RESUMO
Liver diseases, including cirrhosis, viral hepatitis, and hepatocellular carcinoma, account for approximately two million annual deaths worldwide. They place a huge burden on the global healthcare systems, compelling researchers to find effective treatment for liver fibrosis-cirrhosis. Portacaval anastomosis (PCA) is a model of liver damage and fibrosis. Arginine vasopressin (AVP) has been implicated as a proinflammatory-profibrotic hormone. In rats, neurointermediate pituitary lobectomy (NIL) induces a permanent drop (80%) in AVP serum levels. We hypothesized that AVP deficiency (NIL-induced) may decrease liver damage and fibrosis in a rat PCA model. Male Wistar rats were divided into intact control (IC), NIL, PCA, and PCA+NIL groups. Liver function tests, liver gene relative expressions (IL-1, IL-10, TGF-ß, COLL-I, MMP-9, and MMP-13), and histopathological assessments were performed. In comparison with those in the IC and PCA groups, bilirubin, protein serum, and liver glycogen levels were restored in the PCA+NIL group. NIL in the PCA animals also decreased the gene expression levels of IL-1 and COLL-I, while increasing those of IL-10, TGF-ß, and MMP-13. Histopathology of this group also showed significantly decreased signs of liver damage with lower extent of collagen deposition and fibrosis. Low AVP serum levels were not enough to fully activate the AVP receptors resulting in the decreased activation of cell signaling pathways associated with proinflammatory-profibrotic responses, while activating cell molecular signaling pathways associated with an anti-inflammatory-fibrotic state. Thus, partial reversion of liver damage and fibrosis was observed. The study supports the crucial role of AVP in the inflammatory-fibrotic processes and maintenance of immune competence. The success of the AVP deficiency strategy suggests that blocking AVP receptors may be therapeutically useful to treat inflammatory-fibrotic liver diseases.
Assuntos
Arginina Vasopressina/deficiência , Cirrose Hepática/patologia , Falência Hepática/imunologia , Hipófise/metabolismo , Receptores de Vasopressinas/metabolismo , Animais , Arginina Vasopressina/sangue , Modelos Animais de Doenças , Humanos , Hipofisectomia , Cirrose Hepática/sangue , Cirrose Hepática/imunologia , Falência Hepática/sangue , Falência Hepática/patologia , Masculino , Hipófise/cirurgia , Derivação Portocava Cirúrgica , Ratos , Ratos Wistar , Transdução de Sinais/imunologiaRESUMO
OBJECTIVES: Vitamin D deficiency may be associated with comorbidities and poor prognosis. However, this association in patients in the intensive care unit (ICU) has not been fully elucidated. The aim of this study was to investigate whether the serum concentrations of 25-hydroxyvitamin D (25[OH]D) within the first 48 h after ICU admission are associated with prognostic indicators (Acute Physiology and Chronic Health Evaluation [APACHE] II, Sequential Organ Failure Assessment [SOFA] score, Charlson comorbidity index [CCI]), clinical complications, serum C-reactive protein (CRP) concentrations, mechanical ventilation duration, and mortality. METHODS: Seventy-one patients were admitted to the ICU, and their concentrations of 25(OH)D in the first 48 h were analyzed. To evaluate the prognostic factors in the ICU, APACHE II scores, SOFA scores, CCI questionnaires, mechanical ventilation time, CRP, and mortality were used. RESULTS: The mean concentration of 25(OH)D was 17.7 ± 8.27 ng/mL (range 3.5-37.5 ng/mL), with 91.6% presenting with deficiency at admission. Although no associations were found between serum 25(OH)D concentrations with mechanical ventilation time, CRP, mortality, and APACHE II and SOFA severity scores, we found associations with the CCI when adjusted by age (model 1: odds ratio [OR], 1.64; 95% confidence interval [CI], 1.14-2.34) and by age, sex and body mass index (model 2: OR, 1.59; 95% CI, 1.10-2.34). In addition, among the comorbidities present, 25(OH)D concentrations were inversely associated with cancer (crude model OR, 3.42; 95% CI, 1.21-9.64) and liver disease (crude model OR, 9.64; 95% CI, 2.28-40.60). CONCLUSION: We found a strong association between 25(OH)D concentrations and the prognostic indicator CCI and clinical complications (acute respiratory insufficiency, acute liver failure, and infections), but no associations with the prognostic indicators APACHE II and SOFA score, CRP, mechanical ventilation duration, or mortality. The main comorbidities associated with low 25(OH)D were cancer and liver disease, suggesting that the determination of 25(OH)vitamin D is relevant during the ICU stay.
