Peripheral neurotoxicity with tacrolimus.
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Adult↗
Biomedical subjects
B Dousset
Publications and source records attributed to B Dousset.
The influence of cold ischemia time on biliary complications following liver transplantation.
Biliary complications are a continuing source of morbidity and mortality following orthotopic liver transplantation. The results of 100 whole-liver allografts performed in 92 adult patients were reviewed to determine whether cold ischemia time and preservation injury influenced both the incidence and type of biliary complications. Mean cold ischemia time was 10.2 +/- 0.5 h (range 3.6-19). Eighteen patients (19.6%) developed 25 biliary complications: there were eight anastomotic leaks, eight anastomotic strictures, six non-anastomotic strictures, two cystic duct mucoceles, and one biliary fistula following T-tube removal. Despite the high rate of reoperative surgery (68%), no death was attributable to biliary complications. Neither cold ischemia time nor early graft function influenced the rate of biliary complications or strictures of either type. Furthermore, an analysis of different factors revealed no predisposing effect of the pre-operative status of the recipient, type of biliary reconstruction, blood requirement, vascular complications, rejection or cytomegalovirus infection on the incidence of biliary complications or strictures. Only chronic rejection could be singled out as a risk factor for non-anastomotic strictures (p = 0.05). These results suggest that prolonged cold ischemia time does not seem to affect the rate or type of biliary complications following orthotopic liver transplantation. In view of these data, there is no clear reason to reconsider prolonged cold ischemia up to 15 h in University of Wisconsin solution, as it has transformed liver transplantation from an emergency operation to a semi-elective procedure and allows longer back-table preparation for graft reduction of splitting.
Adolescent↗
Serum lipids and apolipoproteins in liver transplant recipients: a comparative study of cyclosporin A and FK 506.
The immunosuppressive agent cyclosporin A (CsA) is reportedly associated with clinically adverse effects on circulating lipid and apolipoprotein concentrations. To date few data have been reported concerning the effects on lipid metabolism of the new macrolide immunosuppressive agent FK 506, and no comparative studies of the effects of these drugs have been performed. In consideration of the pivotal role of the liver in lipid metabolism, we measured fasting serum lipids and apolipoproteins a median of 8 (range 5 to 9) months after the operation in 20 clinically stable liver transplant recipients randomly allocated to maintenance immunosuppression with CsA +/- azathioprine (n = 10) or FK 506 (n = 10). To avoid the confounding effects of corticosteroids on lipid metabolism, prednisolone was withdrawn at least 6 weeks beforehand in each case. Ten healthy volunteers matched for age and body mass index served as control subjects. Serum total cholesterol concentration was significantly lower in both the CsA (p < 0.001) and FK 506 (p < 0.05) treatment groups when compared with the healthy control subjects. Serum high-density lipoprotein (HDL) cholesterol concentration was also significantly lower in both the CsA (p < 0.005) and FK 506 (p < 0.01) treatment groups. Neither the ratio of serum total cholesterol to HDL cholesterol nor the fasting triglyceride concentrations were significantly different (p > 0.1) from those of the healthy control subjects for either transplant group. Serum apolipoprotein B level was lower than that of the control group in both the CsA (p < 0.005) and FK 506 groups (p = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)
Apolipoproteins↗
[Ascites after liver transplantation in children].
The objective of this study, based on a series of 148 transplants performed in 131 children, was to evaluate the frequency, complications and predisposing factors of ascites occurring after liver transplantation (LT). The diagnosis of post-LT ascites was defined as a drainage rate greater than 25 ml/kg/day (or- > 500 ml/day) persisting for at least 72 hours after removal of the drains. Among the 123 transplants analysed, 31 (25.2%) were complicated by ascites (group I). Group II consisted of 92 LT without ascites. This ascites was predominantly lymphocytic (669 +/- 1,104/mm3), rich in proteins (32 +/- 13 g/l), with a low triglyceride concentration. The mean duration of ascites was 25 +/- 19 days. Complications of ascites included: infection of ascitic liquid (35%), respiratory complications (65%), parietal complications (50%), consumption coagulopathy (35%), functional renal failure (Creat > 130 mumol/l, 35%). There were 9 deaths (29%) in group I versus 8 in group II (p < 0.02). The predictive factors, pre-LT, of postoperative ascites included: serum bilirubin > 300 mumol/l (p < 0.02); PT < 30% (p < 0.05); and serum albumin < 30 g/l (p < 0.05). Intraoperative factors favouring the development of ascites were end-to-side cavo-caval implantation of the graft when it was reduced (p < 0.02) and a volume of transfused blood after unclamping greater than 60 ml/kg (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
A simplified technique of ex situ hepatic surgical treatment.
