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Successful twin pregnancy after orthotopic liver transplantation
Coelho, Júlio Cezar Uili;Parolin, M?nica Beatriz;Matias, Jorge E. Fouto;
Arquivos de Gastroenterologia , 2002, DOI: 10.1590/S0004-28032002000400007
Abstract: aim: report of a case of successful twin pregnancy following liver transplantation. patient and method: a 42-year-old nulliparous-woman was subjected to an orthotopic liver transplantation due to budd-chiari syndrome. sixteen months after the transplantation, an ultrasonography revealed twin pregnancy. her prenatal course was uneventful, except for mild arterial hypertension. the immunosuppressive agents used during pregnancy were cyclosporine and prednisone. result: the patient gave birth to two healthy girls at 37 weeks of gestation. the patient's postpartum course was uneventful with normal liver and renal function tests. conclusion: following successful pregnancy, women may become pregnant and give birth to normal children, including twins
Successful twin pregnancy after orthotopic liver transplantation
Coelho Júlio Cezar Uili,Parolin M?nica Beatriz,Matias Jorge E. Fouto
Arquivos de Gastroenterologia , 2002,
Abstract: AIM: Report of a case of successful twin pregnancy following liver transplantation. PATIENT AND METHOD: A 42-year-old nulliparous-woman was subjected to an orthotopic liver transplantation due to Budd-Chiari syndrome. Sixteen months after the transplantation, an ultrasonography revealed twin pregnancy. Her prenatal course was uneventful, except for mild arterial hypertension. The immunosuppressive agents used during pregnancy were cyclosporine and prednisone. RESULT: The patient gave birth to two healthy girls at 37 weeks of gestation. The patient's postpartum course was uneventful with normal liver and renal function tests. CONCLUSION: Following successful pregnancy, women may become pregnant and give birth to normal children, including twins
Aspergillus endophthalmitis in orthotopic liver transplantation  [cached]
Hosseini Hamid,Saki Soraya,Saki Nasrin,Eghtedari Masoomeh
Indian Journal of Medical Sciences , 2009,
Abstract: In this report, we describe a patient with drug-induced liver failure who developed endogenous endophthalmitis after liver transplantation. Our patient′s clinical course was so fulminant that the eye was lost in less than 1 month, without any response to therapy. Recognition of this infection is important because many patients die of disseminated Aspergillus infection, which may be detected early with bedside funduscopic examination by an ophthalmologist. Probably if the patient had referred to us earlier, it may have been possible to save the eye.
Transfusion practice in orthotopic liver transplantation  [cached]
Devi Allanki
Indian Journal of Critical Care Medicine , 2009,
Abstract: Liver transplant procedures require the most blood components, despite the fact that blood use in liver transplantation has declined dramatically over the last decade. Liver transplant recipients present unique challenges, not only in terms of blood supply, but also requirements for specialized blood components, serologic problems, and immunologic effects of transfusion on both the allograft and the recipient. The cause of intraoperative blood loss in liver transplantation is multifactorial, due to both technical factors and poor coagulation control. This procedure carries the risk of massive blood loss, which requires massive transfusions and is associated with postoperative infections, reduced graft survival, multi-organ dysfunction, and higher risk of mortality. Efforts to reduce intraoperative bleeding leading to limitation of blood transfusions are desirable to improve results and also to control costs. Method of literature search: The name of topic is typed and searched in Google search. The name of topic is typed and searched in PubMed search. Related articles were also searched. Some standard books in Transfusion Medicine were also referred.
Neuroendocrine Liver Metastases and Orthotopic Liver Transplantation: The US Experience  [PDF]
N. Thao T. Nguyen,Theresa R. Harring,John A. Goss,Christine A. O'Mahony
International Journal of Hepatology , 2011, DOI: 10.4061/2011/742890
Abstract: Liver transplantation remains a controversial therapy for Neuroendocrine liver metastases (NLM), with coflicting suvival data reported. The aim was to assess the evolution of outcomes for patients transplanted for NLM in the US, both before and after the introduction of the MELD scoring system in 2002. The UNOS/OPTN database was reviewed to identify patients diagnosed with NLM who subsequently underwent a liver transplantation from 1988 to March 2011 ( ); Patient survival was determined using Kaplan-Meier methods and log-rank tests, and cox regression analysis was performed, using SPSS 15.0 (SPSS, Inc, Chicago, IL). The overall NLM patient survivals in the pre-MELD era were 79.5%, 61.4%, and 49.2% at 1, 3, and 5 years, respectively. After the introduction of the MELD score, NET/NLM patients had improved overall patient survivals at 1, 3, and 5 years of 84.7%, 65%, and 57.8%. Patients transplanted after 2002 had an improved survival outcome. Notably, the overall patient survival for NET is not significantly different when compared to the outcomes of patients transplanted for HCC, in the current era. This progress acknowleges the significant improvement in outcomes for NLM patients after liver transplantation and the potential for further gain in the survival of otherwise nonsurgical, terminal patients. 1. Introduction Neuroendocrine tumors (NETs) encompass a broad group of neoplasms which originate from cells of the endocrine and nervous systems and are of similar indolent character. NETs are most commonly located in the gastrointestinal system, including the pancreas, but also arise from many other parts of the body. Patients with gastroenteropancreatic neuroendocrine tumors commonly develop liver metastases, which after protracted periods contribute towards morbidity and mortality [1–4]. In fact, the majority of patients with NET will have liver metastases discovered at the same time as diagnosis [4, 5]. The liver metastases associated with NET are typically multifocal and diffuse, compromising liver anatomy and function. With excess hormone production, these metastases can lead to debilitating symptoms, in addition to end-stage liver disease and death. Patients with neuroendocrine liver metastases (NLM) respond well to surgical resection, but, for patients who are ineligible due to widespread hepatic involvement, orthotopic liver transplantation (OLT) can be considered for curative therapy [4]. NLM is the only acceptable indication for OLT in the setting of metastatic malignancies, enabled by their slow growth rate and relatively low-grade malignancy.
