ABSTRACT
BACKGROUND: Renal dysfunction is a common complication of advanced liver failure and liver transplantation. Since the introduction of the MELD criteria the proportion of patients with advanced chronic kidney disease and need for liver transplantation has increased. One alternative is the combined liver-kidney transplant (CLKT). The aim of this study was to evaluate the outcome of this type of transplant in our center. METHODS: We retrospectively analyzed all combined simultaneous or sequential transplants from 1989 to 2012. We studied demographic and clinical variables. Survival analysis was performed by Kaplan-Meier method. RESULTS: In the study period, 1,265 kidney and 1,050 liver transplantations were performed; 34 were CLKT (to 29 adults and 5 children); 13 of these were simultaneous and 12 sequential liver-kidney. We also carried out 4 triple liver-pancreas-kidney transplantations, 3 simultaneous and 1 sequential. The mean age was 44.1 ± 15 years, and 27 were male (93.1%); 9 (37.5%) were diabetic. The main causes of liver disease were viral (n = 11 [41.3%; hepatitis virus B, C, or both] and alcoholism (9 [31%]). The renal disease etiology was unknown in 16 (55.1%), IgA nephropathy in 2 (6.8%), membranoproliferative glomerulonephritis in 2 (6.8%), and calcineurin inhibitor toxicity in 4 (13.6%). Transjugular renal biopsy was performed in 6 sequential transplants. Survival of patients who received a CLKT was excellent: 91%, 51%, and 40%, at 1, 5, and 10 years, respectively. No significant difference was found between sequential and simultaneous transplants (log rank 0.5). CONCLUSIONS: Our results of CLKT show results similar or superior to those of other series and are an alternative to consider in candidates for liver transplantation with chronic kidney disease. Transjugular biopsy is an alternative to study the etiology of renal disease in patients with hepatic dysfunction before or after liver transplantation.
Subject(s)
End Stage Liver Disease/surgery , Hepatorenal Syndrome/surgery , Kidney Failure, Chronic/surgery , Kidney Transplantation , Liver Transplantation , Adult , Biopsy , End Stage Liver Disease/diagnosis , End Stage Liver Disease/mortality , Female , Health Care Surveys , Hepatorenal Syndrome/diagnosis , Hepatorenal Syndrome/mortality , Humans , Kaplan-Meier Estimate , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/mortality , Kidney Transplantation/adverse effects , Kidney Transplantation/mortality , Liver Transplantation/adverse effects , Liver Transplantation/mortality , Male , Middle Aged , Pancreas Transplantation , Retrospective Studies , Risk Factors , Spain , Time Factors , Treatment OutcomeABSTRACT
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Subject(s)
Humans , Liver Failure/physiopathology , Hepatic Insufficiency/physiopathology , Liver Cirrhosis/physiopathology , Ascites/therapy , Paracentesis , Hepatorenal Syndrome/therapy , Renal Insufficiency/therapy , Hyponatremia/therapy , Hepatitis C, Chronic/drug therapy , Hepatitis B, Chronic/drug therapyABSTRACT
Introducción. La enseñanza de la patología médica a través de imágenes es la clave para conseguir habilidad clínica en el diagnóstico. Objetivos. Comparar la eficacia docente de un método de enseñanza basado en imágenes en un entorno no presencial frente a la enseñanza tradicional en un entorno presencial, y evaluar el grado de satisfacción del alumno sobre este método de innovación docente en la enseñanza de la patología médica. Materiales y métodos. El estudio se realizó durante el curso 2005-2006 entre 62 alumnos de Patología médica, de la Facultad de Medicina de Córdoba. Se compararon los dos métodos de enseñanza: el presencial (en cada seminario se expusieron verbalmente 15 imágenes) y en el no presencial (imágenes clínicas expuestas en la página web de la Facultad de Medicina con tutorización a través del correo electrónico). La evaluación consistió en la valoración clínica de 16 imágenes (ocho imágenes de cada modelo de enseñanza). Se comparó la puntuación del examen teórico con la de las imágenes clínicas. Tras el examen final, el alumno realizó un cuestionario de evaluación. Resultados. La calificación media final de las imágenes (sobre 10 puntos) fue de: 6.8+/-1.5 y la del test (sobre 10 puntos) fue de 7.3+/-0.9. La calificación media de las imágenes expuestas en la web (7.4+/-1.6) fue superior a la del modelo presencial (6.3+/-1.7) p<0.0001. Existía una correlación entre la puntuación total de la imagen y la del test (r:0.584, p<0.0001). Asimismo, se correlacionaba la calificación de la imagen del modelo presencial y la e la imagen expuesta en al web (r:0.697, p<0.0001. Conclusiones. Las calificaciones de los casos expuestos en la web fueron superiores a las de los casos expuestos en los seminarios presenciales. La enseñanza de la patología médica a través de imágenes clínicas fue un método muy bien considerado por los alumnos (AU)
