In liver transplantation in the normal clinical setting, the pharmacokinetic advantages of Neoral translate into clinical superiority over Sandimmun without a negative impact on safety. Recent data indicate that it is not optimal to use i.v. cyclosporine initially in this type of study, but the benefit was seen despite this. In keeping with the previous pharmacokinetic studies, patients managed by T-tube biliary drainage, and hence with no or limited bile available in the gastrointestinal tract, did particularly well with Neoral.
Here we report the first adult patient who survived severe adenoviral hepatitis of a liver graft, in contrast to 4 previously reported cases in adults, all of which had a fatal outcome. Early diagnosis was based on the immunohistological detection of adenoviral protein in the context of biopsy-proven hepatitis. Dramatic reduction of immunosuppression along with supportive care were the treatment strategies in this case. Adenoviral infection of the allograft should always be considered as a differential diagnosis when clinical signs of severe hepatitis are present after liver transplantation. Accurate diagnosis with immunohistochemical detection of viral proteins in the liver graft is of paramount importance for the early diagnosis and management of this uncommon, severe, and probably underdiagnosed entity.
More than 3000 abstracts of innovative and exciting findings, covering the whole field of organ transplantation, were presented at the World Transplant Congress 2014. Key areas of presentations across all organs and tissues included HLA antibodies, antibodymediated rejection, living donation, immunosuppression, organ perfusion and surgical procedures. In addition, cutting edge science and future perspectives were presented in state-of-the-art lectures. This review will present highlights of this meeting and demonstrate strength and success of clinical sciences in transplantation.
This paper is a review of some aspects of acute pancreatitis (AP) (definition criteria, outcome, and prognostic factors) and a reminder of the invaluable contribution of computed tomography (CT) in confirming the diagnosis of AP, distinguishing between edematous and necrotizing forms, and in providing prognostic information via detection of possible extrapancreatic spreads (EPS). The Geneva experience (510 cases of AP over a 9-year period) has shown that no fatalities occurred when no EPS were found on CT performed within 48 h of admission; mortality was 1.5% in the case of 1 or 2 EPS and 19 % in the case of 3 EPS or more.
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