Horacio íos R

Trasplante hepático en adultos: casuística de Clínica Alemana de Santiago

Background: The success of orthotopic liver transplantation (OLT) has resulted in its widespread use for different liver diseases. Aim: To report our 8 years experience with adult OLT at Clinica Alemana de Santiago. Patients and methods: In all transplantations done at the center, we recorded patients overall data and survival, postoperative medical and surgical complications and causes of death. Results: Between November 1993 and September 2001, 51 consecutive OLT were performed in 44 patients (22 females, median age 45 years old). Thirty eight patients presented with chronic and 6 with acute or sub-acute liver failure. Cryptogenic cirrhosis and hepatitis C infection were the most common causes for OLT. Postoperative bleeding and extra-hepatic biliary complications were seen in 17.6 and 21.5% of cases respectively. Acute rejection, bacterial infections, CMV infection or disease and post OLT hemodialysis were the most common medical complications (51, 31, 19.6 and 19.6% of cases respectively). The overall 1 and 5 years survival rates were 80% and 73% respectively. Considering exclusively the last 22 OLT performed since January 1999, the 1 year survival rate has improved to 91%. Conclusions: Liver transplantation in Chile provides a good long term survival with acceptable morbidity, due to a multidisciplinary approach management. The survival rates have improved over the last few years probably due to better surgical techniques, ICU care and immunosuppression. These overall results are comparable with those from other Centers in developed countries (Rev Med Chile 2002; 130: 779-86)

Rescate con Sirolimus por rechazo agudo recurrente y diabetes mellitus en trasplante hepático: Caso clínico pediátrico

Sirolimus (SRL) is a new immunosuppressive drug approved for renal transplantation, but is being used increasingly in orthotopic liver transplantation (OLT). Compared with the calcineurin inhibitors, SRL has different mechanisms of action and side effects profile. Thus, this drug offers significant potential advantages over other immunosuppressive agents. SRL does not cause glucose intolerance, hypertension or renal failure, but it may cause dyslipidemia, hepatic artery thrombosis, thrombocytopenia, anemia, leukopenia, oral mucosa ulcers, edema, arthralgias and wound complications. SRL inhibits the signal of interleukin 2 at a post-receptor level, inhibiting lymphocyte proliferation and fibroblast proliferation. It also has antineoplastic and antifungal effects. We report a 10 years old girl who underwent OLT, experiencing a biopsy-proven recurrent acute rejection (AR) in spite of using three immunosuppressive agents (tacrolimus, mofetil micofenolate and steroids). She developed diabetes mellitus as a consequence of the immunosuppressive therapy. She was rescued with SRL, not experiencing AR again. Mofetil micofenolate, steroids and insulin could be discontinued and tacrolimus doses were reduced, without experiencing severe complications. SRL is a new and safe immunosuppressive agent for rescue in patients with OLT and recurrent AR.

Falla hepática fulminante por parvovirus B 19 y trasplante hepático, caso clínico

Introduccion: La infeccion por parvovirus humano B19 (PHB 19) produce un amplio rango de enfermedades que van desde eritema infeccioso en ninos hasta artritis aguda en adultos. Algunos estudios sugieren un rol patogenico del PHB 19 en el desarrollo de la hepatitis aguda (HA) y falla hepatica fulminante (FHF) en ninos y adultos. La Anemia aplastica (AA) es una complicacion reconocida de la HA y FHF por PHB 19. Objetivo: Reportar un caso de FHF por infeccion por PHB 19 y revisar la literatura. Caso clinico: Nina de 7 anos de edad con HA que en una semana desarrollo FHF con serologia IgM anti-PHB 19 positiva. Otras causas virales, autoinmunes, metabolicas o toxicas fueron descartadas. Fue sometida a trasplante hepatico ortotopico (THO) y un ano despues no ha presentado complicaciones. Conclusiones: El PHB 19 puede causar HA y FHF, su oportuno diagnostico y tratamiento, que en el caso de la FHF incluye el THO puede resultar en un pronostico favorable

Hiperplasia nodular focal del hígado en niños y Trasplante Hepático

La Hiperplasia Nodular Focal (HNF) del higado es una tumoracion benigna probablemente secundaria a una alteracion en la vascularizacion del parenquima hepatico, rara en la edad pediatrica. Objetivo: Reportar un caso clinico de HNF que requirio trasplante hepatico ortotopico (THO) y revisar la literatura actual con respecto a la conducta terapeutica a seguir. Caso clinico: Nino de 15 anos de edad con una masa abdominal palpable. Ecografia y tomografia axial computada de abdomen demostraron un tumor multifocal en ambos lobulos hepaticos de caracteristicas irresecables. Biopsia operatoria del higado confirmo una HNF. El paciente desarrollo hipertension portal debido a compresion tumoral de la vena porta, con ascitis, encefalopatia hepatica e insuficiencia renal, por lo que se decidio su manejo mediante un THO en injerto total, con una excelente evolucion a 5 anos de seguimiento. Conclusion: La decision entre un enfoque conservador o quirurgico depende de las caracteristicas de cada caso, siendo el THO una alternativa terapeutica en pacientes con tumores hepaticos benignos e irresecables

Ictericia obstructiva secundaria a migración de fragmentos de hepatocarcinoma a la vía biliar

Obstructive jaundice secondary to hepatocellular carcinoma fragments migrated to common bile duct Obstructive jaundice is a rare presentation of hepatocellular carcinoma (HC), and when it occurs, usually is due to progressive damage from cirrhosis, or extensive tumor infiltration. Tumor growth through the bile duct is being described with increasing frequency as a cause of obstructive jaundice. Rarely, it may be hepa- tocarcinoma fragments that migrate to the bile duct, obstructing it. We present a case of obstructive jaundice due to migration of fragments of hepatocellular carcinoma to the bile duct in a patient treated 7 years before, for an HC with a curative resection.

Neumatosis Intestinal: Caso Clínico-Radiológico*

Pneumatosis intestinalis. A case report The case of a women 89 year old with an apparent partial intestinal obstruction is presented. The CT scan of abdomen and pelvis shows evident pneumatosis intestinalis (PI) within gas in the portal system. Expectant medical treatment was performed. Eight days later, a second CT scan showed almost complete remission of pneumatosis and gas in the portal system. The presence of gas in the bowel wall is a sign that can be find in benign to life threatening conditions. A review of the pathogenesis, radiological presentation and the different causes of PI are presented, based in the case report.

Trasplante combinado hepato-renal: a propósito de un caso

End stage renal disease is not an absolute contraindication for liv-er transplantation (LT) in patients with end stage liver disease. Actuarial patient and graft sur-vival are comparable for children and adults who undergo LT alone and liver-kidney trans-plantation (LKT). The most common indications for LKT are the primary hyperoxaluria type I(PH1) and the liver and renal polycystic disease. We report a 12 years old boy with congenitalhepatic fibrosis with severe portal hypertension, encephalopathy and polycystic kidney diseasewith end stage renal disease on dialysis that underwent LKT. During the second postoperativeweek, he had a biopsy-proven acute liver and renal rejection, that had a good response to corti-costeroids. Thirty days after surgery, the liver biopsy was without rejection. No other complica-tions were observed (Rev Med Chile 2003; 131: 1309-12).(