RESUMO
STUDY DESIGN: Between July 1993 and March 1997, 110 children were listed for primary elective liver transplantation with cadaveric (Cad: n = 68) or living-related (LR: n = 42) donors. Pregraft mortality, post-transplant survival, and surgical and immunologic complications were retrospectively compared in both groups. RESULTS: The pregraft mortality rate was 10 (15%) of 68 versus 1 (2%) of 42 in the Cad and LR groups, respectively (P =.049). Postliver transplantation 1-year patient and graft survival rates were 87% and 75% in the Cad group (n = 49) versus 92% and 90% in the LR group (n = 41), respectively (NS). The incidence of post-transplant complications was as follows: hepatic artery thrombosis (Cad: 16%; LR: 0%, P =.020), portal vein thrombosis (Cad: 8%; LR: 2%, NS), and biliary complications (Cad: 14%; LR: 34%, P =.044). The overall incidence of acute rejection was similar in both groups; however, a lower incidence of acute rejection occurred in LR graft recipients treated with tacrolimus. CONCLUSIONS: The introduction of an LR donor liver transplantation program allowed a significant decrease in the pretransplant mortality rate, with a consequent overall improvement in patient survival compared with the Cad series. The incidence of biliary complications was higher in the LR series, whereas better human leukocyte antigen matching in this subgroup did not result in a lower rejection incidence.
Assuntos
Transplante de Fígado , Doadores Vivos , Adolescente , Bélgica/epidemiologia , Cadáver , Criança , Pré-Escolar , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Incidência , Lactente , Falência Hepática/mortalidade , Falência Hepática/cirurgia , Transplante de Fígado/mortalidade , Transplante de Fígado/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Delayed response to medical treatment sometimes leads to unnecessary liver transplantation in patients with severely decompensated Wilson disease. We report the course of five patients (mean age 13.4 years, range 11 to 15 years) with severely decompensated Wilson disease who were successfully treated medically. Prothrombin time improved after a minimum of 1 month and returned to normal within 3 months to 1 year or more.
Assuntos
Antibacterianos/uso terapêutico , Degeneração Hepatolenticular/tratamento farmacológico , Degeneração Hepatolenticular/terapia , Penicilamina/uso terapêutico , Sulfatos/uso terapêutico , Compostos de Zinco/uso terapêutico , Adolescente , Antibacterianos/administração & dosagem , Terapia por Quelação , Criança , Cobre/urina , Feminino , Hemólise , Humanos , Penicilamina/administração & dosagem , Tempo de Protrombina , Sulfatos/administração & dosagem , Compostos de Zinco/administração & dosagem , Sulfato de ZincoRESUMO
Two years after an orthotopic liver transplantation, a multifocal hepatic tumor with lymphonodular metastases, identified as a fibrosarcoma, developed in a 4-year-old girl being treated with cyclosporine. On a needle biopsy sample, genetic typing of the HLA-DR group revealed that tumoral cells were from the recipient.
Assuntos
Fibrossarcoma/etiologia , Neoplasias Hepáticas/etiologia , Transplante de Fígado/efeitos adversos , Pré-Escolar , DNA de Neoplasias/análise , Feminino , Fibrossarcoma/genética , Antígenos HLA-DR/genética , Humanos , Neoplasias Hepáticas/genética , Doadores de TecidosRESUMO
An acute or fulminant adenovirus hepatitis developed in 5 of 224 pediatric patients who were recipients of orthotopic liver transplants. All had received prednisolone, azathioprine, and cyclosporine as basal immunosuppression, and four received monoclonal (OKT3) or polyclonal (antithymocyte globulin) antibodies for steroid-resistant rejection episodes. These patients initially had high fever and a worsening condition for a mean of 73 days after transplantation (range 44 to 140 days). Results of biochemical tests showed very high serum levels of lactate dehydrogenase. Aspartate aminotransferase values were always markedly more elevated than those of alanine aminotransferase. Two patients had severe leukopenia. Results of histologic studies of the liver showed extensive areas of confluent necrosis and targetlike hepatocyte nuclei. Typical intranuclear viral inclusions were observed on electron microscopy. Adenovirus was cultured in all patients and in two relatives. Two patients died of liver failure; others recovered after cessation of immunosuppression. We conclude that adenovirus hepatitis can be fatal in liver transplant recipients. There is no specific treatment, and immunosuppression must be discontinued.
Assuntos
Infecções por Adenovirus Humanos/etiologia , Hepatite Viral Humana/etiologia , Transplante de Fígado/efeitos adversos , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/patologia , Adenovírus Humanos/classificação , Adenovírus Humanos/isolamento & purificação , Azatioprina/administração & dosagem , Azatioprina/uso terapêutico , Atresia Biliar/cirurgia , Pré-Escolar , Ciclosporina/administração & dosagem , Ciclosporina/uso terapêutico , Hepatite Viral Humana/diagnóstico , Hepatite Viral Humana/patologia , Humanos , Lactente , Hepatopatias/cirurgia , Transplante de Fígado/patologia , Necrose , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Fatores de TempoRESUMO
Of 139 children who received an orthotopic liver transplant in our center between March 1984 and July 1989, a total of 17 patients (12%) had transplants before their first birthday (mean age 10.3 months; range 8 to 11). The mean weight was 7.3 kg (range 5.2 to 13). Nine retransplantations were performed in five children because of primary nonfunction (three children), hepatic artery thrombosis (four), or rejection (two). A reduced donor liver was used for 11 of 26 transplants. Baseline immunosuppression included cyclosporine, prednisone, and azathioprine with OKT3 or anti-thymocyte globulin for steroid-resistant rejection episodes. Survivors were discharged after a mean hospital stay of 47 days (range 22 to 87), and nonsurvivors died within a mean of 40 days (range 0 to 120). The 1 year actuarial survival rate was 64.7%, in comparison with 75.8% in the whole series. One patient died perioperatively, two died from primary nonfunction, one from adenovirus infection, two from rejection, and one from bone marrow aplasia. Eighteen rejection episodes, of which 11 were steroid resistant, occurred in 11 patients. Our series shows that liver transplantation can be successful in this age group.