Severe Acute Hyperkalemia during Pre-Anhepatic Stage in Cadaveric Orthotopic Liver Transplantation
Mohammad Ali Sahmeddini,Mohammad Bagher Khosravi
Iranian Journal of Medical Sciences , 2012,
Abstract: A serious hazard to patients during orthotopic liver transplantation is hyperkalemia. Although the most frequent and hazardous hyperkalemia occurs immediately after reperfusion of the newly transplanted liver, morbid hyperkalemia could happen in the other phases during orthotopic liver transplantation. However, pre-anhepatic hyperkalemia during orthotopic liver transplantation is rare. This report describes one such patient, who without transfusion, developed severe hyperkalemia during pre-anhepatic phase. The variations in serum potassium concentration of the present case indicate that it is necessary to take care of the changes of serum potassium concentration not only during reperfusion but also during the other phases of the liver transplantation.
Hemodynamics alterations during orthotopic liver experimental transplantation in pigs
Torres, Orlando Jorge Martins;Pantoja, Patrícia Brand?o;Barbosa, Erica Sampaio;Barros, Cristiany de Almeida;Servin, Elizabeth Teixeira Noguera;Servin, Santiago Cirilo Noguera;
Acta Cirurgica Brasileira , 2008, DOI: 10.1590/S0102-86502008000200005
Abstract: purpose: to describe the hemodynamics alterations during orthotopic liver transplantation in pigs. methods: in the period from april 2004 to december 2005, forty-four female landrace pigs, weighting between 32 and 38 kg were undergone to orthotopic liver transplantation. the animals were divided into two groups, donor and recipient pairs, which received whole liver grafts. the surgical procedure was divided into four parts: harvested, back-table, hepatectomy of the recipient and implantation. we analyze heart rate, blood gas, mean systemic arterial pressure (map-mmhg), central venous pressure, ph, na-, k+, cl-, ca+ and urinary output. results: the mean anhepatic time was 69 min, cold ischemia was 252.2 min and back-table was 56.6 min. blood pressure and heart rate dropped significantly during anhepatic phase and after revascularization. blood gas and electrolytes alterations were observed during anhepatic and reperfusion phases. although alterations were noted during these phases, the hemodynamic status was recovered and stabilized in the end of the surgery. conclusions: simplified technique of liver transplant was achieved and description of hemodynamic alterations was possible in pigs.
Management of biliary complications after orthotopic liver transplantation: The role of endoscopy  [cached]
Maria C Londo?o, Domingo Balderramo, Andrés Cárdenas
World Journal of Gastroenterology , 2008,
Abstract: Biliary complications are significant causes of morbidity and mortality after orthotopic liver transplantation (OLT). The estimated incidence of biliary complications after OLT ranges between 10%-25%, however, these numbers continue to decline due to improvement in surgical techniques. The most common biliary complications are strictures (both anastomotic and non-anastomotic) and bile leaks. Most of these problems can be appropriately managed with endoscopic retrograde cholangiography (ERC). Other complications such as bile duct stones, bile casts, sphincter of Oddi dysfunction, and hemobilia, are less frequent and also can be managed with ERC. This article will review the risk factors, diagnosis, and endoscopic management of the most common biliary complications after OLT.
Acute graft versus host disease after orthotopic liver transplantation  [cached]
Rogulj Inga,Deeg Joachim,Lee Stephanie J
Journal of Hematology & Oncology , 2012, DOI: 10.1186/1756-8722-5-50
Abstract: Graft versus host disease (GVHD) is an uncommon complication after orthotopic liver transplantation (OLT) with an incidence of 0.1–2%, but an 80–100% mortality rate. Patients can present with skin rashes, diarrhea, and bone marrow aplasia between two to eight weeks after OLT. Diagnosis of GVHD is made based on clinical and histologic evidence, supported by chimerism studies showing donor HLA alleles in the recipient bone marrow or blood. Several therapeutic approaches have been used for the management of GVHD after OLT including increased immunosuppression, decreased immunosuppression, and cellular therapies. However, success rates have been low, and new approaches are needed.
Bacteriophage Administration Reduces the Concentration of Listeria monocytogenes in the Gastrointestinal Tract and Its Translocation to Spleen and Liver in Experimentally Infected Mice  [PDF]
Volker Mai,Maria Ukhanova,Lee Visone,Tamar Abuladze,Alexander Sulakvelidze
International Journal of Microbiology , 2010, DOI: 10.1155/2010/624234
Abstract: To investigate the efficacy of phage supplementation in reducing pathogen numbers, mice were treated via oral gavage with a Listeria monocytogenes phage preparation (designated ListShield) before being orally infected with L. monocytogenes. The concentrations of L. monocytogenes in the liver, spleen, and intestines were significantly lower (<.05) in the phage-treated than in the control mice. Phage and antibiotic treatments were similarly effective in reducing the levels of L. monocytogenes in the internal organs of the infected mice. However, the significant weight loss detected in the control and antibiotic-treated groups was not observed in the infected, ListShield-treated mice. Long-term (90 days), biweekly treatment of uninfected mice with ListShield did not elicit detectable changes in the microbiota of their large intestines or deleterious changes in their health. Our data support the potential feasibility of using bacteriophages to control proliferation of L. monocytogenes in mice without affecting commensal microbiota composition.
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