Gustavo Marino

Impact of body mass index on graft failure and overall survival following liver transplant

Abstract:u2002 Goals:u2002 To assess the influence of body mass index (BMI) in the outcome of liver transplantation.

Impact of donor age on graft survival among liver transplant recipients: analysis of the United Network for Organ Sharing database.

THE RELATIONSHIP between donor age and the transplantation of liver and other organs has been analyzed and reported by many investigators. Multiple causes of graft failure in transplant patients are still being evaluated. There are other factors, in addition to age, thought to affect the outcome of liver transplantation including race, gender, comorbidities, body mass index (BMI), functional status, and socioeconomic condition. Preliminary data have shown that mismatch of race (African-Americans donors and white recipients) may significantly increase the risk of liver graft failure independently of risk factors such as gender, ethnicity, and number of comorbidities. It has been demonstrated in recent studies that female recipients of male organs may not have a significant change in the risk of graft failure, but a worse outcome may be seen in male recipients of female organs. Also, it has been found that BMI does not significantly affect the rates of graft failure in liver transplant patients. Previous analyses have indicated that the use of livers from older donors increases the risk of organ failure in liver transplantation. In addition, while some studies support the notion that the age of the donor is very important in liver transplantation, other studies have concluded that advanced donor age should not be a contraindication to liver transplantation especially when individual and careful assessment of the donor was made. The primary objective of this analysis was to evaluate the impact of donor age on the outcome of liver transplantation, independently of other well-known risk factors.

Gastrointestinal involvement in paroxysmal nocturnal hemoglobinuria: First report of electron microscopic findings

Thrombotic complications, particularly microthrombi involving intraabdominal veins leading to intestinal ischemia, have remained a major cause of morbidity in patients with paroxysmal nocturnal hemoglobinuria (PNH). While intestinal ischemia has been postulated to be the cause of recurrent bouts of abdominal pain in this population, direct antemortem evidence for this complication is scarcely documented in the literature. We describe a case of PNH in a patient who presented with abdominal distress three years after the initial diagnosis was established. Clinical features and a combination of diagnostic modalities, including radiography, endoscopy, and histology were used to make the prompt diagnosis of intestinal ischemia. This is the first case in which the electronic microscopy of the gastrointestinal lesion is described. Our patient was successfully treated with conservative measures and anticoagulation.

Pharmacokinetics and biochemical effects of hepapoietin in patients with chronic liver disease.

Hepapoietin is a naturally occurring cytokine that promotes hepatocyte growth. Animal studies have suggested that hepapoietin and hepatocyte growth factor have a potential role in the prevention and management of liver diseases. However, human studies have been lacking.

Endosonographic Findings in Colitis Cystica Profunda

A 27-year-old male was referred to our institution for further evaluation of persistent rectal bleeding. A prior colonoscopy showed a sigmoid soft tissue lesion, and pathology revealed chronic active colitis and granulation tissue with ulcers and focal adenomatous changes. We performed a flexible sigmoidoscopy that showed a 4.5-cm multilobulated polypoid lesion approximately 45 cm from the anal verge (Figure 1). A 20 MHz Olympus endoscopic ultrasound (EUS) miniprobe showed hypoechoic lesion with cystic/spongy features involving the mucosa and submucosa (Figure 2). These features were thought to suggest colitis cystica profunda (CCP). Histologic examination of snare biopsies identified dilated glands with mucinous content, surrounded by variable degrees of fibrosis on a background of interspersed chronic inflammatory cells, with few colonic mucosal crypts and mild inflammatory cell infiltrate (Figure 3). The patient was instructed to follow up with gastroenterology if bleeding recurred.