RESUMO
Our liver transplant program was started in 1993 in a private clinic and a public hospital. Thereafter, a rapid increase in adults and pediatric candidates for this therapeutic option lead to this analysis of results in 165 orthotopic liver transplants (OLT) in 143 patients between November 1993 and December 2002. Seventy-four OLT were performed in 66 adult patients and 91 in the pediatric group. Liver grafts came from cadaveric donors in 145 cases (74 adults and 71 children). The technique of living-related donor was utilized in 20 pediatric cases. Main indications for OLT in the adult group were HCV cirrhosis, primary biliary cirrhosis; biliary atresia and acute liver failure were the indications in pediatric patients. Retransplantation was needed for 23 patients, including 9 adults and 14 children. The most frequent causes of death were sepsis, graft primary nonfunction, and vascular complications. Actuarial survivals at 1 and 5 years were 80.7% and 72.6% for the adult group and 82% and 74.8% for the pediatric group, respectively. Our results are comparable to those published by large, experienced, international centers, with much better financial support.
Assuntos
Transplante de Fígado/estatística & dados numéricos , Adolescente , Adulto , Idoso , Causas de Morte , Chile , Feminino , Seguimentos , Humanos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Listas de EsperaRESUMO
Acute liver failure (ALF) is a severe, life-threatening condition associated with a high mortality rate. The objective of this study is to present the experience of a Chilean liver transplant program with orthotopic liver transplantation (OLT) for ALF. All patients with the diagnosis of ALF evaluated in our program between January 1995 and May 2003 were included in the analyses of etiology and outcomes. Candidates for OLT activated on a national waiting list were transplanted with cadaveric or living-related donor (LRD) organs. Twenty-seven patients age 1 to 19 years (median, 7.4 years) were transplanted at a median weight of 30.7 kg including 17 cadaveric and 10 with LRD livers. Most frequent etiologies were hepatitis A in 10 cases (37%) and unknown in 12 (48.1%). One donor experienced superficial phlebitis. Four patients were retransplanted (14.8%). Twenty patients are alive with 1- and 5-year survival rates of 74.1% At a median follow up of 34 months (range = 2 to 120). Seven patients died due to sepsis, multiorganic failure, graft primary nonfunction, intracranial hemorrhage, and intraoperative cardiac arrest. This experience revealed results comparable to international reports, allowing survival of patients destined to die.
Assuntos
Falência Hepática Aguda/cirurgia , Transplante de Fígado/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Chile , Feminino , Seguimentos , Hepatite A/cirurgia , Humanos , Lactente , Transplante de Fígado/mortalidade , Masculino , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Intravenous drug use, sexual promiscuity and a longer cohabitation period are considered risk factors for familial transmission of hepatitis C virus. The relative importance of this type of transmission is a subject of controversy. AIM: To study familial clustering of hepatitis C virus infection and its risk factors. MATERIAL AND METHODS: HCV positive patients (91 with chronic hepatitis, 88 with cirrhosis, nine with hepatic carcinoma and 29 hemophiliacs) were the index cases. HCV antibodies were measured by ELISA and the type of relationship with the index case was investigated in 317 family members. RESULTS: Positive anti HVC antibodies were detected in 12 of 243 family members of patients with chronic liver disease and in none of the family members of patients with hemophilia. Of these, five were couples of an index case with a long cohabitation period. Ten members had an index case with a severe liver disease (three with Child C cirrhosis and seven with liver carcinoma). CONCLUSIONS: Family transmission of HCV infection is uncommon in Chile. The association of severe liver disease and family transmission could be due to a higher viral load as responsible for transmission during the early periods of a long lasting disease.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Transmissão Vertical de Doenças Infecciosas , Hepatite C Crônica/transmissão , Transmissão de Doença Infecciosa , Anticorpos Anti-Hepatite C/isolamento & purificação , Chile , Fatores de Risco , Hepacivirus/imunologiaRESUMO
Several live oral vaccines (polio, bovine rotavirus, CVD 103-HgR cholera) are less immunogenic in developing than in industrialized countries. It was hypothesized that proximal small bowel bacterial overgrowth (common in children in less developed countries but rare in industrialized settings) diminishes the vibriocidal antibody response to CVD 103-HgR. In total, 202 fasting Santiago schoolchildren aged 5-9 years had lactulose breath H2 tests to detect proximal small bowel bacteria 1 day before ingesting CVD 103-HgR. Florid small bowel overgrowth was observed in 10 (5.6%) of 178 analyzable children. In children with florid overgrowth, vibriocidal seroconversion differed little from other children (60% vs. 67%), but the geometric mean titer was lower (160 vs. 368; P=.25). By logistic regression, increased peak breath H2 at small bowel time points was associated with diminished seroconversion (P=.04), as was the interaction of H2 value and weight (children >25 kg had lower seroconversion rates among subjects with heaviest overgrowth).
