Prognostic model for early acute rejection after liver transplantation

Gómez-Manero, Noemí; Herrero, J.I.; Quiroga, Jorge; Sangro, Bruno; Pardo, Fernando; Cienfuegos, Javier A.; Prieto, Jesús

doi:10.1053/jlts.2001.22460

Cited by 35 publications

(34 citation statements)

References 38 publications

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“…In this series, it did not reach statistical significance, but in other studies, a lower age has been found to be an independent risk factor of rejection (18). This may be the result of immune senescence.…”

Section: Discussioncontrasting

confidence: 88%

Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Herrero¹,

Lucena²,

Quiroga³

et al. 2003

American Journal of Transplantation

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106

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Older age is not considered a contraindication for liver transplantation, but age-related morbidity may be a cause of mortality. Survival and the incidence of the main post-transplant complications were assessed in 111 adult liver transplant recipients. They were divided in two groups according to their age (patients younger than 60 years, n = = 54; patients older than 60 years, n = = 57) and both groups were compared. Older patients were more frequently transplanted for hepatitis C (p = = 0.03) and hepatocellular carcinoma (p = = 0.05) and their liver disease was less advanced (Child-Pugh and MELD scores were significantly lower; p = = 0.004 and p = = 0.05, respectively). After transplantation, older patients had a significantly lower survival (p = = 0.02). Higher age was independently associated with mortality (hazard ratio for each 10-year increase: 2.1; 95% confidence interval: 1.1-4.0; p = = 0.02). The incidence of de novo neoplasia and nonskin neoplasia were higher in older patients (p = = 0.02 and p = = 0.007, respectively). Malignancy was the cause of death in one patient younger than 60 years and in 12 patients older than 60 years (p = = 0.002). In multivariate analysis, a higher age and smoking were independently associated with a higher risk of dying of de novo neoplasia. In conclusion, older liver transplant recipients have a significantly lower survival than younger patients. Malignancy is responsible for this decreased survival.

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Section: Discussioncontrasting

confidence: 88%

Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Herrero¹,

Lucena²,

Quiroga³

et al. 2003

American Journal of Transplantation

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106

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“…El rechazo agudo es una complicación frecuente tras el THO, con una incidencia que varía entre el 40 y el 80% en diferentes series y normalmente se desarrolla en las primeras semanas (6,7,29,30). En nuestro estudio, el rechazo agudo se observó en el 37% de los pacientes, entre los 5 y 15 días tras el trasplante.…”

Section: Discussionunclassified

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

Rodríguez‐Ariza¹,

Monrobel

Martı́nez-Galisteo³

et al. 2008

Rev. esp. enferm. dig.

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INTRODUCCIÓNEl trasplante hepático ortotópico (THO) es el tratamiento de elección para enfermedades hepáticas agudas o crónicas en estadio final. Sin embargo, el seguimiento de Factores pronósticos de complicaciones postoperatorias en el trasplante hepáticoA. Rodríguez-Ariza, A. Monrobel, E. Martínez-Galisteo 1 , C. Alicia Padilla 1 , J. A. Bárcena 1 , E. Fraga, G. Costán, P. Barrera, A. Poyato, J. L. Montero, P. López-Cillero 2 , J. Muntané y M. de la Mata RESUMENObjetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO) se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo.Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias.Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas.Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO. ABSTRACTObjectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT) is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity and mortality in patients undergoing OLT. The purpose of the present study was the identification of factors related to the different postoperative complications after OLT. Experimental design: a prospective study was carried out.Patients: seventy-eight variables were analyzed in 32 consecutive patients undergoing OLT. The factors independently associated with the appearance of postoperative complications were identified using a stepwise logistic regression analysis.Results: the multivariate analysis showed that malondialdehyde and creatinine pretransplant serum levels were associated with the development of renal dysfunction. T...

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“…The potential risk of acute rejection must be faced against the benefit of steroid withdrawal. After LTx, HCV infection has been clearly identified as a risk factor for the development of early acute rejection [19] . On the other hand, the presence, number, and treatment of acute rejections were found to be associated with the histologic recurrence of HCV infection after LTx [20,21] .…”

Section: Discussionmentioning

confidence: 99%

Initial steroid-free immunosuppression after liver transplantation in recipients with hepatitis c virus related cirrhosis

Wietzke‐Braun¹,

Braun²,

Sattler³

et al. 2004

WJG

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AIM: Steroids can increase hepatitis C virus (HCV) replication. After liver transplantation (LTx), steroids are commonly used for immunosuppression and acute rejection is usually treated by high steroid dosages. Steroids can worsen the outcome of recurrent HCV infection. Therefore, we evaluated the outcome of HCV infected liver recipients receiving initial steroid-free immunosuppression. METHODS:Thirty patients undergoing LTx received initial steroid-free immunosuppression. Indication for LTx included 7 patients with HCV related cirrhosis. Initial immunosuppression consisted of tacrolimus 2×0.05 mg/kg·d po and mycophenolate mofetil (MMF) 2×15 mg/kg·d po. The tacrolimus dosage was adjusted to trough levels in the target range of 10-15 µg/L during the first 3 mo and 5-10 µg/L thereafter. Manifestations of acute rejection were verified histologically.

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Prognostic model for early acute rejection after liver transplantation

Cited by 35 publications

References 38 publications

Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Liver Transplant Recipients Older Than 60 Years Have Lower Survival and Higher Incidence of Malignancy

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

Initial steroid-free immunosuppression after liver transplantation in recipients with hepatitis c virus related cirrhosis

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