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1.
R.P. Duarte A.C. Sentanin A.M.O. da Silva R.M. Tonella G.L. Duarte L.S.R. Ratti I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):829-831
Introduction
Liver disease induces many organic and metabolic changes, leading to malnutrition and weight and muscular function loss. Surface electromyography is an easily applicable, noninvasive study, through which the magnitudes of the peaks on the charts depict voluntary muscle activity.Aim
To evaluate the diaphragmatic surface electromyography of postoperative liver transplantation subjects.Methods
Subjects were patients who underwent liver transplantation and extubation in the Clinical Hospital of State University of Campinas. Electromyography data were collected with support pressure of ≤10 cm H2O, Glasgow Coma Scale = 11, and minimum dosages of vasoactive drugs, and data were collected again 30 minutes after extubation. Signal collection was performed with sEMG System Brazil SAS1000V3 electromyograph and electrode stickers. Statistical analysis was performed using R software.Results
The average time of surgery was 345.36 ± 125.62 minutes. Time from spontaneous mode until extubation was 417.14 ± 362.97 minutes. The RMS (root mean square) values of the right and left domes in spontaneous mode with minimal ventilation parameters were 26.68 ± 10.92 and 26.55 ± 10.53, respectively, and the RMS values after extubation were 31.93 ± 18.69 to 34.62 ± 13.55, for right and left domes. The last calculated pretransplant Model for End-stage Liver Disease score averaged 19.64 ± 8.41.Conclusion
There were significant differences between the RMS of the diaphragm domes under mechanical ventilation and after extubation, showing lower effectiveness of the diaphragm muscle against resistance, without the aid of positive pressure and the existing overload of the left dome. 相似文献2.
G. de Lourdes Jorge R. dos Reis Tártaro C.A. Fazzio Escanhoela I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):898-901
Objective
There has been much research on hepatic ischemia and reperfusion by means of short or longer interruption of the portal triad. The aim of this work was to evaluate the mitochondrial respiratory activity and liver histology at 2 different times after the Pringle maneuver.Methods
Twenty-eight male Wistar rats, weighing ～308 g, with histologic and mitochondrial study: immediate ischemic group (IIG; 40 minutes; 9 animals) and late ischemic group (LIG; 28 days; 9 animals). The rats were anesthetized and underwent a U-incision in the abdomen. In a simulated operation, manipulation of the hepatic pedicle was performed (5 animals immediate [ISG] and 5 late [LSG]). The hepatic pedicle was clamped for 20 minutes of ischemia foloowed by 20 minutes of reperfusion. The animals were killed under anesthesia.Results
Mitochondria when stimulated by adenosine diphosphate or carbonylcyanide p-trifluoromethoxyphenylhydrazone had a significant respiratory reduction (P < .001). The respiratory control ratio in the LIG was altered (P < .02) compared with IIG. In the resting state, there was no change in the velocity of respiration between ischemic groups. Histopathologic findings showed 55.5% sinusoidal dilatation in IIG and 66.6% in LIG; 77.7% ballooning in IIG and 55.5% in LIG; and 11.1% focal necrosis in both IIG and LIG.Conclusions
The oxidative phosphorylation system recovered with improvement in mitochondrial respiration; however, morphologic recovery was associated with the type and intensity of injury. 相似文献3.
C.H.P. Reigada E.C. de Ataide T.d.A.P. Mattosinho L.B.E. Costa C.A. Escanhoela I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):761-764
The probable reason for mixing solutions during the harvesting procedure is due to the presence of multiple transplant teams that have their own solution usage tradition. Despite numerous studies comparing the efficacy of different preservation solutions, there is no study addressing the associating solution and if there is any impact on liver graft and patient survival. The aim was to evaluate the effect of the association of preservation solutions during the harvesting procedure on liver transplantation outcomes, especially in relation to the degree of preservation injury in the postreperfusion period and patient survival. We analyzed 206 transplants that were distributed as follows: when there was association (89/206 = 43.2%) and when there was no association (117/206 = 56.8%). There was a statistically significant difference in relation to the degree of preservation injury correlated to cold ischemia time (P = .009, odds ratio 1.992; 95% confidence interval 1.185–3.347). Severe harvesting (grades III and IV) was 71.8% when the solution was not associated (P = .008). There was no difference regarding patient survival either. We found that the association of liver preservation solutions has no impact on patient survival, so it can be done safely. The best survival rate was associated with minimal harvesting. 相似文献
4.
