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  • 1
    Electronic Resource
    Electronic Resource
    Cross-clamping of the three hepatic veins in the piggyback technique is a safe and well tolerated procedure (1998)
    Springer
    Transplant international 11 (1998), S. S248 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Piggyback technique ; Systemic hemodynamics ; Inferior vena cava flow measurements
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A common stump of the three hepatic veins has always been used to fashion the upper vena cava anastomosis in 205 liver transplantations with the piggyback (PGB) technique performed in our Unit, to avoid outflow problems. The aim was to study the repercussion of lateral inferior vena cava (IVC) clamping on IVC flow and pressure as well as on systemic hemodynamics. We have studied 42 orthotopic liver transplantations performed with the PGB technique. Intraoperative IVC blood flow measurements by transit time ultrasonic volume flowmetry, IVC pressure, and systemic hemodynamics were taken before and after lateral IVC clamping. Graft outflow complications, stenosis or kinking of the upper vena cava anastomosis have not been found in any of the 205 PGB procedures. A significant decrease of IVC flow (23 %) and cardiac output (12 %) occurred after IVC clamping,whereas mean arterial and central venous pressures were not altered significantly, probably due to an increase (25 %) of systemic vascular resistance. Only in one case was an almost total clamping of IVC needed. Venovenous bypass was not needed in any case. Renal perfusion pressure was adequate in all cases. We conclude that the use of a common stump of the three hepatic veins for upper vena cava anastomosis in the PGB technique is safe because any outflow problem of the graft is avoided and, at the same time, is well tolerated hemodynamically because most of the IVC flow is preserved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050471
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  • 2
    Electronic Resource
    Electronic Resource
    Efficacy and safety of oral low-dose tacrolimus treatment in liver transplantation (1998)
    Springer
    Transplant international 11 (1998), S. S260 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Tacrolimus ; Rejection ; Toxicity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Eighty-four adult patients were recruited from four centres in Spain to evaluate the efficacy and safety of low-dose (0.1 mg/kg per day) oral tacrolimus plus corticosteroid immunosuppression in liver transplantation. The median daily dose of tacrolimus was increased during the first 3 weeks of therapy from an initial dose of 0.1 mg/kg per day to a maximum of 0.145 mg/kg per day and was subsequently decreased gradually to a minimum of 0.076 mg/kg per day at 1 year. At 7 days posttransplantation, 87.7 % of patients had trough whole blood levels of tacrolimus within the therapeutic range (5–20 ng/ml), and the median levels remained fairly constant during the rest of the year (10.1–11.8 ng/ml). None of the patients required intravenous administration of tacrolimus. At 1 year, Kaplan-Meier estimates showed that 73.8 % of the patients were receiving tacrolimus monotherapy without the need for corticosteroids. One-year patient and graft survival were 75.9 % and 72.3 %, respectively. The incidence of acute rejection was 51.2 %; 9.5 % of cases resolved spontaneously without antirejection therapy and 10.7 % were corticosteroid resistant. Only 1 patient (1.2 %) developed chronic rejection. The most important adverse events were hypertension (45.2 %), tremor (44.0 %), diabetes mellitus (33.3 %), diarrhoea (31 %) and nephrotoxicity (29.8 %). Severe neurotoxicity-like convulsions (4.8 %), dysarthria (9.5 %), delirium (1.2 %), coma (1.2 %) and the need for haemodialysis (3 patients) were uncommon. In conclusion, low-dose oral tacrolimus immunosuppression is associated with low toxicity without compromising efficacy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050474
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  • 3
    Electronic Resource
    Electronic Resource
    Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients (1998)
    Springer
    Transplant international 11 (1998), S. S251 
    Details
    ISSN: 1432-2277
    Keywords: Key words Biliary complications ; Hepatic artery thrombosis ; Liver transplantation ; Hepatic biloma ; Retransplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Biliary complications (BC) are the usual presentation of late hepatic artery thrombosis (HAT) of the liver graft. Our aim was to study the clinical features and outcome of BC secondary to HAT compared to BC which occurred in liver transplant (LT) patients with patent vessels. We present a retrospective study of 224 LTs performed in 204 patients between 1988 and 1996. The mean recipient × s age was 51 years. A choledochocholedochostomy without T-tube was used as biliary reconstruction in most cases (67 %); in 12 %, a choledochojejunostomy was performed. An iliac conduit was necessary in 15 % of cases and back-table arterial reconstruction was performed in 10 % of cases of anatomic variants in graft arteries. Different donor, recipient and intraoperative variables, as well as treatment and outcome, were studied in the two groups of patients presenting BC with or without HAT. BC occurred in 38 cases (17 %) whereas HAT was diagnosed in 11 cases (4.9 %). Therefore, 23 % of BC encountered after LT were secondary to HAT. Nine cases of late HAT manifested as BC, septicaemia (88 %) and hepatic bilomas (8 cases). Percutaneous or surgical drainage of hepatic bilomas was performed in all cases, followed by retransplantation in six cases (66 %). BC secondary to HAT appeared later than the rest of BC. Donor age was the only significant predisposing factor found in our study. Graft survival is significantly reduced as most patients needed retransplantation. In conclusion, BC secondary to HAT presented later in livers from older donors in the form of biliary sepsis and hepatic biloma. Retransplantation was ultimately required in most cases and graft survival was significantly diminished.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050472
