A Herreros De Tejada

Effectiveness of low-dose intramuscular Anti-VHB immune globulin in the prophylaxis of viral B hepatitis reinfection after liver transplantation: preliminary report

INTRODUCTION Prophylaxis using high-dose intravenous anti-HBV immune globulin (HBIG) is effective to prevent reinfection due to hepatitis B virus (HBV) after orthotopic liver transplantation (OLT). However, this treatment is expensive and intravenous administration is difficult during outpatient care. Our aim was to assess the effectiveness of low-dose intramuscular HBIG to prevent HBV reinfection after OLT. PATIENTS Six patients (all men, mean age 41 years, negative HBV DNA without hepatotropic virus coinfection) were transplanted in our institution due to HBV cirrhosis and included in a prospective noncomparative study. Intramuscular HBIG (2000 IU) was administered during the anhepatic phase of OLT, followed by daily 2000 IU doses for 7 days and then monthly. HBV antibody titers were measured every month. Reinfection was defined as the recurrence of surface HBV antigen in serum after transplantation. RESULTS After 1 year follow-up, none of the six patients had detectable HBV surface antigen and the liver biopsies were normal in all cases. Using 2000 IU, anti-HBs levels were: 880+/-356 IU/L at 1 month, 191+/-123 at 6 months, and 225+/-49 after 1 year. In all cases anti-HBs titers were above 100 IU/L during the follow-up. CONCLUSIONS Monthly administration of low-dose (2000 IU) intramuscular HBIG effectively prevents recurrence of HBV infection as well as attains a protective level of anti-HBs antibodies (over 100 IU/L) for at least the first year after transplantation.

Usefulness of mycophenolate mofetil in patients with chronic renal insufficiency after liver transplantation

NEPHROTOXICITY is a common side effect after liver transplantation (LT). Chronic renal insufficiency (CRI) appears in 50% to 79% of patients during long-term follow-up. The incidence of end-stage renal disease (ESRD) ranges between 2% and 9.5%. The use of calcineurin inhibitors (CNI) is the main cause of CRI after LT. Although acute renal failure related to CNI responds to dosage adjustment, the management of patients with CRI is difficult because cyclosporine or tacrolimus dose reduction generally does not improve renal function and withdrawal can be associated with graft rejection. In contrast to CNI, the newer immunosuppressive agents, mycophenolate mofetil (MMF) and sirolimus, are not nephrotoxic. Therefore, trials have been designed to withdraw CNI with the use of these new immunosuppressive agents in patients with chronic renal insufficiency. MMF is an inhibitor of inosine monophosphate dehydrogenase, which inhibits proliferation of T and B lymphocytes. The aim of our study was to evaluate the evolution of the renal function in patients with chronic renal dysfunction after liver transplantation with the use of mycophenolate mofetil, associated with a slow tapering and withdrawal of CNI.

Late mortality in patients with liver transplantation: causes and risk factors

LIVER TRANSPLANTATION (OLT) has become the treatment of choice for end-stage liver failure. Survival after OLT has improved over recent years owing to improved surgical and medical management of these patients. The majority of deaths occur during the first 3 months after liver transplantation, mainly due to infections, allograft failure following primary allograft dysfunction and nonfunction, and technical causes. Although causes of early mortality are well defined, there is a paucity of data on causes of death in long-term survivors of liver transplantation. The aim of this study was to review the causes of late mortality (more than 1 year after OLT) in liver transplant patients in a single adult Liver Transplantation Center.

DISECCIÓN SUBMUCOSA ENDOSCÓPICA: RESULTADOS Y CURVA DE APRENDIZAJE DE UNA SERIE PROSPECTIVA DE 136 CASOS EN DOS CENTROS

Introduccion: La diseccion submucosa endoscopica (DSE) es una de las tecnicas de eleccion para la reseccion en bloque de neoplasias gastrointestinales precoces (NGIP). Objetivo: Evaluar los resultados terapeuticos iniciales y la curva de aprendizaje de la DSE en NGIP tratadas en dos hospitales terciarios. Material y Metodos: Previamente se realizo entrenamiento intensivo porcino en 181 casos. Se evaluo prospectivamente las tasas de exito inicial, reseccion en bloque y R0, velocidad y tasa de complicaciones. Los resultados de la curva de aprendizaje se analizaron por orden cronologico de bloques de 30 casos, excepto el ultimo (16 casos). Resultados: Se realizo DSE en 136 NGIP desde Enero de 2012 hasta Julio de 2016. Edad media 66,3 anos, con 55.8% de varones. Localizacion: colorrectal (72,1%), gastrica (19,1%) y esofagica (8,8%). El exito inicial se observo en el 95,6% de los casos, con tasas de reseccion en bloque y R0 de 95,6% y 83,8% respectivamente. El tamano medio fue de 30,8 mm (rango 4 – 76 mm), con una velocidad global de 8,5 min/cm2. La perforacion fue la principal complicacion (33,1%), requiriendo cirugia un 11,1% de los casos. Media de estancia hospitalaria fue de 2,1 dias. El analisis cronologico demuestra un incremento paulatino de las tasas de exito, velocidad de ejecucion, reseccion en bloque y R0, simultaneamente con una reduccion de la tasa de perforacion y la necesidad de cirugia (Tabla 1). Conclusiones: En el ambito espanol, mas del 70% de las NGIP elegibles para DSE son colorrectales. El entrenamiento previo en modelo animal permite obtener resultados optimos a partir de los 30 primeros casos (exito y reseccion en bloque > 95%, velocidad 95%).