C.H. Puliti Reigada E.C. de Ataide T. de Almeida Prado Mattosinho I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):867-870
Background
Hepatic artery thrombosis (HAT) is reported in 4%-15% of orthotopic liver transplants. Risk factors include technical error in the anastomosis, vascular anatomic variation, and high microvascular resistance. The aim of this study was to verify the incidence of HAT, early or late, and possible risk factors.Methods
This was a retrospective study from January 2007 to December 2012 at the State University of Campinas. Variables analyzed were age, sex, cold and warm ischemia times, underlying disease, presence of hepatocellular carcinoma, Model for End-Stage Liver Disease (MELD) score, arterial anatomic variation in the graft, cytomegalovirus (CMV) infection, rejection, biliary complications, retransplantation rate, and survival.Results
The incidence of HAT was 21/263, or 7.9%. Pure average MELD score was 22 ± 7.4. There was vascular anatomic variation in the graft in 14.2% of cases, in the majority (66.6%) a right hepatic artery from the superior mesenteric artery, and 4.76% of patients had CMV infection and acute cellular rejection (1 case each). There were biliary complications in 38% of patients, 13.3% of cases in patients with early HAT, and 100% of patients with late HAT (P = .002). Body mass index in late HAT was higher (P = .01).Conclusions
Late HAT was related to a significant increase in biliary complications (stenosis), and the survival rate was similar at 5 years. 相似文献5.
M. Bina Possatto E.C. de Ataíde C.A. Fazzio Escanhoela T. Sevá-Pereira R. de Cassia Martins Alves da Silva H. Felicio L.R. de Navarro Amado R. Ferreira da Silva A. Soares Lima I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):863-866
Background
Liver transplantation (LT) is a curative treatment option for hepatocellular carcinoma (HCC); recurrent HCC after liver transplantation (HCC-R) is diagnosed in 9%–16%. The objective of this study was to evaluate which factors are associated with R-HCC after liver transplantation.Methods
This retrospective real-life study analyzed 278 LTs from 3 reference centers (2,093 LTs) in Brazil from 1988 to 2015. HCC-R with histologic confirmation was seen in 40 patients (14.4%).Results
Most of them were male with cirrhosis secondary to viral hepatitis. Only 37.5% underwent chemoembolization, and 50% had cold ischemia time >8 hours. From the explant analysis, most of the patients were outside Milan criteria and 37.5% had microvascular invasion. The donors were mostly male, and the median intensive care unit time was >3 days. The Kaplan-Meier survival was lower according to alpha-fetoprotein (AFP) >200 ng/dL (P = .02), and older donors and more blood transfusions were risk factors for HCC-R death.Conclusion
AFP >200 ng/mL was associated with lower survival, and older donors and more blood transfusions were risk factors for death after HCC-R. A trend to lower survival was observed in patients who did not have chemoembolization and had cold ischemia times >8 hours. 相似文献6.
