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Mendizabal M, Tagliafichi V, Rubinstein F, Rojas P, Marciano S, Yantorno S, Cejas N, Barrabino M, Anders M, Cairo F, Villamil F, Blazquez L, Zerega A, Ferretti S, Fernández D, Paredes S, Aballay Soteras G, Gaite L, Bisigniano L, Silva MO. Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry. Ann Hepatol 2020; 18:338-344. [PMID: 31053539 DOI: 10.1016/j.aohep.2018.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Liver transplantation (LT) for acute liver failure (ALF) still has a high early mortality. We aimed to evaluate changes occurring in recent years and identify risk factors for poor outcomes. MATERIAL AND METHODS Data were retrospectively obtained from the Argentinean Transplant Registry from two time periods (1998-2005 and 2006-2016). We used survival analysis to evaluate risk of death. RESULTS A total of 561 patients were listed for LT (69% female, mean age 39.5±16.4 years). Between early and later periods there was a reduction in wait-list mortality from 27% to 19% (p<0.02) and 1-month post-LT survival rates improved from 70% to 82% (p<0.01). Overall, 61% of the patients underwent LT and 22% died on the waiting list. Among those undergoing LT, Cox regression analysis identified prolonged cold ischemia time (HR 1.18 [1.02-1.36] and serum creatinine (HR 1.31 [1.01-1.71]) as independent risk factors of death post-LT. Etiologies of ALF were only available in the later period (N=363) with indeterminate and autoimmune hepatitis accounting for 28% and 26% of the cases, respectively. After adjusting for age, gender, private/public hospital, INR, creatinine and bilirubin, and considering LT as the competing event, indeterminate etiology was significantly associated with death (SHR 1.63 [1.06-2.51] and autoimmune hepatitis presented a trend to improved survival (SHR 0.61 [0.36-1.05]). CONCLUSIONS Survival of patients with ALF on the waiting list and after LT has significantly improved in recent years. Indeterminate cause and autoimmune hepatitis were the most frequent etiologies of ALF in Argentina and were associated with mortality.
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Affiliation(s)
- Manuel Mendizabal
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN).
| | - Viviana Tagliafichi
- Instituto Nacional Central Unico Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | | | - Paloma Rojas
- Liver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina
| | | | - Silvina Yantorno
- Hepatology and Liver Transplant Program, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Nora Cejas
- Liver Transplant Program, Hospital Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Martín Barrabino
- Liver Transplant Unit, Hospital Privado de Córdoba, Córdoba, Argentina
| | - Margarita Anders
- Hepatology and Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
| | - Fernando Cairo
- Liver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina; Liver Transplant Unit, Hospital Británico, Buenos Aires, Argentina
| | - Federico Villamil
- Liver Transplant Unit, Hospital El Cruce, Florencio Varela, Buenos Aires, Argentina; Liver Transplant Unit, Hospital Británico, Buenos Aires, Argentina
| | - Laura Blazquez
- Liver Transplant Program, Hospital Italiano de Mendoza, Mendoza, Argentina
| | - Alina Zerega
- Liver Transplant Unit, Sanatorio Allende, Córdoba, Argentina
| | | | - Diego Fernández
- Liver Transplant Program, Clínica Privada Pueyrredón, Mar del Plata, Buenos Aires, Argentina
| | - Sebastián Paredes
- Liver Transplant Program, Hospital de Alta Complejidad "Juan D. Perón", Formosa, Argentina
| | - Gabriel Aballay Soteras
- Liver Transplant Program, Hospital Dr. Cosme Argerich, Buenos Aires, Argentina; Liver Transplant Unit, Sanatorio Mitre, Buenos Aires, Argentina
| | - Luis Gaite
- Liver Transplant Program, Clinica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - Liliana Bisigniano
- Instituto Nacional Central Unico Coordinador de Ablación e Implante (INCUCAI), Buenos Aires, Argentina
| | - Marcelo O Silva
- Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN)
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Dip M, Cejas N, Cervio G, Villamil F, Tagliafichi V, Hansen Krogh D, Imventarza O, Soratti C, Bisigniano L. Results after the adoption of a MELD/PELD-based liver allocation policy in Argentina. Pediatr Transplant 2015; 19:56-61. [PMID: 25414131 DOI: 10.1111/petr.12395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 01/02/2023]
Abstract
In July 2005, Argentina switched from a categorical liver allocation system to a MELD/PELD-based policy for patients with CLD. To analyze WL outcomes and survival after LT in children. From January 2000 to December 2010, 923 children were registered. Two consecutive five-yr periods were analyzed and compared: Era I (January 2000-July 2005) (n = 379) and Era II (July 2005-December 31, 2010) (n = 544). All data were prospectively collected and analyzed using the Kaplan-Meier method. After adopting the MELD/PELD system, WL registrations increased by 44% (from 379 to 544) and the number of LT increased by only 24% (from 278 to 365). However, three-month WL mortality rate (32% to 18%, p < 0.0001, HR 2.002 CI 95% 1.5-2.8) decreased significantly. No significant differences were observed between Era 1 and II in one-yr post-LT survival (77.5% vs. 84.1%, p = 0.3053) and in acute re-LT rate (9% vs. 5%, p = 0.1746). Under the MELD/PELD-based allocation system in Argentina, mortality on the WL significantly decreased in children with CLD without affecting post-LT survival, although reduced access to LT was observed.
