RESUMO
Portal vein thrombosis (PVT) is an infrequent complication following hepatic transplantation. However, deterioration of liver function and accompanying complications may be life threatening. Several attempts of surgical or percutaneous transhepatic procedures have been described. In some cases high dose fibrinolytic regimens have been successful. We describe the case of a male liver recipient with recurrent liver fibrosis due to hepatitis B reinfection and late portal vein thrombosis 45 months after transplantation. Complete recanalization was achieved using systemic low dose recombinant tissue plasminogen activator (rt-PA).
Assuntos
Fibrinolíticos/uso terapêutico , Transplante de Fígado , Veia Porta , Complicações Pós-Operatórias , Ativador de Plasminogênio Tecidual/uso terapêutico , Trombose Venosa/tratamento farmacológico , Trombose Venosa/cirurgia , Hepatite B/fisiopatologia , Hepatite B/cirurgia , Humanos , Cirrose Hepática/etiologia , Cirrose Hepática/cirurgia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Veia Porta/cirurgia , Proteínas Recombinantes/uso terapêutico , Recidiva , Trombose Venosa/diagnósticoAssuntos
DNA Viral/sangue , Sobrevivência de Enxerto , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Hepatite B/prevenção & controle , Hepatite B/cirurgia , Imunização Passiva , Transplante de Fígado , Quimioterapia Combinada , Hepatite B/diagnóstico , Humanos , Imunossupressores/uso terapêutico , Falência Hepática/etiologia , Falência Hepática/cirurgia , Transplante de Fígado/mortalidade , Transplante de Fígado/fisiologia , Reação em Cadeia da Polimerase/métodos , Estudos Retrospectivos , Prevenção Secundária , Taxa de SobrevidaRESUMO
In a retrospective study the records of 302 adult patients (167 male, 135 female) after orthotopic liver transplantation (OLT) with a minimum follow-up of 6 months (median follow-up 18 months, maximum 5 yr) were reviewed with regard to cardiovascular risk factors. In 197 patients data concerning the occurrence of arterial hypertension, hyperglycemia, or hypercholesterolemia prior to OLT were available. We found a highly significant increase of cardiovascular risk factors following OLT. Obesity was found in 17.4% of male and 22.2% of female recipients after OLT. Hypercholesterolemia was evident in 66.2% of liver graft recipients. Hypertriglyceridemia occurred in 49.7% of all male patients. In females there was a significantly different prevalence of hypertriglyceridemia comparing patients with a follow-up period up to 2 yr and more than 2 yr (50% vs. 24.6%, p = 0.018). Nearly 45% of all patients met the criteria for arterial hypertension, with a slight increase in male patients beyond the second year of survival (p = 0.094). Hyperglycemia had a significantly higher frequency in male than in female patients (30.5% vs. 10.4%, p < 0.005). Furthermore we observed a clear trend towards reduction of occurrence of hyperglycemia more than 24 months after OLT, but not reaching statistical significance. No correlation was detected when serum levels of triglycerides, and cholesterol, body-mass-index, and arterial blood pressure were compared with applied dosages of immunosuppressive agents [cyclosporin A (CyA), tacrolimus, and prednisolone]. Only decreasing tacrolimus application was significantly correlated with decreasing glucosemia (p = 0.041). Patients receiving tacrolimus instead of CyA as primary immunosuppressant showed a significantly lower prevalence of hypercholesterolemia. Even hypertension, hyperglycemia, hypertriglyceridemia, and obesity had a lower occurrence in patients treated with tacrolimus although not reaching statistical significance.