T.N. de Almeida J.P. Victorino J. Bistafa Liu D. Tófoli Queiroz Campos C. Graf M.C. Jordani L.A. Carneiro d&#x;Albuquerque K.D.S. Mendes O. Castro-e-Silva 《Transplantation proceedings》2018,50(3):841-847
Background
The liver may be injured in situations where it is submitted to ischemia, such as partial hepatectomy and liver transplantation. In all cases, ischemia is followed by reperfusion and, although it is essential for the reestablishment of tissue function, reperfusion may cause greater damage than ischemia, an injury characterized as ischemia-reperfusion (I/R) damage. The aim of this work was to analyze the effect of ischemic preconditioning with the use of methylene blue (MB; 15 mg/kg) 5 or 15 minutes before I/R (IRMB5′ and IRMB15′, respectively) on the hepatic injury occurring after I/R.Methods
Twenty-eight male Wistar rats were used, and liver samples submitted to partial ischemia (IR) or not (NI) were obtained from the same animal. The samples were divided into 7 groups. Data were analyzed statistically by means of the nonparametric Mann-Whitney test and Wilcoxon Matched test, with the level of significance set at 5% (P < .05).Results
The rate of oxygen consumption by state 3 mitochondria was inhibited in all ischemic groups compared with the sham group (SH vs IR: P = .0052; SH vs IRMB5′: P = .0006; SH vs IRMB15′: P = .0048), which did not occur in the nonischemic contralateral portion of the same liver (SH vs NI: P = .7652; SH vs NIMB5′: P = .059; SH vs NIMB15′: P = .3153). The inhibition of the rate of oxygen consumption by state 3 mitochondria was maintained in the presence of MB (IR vs IRMB5′: P = .4563; IR vs IRMB15′: P = .9021). The respiratory control ratio was reduced in all ischemic groups compared with the sham group, owing to the inhibition of oxygen consumption in state 3 (SH vs IR: P = .0151; SH vs IRMB5′: P = .005; SH vs IRMB15′: P = .0007).Conclusions
Methylene blue had no effect on the mitochondrial respiratory parameters studied, but was able to reduce lipid peroxidation, preventing the production of reactive oxygen species (SH vs IRMB15′: P = .0210). 相似文献7.
P. Osni Leão Perin I. de Fátma Ferreira Santana Boin A.M. Oliveira da Silva F. Chueiri Neto L.C. Martins 《Transplantation proceedings》2017,49(4):824-828
Lung ultrasound (LU) is useful in the diagnosis of pulmonary interstitial-alveolar syndrome (IAS) when B-lines are detected. Its prevalence and effect in lung function is not well studied in cirrhotic patients. The objective of this study was to detect the prevalence of interstitial-alveolar involvement with LU and correlate with pulmonary function test to distinguish the effect of ascites and B-lines in pulmonary function. This was an observational single-center study with 49 patients listed for liver transplantation submitted for LU and pulmonary function tests. Patients were divided into 4 groups: no ascites and no B-lines (n = 19), B-lines only (n = 19), ascites only (n = 6), and ascites and B-lines (n = 5). There was a worse forced vital capacity (FVC) in patients with B-lines only (76.1% ± 9.2; P = .0058) and ascites only (66.8% ± 10.2; P = .0010). 1-second forced expiratory volume (FEV1) also was lower in patients with B-lines only (78.5% ± 10.3; P = .0001), ascites only (71.3% ± 13.2; P = .0004), and B-lines and ascites (74.2% ± 7.6; P = .0035). Model for End-Stage Liver Disease score was worse in the group with ascites and B-lines (22.4 ± 10.1; P = .0229). B-Lines reduced FVC and FEV1 in our study and may be an independent factor in worsening pulmonary function in these patients. 相似文献
8.
