142 research outputs found
De novo malignancies following liver transplantation: impact and recommendations
1. De novo malignancy is one of the leading causes of
late mortality after liver transplantation.
2. The risks of skin cancers and lymphoma are more
than 10-fold greater than the risks in an age-matched
and sex-matched general population.
3. Some types of neoplasia, such as lung, head and
neck, and colorectal cancer, are more frequent in liver
transplant recipients than in an age-matched and sexmatched
population. The risks of other frequent malignancies,
such as prostate and breast cancer, do not
seem to be increased.
4. The most important risks for posttransplant malignancy
are Epstein-Barr virus seronegativity (for lymphoma),
sun exposure (for skin cancer), smoking, and
increasing age.
5. Despite the absence of evidence, general recommendations
(such as avoidance of overimmunosuppression,
sunlight protection, and cessation of smoking)
should be given. Screening protocols may help to
detect neoplasia at an early stage of disease
Prophylaxis and treatment of hepatitis B infection in the setting of liver transplantation
Without any treatment, the prognosis of hepatitis B in liver
transplant recipients is very poor. So, antiviral prophylaxis is very
important in patients with hepatitis B who undergo liver transplantation.
Before liver transplantation, a suppression of viral
replication has to be achieved by nucleos(t)ide analogs. Drugs used
in the prophylaxis of post-transplant hepatitis B include immunoglobulin
against HBV and nucleos(t)ide analogs. Prophylaxis
against graft infection must be based on the individual risk of recurrence.
When prophylactic measures have failed and graft infection
has occurred, treatment of recurrent hepatitis B may be
based on the resistance profile of the virus and previous antiviral
exposure. Finally, lamivudine seems to be very effective in the
prevention of de novo hepatitis B in patients transplanted with a
graft from an anti-HBc positive donor
DNA barcoding allows identifcation of undescribed crab megalopas from the open sea
Megalopas of 15 brachyuran crab species collected in the open sea plankton, and unknown until now, were identified using DNA barcodes (COI and 16S rRNA). Specimens belonging to the families Portunidae, Pseudorhombilidae and Xanthidae (Crustacea, Decapoda, Brachyura), and corresponding to the species Achelous floridanus, Arenaeus mexicanus, Callinectes amnicola, C. arcuatus, C. ornatus, C. toxones, Charybdis (Charybdis) hellerii, Portunus hastatus, Thalamita admete, Scopolius nuttingi, Etisus odhneri, Liomera cinctimanus, Neoliomera cerasinus, Pseudoliomera variolosa, and Williamstimpsonia stimpsoni, are described and illustrated, and compared with other congeneric species previously described. We also provide a new geographical record for N. cerasinus and the most remarkable features for each species.En prens
Trasplante hepático
Liver transplantation is an efficient therapeutic
option for terminal hepatic diseases. The principal
indications of liver transplantation are hepatic cirrhosis,
hepatic tumours (mainly, hepotocellular carcinoma)
and acute liver failure. Over the years, the
absolute contraindications for a transplant have lessened.
Surgical techniques have also undergone
changes. The results of liver transplant have improved
so that survival one year after the transplant is close to
90% and after five years some 80% of transplanted
patients continue to live
Expression of Wilms' tumor suppressor in the liver with cirrhosis: relation to hepatocyte nuclear factor 4 and hepatocellular function
The Wilms' tumor suppressor WT1 is a transcriptional regulator present in the fetal but not in the mature liver. Its expression and functional role in liver diseases remains unexplored. In this study, we analyzed WT1 expression by reverse-transcription polymerase chain reaction (RT-PCR) and by immunohistochemistry in normal and diseased livers. In addition, we performed in vitro studies in isolated rat hepatocytes to investigate WT1 regulation and function. We detected WT1 messenger RNA (mRNA) in 18% of normal livers, 17% of chronic hepatitis with minimal fibrosis, 49% of chronic hepatitis with bridging fibrosis, and 71% of cirrhotic livers. In cirrhosis, WT1 immunoreactivity was localized to the nucleus of hepatocytes. WT1 mRNA abundance correlated inversely with prothrombin time (P =.04) and directly with serum bilirubin (P =.002) and with the MELD score (P =.001) of disease severity. In rats, WT1 expression was present in fetal hepatocytes and in the cirrhotic liver but not in normal hepatic tissue. In vitro studies showed that isolated primary hepatocytes express WT1 when stimulated with transforming growth factor beta (TGF-beta) or when the cells undergo dedifferentiation in culture. Moreover, we found that WT1 down-regulates hepatocyte nuclear factor 4 (HNF-4), a factor that is essential to maintain liver function and metabolic regulation in the mature organ. Hepatic expression of HNF-4 was impaired in advanced human cirrhosis and negatively correlated with WT1 mRNA levels (P =.001). In conclusion, we show that WT1 is induced by TGF-beta and down-regulates HNF-4 in liver cells. WT1 is reexpressed in the cirrhotic liver in relation to disease progression and may play a role in the development of hepatic insufficiency in cirrhosis
Influence of tumor characteristics on the outcome of liver transplantation among
Hepatocellular carcinoma (HCC) may recur after liver transplantation (LT), mainly
in patients with multinodular and large tumors. However, factors predictive of
outcome after LT in patients with small tumors remain ill defined. We
investigated which factors were related to mortality or tumor recurrence among 47
liver transplant recipients with liver cirrhosis and HCC and compared them with
107 patients with liver cirrhosis without tumor who underwent LT in the same
period. Patients with HCC were older (P <.001), more frequently had cirrhosis of
a viral origin (P <.001), and had lower Child-Pugh scores (P <.001) than patients
without tumor. Survival of patients with and without tumor was not significantly
different (P =.20). Among patients with HCC, those with lower recurrence-free
survival rates had liver cirrhosis of a viral origin, vascular invasion, bilobar
disease, and tumor-node-metastasis (TNM) stage IV. At multivariate analysis, the
only factor associated with mortality or recurrence was TNM stage IV (P =.02).
Our results suggest that in patients with HCC and TNM stage IV, LT might be
contraindicate
Herpes Zoster After Liver Transplantation: Incidence, Risk Factors, and Complications
Herpes zoster is the consequence of the reactivation of latent varicella-zoster
infection. Immunosuppression may be a predisposing factor for herpes zoster. We
have retrospectively assessed the risk of herpes zoster, the risk factors for its
occurrence, and its evolution in a population of 209 consecutive liver transplant
recipients. Herpes zoster developed in 25 (12%) of patients. One-, 3-, 5-, and
10-year actuarial rates of herpes zoster were 3%, 10%, 14%, and 18%,
respectively. In a case-control study, patients developing herpes zoster were
younger, received a higher number of immunosuppressive drugs, and were more
frequently receiving mycophenolate mofetil or azathioprine. In multivariate
analysis, the only factor related to herpes zoster occurrence was treatment with
mycophenolate mofetil or azathioprine. Eight patients (31%) developed
postherpetic neuralgia. In conclusion, herpes zoster is a relatively common
complication after liver transplantation. It is related to immunosuppressive
therapy. Postherpetic neuralgia develops in one third of patients with
posttransplant herpes zoster
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