Assuntos
Anticorpos Antibacterianos/sangue , Vacinas contra Cólera/administração & dosagem , Vacinas contra Cólera/imunologia , Intestino Delgado/microbiologia , Vibrio cholerae/imunologia , Administração Oral , Testes Respiratórios , Criança , Pré-Escolar , Feminino , Humanos , Hidrogênio/análise , Lactulose/metabolismo , MasculinoRESUMO
BACKGROUND: Hepatitis E virus is an enterally transmitted virus that produces an acute self limited infection. AIM: To study serum antibodies against hepatitis E virus in different patients. PATIENTS AND METHODS: Using and ELISA technique, IgG antibodies against hepatitis E virus were measured in 40 alcoholics, 40 hemophiliacs, 174 blood donors, 36 subjects with acute non A-non B-non C hepatitis and 66 subjects with acute hepatitis A. RESULTS: Antibodies were detected in one alcoholic (2.5%), 3 hemophiliacs (7.5%), 7 blood donors (4%), 3 patients with non A-non B-non C hepatitis (8.3%) and 3 patients with acute hepatitis A (4.5%). CONCLUSIONS: A low frequency of hepatitis E infection was detected in the studied subjects.
Assuntos
Hepatite E/epidemiologia , Adolescente , Adulto , Chile/epidemiologia , Feminino , Seguimentos , Anticorpos Anti-Hepatite/imunologia , Hepatite E/imunologia , Humanos , Masculino , Gravidez , Estudos SoroepidemiológicosRESUMO
The prevalence of hepatitis B and C virus infections, transmitted by blood transfusions, was studied in 79 children with congenital coagulation disorders. Twenty nine percent had evidences of hepatitis B virus infection and 52% evidences of hepatitis C virus infection. Older children and those with the higher number of transfusions had the highest rates of infections. It is concluded that children with congenital coagulation disorders constitute a high risk group for hepatitis B and C virus infections.
Assuntos
Transtornos da Coagulação Sanguínea/congênito , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Reação Transfusional , Adolescente , Transtornos da Coagulação Sanguínea/terapia , Transfusão de Sangue/estatística & dados numéricos , Criança , Pré-Escolar , Hepatite B/transmissão , Hepatite C/transmissão , Humanos , Lactente , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Non-absorbable carbohydrates are widely used in the therapy of hepatic encephalopathy. It has been argued that their effects depend on intestinal fermentation. In some geographic areas other than Chile up to 27% of healthy inhabitants are not able to increase breath hydrogen after a lactulose load, a parameter of intestinal fermentation of carbohydrate. Lactose has been proposed as an alternative to non-absorbable disaccharides in patients with lactase deficiency. AIM: To investigate intestinal fermentation of lactulose and lactose malabsorption in Chilean patients with liver cirrhosis. PATIENTS AND METHODS: 22 healthy controls and 52 patients with liver cirrhosis (16 with hepatic encephalopathy) were prospectively studied by means of lactulose or lactose hydrogen breath tests and lactose tolerance test. MAIN RESULTS: In the control group, 19% were non-hydrogen excretors after lactulose, meanwhile a significant rise in breath hydrogen concentration was observed in all cirrhotic patients (p < 0.01). Lactose tolerance test was indicative of lactase persistance in 37% of cirrhotics and in 43% of controls (NS). Finally, 41% of cirrhotics and 50% of controls had a normal lactose hydrogen breath test (NS). These results were not significantly modified by the presence of hepatic encephalopathy. CONCLUSION: Our data suggest that a lack in bacterial fermentation is not a cause of lactulose therapy failure in Chilean patients with hepatic encephalopathy. Lactose might be an inappropriate substitute to lactulose treating a significant proportion of patients with this condition in our country.