A. Billis L.L.L. Freitas L.B.E. Costa I.S. Barreto M.A. Asato K.S. Araujo D.M. Losada A.P. Herculiani G.V.B.S. Tabosa B.C. Zaidan G.L.P. Oliveira L.Q.A. Bastos R.M. Rocha 《Transplantation proceedings》2017,49(8):1783-1785
Background
The aim of this study was to revise the histopathologic types of neoplasias in the genitourinary tract and determine the frequency of 2 new entities included in the 2016 book of World Health Organization classification of renal tumors. It is not established so far whether these 2 recently described tumors are the most frequent in association with end-stage kidney disease.Methods
In a retrospective analysis, we revised the histopathologic type of 37 genitourinary tumors from 21 patients in dialysis and/or submitted to renal transplantation from 2003 to 2016 aiming to find the frequency of acquired cystic disease–associated renal cell carcinoma and clear cell papillary (tubulopapillary) renal cell carcinoma.Results
From the total of 37 tumors, 34 were from native end-stage kidneys, 1 from the pelvis of the transplant kidney, and 2 from the urinary bladder. The frequencies from native kidneys were: papillary carcinoma, 13/34 (38.2%); papillary adenoma, 9/34 (26.5%); acquired cystic disease–associated renal cell carcinoma, 4/34 (11.8%); oncocytoma, 3/34 (8.8%); conventional clear cell renal cell carcinoma, 3/34 (8.8%); and clear cell papillary (tubulopapillary) renal cell carcinoma, 2/34 (5.34%). The pelvis and urinary bladder tumors were high-grade urothelial carcinomas. The patients with urinary bladder tumors had been treated for polyomavirus infection.Conclusions
The frequencies of acquired cystic disease–associated renal cell carcinoma and clear cell papillary renal cell carcinoma were 11.8% and 5.9%, respectively. However, the spectrum of adenoma/carcinoma papillary tumors composed the majority, 64.7%, of tumors. 相似文献9.
I.R.C. Brasil J. Custodio-Lima R.L. Sampaio A.M.M. Pierre T.M. Esmeraldo R.V.C. Lima L.F.A. Lima R.M. Esmeraldo 《Transplantation proceedings》2017,49(4):871-873
Intoduction
Infection by cytomegalovirus (CMV) is a major cause of morbidity among immunosuppressed patients, especially after solid organ transplantation. The risk of CMV after organ transplantation is strongly related to the serology of the donor and the recipient. The objective of this study was to analyze the outcomes and costs of pre-emptive therapy in patients after liver transplantation with donor-positive/recipient-negative (D+/R?) serostatus.Methods
This retrospective study analyzed all patients who underwent liver transplantation with CMV serostatus D+/R? between January 2012 and December 2015. The service protocol adopts pre-emptive therapy. The outcomes and costs of this therapy are described.Results
Of the 119 patients undergoing liver transplantation, 19 were D+/R? and entered the main analysis. Of these, 7 had positive polymerase chain reaction (PCR) results, and 1 developed CMV disease. Of the 6 patients who received no treatment, none developed CMV disease. Analyzing costs, pre-emptive therapy for these patients generated service savings of R$32,346.00.Conclusions
Although outcomes of universal prophylaxis and pre-emptive therapy are similar, pre-emptive therapy save on costs and have to be considered in patients with high-risk CMV disease after liver transplantation. 相似文献10.
J.C. Wiederkehr M.R. Igreja N. Gonçalves M. Nogara M. Godoy C. Drago A.M. Massutti H.A. Wiederkehr B.A. Wiederkehr 《Transplantation proceedings》2018,50(3):711-713
Institute George-Lopez-1 (IGL-1) solution is a preservation solution with lower potassium and lower viscosity than the University of Wisconsin solution that has been recently used in liver transplantation. In the present series, we compare the outcome of liver grafts from brain-dead donors preserved in IGL-1cold storage solution, with cold ischemia times (CITs) longer than 8 hours and those less than 8 hours. Two hundred fifty-two liver transplantations performed from January 2014 to December 2016 at Hospital Santa Isabel, Blumenau, Brazil, were retrospectively analyzed. The patients were divided in two groups according to the CIT. Group I patients (N = 155) had less than 8 hours of CIT with a mean age of 54 ± 11.35 years, whereas group II patients (N = 97) had more than 8 hours of CIT with a mean age of 52 ± 12.5 years. There was no difference between the groups related to indication for liver transplantation and donor characteristics. The only difference statically significant on laboratory data was between the levels of aspartate aminotransferase at day 1 after transplantation. On day 7 post-transplantation there was no difference statistically significant between aspartate aminotransferase, alanine aminotransferase, and bilirubin levels between the two groups. Similar 1-year patient survival rates were found in both groups, with 85.88% for group I and 85.75% in group II. The IGL-1 solution has been shown to be safe, effective, and with good results in liver transplantations. Early graft function and 1-year patient survival rates did not differ when grafts preserved for less than 8 hours were compared to those with CIT greater than 8 hours. 相似文献
11.
