E. Murio

Influence of anti-HLA antibodies and positive T-lymphocytotoxic crossmatch on survival and graft rejection in human liver transplantation

BACKGROUND/AIMS The role of crossmatching in liver transplantation is controversial. The aim of this study was to investigate retrospectively the effect of sensitization and IgG lymphocytotoxic crossmatching on liver transplantation. METHODS/RESULTS Over 5 years, 20 of 243 (8.2%) first liver transplants were performed with a positive crossmatch and their outcome was compared with the remaining 223 performed with a negative crossmatch. Women had a higher incidence of positive crossmatch than men (p < 0.001). Significant differences in mean panel reactive antibody of 2.7% and 43.3% were found in negative and positive crossmatch patients, respectively (p < 0.001). Severe early rejection resulting in graft loss occurred in eight of 20 positive crossmatch patients, and only one of 223 negative crossmatch patients (p < 0.001). Five of the remaining positive crossmatch patients suffered several acute rejection episodes some months after liver transplantation. Two of 20 in the positive crossmatch group developed chronic rejection (10%) compared with ten of 223 negatives (4.4%) (N.S). Nine of 16 positive crossmatch female recipients suffered graft loss and seven died, representing 1-year graft and patient survival of 56% and 43%, respectively. Fifteen of 68 negative crossmatch female recipients presented graft loss and 12 died, accounting for 1-year patient and graft survival of 82% and 78% (p < 0.005), respectively. Five patients (20%) displayed positive crossmatch at the time of retransplantation, compared with 24 (10%) who were negative (N.S). CONCLUSION Our experience confirms the adverse impact of a positive crossmatch in liver transplantation, particularly in female recipients. Candidates with high panel reactive antibody are more likely to display a positive crossmatch, and therefore to develop early severe rejection and graft failure.

Hemodynamics in human liver transplantation with inferior vena cava preservation

S OME patients do not tolerate inferior vena cava (NC) and portal clamping during the anhepatic phase of orthotopic liver transplantation (OLT), and veno-venous bypass (VVBP) is usually required in order to maintain hemodynamics during this phase.’ Recipient hepatectomy with IVC preservation’ was introduced into our program in 1991 to avoid WBP and complications due to its use. This technique became routine in the majority of cases.3 The aim of this study was to ratify our results by measuring I?C flow and pressure and correlating them with data on patient hemodynamics.

DNA ploidy study of resected hepatocellular carcinoma in cirrhotic liver

BACKGROUND/AIMS Results of several studies on DNA ploidy as a prognostic indicator in hepatocellular carcinoma are contradictory. The present study analysed the correlations between DNA ploidy of resected hepatocellular carcinoma and tumour characteristics, tumour recurrence, risk factors and survival. METHODS Tumoural DNA ploidy of hepatocellular carcinomas from 37 patients with cirrhosis who underwent curative tumour resection was studied by flow cytometry. RESULTS A diploid pattern was found in 23 hepatocellular carcinomas (62.2%) and an aneuploid pattern in 14 (37.8%). The tumour recurrence rate did not differ statistically between diploid (69.6%) and aneuploid (50%) hepatocellular carcinomas. The only prognostic variable with significant difference in DNA pattern was the histologic tumour type; the majority of non-trabecular tumours were aneuploid while most trabecular hepatocellular carcinomas had a diploid DNA pattern. Actuarial survival at 1, 2, 3 and 4 years of patients with diploid and aneuploid tumours was 69.6%, 40.6%, 16.2% and 0%, and 69.3%, 59.4%, 49.5% and 32.9%, respectively (log rank p = 0.1927). CONCLUSION These results indicate that DNA ploidy has no prognostic value in hepatocellular carcinoma.

Arterialización de la vena porta en el trasplante hepático humano

Resumen Existen pocos casos publicados de arterializacion de la vena porta en el trasplante hepatico ortotopico o heterotopico. Objetivo Evaluar el efecto de la arterializacion de la vena porta en la hemodinamica hepatica y la evolucion clinica de tres pacientes sometidos a trasplante hepatico. Metodos Dos pacientes que presentaban trombosis de todo el eje mesenterico-portal recibieron un trasplante hepatico ortotopico, y uno con hepatitis fulminante recibio un trasplante auxiliar heterotopico. En todos los casos se efectuo una arterializacion de la vena porta. Resultados Un paciente fallecio 4 meses despues de la arterializacion portal. Los otros dos permanecen vivos. El injerto auxiliar fue retirado a los tres meses por una completa regeneracion del higado nativo. La funcion hepatica inmediata fue excelente en todos los casos. Solo un paciente, a los 14 meses, desarrollo encefalopatia y hemorragia por varices esofagicas secundaria a hipertension portal causada por la fistula arterioportal. Esta se embolizo con exito a traves de radiologia intervencionista. Los datos hemodinamicos demostraron la ausencia de hipertension portal intrahepatica. Conclusion El trasplante hepatico con arterializacion de la vena porta es una alternativa quirurgica aceptable en los casos de flujo portal insuficiente. La doble circulacion arterial no condiciona cambios hemodinamicos.

CD28 regulation in liver transplant recipients treated with two different immunosuppressive regimens

Twenty-two patients who received a first liver transplant between February 1997 and November 1997 were prospectively studied. Blood samples were taken five times a week in the first 2 weeks and three times weekly in the following 2 weeks for analysis of CD282 and CD692 expression in peripheral blood lymphocyte subsets (CD4 and CD8). Cell percentages were determined with a FACStar flow cytometer (Becton-Dickinson, Erembodegem-Aalst, Belgium), using anti-CD28, anti-CD69 monoclonal antibodies (Becton-Dickinson). Basal immunosuppression consisted of cyclosporine plus prednisone in 9 patients and tacrolimus plus prednisone in 13 patients.