A simplified technique of "ex situ" hepatic surgical treatment, indicated when conventional operation is precluded by a huge centrohepatic tumor or the need of suprahepatic vascular reconstruction, or both, is described. Wide access on all parts of the liver is provided by section of infrahepatic and suprahepatic vena cava, but the continuity of the portal triad is preserved. This technical modification reduces the duration of the anhepatic phase and avoids the risks of artery and biliary reconstruction.
Hepatectomy↗
Extrafascial hyper-reduction of the hepatic graft.
The technique and limits of graft reduction in orthotopic liver transplantation (OLT) are not well-defined, especially for small recipients. To reduce the hepatic graft to the left lateral segment (segments II and III), the authors have used an extrafascial hepatectomy without any dissection of the hepatic hilum. Among 165 pediatric OLT, 22 procedures using such hyper-reduced hepatic grafts were performed upon 21 children of median age 2.6 years between 1988 and 1992. These 22 hyper-reduced hepatic grafts were transplanted orthotopically with conservation of the inferior vena cava of the recipient. The three-year patient survival rate was 66 percent (80 and 50 percent for those patients undergoing elective and emergent procedures, respectively). The main postoperative complications were: primary graft nonfunction (n = 1), arterial complications (n = 2), portal vein thrombosis (n = 1), intra-abdominal bleeding (n = 2) and biliary complications (n = 2). This technique is useful in instances of a large size discrepancy between the donor and recipient. However, it does not increase per se the absolute number of hepatic grafts available for transplantation.
Adolescent↗
Partial hepatic resection for ischemic graft damage after liver transplantation: a graft-saving option?
BACKGROUND: Intrahepatic biliary strictures or parenchymal infarcts may occur after liver transplantation as a complication of ischemic damage to the graft. In some selected cases the lesions appear to be confined to a part of the liver. We report our experience with partial graft resection in this setting. METHODS: From January 1984 to December 1991, 286 liver transplantations were performed in 257 recipients. Seven patients, three children and four adults, underwent partial hepatectomy 3 to 218 weeks after liver transplantation of a full-size graft. The clinical presentation included septic parenchymal infarcts (n = 4) and nonanastomotic biliary strictures (n = 3) complicating (n = 5) artery thrombosis or not (n = 2). There were four left hepatectomies, two left lobectomies, and one right hepatectomy. In four instances partial hepatectomy was performed after failed attempt at biliary reconstruction (n = 2) or arterial revascularization (n = 2). Partial graft resection was performed extrafascially without Pringle's maneuver and mobilization of the remnant liver to preserve its vascularization. RESULTS: No surgical complications occurred, and none of the patients experienced acute hepatic failure during the postoperative period. All patients were discharged home 10 to 96 days (median, 23 days) after liver resection. Two patients had recurrent ischemic cholangitis. One patient underwent successful regrafting for recurrent Budd-Chiari syndrome; one patient died of tumor recurrence. Six patients were alive with a follow-up ranging from 12 to 45 months. CONCLUSIONS: These results suggest that partial graft resection is a safe and graft-saving option after liver transplantation in selected patients with localized ischemic damage of the graft.
Adult↗
Quantification of methylmalonic acid in serum measured by capillary gas chromatography-mass spectrometry as tert.-butyldimethylsilyl derivatives.
Quantification of methylmalonic acid in serum is considered one of the most sensitive parameters for diagnosis of cobalamin deficiency. Methylmalonic acid was measured as tert.-butyldimethylsilyl derivatives formed in the presence of dimethylformamide. Under these conditions the derivative was quantified using gas chromatography-mass spectrometry with selected-ion monitoring at 403 and 406 for methylmalonic acid and methyl-d3-malonic acid, respectively. The characteristics of the method were: linearity from 0.04 to 1.7 mumol/l with linear regression equation y = -0.0199 + 0.727 x (r = 0.999); recovery 95.5 +/- 6.8%; detection threshold 17 fmol injected; within-day variation coefficient ranging from 3.10% to 5.6% according to sample concentration; and day-to-day coefficient of variation of 6.8% and 5.3% for methylmalonic acid concentrations of 0.103 mumol/l and 0.360 mumol/l, respectively. The normal range after log transformation was estimated at 0.03-0.26 mumol/l, 0.06-0.33 mumol/l and 0.02-0.40 mumol/l in children of 4-14 years (n = 39), in healthy subjects at 20-40 years (n = 70) and in healthy elderly persons older than 60 years (n = 14), respectively. The normal range in children was significantly lower than that in adults and, in contrast, normal values in the elderly were significantly higher.