Introduction. The teaching of Internal Medicine through images is the key for the achievement of clinical skills in the diagnosis. Aims. To compare the efficiency of a teaching method based on images in a face-to-face learning situation with the traditional teaching methods, and to evaluate the degree of satisfaction amongst the alumni regarding the new teaching method within the Internal Medicine. Materials and methods. The study was carried out throughout the academic year 2005/06 amongst 62 Internal Medicine students in the School of Medicine in Córdoba. Two teaching methods were compared: (i) face-to-face- 15 images were exposed in workshop, and (ii)distance-clinical images were exposed at the School of Medicine web site through a tutorial system based on e-mail. The evaluation consisted in a clinical evaluation of 16 images-8 images for each teaching method. The results from the multiple choice exam and the clinical images exam were also compared. Finally, students answered an assessment questionnaire. Results. The final average qualification out of 10- for the images was: 6.8+/-1.5 and fot the multiple choice exam out of 10- was 7.3+/-0.9. The average qualification was higher for the images exposed at the web site than for the face-to-face model: (7.4+/-1.6) vs (6.3+/-1.7) p<0.0001. There was a correlation between the total punctuation for the images and the examination (r:0.584, p<0.0001). Moreover, there was also a correlation between the qualification obtained for the images in the face-to-face method and the images exposed on-line (r:0.697, p<0.0001). Conclusions: Qulaifications for the cases displayed on the website were higher than those for the cases exposed on the face-to-face workshops. In addition to this, students had a very positive opinion regarding the new teaching method for Internal Medicine based on clinical images (AU)
Subject(s)
Humans , Internet , Teaching/methods , Teaching Materials , Electronic Mail , Education, Medical/methods , Personal Satisfaction , Surveys and QuestionnairesABSTRACT
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Subject(s)
Humans , Liver Transplantation/methods , Immunosuppression Therapy/methods , Immunity , Adrenal Cortex Hormones/therapeutic use , Immunosuppressive Agents/pharmacokinetics , Virus Replication , Azathioprine/pharmacokinetics , Cyclosporine/pharmacokinetics , Tacrolimus/pharmacokinetics , Sirolimus/pharmacokinetics , Antibodies, Monoclonal/pharmacokineticsABSTRACT
Objetivo: el objetivo de este estudio ha sido evaluar la supervivencia a corto y largo plazo del paciente trasplantado de hígado por hepatocarcinoma (CHC), el riesgo de recidiva tumoral postrasplante y los factores asociados a esta complicación. Diseño: estudio restrospectivo de una serie consecutiva de pacientes trasplantados de hígado por hepatocarcinoma. Pacientes y métodos: enfermos trasplantados por hepatocarcinoma desde el año 1989 hasta noviembre de 2003. Los pacientes fueron seleccionados con unos límites generales de tamaño y número de nódulos que fueron posteriormente publicados como criterios de Milán. En su diagnóstico pretrasplante se siguieron asimismo criterios consensuados en la Conferencia de Barcelona. Resultados: la supervivencia de este grupo de 81 pacientes trasplantados por hepatocarcinoma fue del 80, 61 y 52%, a los 1, 5 y 10 años respectivamente. En el 32% de los casos el CHC fue un hallazgo incidental en el explante. En el 12,3% se constató recidiva tumoral. El estudio multivariante identificó como factores de riesgo de recidiva el tamaño del nódulo (OR = 1,7944) (IC 95% = 1,1332-2,8413) y la invasión vascular (OR = 6,6346) (IC 95% = 1,4624-30,1003). Conclusiones: el trasplante de hígado en pacientes seleccionados con CHC obtiene buenos resultados a medio y largo plazo. El riesgo de recidiva tumoral postrasplante se ha reducido notablemente y está asociado con el tamaño del nódulo y con la invasión vascular microscópica
Objective: the goal of this research has been to evaluate the survival, in long and short term, of the patient receiving liver transplant for hepatocellular carcinoma (HCC), the risk of posttransplant tumor relapse and factors related to this complication. Design: retrospective study of a consecutive series of patients having had liver transplant for HCC. Patients and methodology: transplant patients for HCC from 1989 to November 2003. Patients were selected due to general limitations of nodule size and quantity, which were subsequently published as Milan criteria. Also, criteria agreed in the Conference of Barcelona were followed in the pre-transplant diagnosis. Results: the survival of this 81 patients group was of the 80, 61 and 52% for 1, 5 and 10 years respectively. In the 32% of the cases the HCC was an incidental finding in the explant. In the 12.3%, the tumor relapse was verified. The multivariate research identified the size of the nodule (OR = 1,7944) (IC 95% = 1,1332-2,8413) and the vascular invasion (OR = 6,6346) (IC 95% = 1,4624-30,1003) as risk factors of relapse. Conclusions: the liver transplant in selected patients with HCC has good results in medium and long term. The risk of post-transplant tumor relapse becomes notably reduced and is associated with the size of the nodule and the microscopic vascular invasion
Subject(s)
Humans , Carcinoma, Hepatocellular/mortality , Liver Transplantation/mortality , Liver Neoplasms/mortality , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Retrospective Studies , Risk , Survival Analysis , Treatment Outcome , Neoplasm Staging , Liver Neoplasms/pathology , Liver Neoplasms/surgeryABSTRACT
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Subject(s)
Female , Humans , Male , Drug Resistance, Viral/genetics , Hepatocytes/cytology , Hepatocytes/metabolism , Hepatitis B virus/genetics , Hepatitis B virus/metabolism , Drug Resistance, Viral/physiology , Hepatocytes/pathology , Hepatocytes/virology , Spain/ethnology , Hepatitis B virus/physiology , Hepatitis B virus/pathogenicityABSTRACT
No disponible