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  • 4
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    "Escuela de Astorga, La (L. Alonso Luego, R. Gullón, L. Panero, J. Panero)". Ed. de J. Huerta Calvo (Book Review) (1995)
    Madrid : Periodicals Archive Online (PAO)
    Revista de literatura. 57:113/114 (1995:enero/dic.) 646-648 
    Details
    ISSN: 0034-849X
    Topics: Linguistics and Literary Studies
    Notes: RESEÑAS DE LIBROS
    URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pao:&rft_dat=xri:pao:article:6478-1995-057-13-000033
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  • 5
    Electronic Resource
    Electronic Resource
    Analysis of risk factors following pediatric liver transplantation (2000)
    Springer
    Transplant international 13 (2000), S. S150 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Children ; Risk factors for survival ; Primary non-function ; Hepatic artery thrombosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Several recipient, donor and operation factors as well as postoperative complications related to patient survival after liver transplantation (LT) in children were studied by univariate and multivariate analyses . In a 13-year period, 103 patients under 15 years of age underwent 120 LT; the mean age was 63 months and 36 % were under 2 years of age. Indications for LT were cholestatic disease in 68 (56 %), metabolic diseases in 18 (14 %), fulminant hepatic failure in 8 (7.5 %), cirrhosis in 7 (5.8 %), and retransplants in 17 (14 %). Whole liver was transplanted in 79 % of cases and partial liver in 21 %. Actuarial survival at 1, 5, and 10 years was 70 %, 61 %, and 57 %, respectively. United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non-function (PNF) (RR = 13.9), and hepatic artery thombosis (HAT) (RR = 3.8) were independent factors for lower patient survival in multivariate analysis. Thus, in our experience, postoperative mortality as a consequence of the patient's condition before transplantation, or complications such as PNF or HAT, are the major causes of decreased survival in pediatric LT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050308
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  • 6
    Electronic Resource
    Electronic Resource
    Early use of tacrolimus as rescue therapy for refractory liver allograft rejection (1998)
    Springer
    Transplant international 11 (1998), S. S313 
    Details
    ISSN: 1432-2277
    Keywords: Key words Tacrolimus ; Refractory rejection ; Hepatitis C virus ; Liver transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to compare two different periods of tacrolimus rescue therapy for intractable rejection. From January 1992 to May 1996, 140 liver transplants (LTx) were performed in our hospital under cyclosporine A-based immunosuppression. Twenty-four (17.1 %) patients were switched to tacrolimus because of chronic rejection, steroid-resistant rejection or cholestasic hepatitis C recurrence. Mean follow-up was 21 months (range 12–56 months). In the first period (January 1992–March 1994), conversion to tacrolimus was indicated later, after unsuccessful repeated rejection therapy. In the second period (April 1994–May 1996), conversion to tacrolimus was indicated early, immediately after unseccessful rejection therapy or directly at the moment of diagnosis with no further treatment. Eleven of 54 LTx were treated with tacrolimus in period 1 (20.3 %), and 13 of 86 LTx in period 2 (15.1 %). Only 4 of 11 (36.6 %) grafts converted were rescued during the first period, while 11 of 13 (84.6 %) were rescued in the second (P 〈 0.03). Patients in the first period received more courses of steroids than those of the second (1.7 ± 0.7 vs 0.9 ± 0.7, P 〈 0.02). Furthermore, six patients received one or two courses of OKT3 in period 1 while only one received one course in period 2 (P 〈 0.03). Preconversion mean bilirubin levels of patients in the first period were higher than those in the second (15.9 ± 7.3 mg/dl vs 9.7 ± 5.8 mg/dl, P 〈 0.05). Preconversion mean bilirubin levels of 6.8 ± 5.4 mg/dl and 21.8 ± 18.5 mg/dl were observed in patients with successful and unsuccessful tacrolimus rescue therapy, respectively, independent of the treatment period (P 〈 0.05). Mortality rates were higher in the first period than in the second (82 % versus 23 %; P 〈 0.02). In conclusion, conversion to tacrolimus as rescue therapy for intractable rejection or cholestasic hepatitis C recurrence is an efficacious alternative, particularly when tacrolimus is initiated early.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050486
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