I.F.S.F. Boin

Probable transfusion-transmitted Zika virus in Brazil

Zika virus (ZIKV) is an emerging arthropod‐borne flavivirus transmitted by Aedes mosquitoes. Recent commentaries regarding ZIKV routes of transmission describe a potential transmission by transfusion. Herein, we report a probable case of transfusion‐transmitted ZIKV infection through a platelet transfusion that was detected from postdonation information.

Intraoperative Massive Transfusion Decreases Survival After Liver Transplantation

Patients undergoing liver transplantation often experience coagulopathy and massive intraoperative blood loss that can lead to morbidity and reduced survival. The aim of this study was to verify the survival rate and discover predictive factors for death among liver transplant patients who received massive intraoperative blood transfusions. This cohort study was based on prospective data collected retrospectively from January 2004 to July 2006. The 232 patients were distributed according to their blood requirements, (namely, more or less than 6 units), including red blood cell saver. The statistical analyses were performed using Student t test, Cox hazard regression, and the Kaplan-Meier method (log-rank test). The massively transfused cohort displayed higher Child-Pugh classifications (10.2 vs 9.6; P = .03); model for end-stage liver disease (MELD) scores (19 vs 17; P = .02); recipient weights (75.4 vs 71 kg; P = .03); as well as warm ischemia times (70.7 vs 56.4 minutes; P < .001) and surgery times (584.6 vs 503.4 minutes; P < .05). The proportional hazard (Cox) regression analysis showed that the risk of death increased 2.1% for each unit of donor sodium and 1.6% for each additional year of donors age over 50. The survival rates at 6, 12, 60, and 120 months for > or = 6 vs <6 U of blood transfusion of 63.8% vs 83.3%; 53.9% vs 76.3%; 40% vs 60%; 34.5% vs 49.2%. In conclusion, we observed that patients receiving over 6 red blood cell units intraoperatively displayed reduced survival. Predictive factors for this risk factor were high donor level of sodium and of age.

Yellow fever vaccination in organ transplanted patients: is it safe? A multicenter study.

Yellow fever (YF) may be very serious, with mortality reaching 50%. Live attenuated virus YF vaccine (YFV) is effective, but may present, although rare, life‐threatening side effects and is contraindicated in immunocompromised patients. However, some transplant patients may inadvertently receive the vaccine.

Portal Vein Thrombosis and Liver Transplantation: Long Term

Obstruction of the portal vein may be related to constriction by malignant tumors or thrombosis associated with liver disease. We herein have reported our experience with patients undergoing liver transplantation with portal vein thrombosis (PVT) whose diagnosis was made intraoperatively. From September 1991 to May 2009, we studied 27/419 (6.4%) patients with PVT who were evaluated according to the presence of esophagogastric varices, underlying disease, malignancy, and if there was previous surgery, review of medical records on data collected prospectively. We observed 24 (88.9%) patients with PVT grade 1, 2 (7.4%) with grade 2, and 1 (3.7%) with grade 3. The average age of the PVT patients was 47.5 years; the average model for End-Stage Liver Discase score was 18.3, and the predominant diagnosis, hepatitis C cirrhosis. Eighteen underwent a sclerotherapy/ligature. The sensitivity of ultrasound for grade 1 thrombosis was 39.1%; for grade 2, 50%; and for grade 3, 100%. Portal vein thrombectomy was performed in 24 patients. In other patients (grade 2), we performed an anastomosis of the donor portal vein to the recipient gastric vein or to a greater splanchnic collateral vein. In only 1 patient was the graft performed using the donor portal vein-donor iliac vein-recipient superior mesenteric vein. None of the patients displayed PVT in the immediate postoperative period. Actuarial survivals at the years 1, 3, and 5 were 85%, 74%, and 63%, respectively. We concluded that PVT cannot be considered to be a contraindication for liver transplantation.

