Single center report on complications in steroid-free immunosuppressive therapy of liver transplant recipients
Complications in Immunosuppressive Therapy of Liver Transplant Recipients
BACKGROUND: In liver transplantation (LT), modern immunosuppressive protocol is focused on early corticosteroid (CS) weaning. The aim of the study was to investigate all early transplant-related complications using Clavien grading system, in order to identify a significant relation in two homogenous groups of consecutive liver transplanted patients, only different for steroid avoidance in immunosuppressive regimen. MATERIALS AND METHODS: One group was treated with a tacrolimus-based CS-free immunosuppressive protocol, the other one underwent tacrolimus plus low dose CS therapy. The preoperative continuous variables analyzed were age, gender, model for end-stage liver disease (MELD) score, a…
Peri-Operative Liver Regeneration of the Remnant Liver Volume after Right Hepatectomy for Living Donation: A Multiple Regression Analysis
Early liver regeneration was studied in a series of 70 patients who underwent right hepatectomy for living donation from November 2004 to January 2010. Liver regeneration was evaluated by multidetector computed tomography at a mean time of 61.07 days after surgery. Pre-surgical variables such as age, weight, height, body mass index, liver function tests, creatinine, platelet count, international normalized ratio, glucose, and variables detected with preoperative multidetector computed tomography imaging, including diameter of main portal vein, steatosis, original liver volume and spleen volume, were investigated as potential predictors of liver regeneration. Future remnant liver volume was …
Carbohydrate-deficient glycoprotein syndromes: The Italian experience
An Unexplained Congenital Disorder of Glycosylation-II in a Child with Neurohepatic Involvement, Hypercholesterolemia and Hypoceruloplasminemia
We report on a 12-year-old adopted boy with psychomotor disability, absence seizures, and normal brain MRI. He showed increased (but initially, at 5 months, normal) serum cholesterol, increased alkaline phosphatases, transiently increased transaminases and hypoceruloplasminemia with normal serum and urinary copper. Blood levels of immunoglobulins, haptoglobin, antithrombin, and factor XI were normal. A type 2 serum transferrin isoelectrofocusing and hypoglycosylation of apoCIII pointed to a combined N- and O-glycosylation defect. Neither CDG panel analysis with 79 CDG-related genes, nor whole exome sequencing revealed the cause of this CDG. Whole genome sequencing was not performed since th…
Mutations in the GLA Gene and LysoGb3: Is It Really Anderson-Fabry Disease?
Anderson-Fabry disease (FD) is a rare, progressive, multisystem storage disorder caused by the partial or total deficit of the lysosomal enzyme &alpha
Comparison of two different techniques of reperfusion in adult orthotopic liver transplantation
: The aim of this study was to determine the impact of two reperfusion techniques on the peri-operative hemodynamic changes and early post-operative graft function of adult patients undergoing orthotopic liver transplantation. Material and methods: From June 2003 to May 2004, 50 consecutive liver transplants were performed and divided into two groups: group A, 25 patients, portal vein flush with 500 cm3 of Ringer's lactate without vena caval venting. Group B, 25 patients, vena caval venting with no portal vein flush. Donor and recipient characteristics were similar in both groups. Sixty-four different parameters were analyzed, and Pearson's χ2 test and t-test were used for statistical analy…
Early Regeneration of the Remnant Liver Volume after Right Hepatectomy for Living Donation: A Multiple Regression Analysis.
Early liver regeneration was studied in a series of 70 patients who underwent right hepatectomy for living donation between November 2004 and January 2010. Liver regeneration was evaluated with multidetector computed tomography (MDCT) at a mean of 61.07 days after surgery. Presurgical variables [eg, age, weight, height, body mass index (BMI), liver function tests, creatinine levels, platelet counts, international normalized ratio, and glucose levels] and variables detected with preoperative MDCT imaging [eg, main portal vein diameter, steatosis, original liver volume, and spleen volume (SV)] were investigated as potential predictors of liver regeneration. The future remnant liver volume (FR…
LAPAROSCOPIC LEFT LIVER SECTIONECTOMY (LLLS) FOR PEDIATRIC LIVING RELATED LIVER TRANSPLANTATION (LRLT)
PURPOSE: LRLT in children is a method to provide organs for transplantation. We report 2 cases of LLLS for pediatric LRLT. METHOD: Donor position: lithotomy with surgeon in French position. Trocars: three 12 mm, placed 2 cm upper the supra-umbilical mid-line and sub-costal bi-lateral on the nipple lines; one 5 mm in epigastrium. Special instrumentation: harmonic scissor, ligasure®, Hem-O-Lock clips, and Endo Catch-II® bag. Main steps: division of round, falciform, left triangular ligaments and of lesser omentum; inspection of anatomy; hepatic hilum dissection with exposure of the left hepatic artery; dissection of the right side of the falciform ligament with exposure of the left branch of …