117 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
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
Hyperhomocysteinemia in liver transplant recipients: prevalence and multivariate analysis of predisposing factors.
Liver transplant recipients have an increased risk for cardiovascular disease
because of a high incidence of obesity, arterial hypertension, diabetes mellitus,
and hyperlipidemia. Hyperhomocysteinemia has been found to be an important risk
factor for cardiovascular disease in large studies. Fasting serum levels of
homocysteine were measured in 105 liver transplant recipients, and
hyperhomocysteinemia was defined as a fasting serum homocysteine level greater
than 13 micromol/L. Patients with versus without hyperhomocysteinemia were
compared. The possible association of hyperhomocysteinemia with age, sex, cause
of liver disease, time elapsed since liver transplantation, immunosuppressive
therapy, folic acid level, liver function test results, renal function, and other
cardiovascular risk factors was investigated. Patients with serum homocysteine
levels greater than 15 micromol/L were treated with folic acid, 10 mg/d, and
serum homocysteine levels were measured again 1 to 3 months later in 10 patients.
Hyperhomocysteinemia was detected in 28 patients (27%). In univariate analysis,
it was associated with hepatitis C virus infection, treatment with mycophenolate
mofetil, and greater serum levels of alkaline phosphatase, gamma-glutamyl
transpeptidase, urea, and creatinine. In multivariate analysis, only greater
serum levels of creatinine (P =.006) were associated with hyperhomocysteinemia.
Treatment with folic acid resulted in a decrease in fasting serum homocysteine
levels in 9 of the 10 patients tested (P =.01). Hyperhomocystinemia, associated
with renal dysfunction, is a frequent finding in liver transplant recipients.
Treatment with folic acid may reduce fasting homocysteine levels
Prognostic model for early acute rejection after liver transplantation
Hepatic graft rejection is a common complication after liver transplantation
(LT), with a maximum incidence within the first weeks. The identification of
high-risk patients for early acute rejection (EAR) might be useful for
clinicians. A series of 133 liver graft recipients treated with calcineurin
inhibitors was retrospectively assessed to identify predisposing factors for EAR
and develop a mathematical model to predict the individual risk of each patient.
The incidence of EAR (< or =45 days after LT) was 35.3%. Multivariate analysis
showed that recipient age, underlying liver disease, and Child's class before LT
were independently associated with the development of EAR. Combining these 3
variables, the following risk score for the development of EAR was obtained: EAR
score [F(x)] = 2.44 + (1.14 x hepatitis C virus cirrhosis) + (2.78 x immunologic
cirrhosis) + (2.51 x metabolic cirrhosis)--(0.08 x recipient age in years) +
(1.65 x Child's class A) [corrected]. Risk for rejection = e(F(x))/1 + e(F(x)).
The combination of age, cause of liver disease, and Child's class may allow us to
predict the risk for EAR
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