Possible influence of glutathione S-transferase GSTT1 null genotype on age of onset of sporadic colorectal adenocarcinoma

AbstractINTRODUCTION: Glutathione S-transferase enzymes mediate exposure to cytotoxic and genotoxic agents and may be involved in cancer susceptibility. Both glutathione S-transferase mu 1 (GSTM1) and GST theta 1 (GSTT1) genes have a null variant allele in which the entire gene is absent. The association of glutathione S-transferase null genotype and risk of developing colorectal cancer is not yet fully clarified. METHODS: We tested whether the null genotypes for GSTM1 and GSTT1 genes altered the risk for sporadic colorectal adenocarcinoma in Brazilian patients. Genomic DNA from 102 sporadic colorectal adenocarcinoma patients and 300 controls was analyzed by polymerase chain reaction. RESULTS: Frequencies of GSTM1, GSTT1, and null combined genotypes were similar in patients and controls (49.9 vs. 44.6 percent, 16.6 vs. 17.3 percent, and 8.8 vs. 8 percent, respectively). We found a 1.03-fold (95 percent confidence interval, 0.96–1.10) and 1.08-fold (95 percent confidence interval, 0.99–1.18) increased risk associated with GSTM1 and GSTT1 null genotypes, respectively (P = 0.45 and P = 0.08) and a 1.18-fold (95 percent confidence interval, 0.47–2.90) increased risk associated with the combined null genotype (P = 0.74). The GSTT1 null genotype was more common in patients who were diagnosed before the age of 60 years than in those who were diagnosed at an older age (28.8 vs. 4 percent, respectively; P = 0.0008). CONCLUSIONS: The results suggest that inherited absence of this carcinogen detoxification pathway may not be associated with sporadic colorectal adenocarcinoma in the present cases. However, a higher frequency of GSTT1 null genotype in patients diagnosed before the age of 60 years suggests that this genotype could influence the age of disease onset in Brazil.

Evaluation of five DNA extraction methods for detection of H. pylori in formalin-fixed paraffin-embedded (FFPE) liver tissue from patients with hepatocellular carcinoma

Since Helicobacter spp. DNA was identified in liver tissue resected from patients with hepatocelullar carcinoma (HCC), researchers have suggested a role of this bacterium in hepatic carcinogenesis. Archives of formalin-fixed, paraffin-embedded (FFPE) tissues represent an extraordinary source for clinical studies providing many advantages. However, DNA extraction from FFPE tissues is laborious, time-consuming and still remains a challenge. The aim of this study was to evaluate five protocols for DNA extraction from FFPE liver obtained from patients with HCC in order to detect Helicobacter pylori DNA. These methods were: (1) QIAamp FFPE Tissue Kit, (2) QIAamp DNA Mini Kit, (3) Wizard SV Genomic DNA Purification System, (4) RealiaPrep FFPE gDNA Miniprep System and (5) phenol-chloroform. H. pylori detection was performed using 16S rRNA gene amplification by PCR. The highest total amount of DNA was obtained using the phenol-chloroform method. Analyses of 16S rRNA gene amplification did not show statistically significant differences among the methods (p=0.466), although the highest percentage of positive cases (70%) was found in samples extracted with phenol-chloroform. We suggest that of the five methods evaluated, phenol/chloroform is the most suitable for detection of H. pylori in FFPE liver from patients with HCC.

Anxiety levels observed in candidates for liver transplantation.

INTRODUCTION Anxiety can be considered an emotional state that does not present itself at the same intensity in all patients, and can be classified into 3 levels: mild, moderate, and severe. The patient, upon entering the waiting list for transplantation, reflects on the decision taken, which leaves him constantly anxious about the idea of possible death. OBJECTIVE This study had the aim of evaluating the degree of anxiety observed in orthotopic liver transplantation (OLT) candidates and whether there was a correlation between anxiety and etiologic diagnosis. METHODS This study was a prospective study where the patients underwent psychological evaluation by Beck Anxiety Inventory (BAI). The anxiety level was minimal, mild, moderate, or severe. The Model for End-Stage Liver Disease (MELD) score and etiology were recorded. RESULTS The level of anxiety found were as follows: 55% minimal, 27% mild, 12% moderate, and 7% severe. The correlation between level of anxiety and etiologic diagnosis showed that 71% of patients with alcoholic cirrhosis and 60% of those with liver cancer showed a minimal degree of anxiety and 27% of patients with autoimmune cirrhosis had severe anxiety. CONCLUSION We found that in patients with autoimmune hepatitis, the degree of anxiety was more pronounced. It is believed that the absence of physical symptoms is an important factor when observing anxiety in OLT candidates.

