Hyperuricemia, gout, and renal function after liver transplantation.

BACKGROUND: Hyperuricemia is a recognized complication of renal and cardiac transplantation, but the development of hyperuricemia and gout following liver transplantation have received less attention. We have retrospectively assessed the prevalence of hyperuricemia in 134 consecutive liver transplant recipients. RESULTS: Forty-seven percent of the liver transplant recipients studied had hyperuricemia. Serum creatinine was higher in hyperuricemic than in nonhyperuricemic patients. Peak uric acid correlated significantly with corresponding serum creatinine (rs=0.694). Only 6% developed gout. All the patients with gout and 10 hyperuricemic patients with renal impairment but without gout were treated with allopurinol. Over a median period of 3 months, mean serum creatinine fell from 177 micromol/l to 160 micromol/l (P=0.01), without change in type or dose of immuno-suppression. CONCLUSIONS: There is an important association between liver transplantation and hyperuricemia. Treatment with allopurinol results in a significant reduction in serum creatinine in patients with gout and in those with hyperuricemia and renal impairment.

Can the potential benefits of statins in general medical practice be extrapolated to liver transplantation?

Hypercholesterolemia is a common complication of liver transplantation and is a risk factor for cardiovascular disease after renal and heart transplant. The effect of hyperlipidemia after liver transplantation is less certain, but a less favorable outcome is to be expected. 3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors or statins have proven efficacy in reducing serum cholesterol and mortality from cardiovascular disease in the general population. Early evidence shows that statins are safe and effective in treating hypercholesterolemia after liver transplantation. Studies in cardiovascular disease have shown that statins exhibit beneficial properties independent of lipid-lowering. These include anti-inflammatory effects and improvement in endothelial function. Recently, statins were shown to repress induction of major histocompatibility complex class II complexes by interferon-gamma, which in turn suppresses activation of T lymphocytes. Such effects may assume significance when using statins after solid-organ transplants. Pravastatin has been shown to reduce acute rejection after cardiac and renal transplantation and to also reduce natural killer cell cytotoxicity in these populations. It remains to be seen whether statins will demonstrate similar benefits after liver transplantation.

Beneficial effects of converting liver transplant recipients from cyclosporine to tacrolimus on blood pressure, serum lipids, and weight.

Hypertension and hyperlipidemia are more prevalent after liver transplantation with cyclosporine as the primary immunosuppressive agent compared with tacrolimus. To determine whether blood pressure, serum lipid level, or weight improves when patients switch immunosuppression therapy, we retrospectively studied 26 liver transplant recipients with stable graft function who had been converted from cyclosporine to tacrolimus therapy with a median follow-up of 8 months. One of the 26 patients developed pruritus necessitating withdrawal of tacrolimus. The results therefore concern the remaining 25 patients. With the exception of a small decrease in bilirubin level (P <.05), there was no difference in graft or renal function after conversion. Mean systolic blood pressure decreased from 158 +/- 25 to 148 +/- 22 mm Hg over a mean of 8 +/- 3 months after conversion to tacrolimus (P =.015), whereas mean serum cholesterol level decreased from 5.3 +/- 0.9 to 4.9 +/- 0.9 mmol/L (P =.01). Sixty-eight percent of the patients lost weight, from a mean of 79.4 +/- 22.6 to 76.1 +/- 20.1 kg, in the 11 months after switching to tacrolimus therapy (P =.024). Serum triglyceride and blood glucose levels did not change, and no patient developed diabetes mellitus after conversion. These results indicate that switching from cyclosporine to tacrolimus can reduce blood pressure, serum cholesterol level, and weight after liver transplantation.

Beta-tubulin epitope expression in normal and malignant epithelial cells.

The expression of a unique beta-tubulin isoform (class III) was monitored in squamous cell carcinoma (SCC) and normal epithelial cells using a monoclonal tubulin antibody called TuJ1. Whole tissue homogenates of SCC, normal tissue, SCC grown in nude mice, and SCC cultured cells were examined using sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blot. TuJ1 antibody localization was performed using peroxidase immunostaining on paraffin sections of SCC, normal tissue, nude mouse SCC, and immunofluorescent microscopy of SCC cultured cells. The malignant tissues examined stained positive with TuJ1 and a general beta-tubulin antibody, whereas the normal tissues stained positively only for the general beta-tubulin antibody. TuJ1 epitope expression may be a useful marker for SCCs and may assist in understanding differences between normal and malignant squamous cells.

NMR spectroscopy evaluation of plasma "oncolipids" in head and neck cancer.

The use of water-suppressed proton nuclear magnetic resonance spectroscopy of plasma as a serologic test for the detection of malignancy was first described in 1986. That report prompted the present study, which was undertaken to evaluate the efficacy of this test in differentiating patients who have head and neck malignancy from normal controls. Forty-six patients who had a biopsy-proven malignancy of the head and neck and 32 healthy individuals provided plasma for which the nuclear magnetic resonance spectrum was plotted, blind to patient diagnosis or group. The average line-width of methyl and methylene resonance was calculated. Significant differences (p less than 0.05) were found between the group with disease and the group with no disease for the methyl line-widths, using analysis of variance. In spite of this statistical difference, plotting of the values for the methyl, methylene, and average line-widths clearly demonstrated that these three oncolipid measures have no clinical use because of the tremendous overlap between the disease and nondisease groups. The findings of this study do not support the use of water-suppressed proton nuclear magnetic resonance spectroscopy as a clinically useful test for the diagnosis of head and neck malignancy.

Computed tomography diagnosis of acute facial swelling in an adult hemophiliac.

Acute facial swelling can be life-threatening due to airway obstruction. Hemophiliac patients presenting with acute facial swelling must have accurate and expedient diagnosis. We report the case of acute nontraumatic swelling in a hemophiliac patient that was easily and accurately diagnosed by the use of computed tomography scan.

Staging of cervical lymph node metastasis. Comparison of two systems.

In 1977 the American Joint Commission (AJC) revised its system for classification of cervical lymph node metastasis producing a variation from the staging system of the International Union Against Cancer (UICC). A review of 356 evaluable patients was carried out to determine if the AJC or UICC system was prognostically superior. The primary sites of study were the supraglottic larynx in 181, tonsil in 98, and pyriform sinus in 77. All cases were staged using both the AJC and UICC criteria. All demographic, treatment, staging, and survival data were coded for computer entry and analysis. Pairwise comparisons were made for each possible N-class combination using the method of Lee and Desu. For the UICC, statistical difference was detected only between the absence or presence of cervical metastasis but did not statistically differentiate between N1, N2 or the N3 groups. The AJC system on the other hand was highly statistically discriminative between classes. Of 15 possible pairwise comparisons, two were not significantly different. The AJC system appears to be significantly more discriminative than the UICC system.