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Affiliation(s)
- Marcelo Dip
- Sociedad Argentina de Trasplante, Ciudad Autonoma de Buenos Aires, Argentina; Instituto Nacional Central Unico Coordinador de Ablación e Implante (INCUCAI), Ciudad Autonoma de Buenos Aires, Argentina; Hospital de Pediatría Prof. Dr. JP Garrahan, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
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Amante MF, Filippini AV, Cejas N, Lendoire J, Imventarza O, Parisi C. Dress syndrome and fulminant hepatic failure induced by lamotrigine. Ann Hepatol 2009; 8:75-7. [PMID: 19221540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Lamotrigine is a non-aromatic antiepileptic drug. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe idiosyncratic reaction to drugs, especially anti-epileptic drugs. Associated clinical features include cutaneous eruption, fever, multiple peripheral lymphadenopathies, and potentially life-threatening damage of one or more organs. We report a case of DRESS syndrome induced by lamotrigine presenting with a hypersensitivity syndrome and fulminant hepatic failure requiring liver transplant. A 21-year old female patient presented an episode of seizure with loss of conscience. CT and EEG studies performed were normal. Treatment with lamotrigine was prescribed. In the course of 30 days, the patient developed skin lesions, pruritus, cholestatic hepatitis, and systemic symptoms -fever, lymphadenopathies, extensive exfoliative erythematous maculopapular rash, and jaundice. Serologic and laboratory tests showed no other causes responsible for the clinical spectrum. Hematologic tests revealed peripheral eosinophilia. Fulminant hepatic failure was diagnosed and an orthotopic liver transplant was performed. Histologic sections of the explanted liver demonstrated submassive hepatic necrosis, with the remnant portal spaces and lobules showing a mixed inflammatory infiltrate with lymphocytes and eosinophils. Lamotrigine treatment has been associated with multiorgan failure, DRESS syndrome, acute hepatic failure, and disseminated intravascular coagulation. In conclusion, we suggest that these potentially fatal side effects should be considered in any patient with clinical deterioration following administration of this drug.
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Affiliation(s)
- Marcelo Fabián Amante
- Department of Pathology, Dr. Cosme Argerich General Hospital, Buenos Aires, Argentina.
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Ahualli L, Stewart-Harris A, Bastianelli G, Radlovachki D, Bartolomé A, Trigo PL, Cejas N, Aballay Soteras G, Duek F, Lendoire J, Imventarza O, Parisi C, Belforte S, Maiolo E, Castro C, Merino D, Picone V. Combined cardiohepatic transplantation due to severe heterozygous familiar hypercholesteremia type II: first case in Argentina--a case report. Transplant Proc 2007; 39:2449-53. [PMID: 17889215 DOI: 10.1016/j.transproceed.2007.07.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heterozygous familial hypercholesteremia type II is a recessive autonomic disease with a population incidence <or=1:500. It develops as a consequence of a mutation in the LDLR gene. Patients suffer extremely high LDL and VLDL cholesterol values, dying from coronary compromise at early ages. As cholesterol synthesis is an hepatic process, and as there is a lack of gene therapy, hepatic transplantation is the only therapeutic option in cases refractory to medical treatment. In this report, we have described the first case of combined cardiohepatic transplantation in Argentina, which was performed in a male patient with severe aortic stenosis and terminal ischemic cardiopathy secondary to severe familial hypercholesteremia type II.
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Affiliation(s)
- L Ahualli
- Heart Transplantation Unit, Argerich Hospital, Buenos Aires, Argentina.
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Lendoire J, Raffin G, Cejas N, Duek F, Barros schelotto P, Trigo P, Quarin C, Garay V, Imventarza O. Liver transplantation in adult patients with portal vein thrombosis: risk factors, management and outcome. HPB (Oxford) 2007; 9:352-6. [PMID: 18345318 PMCID: PMC2225512 DOI: 10.1080/13651820701599033] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is a well recognized complication of patients with end-stage cirrhosis and its incidence ranges from 2 to 26%. The aim of this study was to analyze the results and long-term follow-up of a consecutive series of liver transplants performed in patients with PVT and compare them with patients transplanted without PVT. PATIENTS AND METHODS Between July 1995 and June 2006, 26 liver transplants were performed in patients with PVT (8.7%). Risk factors and variables associated with the transplant and the post-transplant period were analyzed. A comparative analysis with 273 patients transplanted without PVT was performed. RESULTS The patients comprised 53.8% males, average age 40, 7 years. PVT was detected during surgery in 65%. Indications for transplantation were: post-necrotic cirrhosis 73%, cholestatic liver diseases 23%, and congenital liver fibrosis 4%. Child-Pugh C: 61.5%. Techniques were trombectomy in 21 patients with PVT grades I, II, IV, and extra-anatomical mesenteric graft in 5 with grade III. Morbidity was 57.7%, recurrence of PVT was 7.7%, and in-hospital mortality was 26.9%. Greater operative time, transfusion requirements, and re-operations were found in PVT patients. One-year survival was 59.6%: 75.2% for grade 1 and 44.8% for grades 2, 3, and 4. DISCUSSION The study demonstrated a PVT prevalence of 8.7%, a higher incidence of partial thrombosis (grade 1), and successful management of PVT grade 4 with thrombectomy. Liver transplant in PVT patients was associated with an increased operative time, transfusion requirements, re-interventions, and lower survival rate according to PVT extension.
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Affiliation(s)
- J. Lendoire
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
| | - G. Raffin
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
| | - N. Cejas
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
| | - F. Duek
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
| | | | - P. Trigo
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
| | - C. Quarin
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
| | - V. Garay
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
| | - O. Imventarza
- Liver Transplantation Unit, Hospital Dr Cosme ArgerichBuenos AiresArgentina
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