ABSTRACT
OBJECTIVE: This study analyzed the factors related to recurrence of hepatitis C virus (HCV) among orthotopic liver transplantation (OLT) patients. PATIENTS AND METHODS: We undertook a multicenter, prospective, observational study of OLT patients transplanted due to HCV at four Andalusian transplantation centers from 2005 to 2007. Patients were excluded if their survival was less than 1 month. The analysis included 110 pre-, peri-, and posttransplant variables that could affect HCV recurrence. We also examined the influence of cardiovascular risk factors and immunosuppression on HCV. RESULTS: Among 121 HCV patients, 83 (69%) experienced a histologically significant recurrence of HCV, including 13 (16%) who died compared with 5 of 38 (13%) who did not show a severe recurrence of HCV (P = .3). The mean follow-up was 44 months (range, 4 to 64 months). The mean time to appearance of the relapse was 9 months (range, 1 to 40 months) with no differences according to the type of immunosuppression. Of all study variables, donor age (> 52 years) showed a trend for greater recurrence (P = .1). The use of powerful immunosuppression (three or more drugs), either as induction or as sustained therapy, during the first posttransplantation year was significantly associated with a greater relapse rate (P < .01), albeit with no significant difference according to the type of calcineurin inhibitor. Mycophenolate mofetil was not associated with a greater posttransplantation viral load or earlier relapse, although its use in multiple immunosuppression schedules was associated with a greater relapse rate (P < .01). Survival of patients with recurrent HCV was reduced, although not significantly. Multivariate analysis showed a 4.4 times greater risk for developing de novo diabetes mellitus (DM) among patients with a severe relapse of HCV. CONCLUSIONS: There was an important trend toward a greater recurrence rate of HCV among patients who received powerful immunosuppression protocols, particularly during the first 12 months. Special attention should be given to the risk for de novo DM among HCV-positive patients.
Subject(s)
Hepatitis C/diagnosis , Hepatitis C/therapy , Liver Failure/diagnosis , Liver Failure/therapy , Liver Transplantation/methods , Registries , Cardiovascular Diseases/pathology , Hepacivirus , Hepatitis C/pathology , Humans , Immunosuppressive Agents/therapeutic use , Liver Failure/pathology , Middle Aged , Prospective Studies , Recurrence , Risk Factors , Spain , Time FactorsABSTRACT
AIMS: We sought to analyze the cardiovascular risk factors (CVRF) in liver transplantation and their relation to immunosuppression and hepatitis C virus (HCV) infection. PATIENTS AND METHODS: The study included all 158 liver transplants performed between January 2005 and December 2008 that had a minimum follow-up of 1 year. There were 104 men (64%) and 54 women (36%). Data were recorded on both the pretransplant prevalence as well as new cases of diabetes mellitus (DM), hypertension, hypertriglyceridemia, hypercholesterolemia, and hyperuricemia, defined by the need for drug therapy, after a mean follow-up period of 38 months (range, 12-64). We also examined the influence on CVRF of immunosuppression and HCV. RESULTS: Tacrolimus was prescribed for 61% of the patients and cyclosporine, 39%. Upon univariate analysis only hypertension was significantly associated with the use of cyclosporine (P < .03). There was a trend to a greater incidence of hypercholesterolemia with cyclosporine (P = .1) and DM with tacrolimus (P = .1). The presence of HCV was significantly associated with a greater incidence of de novo DM (P < .01), as was a severe relapse of hepatitis C (P < .03). Multivariate analysis showed a 4.4 times greater risk for developing de novo DM among patients with a severe relapse of HCV. CONCLUSION: The development of CVRF after liver transplantation was manifested, mainly during the first 3 months posttransplantation. Special attention should be given to the risk for de novo DM among HCV positive patients.
Subject(s)
Cardiovascular Diseases/etiology , Liver Transplantation/adverse effects , Cardiovascular Diseases/epidemiology , Cyclosporine/administration & dosage , Female , Humans , Immunosuppressive Agents/administration & dosage , Male , Multivariate Analysis , Prevalence , Risk Factors , Tacrolimus/administration & dosageABSTRACT
Admite la existencia de sistemas legales que proponen a veces soluciones diferentes a los problemas que se plantean entre usos y usuarios pero se advierte en todos esos sistemas legales que la mayor o menor intervencion de la administracion en estos conflictos esta directamente relacionada con la mayor o menor extensión que se de al dominio público hídrico. Se analiza el uso comun de las aguas publicas y privadas y los usos especiales de las mismas. Hace referencia a los conflictos entre usuarios de distintos tipos de aguas. Esquematiza los medios de proteccion de los usuarios frente a hechos de terceros y de terceros ante hechos de usuarios. Finalmente alude a dos hipotesis de conflictos por diferentes regulaciones
Subject(s)
Argentina , Water Supply Enterprises , Sanitary ManagementABSTRACT
Relaciona la cuestión de los registros, el catastro y las cargas financieras, con los sistemas legales vigentes en derecho y administración de aguas y en la otra parte relaciona la publicidad posesoria y registral. Vincula el registro de la propiedad y el de aguas, analiza los registros de aguas publicas refiriendose separadamente a los registros de permisos y de concesiones. Finalmente transcribe las conclusiones del seminario internacional sobre registro y catastro de aguas y cargas financieras de la concesión
Subject(s)
Water Supply , Argentina , Censuses , Water RightsABSTRACT
Relaciona la cuestión de los registros, el catastro y las cargas financieras, con los sistemas legales vigentes en derecho y administración de aguas y en la otra parte relaciona la publicidad posesoria y registral. Vincula el registro de la propiedad y el de aguas, analiza los registros de aguas publicas refiriendose separadamente a los registros de permisos y de concesiones. Finalmente transcribe las conclusiones del seminario internacional sobre registro y catastro de aguas y cargas financieras de la concesión
