Trasplante de hígado en México: informe del primer caso exitoso / Human orthotopic liver transplantation: first case in Mexico

Se informa el primer caso exitoso de trasplante hepático en humanos en México. Se hace mención a los trabajos experimentales previos de este grupo. El caso corresponde a un hombre de 41 años de edad, con historia de hipertensión arterial y hepatitis en 1975 con cirrosis hepática postnecrótica corroborada por biopsia en 1985 y marcadores inmunológicos para hepatitis negativos, con una reserva funcional limitada (clasificación C Child-Pugh). El 2 de mayo de 1988, a través del Programa Nacional de Trasplantes, se obtuvo un injerto hepático, proveniente de un paciente con muerte cerebral posterior a un accidente cerebrovascular. Se efectuó trasplante hepático ortotópico utilizando un puente veno-venoso portosistémico. Desde entonces se ha manejado con triple esquema inmunosupresor a base de ciclosporina, azatioprina y prednisona. Su evolución postoperatoria inmediata cursó con colestasis idiopática, un episodio de rechazo agudo, hipertensión arterial, disfunción renal, herpes esofágico y linfocele inguinal, problemas que fueron resueltos satisfactoriamente. Actualmente a 28 meses postrasplante recibe dosis mínimas útiles de inmunosupresores, su función hepática es normal y su calidad de vida ha sido muy satisfactoria

[Liver transplantation in Mexico. Report of the first successful case]. / Trasplante de hígado en México. Informe del primer caso exitoso.

This article reports the first successful human orthotopic liver transplantation performed in Mexico. The recipient was a 41 year old white male, with a history of essential hypertension and hepatitis in 1975. The diagnosis of postnecrotic cirrhosis was made in 1985 by liver biopsy. The HBsAg was negative and the functional reserve of the liver was limited (Stage "C" of the Child-Pugh classification). A liver graft was obtained through the National Cadaver Organ Transplant Program on May 2, 1988 and an orthotopic liver transplantation was performed without incidents, using the portosystemic veno-venous bypass. Inmunosuppression was carried out with triple drug therapy, cyclosporine, azathioprine, and prednisone. His postoperative course was characterized by idiopathic cholestasis, one episode of acute rejerction, arterial hypertension, renal dysfunction, esophageal herpes and inguinal lymphocele, all of which resolved. Currently the patient is alive 22 months postransplantation with normal liver function and adequate quality of life.

[Organ transplantation as a health priority in developing countries]. / Transplante de órganos como una prioridad de salud en paises en desarrollo.

The epidemiology profile of developing countries is in transition. While the prevalence of infectious and preventable diseases, malnutrition, and in general the health problems traditionally associated to the poor, is still high, the characteristic health profile of industrialized countries (i.e. chronic and degenerative diseases, accidents, violence, social pathology) is beginning to surface. This paper focuses on the need to consider organ transplantation as a health priority in developing countries, as an important element in the global strategy to cover both aspects of the health care demand.

[Renovascular hypertension. Studies of 16 cases with long-term follow-up]. / Hipertensión renovascular. Estudio de 16 casos seguidos a largo plazo.

Surgical correction of renovascular hypertension was studied in 16 patients. In all the patients severe high blood pressure and stenosis of at least one renal artery was demonstrated; in 14 patients plasma renin activity (PRA) in renal veins and peripheral blood was measured. All cases were followed for 36 to 48 months after surgical treatment. Blood pressure was normalized after surgical treatment (2 aortorenal bypasses, 2 nephrectomies and 7 autotransplants) in 7 patients, all of them had hyperreninemia, hypersecretion from the stenotic kidney and suppression of the contralateral kidney. In one patient with stenosis of one renal artery, blood pressure was normalized after surgery, even though no alterations in renin secretion was demonstrated. Surgery (1 bypass, 2 nephrectomies, 1 autotransplant and 1 aortorenal anastomosis) induced a decrease in blood pressure in five patients, all had normal PRA in peripheral blood and hypersecretion from the stenotic kidney. Three patients remained hypertensive in spite of nephrectomy of the stenotic kidney all had hyperreninemia without lateralization. In two patients renal failure was evident from the time they entered the study; both had hyperreninemia, lateralization and suppression of the contralateral kidney, one improved with nephrectomy of stenotic kidney and hemi-nephrectomy of the contralateral and the other remained hypertensive after nephrectomy. The initial status of renin secretion has prognostic value for the response to surgical treatment of renovascular hypertension.

HLA A and B antigens in Takayasu's artritis.

La frecuencia de los antigenos HLA del locus A y B se estudio en mexicanos con arteritis de Takayasu, una enfermedad relativamente frecuente en mujeres jovenes orientales e indoamericanas.No se encontro una asociacion clara entre ninguno de los antigenos HLA estudiados y la enfermedad, aunque hubo una debil asociacion entre esta y HLA B5. Estudios hechos en Japan han identificado esa asociacion y otra con Bw52, un "split" de B5