Adolescent↗
Improvement of the diagnosis of the cause of pleural effusion in patients with lung cancer by simultaneous quantification of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) pleural levels.
Carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) level determinations were carried out by radioimmunoassay in pleural fluid and plasma samples obtained from 24 patients with malignant pleural effusions and 18 patients with non-malignant pleural effusions, and compared to cytological and pathological results. Using a pathological cut-off level of 25 ng/ml for CEA and 8 ng/ml for NSE, we demonstrated that, in the diagnosis of the malignant nature of pleural effusions, the simultaneous quantification of CEA and NSE in pleural fluid possesses better discriminative values than the simultaneous quantification of both markers in plasma or the separate quantification of each marker, in pleural fluid and in plasma.
Biomarkers, Tumor↗
Tumour necrosis factor alpha and interleukin 2 in normal and infected human seminal fluid.
The presence of cytokines such as the tumour necrosis factor alpha (TNF alpha) and interleukin 2 (IL2) in human spermatozoa is still to be defined. The aim of this study was to measure the concentration of both soluble factors in seminal fluid. Data from normal semen samples (n = 24) confirmed the presence of IL2 (258 +/- 84 fmol/ml corresponding to 953 +/- 369 fmol/total volume of ejaculate) and TNF alpha (62.2 +/- 16.4 fmol/ml corresponding to 231.3 +/- 86 fmol/total volume of ejaculate). A significant positive correlation (r = 0.59; P < 0.01) was observed between the TNF alpha and the IL2 concentrations. The concentrations of these cytokines were not related to sperm parameters. In contrast, IL2 concentrations (196.9 +/- 60.4 fmol/ml; 686.2 +/- 236.7 fmol/total volume of ejaculate) evaluated in 16 seminal fluids with identified bacterial agents were lower than in the control group, whereas TNF alpha concentrations (68.6 +/- 12.3 fmol/ml; 241.3 +/- 78.9 fmol/total volume of ejaculate) were not significantly different from the controls. Further studies are needed to determine the potential role of these cytokines in the physiology of semen and their usefulness as indicators of reproductive pathology.
Bacteria↗
Acute liver allograft rejection--is treatment always necessary?
A group of 195 consecutive adult patients who received a primary orthotopic liver allograft were reviewed retrospectively to analyze the incidence of rejection, the response to antirejection therapy, and the impact of acute rejection on the development of ductopenic rejection. The diagnosis of acute rejection (AR) was based on a combination of clinical and histological criteria, and 69.7% of the patients had at least one episode of acute rejection. Only 6.7% of the patients failed to respond to steroids and were treated with OKT3. Four (2.3%) patients developed acute vanishing bile duct syndrome (within 60 days) and 6 (3.5%) patients developed chronic rejection. Eight patients who spontaneously recovered from AR without additional immunosuppression are described in detail. In addition to histological damage, all developed significant hepatic dysfunction. Except for one patient who died from disseminated fungal infection, the 7 remaining patients are alive with excellent graft function 7 to 21 months posttransplant. While severe AR and recurrent AR should be treated without delay, some patients with mild-to-moderate rejection and hepatic dysfunction may resolve without additional immunosuppression.
Acute Disease↗
Steroid withdrawal from long-term immunosuppression in liver allograft recipients.
Corticosteroids were withdrawn from the immunosuppressive regimen of 168/197 (85%) of liver transplant patients who survived for more than three months. In 14, steroids were restarted for reasons other than rejection. The remaining 154 patients were evaluated for the occurrence of rejection and graft loss. Risk factors for the development of rejection after steroid withdrawal were assessed. There were 13 episodes of rejection in 12 (7.8%) grafts; 7 (4.5%) experienced acute cellular rejection, and 6 (3.9%) developed chronic ductopenic rejection. All cases of acute rejection resolved with high-dose steroids. Graft and patient loss due to chronic rejection was 3 (1.9%) and 2 (1.3%), respectively. Chronic rejection resolved in 1 patient, 1 was successfully retransplanted, and in the other 2 the principal cause of death was recurrent tumor. None of the risk factors examined (primary indication for transplant, severity of previous acute rejection, use of OKT3, retransplantation, ABO blood group donor/recipient match, CMV infection, and CsA mono versus CsA and AZA double therapy) were associated with the development of chronic rejection poststeroid withdrawal. The prevalence of side effects, after steroid withdrawal, was low; 66% of patients never required antihypertensive medication; 14% experienced a significant septic episode, and only 4 died with sepsis as the major factor. There were no fungal sepsis and no new cases of diabetes. Withdrawal of corticosteroids after 3 months can be successfully achieved in the majority of liver allograft recipients and is associated with a low rate of rejection, graft loss, and complications attributable to immunosuppressive medication.
