , Female , Humans , Male , Retrospective StudiesABSTRACT
BACKGROUND: Solitary pancreas transplants, both pancreas transplant alone (PTA) and pancreas after kidney (PAK), have higher rejection rates and lower graft survivals than simultaneous pancreas-kidney transplants (SPK). The aim of this study is to compare three different antibody induction regimens in solitary pancreas transplant recipients and to assess the role of surveillance pancreas biopsies in the management of these patients. METHODS: Solitary pancreas transplant recipients between 01/98 to 02/00 (n=29) received induction with either daclizumab (1 mg/kg on day 0, 7, 14), OKT 3 (5 mg/day x0-7), or thymoglobulin (1.5 mg/kg/day x0-10). Maintenance immunosuppression was similar for the three groups. All rejections were biopsy-proven either by surveillance/protocol or when clinically indicated. RESULTS: The 1-year graft survival was 89.3% overall and 91.7% in the thymoglobulin group. Thymoglobulin significantly decreased rejection in the first 6 months when compared with OKT3 or daclizumab (7.7 vs. 60 vs. 50%). Acute rejections were seen on surveillance biopsies in the absence of biochemical abnormalities in 40% of patients. CONCLUSIONS: Thymoglobulin induction regimen led to a low incidence of acute rejection and a high rate of graft survival in solitary pancreas transplants. In addition, surveillance biopsies were useful in the detection of early acute rejection in the absence of biochemical abnormalities.
Subject(s)
Antilymphocyte Serum/therapeutic use , Graft Rejection/prevention & control , Immunosuppressive Agents/therapeutic use , Pancreas Transplantation/immunology , Adult , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized , Biopsy , Daclizumab , Female , Graft Survival , Humans , Immunoglobulin G/therapeutic use , Kidney Transplantation , Male , Muromonab-CD3/therapeutic use , Pancreas/pathologyABSTRACT
Se presenta el caso de una paciente de 20 años con diagnostico de insuficiencia renal cronica terminal y cardiopatia dilatada a quien se le practicó trasplante simultáneo de corazón - rinon de un mismo donante, en el Hospital Clinica San Rafael de Santafe de Bogota, D. C., en octubre de 1996. Recibio terapia secuencial de inmunosupresion. Los dos injertos funcionan adecuadamente y no ha presentado episodios de rechazo agudo.
Subject(s)
Heart Transplantation , Kidney TransplantationABSTRACT
Se presenta el caso de un paciente de 50 años de edad con antecedente de trasplante renal de donante vivo relacionado quien despues del segundo ciclo de tratamiento para rechazo agudo del trasplante presenta perforacion espontánea del colon, haciendose evidente la dificultad para el diagnostico temprano de esta patologia en pacientes que reciben algun tipo de inmunosupresion. Al rededor del caso se discute y revisa el tema de la incidencia de los inmunosupresores sobre la integridad del colon.
Subject(s)
Colon , Rupture, Spontaneous/surgery , Rupture, Spontaneous/immunology , Kidney TransplantationABSTRACT
El desarrollo de los programas de trasplante de organos y tejidos ha dependido de la existencia de redes de donacion que reunan los hospitales generadores de posibles donantes y los grupos de trasplante. La integracion de los programas de trasplantes de Santafe de Bogota a traves de la Corporacion Red de Trasplantes ha incrementado el numero de trasplantes en la ciudad, gracias a la promocion de la donacion, deteccion de posibles donantes y generacion de una "cultura del trasplante ".
Subject(s)
Biological Specimen Banks , Transplantation/trends , TransplantationABSTRACT
Se revisan las caracteristicas más importantes del traumatismo retroperitoneal tanto en sus aspectos generales como en sus problemas especificos de diagnostico y tratamiento. Se hace enfasis en la clasificacion y el tratamiento de los hematomas retroperitoneales traumáticos, dividiendolos en cuatro grupos, a saber: centrales, del flanco, pelvicos y combinados; se analiza el procedimiento quirurgico por seguir en cada uno de ellos con base en la experiencia obtenida en el Hospital Universitario de San Ignacio de Bogota. Igualmente se analizan algunos aspectos particulares en el diagnostico, tratamiento y evolucion de las heridas penetrantes de la region posterior y se hace enfasis en que la mejor terapeutica para estos pacientes es el estudio selectivo que produce los mejores indices de sobrevida y el menor numero de laparotomias no terapeuticas.
