RESUMEN
BACKGROUND/AIMS: Liver transplantation for alcoholic end-stage liver disease remains controversial at many transplant centers. The aim of the present study was to evaluate the outcome of patients with alcoholic liver disease who underwent liver transplantation at Centro Trapianti, Policlinico S. Orsola, Bologna. METHODOLOGY: We describe the outcomes of 18 alcoholic patients with end-stage liver disease who received orthotopic liver transplants at our center from April, 1986 to February, 1996. The data obtained was compared with that of 114 patients with virus-related cirrhosis selected as transplant controls. An absolute period of abstinence from alcohol consumption for at least six months was required. RESULTS: Regarding the actuarial survival rate and non-fatal post-transplant complications, no significant differences were noted in comparing the non-alcoholic with the alcoholic recipients, except for a higher incidence of Cytomegalovirus infection in the alcoholic group followed-up for more than four months. The alcoholic relapse rate was 27.2%, but only one patient returned to harmful drinking. Seventy-three percent of subjects who were followed-up for at least six months were occupied in gainful employment. Alcoholic relapse did not affect employment status. CONCLUSION: This data demonstrates that liver transplantation for selected patients with end-stage alcohol-related cirrhosis achieves good results in survival, complications and employment status, and it appears difficult to defend an inflexible claim to have demonstrated an absolute long-term abstinence before transplantation when a severe deterioration of liver function is present.
Asunto(s)
Cirrosis Hepática Alcohólica/cirugía , Trasplante de Hígado , Análisis Actuarial , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Cirrosis Hepática/mortalidad , Cirrosis Hepática/cirugía , Cirrosis Hepática/virología , Cirrosis Hepática Alcohólica/mortalidad , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Recurrencia , Templanza , Resultado del TratamientoRESUMEN
The sensitivity of liver cells to anoxia is a major problem afflicting liver preservation and transplantation. Intermittent ischemia has been proposed to reduce reperfusion injury. The aim of the study was to assess oxygen free radical formation and cell injury during continuous or intermittent anoxia/reoxygenation in rat hepatocytes. Anion superoxide was measured by lucigenin-enhanced chemiluminescence and cell damage by LDH release and trypan blue uptake. During anoxia, superoxide generation dropped to background level in both groups; trypan blue uptake and LDH release, which increased progressively, were significantly greater in hepatocytes exposed to continuous compared to intermittent anoxia. During reoxygenation, a massive generation of superoxide anion formation, followed by a sharp increase in LDH release, was observed in both groups. However, both oxyradical generation and cell injury were significantly greater in cells exposed to continuous compared to intermittent anoxia. The data, showing that intermittent oxygen deprivation reduce liver cell injury and oxygen free radical formation determined by anoxia/reoxygenation, suggest a novel possible approach to the reduction of reperfusion injury.
Asunto(s)
Hipoxia de la Célula/fisiología , Hígado/efectos de los fármacos , Oxígeno/farmacología , Periodicidad , Especies Reactivas de Oxígeno , Animales , Radicales Libres , Hígado/patología , Mediciones Luminiscentes , Masculino , Ratas , Ratas Sprague-DawleyRESUMEN
Primary hepatic leiomyosarcoma is a very rare tumour only eighteen cases having been reported in the literature. A new case of this tumour is reported here, in which a complete diagnostic imaging work-up was performed, leading to the pathologic diagnosis, obtained with ultrasonically-guided coarse needle biopsy. Transarterial chemoembolisation, a new therapeutic option for this disease, was attempted without success.