Adolescent↗
Metabolic effects of cyclosporin A and FK 506 in liver transplant recipients.
Postoperative diabetes is a reported feature of the immunosuppressive agents cyclosporin A and FK 506. To date, however, no randomized comparative studies of the metabolic effects of these two drugs have been performed. In this study, extended (300 min) oral glucose tolerance tests (75 g) were performed a median of 8 mo (range 5-9 mo) postoperatively in 20 clinically stable liver transplant recipients randomly allocated to maintenance immunosuppression with either cyclosporin A (with or without azathioprine) or FK 506. None of the patients had clinically overt diabetes antedating transplantation. To avoid the confounding effects of corticosteroids, prednisolone was withdrawn at least 6 wk beforehand in each case. Ten healthy volunteers matched for age and body mass index served as control subjects. Overall blood glucose concentrations after the glucose challenge were significantly elevated in both groups of transplant recipients (P < 0.005 and P < 0.001 for cyclosporin A and FK 506 treatment groups, respectively) compared with the healthy control subjects. Venous whole-blood glucose concentration (mean +/- SE) 120 min after the ingestion of oral glucose was significantly higher in both the cyclosporin A (P < 0.05) and FK 506 (P < 0.01) treatment groups compared with the control subjects (6.6 +/- 0.5 vs. 8.8 +/- 0.9 vs. 5.2 +/- 0.2 mM, respectively). According to 1985 WHO criteria, 4 of 10 cyclosporin A-treated patients had impaired glucose tolerance, whereas 3 of 10 FK 506-treated patients had diabetes with 4 others having impaired glucose tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)
Analysis of Variance↗
[Interleukin-2 and human seminal fluid].
Involvement of the cytokines in male infertility were considered from in vitro studies, however the nature and the role of the mediator susceptible of arising in vivo is not completely elucidated. The purpose of this study is to measure the concentrations of interleukin-2 (IL-2) in normal and pathologic seminal fluid and to analyse their relationship with semen parameters. Our results demonstrate the presence of IL-2 in seminal fluid. Comparatively to normal seminal fluid, significant lower IL-2 concentrations were observed in infected semen samples or with sperm antibodies. No correlation was found between the cytokines values and the sperm parameters.
Autoimmune Diseases↗
Role of the kidney in the expression of low molecular weight factors with growth factor activity.
Small molecules of peptidic nature, called low molecular weight growth factors (LMW-GF < 1000 Da) are present in normal human serum ultrafiltrate. They enhance the somatomedin activity as measured by the incorporation of 35SO4 into chick embryo cartilages. On the basis of this in vitro test, LMW-GF activities were measured in serum ultrafiltrates of hemodialyzed patients and renal transplant recipients during the post-transplantation follow-up. LMW-GF activity was always zero in patients with chronic renal failure. It was checked that these results were not due to the presence of low molecular weight somatomedin inhibitors or to the increased sulfate concentration. After successful renal transplantation, the LMW-GF activity of patients ultrafiltrates returned to normal at the same time or before the improvement of renal function. In case of post-transplant complications, a decrease in LMW-GF activity accompanied or even occurred prior to impairment of renal function. In functioning graft, LMW-GF activity reappears rapidly, whereas its normalization is delayed in case of tubular nephropathy or episode of acute rejection. It was suggested that the kidney is involved in LMW-GF molecules production or processing. It could be speculated that LMW-GF activity might be a prognostic factor in renal transplantation.
Adult↗
Partial hepatic resection following liver transplantation.
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Adult↗
[Endothelin and kidney].
Endothelial and epithelial cells release a potent 21-residue peptide, endothelin (ET) which is an endothelium-derived-contracting-factor (EDCF). The peptide causes contraction of vessels and induces sustained blood pressure elevation. Beside its role in the vasoconstriction ET has strong inotropic effect on the myocardium and induces smooth muscle cells contractions. Renal actions, similar to angiotensin and norepinephrine, focus on its potential importance in nephrology. Acute and chronic renal failure showed increased plasma and urinary ET levels. An understanding of the regulation of the release of ET may provide knowledge about the pathogenesis of acute renal failure, the progression of chronic renal failure and cyclosporin A induced toxicity. Further research is needed to substantiate the new and promising perspective of ET in human diseases and therapy.
Animals↗
[Variations of arterial and venous levels of endothelin during percutaneous transluminal angioplasty].
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Aged↗