RESUMEN
Orthotopic liver transplantation (OLT) has been very difficult to develop in Mexico and for many years its occurrence was anecdotal. This report presents the results of a pediatric liver transplant program, analyzing the variables that affect outcomes. Between June 1998 and March 2004, 35 OLT were performed in 34 recipients including 80% cadaveric whole-organ grafts and 20% segmental grafts, with 11% from cadaveric and 9% from living donors. Most of the recipients were infants or toddlers weighing less than 15 kg. There was only 1 case of arterial thrombosis (2.8%); the graft was saved with a Kasai procedure. Biliary complications were present in 22% of cases, all resolved with reoperations. Posttransplant cytomegalovirus infection or reactivation (28%), acute rejection (25%), or posttransplant lymphoproliferative disorders (5.7%) were not a cause of graft or patient loss. Overall, 1- and 5-year patient survival rates are 77.1% and 74.2%, respectively; however, when the 1998-2000 cohort was compared with the 2001-2004 cohort, there was a significant difference in survival (P = .004). The 1-year patient survival for the later group is 91.6%. We performed the first successful living donor liver transplantation and the first simultaneous liver-kidney transplantation in a child in our country. Our results demonstrate that pediatric liver transplantation is a feasible undertaking in Mexico, with survival rates comparable to those of foreign centers.
Asunto(s)
Trasplante de Hígado/estadística & datos numéricos , Cadáver , Niño , Humanos , Trasplante de Hígado/mortalidad , Donadores Vivos , México , Estudios Retrospectivos , Análisis de Supervivencia , Factores de Tiempo , Donantes de TejidosRESUMEN
Cytomegalovirus (CMV) infection in immunocompromised host is an important cause of morbidity and mortality. The protective immunity against the virus is both humoral and cellular. Immunologic mechanisms in rejection as in the immune response against CMV infection are similar but there is difficult to separe as histologic and clinically independent events. At least eight different genes of CMV are homologous to human proteins related to the immune response. The potential role of these genes with homology to human genes can be at different levels. The relevance that immunodominant antigens have on the natural control of CMV infection, suggests that the future design of a vaccine directed to protecting from disease those susceptible to primary infection, in an immunocompromised state, should involve a combination of antigens that include pp65, IE1-exon 4 and gB as a recombinant proteins.