Assuntos
Estado Terminal/mortalidade , Admissão do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Deficiência de Vitamina D/mortalidade , Vitamina D/análogos & derivados , APACHE , Doença Aguda , Adulto , Idoso , Proteína C-Reativa/análise , Comorbidade , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Infecções/sangue , Infecções/complicações , Infecções/mortalidade , Unidades de Terapia Intensiva , Falência Hepática/sangue , Falência Hepática/complicações , Falência Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Neoplasias/complicações , Neoplasias/mortalidade , Escores de Disfunção Orgânica , Prognóstico , Respiração Artificial , Insuficiência Respiratória/sangue , Insuficiência Respiratória/complicações , Insuficiência Respiratória/mortalidade , Fatores de Tempo , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/complicaçõesRESUMO
In January 2015, a 20-month-old child and her family took part in recreational activities at Carrasco and Malvín beaches (Montevideo, Uruguay). An intense harmful algae bloom (HAB) was developing along the coast at that time. A few hours after the last recreational exposure episode, the family suffered gastrointestinal symptoms which were self-limited except in the child's case, who was admitted to hospital in Uruguay with diarrhea, vomiting, fatigue, and jaundice. The patient had increased serum levels of liver enzymes and bilirubin and five days later presented acute liver failure. She was referred to the Italian Hospital in Buenos Aires, being admitted with grade II-III encephalopathy and hepatomegaly and requiring mechanical respiratory assistance. Serology tests for hepatitis A, B, and C, Epstein-Barr virus, and cytomegalovirus were negative. Laboratory features showed anemia, coagulopathy, and increased serum levels of ammonium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin. Autoimmune Hepatitis Type-II (AH-II) was the initial diagnosis based on a liver kidney microsomal type 1 antibodies (LKM-1) positive result, and twenty days later a liver transplant was performed. The liver histopathology had indicated hemorrhagic necrosis in zone 3, and cholestasis and nodular regeneration, which were not characteristic of AH-II. LC/ESI-HRMS (liquid chromatography electrospray ionization high-resolution mass spectrometry) analysis of MCs in the explanted liver revealed the presence of Microsytin-LR (MC-LR) (2.4 ng·gr-1 tissue) and [D-Leu¹]MC-LR (75.4 ng·gr-1 tissue), which constitute a toxicological nexus and indicate a preponderant role of microcystins in the development of fulminant hepatitis.
Assuntos
Proliferação Nociva de Algas , Falência Hepática/etiologia , Microcistinas/toxicidade , Poluentes da Água/toxicidade , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Praias , Bilirrubina/sangue , Exposição Ambiental , Feminino , Humanos , Lactente , Fígado/metabolismo , Fígado/patologia , Falência Hepática/sangue , Falência Hepática/patologia , UruguaiRESUMO
UNLABELLED: Background and rationale for the study. There is currently no definition of post-transjugular intrahepatic portosystemic shunt (TIPS) liver failure (PTLF), which constitutes a barrier to standardization of TIPS results reporting and limits the ability to compare liver failure incidence across clinical studies. Thisdescriptive study proposes and preliminarily tests the performance of a PTLF definition and grading system. RESULTS: PTLF was defined by ≥ 3-fold bilirubin and/or ≥ 2-fold INR elevation associated with clinical outcomes of prolonged hospitalization/increase in care level (grade 1), TIPS reduction or liver transplantation (grade 2), or death (grade 3) within 30-days of TIPS. PTLF incidence was 20% (grades 1, 2, 3: 10%, 3%, 8%) among 270 TIPS cases, and the scheme identified patients at increased risk for morbidity and mortality with a statistically significant difference in clinical outcomes between PTLF and non-PTLF groups (P<0.0001). CONCLUSIONS: In conclusion, the PTLF definition and classification scheme put forth distributes patients into unique risk groups. PTLF grading may thus be useful for standardization of TIPS results reporting.
