RESUMEN
Liver transplantation is a life saving procedure for patients with a variety of irreversible acute and chronic liver diseases for which no other therapy is available. To date, success of transplantation has been significantly improved with 1-year graft and patient survival rates of approximately 90%. As new information becomes available the indications for individual diseases have been changed somewhat. This review will provide a general basis for patient selection and timing of liver transplantation for adult patients with chronic liver disease.
Asunto(s)
Hepatopatías/cirugía , Trasplante de Hígado , Selección de Paciente , Adulto , Humanos , Hepatopatías/etiología , Hepatopatías/fisiopatología , Factores de TiempoRESUMEN
BACKGROUND: Chronic pancreatitis following acute fatty liver of pregnancy is rarely reported. METHODS: We treated a 34-year-old woman who developed acute fatty liver of pregnancy (AFLP) after delivery by caesarean section at 32 weeks of gestation. AFLP was complicated by acute pancreatitis and multiple organ failure. The management of the disease was primarily supportive. She recovered from acute fulminant liver failure and multi-organ failure, apart from the development of symptomatic chronic pancreatitis thereafter. RESULTS: Investigations failed to identify any other causes of chronic pancreatitis. The patient responded very well to pancreatic enzyme supplement for the treatment of steatorrhoea. CONCLUSION: To our knowledge, this is the first report of chronic pancreatitis as a consequence of multi-organ dysfunction caused by AFLP.
Asunto(s)
Hígado Graso/complicaciones , Fallo Hepático Agudo/complicaciones , Insuficiencia Multiorgánica/complicaciones , Pancreatitis Crónica/etiología , Complicaciones del Embarazo , Enfermedad Aguda , Adulto , Femenino , Humanos , Pancreatitis Crónica/diagnóstico por imagen , Embarazo , Tomografía Computarizada por Rayos XRESUMEN
Fibrosing cholestatic hepatitis (FCH) is an aggressive and usually fatal form of viral hepatitis in immunocompromised patients. It is characterized by progressive cholestasis leading to hepatic failure, and a characteristic histopathological features including: periportal fibrosis, ballooning degeneration of hepatocytes, cholestasis, with minimal inflammation. FCH has been reported almost exclusively in heavily immunosuppressed organ transplant recipients or patients with AIDS. This case report describes a previously immunocompetent patient with previously stable chronic hepatitis C who developed fibrosing cholestatic hepatitis after receiving cyclophosphamide and corticosteroids for active glomerulonephritis.
Asunto(s)
Corticoesteroides/efectos adversos , Ciclofosfamida/efectos adversos , Glomerulonefritis/tratamiento farmacológico , Hepatitis C Crónica/complicaciones , Inmunosupresores/efectos adversos , Cirrosis Hepática/inducido químicamente , Corticoesteroides/uso terapéutico , Ciclofosfamida/uso terapéutico , Progresión de la Enfermedad , Resultado Fatal , Femenino , Hepatitis C Crónica/patología , Humanos , Inmunosupresores/uso terapéutico , Cirrosis Hepática/patología , Persona de Mediana EdadRESUMEN
A 67-year-old woman underwent an orthotopic liver transplantation for end stage liver disease secondary to chronic autoimmune hepatitis. She developed sudden massive hematochezia on post-operative day 23 with hemodynamic compromise. The source of hemorrhage was found at colonoscopy after careful irrigation and inspection to be a dieulafoy lesion situated just proximal to the anorectal junction. Hemostasis was achieved with epinephrine injection and thermal coagulation.
Asunto(s)
Hemorragia Gastrointestinal/etiología , Trasplante de Hígado/efectos adversos , Anciano , Canal Anal/irrigación sanguínea , Canal Anal/patología , Enfermedades del Ano/patología , Enfermedades del Ano/terapia , Arterias/patología , Femenino , Hemorragia Gastrointestinal/patología , Hemorragia Gastrointestinal/terapia , Humanos , Trasplante de Hígado/patología , Enfermedades del Recto/patología , Enfermedades del Recto/terapia , Recto/irrigación sanguínea , Recto/patologíaRESUMEN
Prophylaxis against recurrent hepatitis B virus (HBV) infection with hepatitis B immune globulin (HBIG), in combination with antiviral agents such as lamivudine, has allowed transplantation for this condition to become feasible and accepted. Current protocols allow for HBIG administration either intravenously or intramuscularly. To date, there has been no reported experience with the subcutaneous route of post-transplant HBIG delivery. We report our experience of a 60-yr-old man for whom liver transplantation was performed for chronic HBV. HBIG was administered intramuscularly during the anhepatic phase of surgery. The finding of a portal vein thrombosis requiring repeated thrombectomy necessitated chronic anticoagulation. Post-operatively, HBIG was administered subcutaneously, in four separate injections, for a daily dose of 2170 IU along with continued lamivudine dosing. Hepatitis B surface antibody (anti-HBs) titres reached a serum concentration of >500 IU/L by seven d post-transplant and approximately 1000 IU/L by nine d post-transplant. Five months post-transplant, with continued combination of subcutaneous HBIG and lamivudine, there has been no recurrent HBV infection and anti-HBs titres have been at target levels. Our experience suggests that subcutaneous delivery of HBIG may be a feasible consideration when intramuscular/intravenous dosing is not possible.