Profile of Respiratory Evaluation Through Surface Electromyography, Manovacuometry, and Espirometry in Candidates on the Liver Transplant Waiting List

INTRODUCTION Electromyography (EMG) is the examination of skeletal muscle membrane electrical activity in response to physiologic activation. In healthy muscles, the square root (root mean square [RMS] is related to the amplitude of the obtained signal. Respiratory muscles are studied, especially those important for compliance, the diaphragm and the rectus abdominis. An evaluation to detect respiratory muscle deficits among liver disease patients on the waiting list for transplantation may serve as an alternative to providing specific treatments reducing the possibility of respiratory complications after transplantation. OBJECTIVE To study muscle activity by evaluating respiratory and surface EMG of the right diaphragm and right rectus abdominis muscles in patients on the liver transplant waiting list. METHOD Respiratory evaluation of muscle strength (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) with a manometer -300, +300 from Gen-air; spirometry with Easyware Spirometer version 2.20; pulse oximetry with Nonim oximeter; Model for End-Stage Liver Disease (MELD) score as well as surface EMG of the diaphragm and rectus abdominis muscles from EMG/Brazil were applied in healthy and liver diseased subjects. RESULTS The 87 liver disease patients showed a mean age of 53.9 ± 7.3 years, mean body mass index of 28.21 ± 5.04 kg/m2 with 24.14% smokers (n = 21) and 43.68% physically active (n = 38 p) showing Diaphragm RMS of 61.05 ± 68.48 μV; rectus abdominis RMS of 45.28 ± 53.82 μV; MEP of 100.28 ± 27.85 cm H(2)O; and MIP of 92.41 ± 29.77 cm H2O. The average MELD of studied patients was 16.5 ± 0.71. CONCLUSION The respiratory profiles of patients on the liver transplant waiting list concerning muscle support were precarious owing to ascites and motor adynamia.

Human herpesvirus 6 in donor biopsies associated with the incidence of clinical cytomegalovirus disease and hepatitis C virus recurrence.

BACKGROUND Reactivation of cytomegalovirus (CMV) and human herpesvirus 6 (HHV-6), as well as the recurrence of hepatitis C virus (HCV), occurs in the post liver transplantation period. However, their correlations remain questionable. The objectives of this study were to analyze the presence of CMV DNA and HHV-6 DNA in pre-transplant and post-transplant liver graft biopsies and to determine any correlations with CMV disease and HCV recurrence. METHODS Forty-one liver transplant recipients were followed up in the post-transplant period. The presence of CMV DNA and HHV-6 DNA was detected by nested PCR. RESULTS Four patients (4/41, 9.8%) were positive for CMV DNA in pre-transplant biopsies and three of them remained positive after transplantation; 11 patients became positive in the post-transplant biopsies (p=0.06). Fifteen (15/41, 36.6%) patients were positive for HHV-6 DNA in pre-transplant biopsies and 11 of these remained positive after transplantation. Another 11 patients became positive after the surgery (p=0.05). CMV disease occurred in 17 recipients; 10 of these 17 (58.8%) patients were positive for HHV-6 DNA in pre-transplant biopsies and they continued positive after transplantation (p=0.0128). Twenty-eight patients were transplanted due to hepatitis C; 12 of these patients had recurrence of the virus, and HHV-6 was positive in nine of the 12 (75%) patients (p=0.049). CONCLUSIONS Recipients with HHV-6 DNA in pre-transplant graft biopsies remained positive post transplantation, showing a possible risk for post-transplant allograft loss because there was an association between HHV-6 and recurrent HCV and CMV disease.

Cytomegalovirus, Human Herpesvirus-6, and Human Herpesvirus-7 in Adult Liver Transplant Recipients: Diagnosis Based on Antigenemia

Human herpesvirus (HHV)-6, HHV-7, and cytomegalovirus (CMV) that remain latent after primary infection can be reactivated during immunosuppression following organ transplantation in liver transplant recipients. The aim of this study was to monitor active infections for HHV-6, HHV-7, and CMV among adult liver transplantation recipients using antigenemia detected by an immunoperoxidase staining. Twenty-eight adult liver transplant patients were monitored using antigenemia in blood samples obtained at the time of transplantation, as well as weekly in the first month and once a month for 6 months. Of these patients, 28.5% showed positive CMV antigenemia; 39.2%, HHV-6 antigenemia; and 14.2%, HHV-7 antigenemia. The detection of the three viruses was considered to be independent of one another (P>.05). The results described above showed that few patients remain free of beta herpesviruses after liver transplantation. Most patients were infected sequentially and not concurrently. Antigenemia has been considered useful to detect active HHV-6 and HHV-7 infections. Antigenemia can be more efficiently interpreted when compared with polymerase chain reaction results, although other studies are necessary to establish the reference of HHV-6 and HHV-7 antigenemia.