Assuntos
Hipertensão Portal/cirurgia , Falência Hepática/classificação , Transplante de Fígado , Derivação Portossistêmica Transjugular Intra-Hepática , Complicações Pós-Operatórias/classificação , Idoso , Bilirrubina/sangue , Transtornos da Coagulação Sanguínea/sangue , Estudos de Coortes , Feminino , Encefalopatia Hepática , Humanos , Incidência , Coeficiente Internacional Normatizado , Falência Hepática/sangue , Falência Hepática/diagnóstico , Falência Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
This study aimed to evaluate the influence of plasma exchange (PE) treatment of patients with liver failure on the patient's immune function, including peripheral blood T lymphocytes and cytokines. Patients accepting PE for liver failure from October 2011 to February 2012 were included prospectively in the research group. Peripheral blood samples were collected at set time points. The percentages of T lymphocyte subtypes were detected by flow cytometry using different fluorescence labels including CD3-FITC, CD4-PerCP, CD8-PE, CD25-FITC, and Foxp3-PE. Changes in serum IL-17 concentration were followed by ELISA. In all fifteen patients who accepted PE, the percentages of CD3(+) and CD8(+) T cells increased immediately after the procedure and then reduced gradually. These significant changes were confirmed by statistical analysis (P < 0.05). The percentage of CD4(+) T cells also increased after PE to a certain extent, but failed to show statistical significance. The positive ratio of CD4(+)CD25(+)Foxp3(+) T cells (Treg) increased after the treatment with statistical difference (P < 0.05). The concentration of IL-17 in patient serum increased significantly following PE treatment (P < 0.05). These results demonstrated that T lymphocyte subgroups of patients with liver failure could be influenced after PE treatment, and that cellular immunity could be recovered. PE treatment, therefore, can be viewed as providing reliable protection for the reconstruction of the patient immune system.
Assuntos
Falência Hepática/imunologia , Falência Hepática/terapia , Transplante de Fígado , Troca Plasmática , Adulto , Antígenos CD/metabolismo , Feminino , Citometria de Fluxo , Fatores de Transcrição Forkhead/metabolismo , Humanos , Interleucina-17/sangue , Falência Hepática/sangue , Subpopulações de Linfócitos/imunologia , Masculino , Linfócitos T/imunologiaAssuntos
Dor Abdominal/etiologia , Transtornos da Consciência/etiologia , Hiperamonemia/etiologia , Falência Hepática/etiologia , Síndrome de Reye/diagnóstico , Doença Aguda , Traumatismos do Tornozelo/complicações , Artralgia/etiologia , Aspirina/efeitos adversos , Criança , Diagnóstico Diferencial , Fadiga/etiologia , Feminino , Transtornos Hemorrágicos/etiologia , Humanos , Hipoglicemia/etiologia , Hipotensão/etiologia , Lactulose/uso terapêutico , Falência Hepática/sangue , Falência Hepática/diagnóstico , Síndrome de Reye/complicações , Febre Reumática/diagnóstico , Vitamina K/uso terapêuticoRESUMO
BACKGROUND: Hepatitis E virus (HEV) has been described as an emerging pathogen in Brazil and seems to be widely disseminated among swine herds. An autochthonous human case of acute hepatitis E was recently reported. To obtain a better understanding of the phenotypic profiles of both human and swine HEV strains, a experimental study was conducted using the animal model, Macaca fascicularis. METHODS: Six cynomolgus monkeys (Macaca fascicularis) were inoculated intravenously with swine HEV genotype 3 that was isolated from naturally and experimentally infected pigs in Brazil and the Netherlands. Two other monkeys were inoculated with HEV genotype 3 that was recovered from Brazilian and Argentinean patients with locally acquired acute and fulminant hepatitis E. The haematological, biochemical, and virological parameters of all animals were monitored for 67 days. RESULTS: Subclinical hepatitis was observed in all monkeys after inoculation with HEV genotype 3 that was recovered from the infected swine and human patients. HEV RNA was detected in the serum and/or faeces of 6 out of the 8 cynomolgus monkeys between 5 and 53 days after inoculation. The mild inflammation of liver tissues and elevations of discrete liver enzymes were