L. Campanati-Palhares T.C. Simoncini P.G. da Silva Augusto F.D. Masi Galhardo M.G. Pereira B.S. Vian M. Mazzali 《Transplantation proceedings》2018,50(3):750-753
Introduction
Chronic kidney disease can lead to dysfunction of the respiratory, cardiac, and musculoskeletal systems, altering the body's metabolism. Renal transplantation and hospital physiotherapy, through specific protocols, can improve these dysfunctions.Objectives
This study evaluates the impact of a hospital physiotherapeutic protocol in quality of life (QoL), respiratory muscle strength, peak expiratory flow, and 6-minute walk test (6MWT) in the preoperative, first, and fifth days after renal transplantation.Methods
We evaluated 39 patients who received a renal transplant at Clinics Hospital of University of Campinas for respiratory muscle strength, expiratory peak flow, and functional capacity by the 6MWT. The short form–36 quality of life questionnaire was applied to 12 patients.Results
We observed a significant reduction in respiratory muscle strength and peak expiratory flow in the first postoperative day. On postoperative day 5, there was improvement in respiratory muscle strength and expiratory peak flow. However, aerobic capacity measured by 6MWT remained below predicted. Analysis of QoL showed an improvement in almost all analyzed domains after transplantation.Conclusion
A specific physiotherapeutic protocol applied early after transplantation provided recovery of respiratory muscle strength and QoL. However, longer training is necessary to obtain adequate aerobic rehabilitation. 相似文献12.
E.C. Ataide S.R. Perales M.G. Silva F.C. Filho A.C. Sparapani P.F. Latuf Filho R.S.B. Stucchi J. Vassallo C.A.F. Escanhoela I.F.S.F. Boin 《Transplantation proceedings》2017,49(4):858-862
Background
Hepatocellular carcinoma (HCC) is the 6th leading cause of cancer worldwide. Its recurrence ranges from 6% to 26%. In the literature, many factors are associated with higher risk of recurrence, without a clear definition of the best method that could predict this highly lethal event.Objective
The aim of this study was to evaluate the immunoexpression of immunohistochemical markers: HSP70, glypican 3, glutamine synthetase, and beta-catenin, as well as studying their association with tumor characteristics and prognosis of patients undergoing liver transplantation for HCC.Methods
We studied 90 patients who underwent liver transplantation from 1998 to 2012. Afterwards we evaluated factors related to survival, tumor recurrence, and the correlation of expression of the immunohistochemical markers.Results
Immunohistochemical marker glutamine synthetase showed a positive trend toward better survival. HSP70-positive patients had a higher prevalence of histologic grade III. Patients with positive glypican 3 showed larger lesions and a higher number with AFP >200 ng/mL. Patients with positive beta-catenin showed larger nodules and more with histologic grade III. The association between beta-catenin and glypican 3 showed positive association with larger nodules.Conclusions
Most of the markers studied had a correlation with at least one of the variables studied, confirming our hypothesis that these markers can indeed assist in assessing the prognosis of patients undergoing liver transplantation for HCC. 相似文献13.
