RESUMO
INTRODUCTION: Biliary complications (BC) are one of the most frequent surgical complications after liver transplantation. They include biliary stenosis, leaks, choledocolitiasis and sphincter of Oddi dysfunction. These complications can cause graft dysfunction, retrasplantation, or even death. The purpose of this study was to identify factors related to BC. MATERIALS AND METHODS: The medical records of all adult patients who underwent their first liver transplantation in our institution from 2005 to 2013 were reviewed, and any BC that required management was recorded. Cumulative incidence of BC was estimated using Kaplan-Meier. Patient and graft survival was compared using the log-rank test. The Cox regression model was used to establish associated factors. RESULTS: Of the 236 patients who underwent liver transplantation, 41 patients (17.8%) developed BC. Cumulative incidence was 12.9%, 17.2%, and 20%, after 1, 3 and 5 years of the transplantation, respectively. Twenty-six cases of biliary stenosis, 11 of leaks, and 4 of choledocolitiasis were identified. Most patients were managed endoscopically (82.9%). There were no differences in patient or graft survival. DISCUSSION: Biliary stenosis is the most frequent BC. Patients with higher risk of BC were of blood type AB (P < .001), had viral hepatitis (P = .049), or had alcoholic cirrhosis (P = .036). The success with the endoscopic treatment reduced the need for surgical interventions. CONCLUSIONS: The incidence of BC in our institution is comparable with the incidence reported in other institutions. Further prospective studies with larger series of patients are warranted to identify other factors associated with development of BC.
Assuntos
Doenças dos Ductos Biliares/etiologia , Transplante de Fígado/efeitos adversos , Adulto , Idoso , Doenças dos Ductos Biliares/mortalidade , Colestase/etiologia , Colestase/mortalidade , Colômbia/epidemiologia , Endoscopia do Sistema Digestório/estatística & dados numéricos , Feminino , Sobrevivência de Enxerto/fisiologia , Humanos , Incidência , Cirrose Hepática Alcoólica/mortalidade , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Reoperação/mortalidade , Reoperação/estatística & dados numéricos , Fatores de RiscoRESUMO
Malaria is an exotic complication in liver transplants patients. It can be acquired either by transfusion of blood products or through the transplanted organ. Infections caused by Plasmodium spp are unusual in liver transplants; to date, only four cases have been reported in the literature. Herein we have presented a case of Plasmodium vivax in a liver transplant patient. This diagnosis must be excluded in febrile transplant patients in endemic areas, especially during the first 2 months. An epidemiological history relevant for malaria both in the donor and in the recipient must be routinely included with screening tests.
Assuntos
Antimaláricos/uso terapêutico , Transplante de Fígado/efeitos adversos , Malária Vivax/diagnóstico , Adulto , Animais , Transfusão de Sangue , Colômbia , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/uso terapêutico , Período Intraoperatório , Falência Hepática/cirurgia , Malária Vivax/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Plasmodium vivax/isolamento & purificação , Resultado do TratamentoRESUMO
Tuberculosis, caused by Mycobacterium bovis is emerging as the most important disease affecting cattle. Furthermore, it results in a major public health problem when transmitted to humans. Due to its difficult and non-specific diagnosis, M. bovis has been declared to be one of the etiologic agents causing significant economic loss in the cattle industry. Our group evaluated a more rapid and specific method, based on a new polymerase chain reaction species-specific primers, which amplifies a 470-base pair fragment of the M. bovis genome. A total of 275 milk-producing cows were studied by intradermal tuberculin test (ITT) which gave 184 positive and 91 negative cases. From them, 50 animals were taken from a cattle ranch free of tuberculosis. Three different samples were collected from each animal (blood, nasal mucus, and milk). Positive results were obtained from 26 animals by PCR (11.4%), 1 by bacteriological culturing (0.4%) and 1 by bacilloscopy (0.4%). This finding suggests, as in previous reports, that ITT, normally used for bovine tuberculosis detection, has the inconvenience of having a broad range of specificity and sensitivity, and the PCR technique is a more specific and sensitive test to detect infection associated with M. bovis. Therefore, we propose this PCR assay as a useful tool in the epidemiological characterization of infected animals in areas considered to be at high risk of transmission.