observed. Seroconversions to anti-HEV IgM and/or IgG were detected in 7 animals. Reactivities to anti-HEV IgA were also detected in the salivary samples of 3 animals. Interestingly, all of the infected monkeys showed severe lymphopenia and a trend toward monocytosis, which coincided with elevations in alanine aminotransferase and antibody titres. CONCLUSIONS: The ability of HEV to cross the species barrier was confirmed for both the swine (Brazilian and Dutch) and human (Argentinean) strains, thus reinforcing the zoonotic risk of hepatitis E in South America. Cynomolgus monkeys that were infected with HEV genotype 3 developed subclinical hepatitis that was associated with haematological changes. Haematological approaches should be considered in future studies of HEV infection.
Assuntos
Vírus da Hepatite E/patogenicidade , Hepatite E/veterinária , Hepatite E/virologia , Falência Hepática/virologia , Doenças dos Suínos/virologia , Adulto , Animais , Feminino , Hepatite E/sangue , Vírus da Hepatite E/classificação , Humanos , Lactente , Contagem de Leucócitos , Falência Hepática/sangue , Macaca fascicularis , Masculino , Especificidade da Espécie , Suínos , Doenças dos Suínos/sangueRESUMO
CONTEXT: Living donor liver transplantation has become an alternative to reduce the lack of organ donation. OBJECTIVE: To identify factors predictive of early graft loss in the first 3 months after living donor liver transplantation. METHODS: Seventy-eight adults submitted to living donor liver transplantation were divided into group I with 62 (79.5%) patients with graft survival longer than 3 months, and group II with 16 (20.5%) patients who died and/or showed graft failure within 3 months after liver transplantation. The variables analyzed were gender, age, etiology of liver disease, Child-Pugh classification, model of end-stage liver disease (MELD score), pretransplantation serum sodium level, and graft weight-to-recipient body weight (GRBW) ratio. The GRBW ratio was categorized into < 0.8 and MELD score into >18. The chi-square test, Student t-test and uni- and multivariate analysis were used for the evaluation of risk factors for early graft loss. RESULTS: MELD score <18 (P<0.001) and serum sodium level > 135 mEq/L (P = 0.03) were higher in group II than in group I. In the multivariate analysis MELD scores > 18 (P<0.001) and GRBW ratios < 0.8 (P<0.04) were significant. CONCLUSIONS: MELD scores >18 and GRBW < 0.8 ratios are associated with higher probability of graft failure after living donor liver transplantation.
Assuntos
Rejeição de Enxerto/mortalidade , Falência Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Doadores Vivos , Sódio/sangue , Adulto , Idoso , Biomarcadores/sangue , Métodos Epidemiológicos , Feminino , Humanos , Falência Hepática/sangue , Falência Hepática/mortalidade , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-IdadeRESUMO
CONTEXT: Living donor liver transplantation has become an alternative to reduce the lack of organ donation. OBJECTIVE: To identify factors predictive of early graft loss in the first 3 months after living donor liver transplantation. METHODS: Seventy-eight adults submitted to living donor liver transplantation were divided into group I with 62 (79.5%) patients with graft survival longer than 3 months, and group II with 16 (20.5%) patients who died and/or showed graft failure within 3 months after liver transplantation. The variables analyzed were gender, age, etiology of liver disease, Child-Pugh classification, model of end-stage liver disease (MELD score), pretransplantation serum sodium level, and graft weight-to-recipient body weight (GRBW) ratio. The GRBW ratio was categorized into < 0.8 and MELD score into >18. The chi-square test, Student t-test and uni- and multivariate analysis were used for the evaluation of risk factors for early graft loss. RESULTS: MELD score <18 (P<0.001) and serum sodium level > 135 mEq/L (P = 0.03) were higher in group II than in group I. In the multivariate analysis MELD scores > 18 (P<0.001) and GRBW ratios < 0.8 (P<0.04) were significant. CONCLUSIONS: MELD scores >18 and GRBW < 0.8 ratios are associated with higher probability of graft failure after living donor liver transplantation.