C. Corradi-Perini T.M. Santos N.O.S. Camara M.C. Riella C.A.M. Aita 《Transplantation proceedings》2017,49(4):902-905
Bone marrow–mesenchymal stem cells (BM-MSCs) have generated a great perspective in the field of regenerative medicine, and also in the treatment of inflammatory and autoimmune diseases in the past decade due to their immunomodulatory and anti-inflammatory properties. Here, we investigated the effect of xenogeneic BM-MSCs and pancreatic islets co-transplantation obtained from Wistar rats in preventing rejection or inducing tolerance to islet transplantation in non-obese diabetic mice. Non-obese diabetic mice were treated with co-transplantation of pancreatic islets and BM-MSCs (islet + MSCs group) or pancreatic islets only (islet group). Compared to the islet group, islet + MSCs had a lower expression of inflammatory markers, such as, tumor necrosis factor– α (13.40 ± 0.57 vs. 9.90 ± 0.12, P = .01), monocyte chemoattractant protein 1 (51.30 ± 6.80 vs. 9.00 ± 1.80, P = .01), and interleukin 1β (IL-1β) (16.2 ± 1.65 vs. 6.80 ± 1.00, P = .04). Comparing the expression of immune tolerance markers, it is noted that animals receiving the co-transplantation showed a significantly higher expression than the islet group of IL-4 (25.60 ± 1.96 vs. 2.80 ± 0.20, P = .004), IL-10 (188.40 ± 4.60 vs. 4.55 ± 0.12, P = .0001), and forkhead box P3 (34.20 ± 1.3 vs. 1.30 ± 0.2, P = .004), respectively. These results suggest an immunomodulatory action of BM-MSC in islet xenotransplantation showing that these stem cells have the potential to mitigate the early losses of grafts, due to the regulation of the inflammatory process of transplantation. 相似文献
14.
15.
L.S. Nacif R.S. Pinheiro V. Rocha-Santos V.M. Barbosa A.P. de Moura Dias R.B. Martino R.A. Macedo L. Ducatti L. Haddad F. Galvão W. Andraus L. Carneiro D’ Albuquerque 《Transplantation proceedings》2018,50(3):766-768
Background
Liver transplantation has evolved significantly in recent years, with each advancement part of the effort toward increasing patient and graft survival as well as quality of life. The objective of this study was to evaluate the prognostic factors and selection criteria for liver transplantation.Methods
Our study was a statistical analysis, logistic regression, and survival evaluation of a total of 80 liver transplants that were performed between June 1, 2016 and September 24, 2016. Recipient factors evaluated included age, retransplantation, hemodialysis, cardiac risk, portal vein thrombosis, hospitalization, fulminant hepatitis, previous surgery, renal failure, and Model for End-stage Liver Disease (MELD) score. Donor factors included age, cardiac arrest, acidosis, days in the intensive care unit, steatosis, and vasoactive drug use.Results
Of the 80 patients transplanted, 65 deceased donor liver transplants (DDLTs) and 15 living donor liver transplants (LDLTs) were performed. LDLT overall 1-year patient survival was 77.5% and graft survival 75%, and DDLT overall patient survival was 89.23% and graft survival was 86.15%. On evaluated score criteria analyzed we observed a significant score on recipient (P = .01) and not significant on donor (P =.45). Isolated factors evaluated included recipient age (relative risk [RR] 3.15, 95% confidence interval [CI] 0.89 to 11.09; P = .074), retransplant (RR 4.22, 95% CI 1.36 to 13.1; P = .013), and hemodialysis (RR 4.23, 95% CI 1.45 to 12.31, P = .008). On donor evaluation, we observed moderate and severe steatosis (RR 3.8, 95% CI 0.86 to 16.62; P = .06).Conclusion
In conclusion, we demonstrate a relevant model of criteria selection of liver transplant patients that is able to make a better match between the donor and recipient allocation for a better graft and patient survival. 相似文献16.
H.F. Costa F.P. dos Reis O. Gomes-Junior L.M. Fernandes L.G. Abdalla S.V. Campos R.H.O.B. Teixeira M.N. Samano P.M. Pêgo-Fernandes 《Transplantation proceedings》2017,49(4):878-881
Surgical and nonsurgical abdominal complications have been described after lung transplantation. However, there is limited data on this event in this population. The objective of this study was to analyze the incidence of abdominal complications in patients undergoing lung transplantation at the Heart Institute of the Faculty of Medicine, University of São Paulo (InCor-HCFMUSP) between the years 2003 and 2016. The main causes of abdominal complications were inflammatory acute abdomen (7 patients; 14%), obstructive acute abdomen (9 patients; 18%), gastroparesis (4 patients; 8%), distal intestinal obstruction syndrome (4 patients; 8%), perforated acute abdomen (7 patients; 14%), cytomegalovirus (CMV; 6 patients; 12%), and other reasons (12 patients; 26%). Separating these patients according to Clavien-Dindo classification, we had 21 patients (43%) with complications grade II, 4 patients (8%) with complications grade IIIa, 7 patients (14%) with grade IIIb complications, 7 patients (14%) with grade IV complications, and 10 patients (21%) with grade complications V. In conclusion, abdominal disorders are seriously increased after lung transplantation and correlate with a high mortality. Early abdominal surgical complication has worse prognosis. 相似文献
17.
