Erwin Buckel

Early steroid withdrawal in pediatric renal transplant on newer immunosuppressive drugs.

Abstract:u2002 Steroids have been a cornerstone in renal transplant immunosuppression. New immunosuppressive drugs have led to protocols using early steroid withdrawal or complete avoidance. A prospective protocol in 23 pediatric renal transplant (ages 2–14u2003yr) who received decreasing steroid doses stopping at day 7 post‐Tx, FK, and MMF were compared with a CsA, AZT, historically matched steroid‐based control group. Basiliximab was used in two doses. Anthropometric, biochemical variables, AR rates, and CMV infection were evaluated and compared using Student’s t‐test and regression analysis. A better growth pattern was seen in steroid withdrawal group. GFR rate and serum glucose were similar in both groups. Total serum cholesterol levels were significantly lower in steroid withdrawal group. The incidence of AR at 12u2003months was 4.3% in steroid withdrawal group vs. 8.6% in steroid‐based group (pu2003=u2003ns). No difference in CMV infection was observed. Hemoglobin levels were low during the first months in both groups; reached normal values after sixu2003months. SBP became higher at 12u2003months in steroid‐based group. Patient and graft survival was 98% in both groups at one‐yr post‐transplant. Early steroid withdrawal was efficacious, safe, and did not increase risk of rejection, preserving optimal growth, renal function, and reducing cardiovascular risk factors.

Trasplante hepático en Chile: Aspectos generales, indicaciones y contraindicaciones (Documento de consenso)

Liver transplantation is an excellent therapeutic option forterminal liver disease. During the last decades the results of liver transplantation have improvedsignificantly with a patient survival rate of nearly 90% at one year and 80% at 5 years offollow-up. The main indications for liver transplantation include: end-stage liver diseaseassociated to cirrhosis, acute liver failure, and hepatic tumors (mainly hepatocarcinoma). Theabsolute contraindications for a transplant are less frequent than in the past, and include:severe co-morbidity (cardiac or pulmonary), sepsis, advanced HIV disease and extra-hepaticmalignancy. This document presents a Consensus of the main groups performing livertransplantation in Chile, about its indications and contraindications. It also reviews generalaspects of liver transplantation, including the selection and referral of liver transplantcandidates, allocation of organs and the evaluation of severity of liver disease (Rev Med Chile2008; 136: 793-804).(

Trasplante simultáneo de páncreas y riñon en diabetes mellitus tipo 1: Experiencia de un centro en Chile

Normal 0 21 false false false /* Style Definitions */ n table.MsoNormalTable n {mso-style-name:Tabla normal; n mso-tstyle-rowband-size:0; n mso-tstyle-colband-size:0; n mso-style-noshow:yes; n mso-style-parent:; n mso-padding-alt:0cm 5.4pt 0cm 5.4pt; n mso-para-margin:0cm; n mso-para-margin-bottom:.0001pt; n mso-pagination:widow-orphan; n font-size:10.0pt; n font-family:Times New Roman; n mso-ansi-language:#0400; n mso-fareast-language:#0400; n mso-bidi-language:#0400;} n El trasplante simultaneo de pancreas y rinon de donante cadaverico (TSPR) es el tratamiento que ofrece la mejor sobrevida para los pacientes con insuficiencia renal cronica avanzada secundaria a Diabetes Mellitus Tipo 1 (DM 1). En esta comunicacion se presentan los resultados de 12 receptores de TSPR tratados en un centro en un programa iniciado en 1994 con un tiempo de observacion promedio de 6,8 (rango 2 a 15) anos. Once receptores estaban en dialisis antes del trasplante. La incompatibilidad promedio de antigenos HLA A,B, DR fue de 4,3. El promedio de sensibilizacion pretrasplante medido mediante el porcentaje de PRA fue de 3,3% (PRA maximo 27%). Los tiempos promedio de isquemia fria del pancreas y rinon fueron de 6 y 10 horas. El pancreas fue abocado a vejiga en 8 casos y a intestino en 4 pacientes. Once pacientes recibieron induccion con anticuerpos; la inmunosupresion de mantencion consistio en Ciclosporina o Tacrolimus asociado a un antiproliferativo. La sobrevida a 10 anos de pacientes, injertos renales e injertos pancreaticos (metodo de Kaplan-Meier) fue de 70%, 73% y 72%. Se observaron episodios de rechazo celular y humoral en el 50% de los pacientes, con buena respuesta a tratamiento, excepto en un caso. En conclusion, esta experiencia confirma que el TSPR tiene en Chile una excelente sobrevida de pacientes e injertos, asegurando independencia de insulina y dialisis por un periodo de a lo menos 10 anos a 2/3 de los enfermos.

Metástasis pancreáticas tardías secundarias a cáncer de células renales: Caso clínico

We report the case of a 60-year-old woman with multiple pancreatic nodules found on abdominal computed tomography. Thirteen years earlier she had undergone a left nephrectomy for renal cell carcinoma. The patient underwent surgery with a preoperative diagnosis of multifocal metastatic or neuroendocrine tumor. At surgery, two metastatic nodules of renal cell carcinoma were found and excised. After four years of follow up there is no evidence of recurrence.

Síndrome pequeño para su tamaño, (small-for-size), como complicación de un trasplante hepático con donante vivo adulto relacionado

Although the use of cadaveric split or living donor liver transplantation is a valid option for liver transplants, they have several complications, being the small-for-size syndrome one of the most frequent. This entity is mainly due to the incapacity that the graft has to meet the blood drainage demands. We report a 61 year-old patient with sub-acute liver failure, transplanted with a partial liver graft that developed hyperbilirubinemia, ascites and liver function deterioration. A meso-caval shunt was performed, after which the ascites resolved, serum bilirubin normalized and the synthetic function of the liver improved. After one month, a follow-up CT seen showed the absence of blood flow in the shunt, possible due to the reduction of the hyper-perfusion of the liver. The clinical and biochemical condition of the patient continued improving despite the lack of flow through the shunt.

Fenómeno de acomodación inmunológica: Trasplante hepático ABO incompatible. Caso clínico

We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accommodation opens the possibility of using ABO-incompatible organs as a definitive grafts.