CONTEXTO: O transplante hepático intervivos constitui alternativa para amenizar a falta de doação de órgãos. OBJETIVO: Identificar os fatores preditivos da perda precoce do enxerto hepático nos 3 primeiros meses após transplante hepático intervivo. MÉTODOS: Setenta e oito adultos submetidos ao transplante de fígado intervivos foram divididos em grupo I com 62 (79,5%) doentes com sobrevivência do enxerto superior a 3 meses, e grupo II com 16 (20,5%) que faleceram e/ou apresentaram falha do enxerto até 3 meses após o transplante hepático. As variáveis analisadas foram: sexo, idade, origem da doença hepática, classificação de Child-Pugh, critério MELD, nível sérico de sódio pré-transplante e relação GRBW. O critério MELD foi categorizado em > 18 e a relação GRBW em < 0,8. Na avaliação dos fatores de risco para perda precoce do enxerto hepático foi utilizada a análise uni e multivariada. RESULTADOS: Critério MELD <18 (P = 0,001) e nível sérico de sódio >135 mEq/L (P = 0,03) foram maiores nos doentes do grupo II. A probabilidade de perda do enxerto no transplante hepático intervivos teve como variáveis independentes o índice MELD > 18 e a relação GRBW< 0,8. CONCLUSÃO: Os valores de MELD >18 e GRBW <0,8 estão associados com maior probabilidade de insucesso no transplante hepático intervivos.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rejeição de Enxerto/mortalidade , Doadores Vivos , Falência Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Sódio/sangue , Biomarcadores/sangue , Métodos Epidemiológicos , Falência Hepática/sangue , Falência Hepática/mortalidade , Transplante de Fígado/mortalidadeRESUMO
A relevância da utilização de albumina em pacientes com doença aguda ou crônica permanece controversa. Apesar da importância fisiológica e dos potenciais efeitos benéficos, sua utilização é baseada na prática clínica e não sustentada nas evidências dos estudos clínicos. Resultados promissores de seu uso são confirmados na falência hepática, no infarto cerebral e, talvez, em situações de exceção na reposição volêmica de pacientes críticos.
The relevance of human albumin administration remains controversial. Albumin infusion has not proven to achieve clinical benefit in many acute and chronic disease states with a few exceptions in liver failure, cerebral infarction and may be in acute hypovolemia in the critical patients.
Assuntos
Humanos , Masculino , Feminino , Albumina Sérica/administração & dosagem , Revisão de Uso de Medicamentos , Falência Hepática/sangue , Falência Hepática/terapia , Infarto Cerebral/sangue , Infarto Cerebral/terapia , Hipoalbuminemia/terapia , Hipovolemia/terapia , Substitutos do PlasmaRESUMO
OBJECTIVES: To test the hypothesis that early trends in common blood tests may delineate risks of liver failure (LF) in infants with parenteral nutrition-associated liver disease (PNALD) from short bowel syndrome and suggest criteria for transplant referral. STUDY DESIGN: Total levels of bilirubin, gamma-glutamyl transferase, albumin, alanine aminotransferase, platelet count, and absolute neutrophil count were recorded every 3 months for 61 infants with PNALD who were being considered for intestinal transplant starting at age 3 months until death without transplant (n = 12), LF with transplant (n = 35), or liver recovery without transplant (n = 14). Probabilities of LF were determined with logistic regression. RESULTS: Independent predictors of LF were, in descending order, total bilirubin level (odds ratio [OR] = 1.195), platelet count (OR = 0.992), and albumin level (OR = 0.248). Predicted probabilities of eventual LF varied from 36% to 38% at ages 3 to 6 months when the total bilirubin level was 6.0 mg/dL, platelet count was 220 x 10(3)/microL, and albumin level was 3.5 g/dL to 83% to 84% when the total bilirubin level was 11.7 mg/dL, platelet count was 168 x 10(3)/microL, and albumin level was 3.0 g/dL. CONCLUSIONS: Transplant referral for a total bilirubin level of 6 mg/dL between 3 to 6 months of age is appropriate, because the probability of LF is at least 36%.
