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Delayed Construction of the Bilio-Digestive Anastomosis in Right Living Donor Liver Transplantation
No full textWe describe a two-step procedure in the transplantation of a right lobe liver graft obtained from a living donor, in which the biliary anastomosis is delayed until the day after the actual implantation of the graft. The purpose of the two-step procedure is to minimize the factors that might contribute to biliary complications in living donor liver transplantation (LDLT). Three patients who received a graft with two hepatic ducts underwent Roux-en-Y hepatico-jejunostomies during a separate procedure the day after the implantation of the graft. Length of intubation, recovery of enteral alimentation, and hospital stay were similar to the patients who underwent one-step transplant. No biliary or infectious complications occurred. Delaying the hepatico-jejunostomy when two ducts are present and a bilio-digestive anastomosis is planned has no negative impact on the postoperative course of the patients but can ameliorate the conditions under which the anastomoses must be performed
Delayed construction of the bilio-digestive anastomosis in right living donor liver transplantation
No full textWe describe a two-step procedure in the transplantation of a right lobe liver graft obtained from a living donor, in which the biliary anastomosis is delayed until the day after the actual implantation of the graft. The purpose of the two-step procedure is to minimize the factors that might contribute to biliary complications in living donor liver transplantation (LDLT). Three patients who received a graft with two hepatic ducts underwent Roux-en-Y hepatico-jejunostomies during a separate procedure the day after the implantation of the graft. Length of intubation, recovery of enteral alimentation, and hospital stay were similar to the patients who underwent one-step transplant. No biliary or infectious complications occurred. Delaying the hepatico-jejunostomy when two ducts are present and a bilio-digestive anastomosis is planned has no negative impact on the postoperative course of the patients but can ameliorate the conditions under which the anastomoses must be performed
Successful rescue of refractory, severe antibody mediated rejection with splenectomy
No full textAntibody-mediated rejection (AMR) commonly occurs after transplantation of ABO-incompatible and sensitized renal transplant. Treatment regimens commonly include a combination of plasmapheresis (PL) and intravenous immunoglobulin (IVIG). However, some cases of AMR remain refractory to treatment. We report a case series of four patients with AMR refractory to standard therapy (ST) who resolved after splenectomy. Four living donor kidney transplant recipients were diagnosed with AMR. Two patients were ABO incompatible, one was cross-match positive and one had no obvious predisposing factors. After failure of therapy with corticosteroids, PL, IVIG, Thymoglobulin, and Rituximab (three patients) or Campath (one patient), AMR was treated with laparoscopic splenectomy. After an average of I I days of ST, laparoscopic splenectomy was performed for rescue. The urinary output improved immediately in all patients, serum creatinine levels decreased within 48 hr, and ABO titers fell in the ABO-incompatible patient and the cross-match became negative in the two sensitized patients. Splenectomy may play a role in the treatment of AMR refractory to ST
Standard chronic immunosuppression after kidney transplantation for systemic lupus erythematosus eliminates recurrence of disease
No full textBackground: There is only limited experience in patients with systemic lupus erythematosus (SLE) with drugs that have developed for immunosuppression after organ transplantation, namely calcineurin inhibitors (CI). The aim of this study is to determine the effect of these drugs on disease activity after kidney transplant in patients affected by SLE. Methods: Between January 1990 to March 2003, 13 patients with end- stage renal disease secondary to SLE received 14 kidney transplants. The outcome variables assessed include graft and patient survival as well as clinical and serological lupus activity. Results: All received CI-based immunosuppression (cyclosporine or tacrolimus). Actuarial patient and graft survivals at 5 yr were 100 and 93%, respectively. Recurrence of clinical or serological disease was never detected. Conclusions: To date, only anecdotal experience with CI in the treatment of SLE has been reported. The favorable response observed in our patients suggests that CI at low-doses are effective in preventing SLE-reactivation. Further studies focused on calcineurin inhibitor treatment in SLE patients who fail to respond to standard medical management should be conducted
Hepatic venous outflow reconstruction in adult living donor liver transplants without portal hypertension
No full textGraft congestion is one of the causes of poor graft function in segmental liver transplantation. Three factors are implicated in segmental graft congestion: graft size, hepatic venous outflow and portal inflow. The graft size must be matched to the body weight, which is conventionally done by using graft to body weight ratio. Hepatic blood outflow must be optimized by hepatic vein reconstruction, which can be complicated. High portal blood flow has been shown to be detrimental to small-for-size grafts. These factors are strictly connected to each other. They can all contribute to graft congestion and poor function, while one factor can compensate for the others and decrease congestion. Ideally, all the accessory veins should be reconstructed, if possible, to maximize the outflow. In the absence of portal hypertension and with an adequate sized graft, complex venous reconstruction may not be necessary. We present a case report of an adult living donor liver transplant with the favorable conditions of normal portal pressure and a large sized graft, but complicated by the presence of several accessory hepatic veins. A simple hepatic vein anastomosis was sufficient for adequate outflow and prompt graft function
Successful treatment of trauma-induced short bowel syndrome with early living related bowel transplantation
No full textPeliosis hepatis in a living related liver transplantation donor candidate
No full textPeliosis hepatis is a rare benign condition histologically characterized by multiple cystic blood-filled spaces distributed throughout the liver parenchyma. Peliosis hepatis has been associated with malignancies, immunosuppression, infections and medications. We report a case of peliosis hepatis in a candidate for living liver donation, which regressed with restitutio ad integrum, after the noxious stimulus was stopped. We conclude that after diagnosis of peliosis hepatis is established and its cause is removed, simple radiographic imaging is sufficient to document the restitutio ad integrum of the parenchyma, avoiding repeat histological confirmation
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
'Prope' tolerance in a noncompliant living related small bowel transplant recipient after severe rejection
No full textAdvances in immunosuppression and surgical technique have greatly improved patient outcomes after intestinal transplantation. However, the procedure remains one of the most challenging among solid organ transplantation as a result of the high rate of acute rejection, sepsis, and posttransplantation lymphoproliferative disorder. Recently, clinical trials to explore tolerance protocols in humans have been initiated, including small bowel transplant recipients, with results not always reproducible. The concept of operational tolerance is more meaningful in the clinical setting when physiological stability of graft function is achieved in the absence of maintenance immunosuppression. We report the intriguing case of a living related small bowel transplant recipient who developed clinical "prope" tolerance to the graft after treatment of severe acute rejection despite continuous noncompliance with immunosuppressive therapy
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