ABSTRACT
BACKGROUND: Ecstasy is a neurotoxic and hepatotoxic drug. Brain edema and fulminant hepatic failure are two of the most serious complications associated with the consumption of ecstasy. Acute ecstasy intoxication can transform a patient into an organ donor or a hepatic graft recipient. MATERIALS AND METHODS: In the last 5 years in our centers, we have had two multiorgan donors who died from ecstasy-induced brain edema and three patients who required urgent orthotopic liver transplantation for treatment of severe acute hepatocellular failure induced by this drug. We performed eight transplantations using the organs of these two brain-dead donors: one heart, one bipulmonary, three kidneys, one kidney-pancreas, and two livers. RESULTS: Toxicity caused by ecstasy was not observed in any of the eight patients who underwent transplantation. The clinical state and the graft function of the heart, two liver, renopancreatic, and three kidney recipients were normal for a follow-up period that ranged between 7 months and 4.5 years. The lung recipient died from multiorgan failure secondary to bilateral pneumonia 5 days after the transplantation, and one of the kidney transplant patients died as a result of intestinal lymphoma 6 months after transplantation. The three liver transplantations in the three patients with ecstasy-induced fulminant hepatic failure were performed successfully using orthotopic transplantation. These three recipients are asymptomatic and have normal-functioning hepatic grafts after follow-up of 3.5 years, 15 months, and 11 months, respectively. CONCLUSIONS: The thoracic and abdominal organs of people dying from ecstasy intoxication can be viable for transplantation. The short- and medium-term survival of the graft and of the recipient have been similar to that of other organ donors. Urgent liver transplantation is an effective therapeutic option in patients with ecstasy-induced acute hepatocellular failure.
Subject(s)
Brain Death , Liver Failure/chemically induced , Liver Failure/surgery , Liver Transplantation , N-Methyl-3,4-methylenedioxyamphetamine/poisoning , Tissue Donors , Adolescent , Adult , Female , Heart Transplantation , Humans , Kidney Transplantation , Lung Transplantation , Male , Middle Aged , Pancreas TransplantationABSTRACT
FUNDAMENTOS. La neutropenia persistente es frecuente en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) con inmunodepresión grave. El factor estimulante de colonias de granulocitos (G-CSF) induce la proliferación y diferenciación de los precursores de los granulocitos. Nuestro objetivo ha sido valorar la respuesta a la terapia con G-CSF en pacientes con infección avanzada por VIH y neutropenia prolongada. M ÉTODOS. Revisión retrospectiva entre el 1-12-92 y el 30-1-98 de los episodios con un recuento de neutrófilos menor de 1.000 x 106/litro, durante al menos 7 días y que en algún momento han evolucionado a cifras menores de 500 x 106/litro. RESULTADOS. Se estudian 36 episodios. En 9 de ellos se realizó tratamiento con G-CSF con una mediana de duración de 9 (3-76) semanas. El número de episodios de neutropenia que precisaron ingresar por fiebre relacionada con la misma fue significativamente menor entre los que recibieron G-CSF frente a los que no lo hicieron (22,2 por ciento frente al 66,7 por ciento). CONCLUSIÓN. En este estudio, el menor riesgo de ingreso por fiebre y neutropenia se asocia significativamente con la administración de G-CSF en pacientes con recuentos de neutrófilos menores de 500 x 106/litro, con una buena tolerancia al tratamiento (AU)