Assuntos
Falência Hepática/diagnóstico , Nutrição Parenteral/efeitos adversos , Síndrome do Intestino Curto/terapia , Alanina Transaminase/sangue , Bilirrubina/sangue , Progressão da Doença , Seguimentos , Humanos , Lactente , Falência Hepática/sangue , Falência Hepática/etiologia , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Síndrome do Intestino Curto/complicações , gama-Glutamiltransferase/sangueRESUMO
AIM: To evaluate the prognostic value of percentage of (13)C-phenylalanine oxidation ((13)C-PheOx) obtained by (13)C-phenylalanine breath test ((13)C-PheBT) on the survival of patients with chronic liver failure. METHODS: The hepatic function was determined by standard liver blood tests and the percentage of (13)C-PheOx in 118 chronic liver failure patients. The follow-up period was of 64 mo. Survival analysis was performed by the Kaplan-Meier method and variables that were significant (P < 0.10) in univariate analysis and subsequently introduced in a multivariate analysis according to the hazard model proposed by Cox. RESULTS: Forty-one patients died due to progressive liver failure during the follow-up period. The probability of survival at 12, 24, 36, 48 and 64 mo was 0.88, 0.78, 0.66, 0.57 and 0.19, respectively. Multivariate analysis demonstrated that Child-Pugh classes, age, creatinine and the percentage of (13)C-PheOx (HR 0.338, 95% CI: 0.150-0.762, P = 0.009) were independent predictors of survival. When Child-Pugh classes were replaced by all the parameters of the score, only albumin, bilirubin, creatinine, age and the percentage of (13)C-PheOx (HR 0.449, 95% CI: 0.206-0.979, P = 0.034) were found to be independent predictors of survival. CONCLUSION: Percentage of (13)C-PheOx obtained by (13)C-PheBT is a strong predictor of survival in patients with chronic liver disease.
Assuntos
Testes Respiratórios/métodos , Falência Hepática/mortalidade , Fenilalanina/análise , Adulto , Fatores Etários , Isótopos de Carbono , Doença Crônica , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Falência Hepática/sangue , Falência Hepática/diagnóstico , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Reprodutibilidade dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Hepatitis B virus (HBV) and hepatitis C virus (HCV) share modes of transmission and their combined infection is a fairly frequent occurrence particularly in areas where the two viruses are endemic and among subjects with a high risk of parenteral infections. Moreover, the number of coinfected patients is likely higher than is usually thought. In fact, many studies have shown that HBV genomes may also be present in HBsAg-negative patients, particularly in those with HCV-related chronic hepatitis. This condition is commonly called "occult HBV infection". Much evidence suggests that coinfection by HBV and HCV may have considerable clinical relevance. In particular, this condition is generally believed to be a factor favouring the progression of liver fibrosis toward cirrhosis and the development of liver cancer, and in case of both overt and occult HBV infection. In spite of its potential clinical impact, however, there is few information about the possible interplay between the two viruses. Here, we concisely reviewed the available data on the virological and clinical features of the dual HBV/HCV infection prospecting the aspects that should be highlighted in the nearest future for improving the knowledge on this important field of the hepatology.
