Subject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Hypertension, Portal/etiology , Liver Cirrhosis/diagnosis , Liver Neoplasms/diagnosis , Liver Neoplasms/secondary , Liver/pathology , Antineoplastic Agents, Hormonal/therapeutic use , Brain Neoplasms/secondary , Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/drug therapy , Fatal Outcome , Female , Humans , Liver Neoplasms/complications , Liver Neoplasms/pathology , Middle Aged , Tamoxifen/therapeutic useABSTRACT
Because of the current organ shortage, some liver transplant programs have begun to accept marginal organs that previously would have been rejected. An example is the use of donors with evidence of past hepatitis B virus (HBV) infection. To gain insight into the use of hepatitis B core antibody-positive (anti-HBc(+)) donor livers in recipients without evidence of HBV infection, we conducted a survey. Surveys consisting of 12 multiple-choice questions were sent to all 110 liver transplant programs across the United States in mid-2001, and 56 of 110 surveys (51%) could be evaluated. Overall, 32 of 56 programs (57%) indicated they would transplant an anti-HBc(+) liver into a recipient without serological evidence of HBV infection. Of those who would accept an anti-HBc(+) liver, 16 of 27 respondents (59%) indicated knowledge of HBV DNA status would change their protocol; 46% of these respondents would decrease prophylaxis if HBV DNA was negative, 27% would increase prophylaxis if HBV DNA was positive, and 27% would not accept the liver if HBV DNA was positive. Conversely, 9 of 28 respondents (32%) who would not accept an anti-HBc(+) liver stated that knowing HBV DNA status would change their protocol in that they might consider accepting livers if HBV DNA was negative. In conclusion, as of mid-2001, of transplant medical directors in the United States who responded to our survey, 57% would accept an anti-HBc(+) donor liver for an HBV-naïve recipient. Treatment protocols for using these organs varied. Knowledge about HBV DNA status of the donor and/or liver would greatly influence prophylaxis for those accepting anti-HBc(+) donor livers.
Subject(s)
Liver Transplantation/immunology , Practice Patterns, Physicians' , Tissue Donors , Clinical Protocols , DNA, Viral/analysis , Hepatitis B Antibodies , Hepatitis B virus/genetics , Humans , United StatesABSTRACT
A wide variety of infectious diseases affect injection drug users. One of the most common is viral hepatitis. In the United States, hepatitis B affects 1.5 million people, and hepatitis C affects more than 4 million people, many of whom are past or current users of injected drugs. Although the treatment for chronic hepatitis B and hepatitis C has improved, protocols specifically designed for injection drug users, especially given their lifestyle and reportedly low compliance rates, are seriously lacking. These disorders can lead to cirrhosis, hepatocellular carcinoma, and the need for liver transplantation in a sizeable proportion of cases. Therefore, early intervention should be a top priority.
Subject(s)
Hepatitis, Viral, Human , Substance Abuse, Intravenous , Adult , Hepatitis, Viral, Human/drug therapy , Hepatitis, Viral, Human/epidemiology , Hepatitis, Viral, Human/transmission , Humans , Prevalence , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/economics , Substance Abuse, Intravenous/epidemiology , United States/epidemiologyABSTRACT
Liver transplantation plays an important role in the treatment of patients with fulminant hepatic failure (FHF). Early determination of prognosis in cases of FHF is important to allow prompt decision-making regarding the need for liver transplantation. Mushroom poisoning is a rare cause of FHF, and as a result, prognostic criteria are not well recognized. It appears that the severity of coagulopathy and encephalopathy predicts a poor outcome, whereas the degree of bilirubin elevation may not. We present a case of FHF related to mushroom poisoning that required liver transplantation. The clinical presentation, medical management, and prognostic criteria in mushroom poisoning are discussed.
Subject(s)
Liver Failure/surgery , Liver Transplantation , Mushroom Poisoning/surgery , Fatal Outcome , Female , Humans , Liver/pathology , Liver Failure/etiology , Middle Aged , Mushroom Poisoning/complications , Mushroom Poisoning/pathology , Mushroom Poisoning/physiopathologyABSTRACT
Preview As the name implies, Henoch-Schönlein purpura is a vasculitic disease, but it also affects multiple organ systems. Although the exact cause of the disease has not been determined, recent studies have shed some light on its pathogenesis. This article reviews these studies and discusses the various manifestations and possible complications. Two classification systems are also included.