M.V. de Sousa J.P. Guida C.F. do Valle L.F. Camargo G.G. Rivelli M. Mazzali 《Transplantation proceedings》2017,49(4):813-816
Background
Aldosterone is involved in the process of renal allograft fibrosis, clinically manifest by proteinuria and allograft dysfunction, with increased risk for cardiovascular death. The treatment with aldosterone antagonists appears to be effective in controlling proteinuria, with a protective effect on progression of renal fibrosis.Methods
This retrospective, cohort study included kidney transplant recipients from January 1993 to June 2015. Inclusion criteria were persistent proteinuria >0.5 g/d, longer than 6 months, and spironolactone therapy.Results
One hundred forty transplant recipients fulfilled the inclusion criteria and were divided into 3 groups, according to proteinuria levels at the beginning of spironolactone therapy: low (<1 g/24 h), intermediate (1–3 g/24 h), and nephrotic (>3 g/24 h). Groups were comparable in demographic data, with a higher incidence of living related donors in the nephrotic group. In patients with proteinuria ≥1 g/d, we observed a significant reduction in proteinuria after 6 months of therapy that persisted over time. Blood pressure and glomerular filtration rate persisted stable over time. Adverse events were not severe to withdrawal therapy.Conclusions
Spironolactone can be a safe alternative to control post-transplant proteinuria, especially in patients with mild to moderate allograft dysfunction with proteinuria ≥1 g/day. 相似文献18.
Gustavo de Sousa Arantes Ferreira André Luis Conde Watanabe Natália de Carvalho Trevizoli Fernando Marcus Felippe Jorge Priscila Brizolla de Campos Luiz Gustavo Guedes Diaz Larissa Pimenta Meireles Milla Carolina Costa Lafetá Araújo 《Transplantation proceedings》2019,51(5):1629-1632
Thrombosis of the inferior vena cava is a clinical condition with very diverse presentations, ranging from asymptomatic patients to others with severe edema in the legs and lower torso. We report the case of a 27-year-old female patient, previously diagnosed with autoimmune hepatitis, with asymptomatic extensive thrombosis of the inferior vena cava. The thrombus extended from the renal veins up to the emergence of the hepatic veins, causing post-sinusoidal portal hypertension (Budd-Chiari syndrome). The patient underwent an orthotopic cadaveric liver transplant with removal of the retrohepatic vena cava and thrombectomy of blood clots from the infrahepatic vena cava. She initially recovered well from surgery, but on the 8 postoperative day she had a significant increase in hepatic injury markers and was diagnosed with rethrombosis of the inferior vena cava and hepatic veins. A surgical thrombectomy was performed, with an intraoperative finding of chronic thrombus in both renal veins, previously undiagnosed. The thrombectomy was successful, but the patient's hepatic function continued to worsen and a second liver transplant was performed. After the second transplant she underwent several imaging exams that showed no signs of rethrombosis. She was kept on postoperative anticoagulation indefinitely, first with intravenous heparin then with rivaroxaban. An extensive investigation failed to identify any causes of thrombophilia associated with this vast thrombosis. She is currently alive and with good graft function 1 year and 4 months after the second transplant. 相似文献
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A.H.d.S. Quintella M.F. Lasmar R.A. Fabreti-Oliveira E. Nascimento 《Transplantation proceedings》2018,50(3):737-742