Assuntos
Hepatite B/complicações , Hepatite C Crônica/complicações , Falência Hepática/virologia , DNA Viral/sangue , Hepacivirus/genética , Hepacivirus/imunologia , Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/genética , Vírus da Hepatite B/imunologia , Hepatite C Crônica/sangue , Humanos , Falência Hepática/sangue , RNA Viral/sangueRESUMO
BACKGROUND: Acute renal failure (ARF) is a common complication after liver transplantation (LTx). Identification of risk factors may prevent the development and attenuate the impact of ARF on patients outcome after LTX. METHODS: Retrospective analysis of variables in the pre, intra, and postoperative periods of 92 patients submitted to LTx was performed in order to identify risk factors for development of ARF after LTx. ARF was defined as serum creatinine > or = 2.0 mg/dL in the first 30 days after LTx. Univariate and multivariate analysis by logistic regression were performed. RESULTS: ARF group comprised 56 patients (61%). Preoperative serum creatinine was higher in ARF group. During the intraoperative period, ARF group required more blood transfusions, developed more episodes of hypotension and presented longer anesthesia time. In the postoperative period, ARF group presented higher serum bilirubin and more episodes of hypotension. Dialysis was required in 10 patients (11%). The identifled risk factors for development of ARF were: preoperative serum creatinine > 1.0 mg/dL. more than five blood transfusions in the intraoperative period, hypotension during intra and postoperative periods. The identified mortality risk factors were hypotension in the postoperative period and no recovery of renal function after 30 days. CONCLUSIONS: Several factors are involved in the pathogenesis of ARF after LTx and may influence patients outcome and mortality. Pretransplant renal function and hemodynamic conditions in the operative and postoperative periods were identified as risk factors for development of ARF after LTx. Nonrenal function recovery and postoperative hypotension were identified as mortality risk factors after LTx.
Assuntos
Injúria Renal Aguda/etiologia , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Injúria Renal Aguda/sangue , Injúria Renal Aguda/terapia , Adulto , Bilirrubina/sangue , Biomarcadores/sangue , Transfusão de Sangue , Brasil , Creatinina/sangue , Ciclosporina/sangue , Ciclosporina/uso terapêutico , Feminino , Seguimentos , Humanos , Hipotensão/sangue , Hipotensão/epidemiologia , Hipotensão/etiologia , Imunossupressores/sangue , Imunossupressores/uso terapêutico , Rim/metabolismo , Rim/fisiopatologia , Falência Hepática/sangue , Falência Hepática/epidemiologia , Falência Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Oligúria/sangue , Oligúria/epidemiologia , Oligúria/etiologia , Complicações Pós-Operatórias/sangue , Potássio/sangue , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Falha de Tratamento , Ureia/sangueRESUMO
Liver transplantation is the only therapeutic option for patients with end-stage liver disease. Nitric oxide, a free radical produced from L-arginine, a potent vasodilator, also inhibits platelet adhesion and aggregation, reduces adhesion of leukocytes to the endothelium and suppresses proliferation of vascular smooth muscle cells. The inducible form of the nitric oxide synthase may generate large quantities of nitric oxide, and may be induced by the action of cytokines and lipopolysaccharides. Nitric oxide can be released from the hepatic vascular endothelium, platelets and Kupffer cells as a response to ischemia-reperfusion injury and circulatory shock. We analyzed the relationships between the levels of nitric oxide, hepatic enzymes and other clinical parameters (glucose, total proteins, total bilirubin, creatinine, albumin) obtained in serum samples before liver transplantation and every 48 h till day 15 in 15 patients aged 40 +/- 13 years. Aspartate aminotransferase and alanine aminotransferase levels changed from high at the beginning, to almost normal at the end of the study, cholinesterase levels remained decreased throughout the study and nitric oxide remained high, never reaching normal values.
