Impact of C2 measurement on cyclosporine Neoral dosing in a Latin-American transplant program: the Guatemalan experience.

Optimal dosing of cyclosporine is difficult in transplant recipients. The introduction of the microemulsion Neoral in 1997 into our program and the measurement of C2 levels since 2000 in our center has allowed for more accurate individual dose finding. In our series, 141 transplant recipients (92 de novo, 49 maintenance) were followed for a 3-year period with C2 monitoring and serum creatinine levels as well as creatinine clearance studies. Biopsy proven acute rejection episodes appeared in three patients. The target levels of C2 during the first week were of vital importance to prevent acute rejection. Targets for the later periods of our study were somewhat lower than those recommended in North American or European studies. Even so, the incidence of acute rejection was low (3.2% for the de novo group). We feel that special populations like ours (mostly Mayan) deserve more attention regarding the finding of the optimal dose for immunosuppressive therapy after kidney transplantation.

Transmisión del plasmodium falciparum en un transplante renal: Diagnóstico incidental por biopsia con aguja fina (Reporte de un caso) / Transmission of Plasmodium Falciparum in a renal transplant: incidental finding in a fine needle aspiration biopsy

La transmisión de malaria por órganos transplantados, constituye una fuente rara pero real de infección y el diagnóstico generalmente no es sospechado. Presentamos el caso de un transplante renal obtenido en una área endémica de paludismo, que consultó por fiebre y artralgias a nuestro Centro para su seguimiento. Una biopsia por aspiración con aguja fina del órgano transplantado reveló como hallazgo incidental la presencia de P. falciparum. Un alto grado de sospecha y el diagnóstico temprano, especialmente en áreas no endémicas, son indispensbles para evitar complicaciones serias como la pérdida del injerto o incluso mortalidad en el paciente inmunosuprimido

Hepatic artery thrombosis in pediatric liver transplantation: graft salvage after thrombectomy.

Hepatic artery thrombosis (HAT) is a devastating complication that may occur after orthotopic liver transplantation (OLT). A higher incidence has been reported in children. Salvage of the graft by thrombectomy has been suggested as an alternative to re-transplantation. In this study we report the outcome of three children who underwent thrombectomy for HAT. Between January 1992 and June 1998, 14 children (< 17 yrs of age) underwent liver transplantation. Three developed HAT (one a whole-liver graft recipient, age 17; two living-related graft recipients, ages 4 and 4.5 yr). In the first patient, thrombosis of the hepatic artery was associated with scattered areas of parenchymal necrosis on computed tomography. In the two living-related patients, HAT was found incidentally during re-exploration for bleeding (day 2 and day 10). Thrombectomy was performed in all three patients. At 18-24 months after thrombectomy, all three children had normal graft function. In the first patient, complete regeneration of the liver has been documented by computed tomography and a late asymptomatic recurrent thrombosis is suggested by absence of arterial flow on Doppler examination. The hepatic artery is patent in the two living-related recipients. One of these living-related recipients developed ischemic bile duct stricture and underwent successful percutaneous balloon dilatation. We conclude that long-term normal graft function can be achieved by thrombectomy in pediatric liver recipients with HAT, even in the presence of limited parenchymal damage.

Intravascular leiomyomatosis: report of a case and review of the literature.

So far, only 13 cases with extension of an intravascular leiomyoma into the heart have been reported. We present the second known case of leiomyomatosis with extension of the tumor through the tricuspid valve into the right ventricle, which was first removed successfully. Ten years after an abdominal hysterectomy for a myomatous uterus, a 53-year old woman presented with a intracavitary mass in the right-sided heart chambers which could be followed retrogradely into the inferior vena cava and right pelvic veins, representing an intravasal extension from the pelvic leiomyoma. The clinical picture, the two-stage operative management, and the postoperative course are reviewed and the literature on the subject is presented.

[Diagnosis and therapy of bile duct cysts in adults]. / Zur Diagnostik und Therapie der Gallengangscysten beim Erwachsenen.

Today the main problem of bile duct cysts is based on their optimal therapy. Conservative approaches only are fit for single selected cases because of the complications and lethality rate inherent to these methods. The usual operative treatment with internal derivation of the cyst by diversion to an intestinal loop does not take account the nowadays well documented risk of development of cancer in the cyst's tissue, mainly in the adult patient. The modern classification according to Todani et al. [14] offers the possibility for a selective approach with regard to the local anatomic-pathological relations found in the intrahepatic as well as in the extrahepatic biliary tree in such patients. The problems of the clinical picture, diagnosis and therapy are discussed on the basis of 6 cases seen at our centre.