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Very late hepatic artery thrombosis after liver transplantation: a diagnosis with a misleading doppler ultrasonographic pattern
No full text
Il trapianto di fegato
No full textThe significant advances achieved in the last years in the field of liver transplantation have led to an almost routinely performance of this therapeutic approach throughout North America and Western Europe. This has led to an increased demand so that today the real problem is the organ availability and the need to use those supplied only for patients with best chances of success. For this reason timing of the operation and patient selection are of critical importance. The ultimate success depends on better surgical procedures and advances in immunosuppressive therapy, but perhaps even more on an accurate patient evaluation. The patient selection is based on standardized medical criteria which constitute the indication in patients with end-stage liver disease and on a careful search for risk factors. To this purpose the evaluation of the tolerance of the hemodinamic stress during clamping of the inferior vena cava is of critical importance and must be carefully evaluated both in patients with known and unknown coronary disease. Another condition to be considered is lung hypertension which is frequently associated with portal hypertension. Finally, important conditions for a good evaluation are the epatopulmonary syndrome and diabetes. The last condition is not a contraindication unless associated with seve-re vascular, cardiac or renal complications
Ultrasonography and hepatic involvment of earlyonset lymphoma after liver transplantation
No full textNo hepatitis recurrence using combination prophylaxis in HBV-positive liver transplant recipients with YMDD mutants
No full textRecurrence of hepatitis B impairs the outcome of liver transplantation (OLT). In serum hepatitis B virus (HBV)-DNA-positive recipients, prophylaxis using lamivudine and immunoglobulins (HBIg) reduces the risk of recurrence, but it is undefined whether this regimen also protects candidates with YMDD mutants. Seventeen OLT viraemic candidates received pre-emptive lamivudine followed by post-OLT prophylaxis with lamivudine and HBIg. Both sera and liver biopsies were prospectively collected and high-sensitive polymerase chain reaction (PCR) assay was applied for HBV-DNA detection. Finally, the presence of YMDD mutants was explored in all PCR-positive samples. All patients remained hepatitis B recurrence-free after a mean follow up of 32 months. By PCR, serum HBV-DNA was detectable in 64.3% of cases at OLT-baseline, in 64.7% under combined prophylaxis and in 58.8% in patients (70.5% of the total) with a minimum follow up of 24 months. At OLT-baseline, YMDD mutants were found in 44.4% of patients. After OLT, mutants were present in 50% of patients but only in 16.6% of cases in the long period. Although 41% of the native livers and 42.8% of the analysed grafts harboured HBV-DNA, YMDD mutants were detected in 57% of the native positive livers. YMDD mutants were largely detected both at OLT-baseline and post-OLT, but their presence decreased over time. Regardless of the presence of YMDD mutants, no hepatitis B recurrence was observed in our OLT recipients using preemptive lamivudine followed by continuous prophylaxis with lamivudine and HBIg
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