Assuntos
Transplante de Fígado/fisiologia , Óxido Nítrico/sangue , Adolescente , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Glicemia/metabolismo , Proteínas Sanguíneas/metabolismo , Colinesterases/sangue , Creatinina/sangue , Feminino , Humanos , Fígado/enzimologia , Falência Hepática/sangue , Falência Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Óxido Nítrico Sintase/sangue , Óxido Nítrico Sintase Tipo II , Albumina Sérica/metabolismoRESUMO
Total serum lipids, as well as apolipoproteins A-I (apo A-I) and B (apo B), were determined in 74 patients with chronic liver failure without cholestasis and in 82 normal subjects. The VLDL, LDL and HDL lipid fractions were reduced in the liver failure group by 36 percent, 24 percent and 46 percent, respectively (P<0.001). Apolipoproteins A-I and B were also reduced by 26 percent and 25 percent, respectively (P<0.001). However, the reduction of HDL cholesterol (HDLc) was more pronounced than that of apo A-I and HDLc:apo A-I ratio was significantly lower in the liver failure group. After separating these patients into groups with plasma albumin lower than 3.0, between 3.0 and 3.5, and higher than 3.5 g/dl, the HDLc:apo A-I ratio was proportional to plasma albumin, but the correlation was not statistically significant. When these patients were separated by the Child classification of liver function, there was a correlation between the HDLc:apo A-I ratio and liver function. The differences in the HDLc:apo A-I ratio between the Child groups B and C, and A and C were statistically significant (P<0.05). We conclude that there is a more pronounced reduction in HDL cholesterol than in apo A-I in liver failure patients. Therefore, the HDLc:apo A-I ratio is a marker of liver function, probably because there is a decreased lecithin-cholesterol acyltransferase production by the diseased liver.
Assuntos
Pessoa de Meia-Idade , Humanos , Feminino , Apolipoproteína A-I/sangue , Apolipoproteínas B/sangue , Lipídeos/sangue , Falência Hepática/sangue , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Lipoproteínas VLDL/sangueRESUMO
Total serum lipids, as well as apolipoproteins A-I (apo A-I) and B (apo B), were determined in 74 patients with chronic liver failure without cholestasis and in 82 normal subjects. The VLDL, LDL and HDL lipid fractions were reduced in the liver failure group by 36%, 24% and 46%, respectively (P < 0.001). Apolipoproteins A-I and B were also reduced by 26% and 25%, respectively (P < 0.001). However, the reduction of HDL cholesterol (HDLc) was more pronounced than that of apo A-I and the HDLc:apo A-I ratio was significantly lower in the liver failure group. After separating these patients into groups with plasma albumin lower than 3.0, between 3.0 and 3.5, and higher than 3.5 g/dl, the HDLc:apo A-I ratio was proportional to plasma albumin, but the correlation was not statistically significant. When these patients were separated by the Child classification of liver function, there was a correlation between the HDLc:apo A-I ratio and liver function. The differences in the HDLc:apo A-I ratio between the Child groups B and C, and A and C were statistically significant (P < 0.05). We conclude that there is a more pronounced reduction in HDL cholesterol than in apo A-I in liver failure patients. Therefore, the HDLc:apo A-I ratio is a marker of liver function, probably because there is a decreased lecithin-cholesterol acyltransferase production by the diseased liver.
Assuntos
Apolipoproteína A-I/sangue , Apolipoproteínas B/sangue , Lipídeos/sangue , Falência Hepática/sangue , Feminino , Humanos , Lipoproteínas HDL/sangue , Lipoproteínas LDL/sangue , Lipoproteínas VLDL/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
This article discusses pharmacokinetics and pharmacodynamics during hepatic, renal, and cardiovascular insufficiencies. Hepatic metabolism of psychotropic drugs and of drugs commonly used in transplant patients that have neuropsychiatric side effects is discussed. Neuropsychiatric effects of immunosuppressant agents, including cyclosporine, corticosteroids, azathioprine, OKT3, and FK 506, are reviewed. Certain infections occur more often in immunosuppressed patients; their treatment with antiviral, antifungal, and antibiotic drugs may have neuropsychiatric consequences. Because of altered drug sensitivities and metabolism, drug interactions, and severe medical illness, most drugs are used in reduced doses.