Biomedical subjects
I Garcia
Publications and source records attributed to I Garcia.
Effects of intraoperative blood transfusion on postoperative complications and survival after orthotopic liver transplantation.
BACKGROUND/AIMS: Massive blood transfusion related to the coagulation disorders occurring during the anhepatic and reperfusion phases, remains a serious problem during orthotopic liver transplantation. To analyze the influence of intraoperative blood transfusion on postoperative complications, and survival and to identify the preoperative variables associated with greater intraoperative bleeding, 100 orthotopic liver transplantations, carried out on adults, were reviewed in our center. METHODOLOGY: Patients were grouped into three categories according to intraoperative blood volume transfused; group A, 1.5 or less blood volumes transfused; group B, > 1.5 and < 3 volumes used and group C, 3 or more volumes given. RESULTS: Group C patients had a higher incidence of upper abdominal surgery (p < 0.01 between groups C and A. and p<0.05 between groups C and B); higher values of postoperative total bilirubin and SGOT, and lower prothrombin activity. Acute rejection and steroid-resistant episodes per patient occurred less commonly (p <0.01 between groups C and A) and so did chronic rejection (p <0.05 between groups C and B). Higher infection rate, and gastrointestinal and intraabdominal complication rates were also noticed in groups C and B (p < 0.01 and p < 0.05 respectively). Patient survival rates were lower in group C (p < 0.05 between groups C and A). CONCLUSIONS: It was concluded that previous upper abdominal surgery was the only preoperative factor associated with massive blood transfusion. Poor graft function during the first days after transplant, higher incidence of infections, higher incidence of gastrointestinal and intraabdominal complications, and lower rejection episodes and survival for patients receiving intraoperatively large amounts of blood can be expected.
Orthotopic liver transplantation in 4 patients with portal hypertension and non-cirrhotic nodular liver.
BACKGROUND/AIMS: Non-cirrhotic nodular liver may occasionally be associated with portal hypertension, with complications such as ascites, bleeding esophageal varices and sometimes hepatic encephalopathy. Four patients treated with transplantation are hereby described. METHODOLOGY: All 4 patients had orthotopic transplantation. Cyclosporine based immunosuppression was used in all patients. RESULTS: The first patient had nodular regenerative hyperplasia in the resected native liver and in the graft seven years after the transplant, what could be considered as recurrence of the disease. There were two more cases of nodular regenerative hyperplasia; one of them was diagnosed 9 years before transplantation, but he developed progressive liver failure. The fourth patient had chronic renal failure and a nodular liver. His general condition and fear of untreatable ascites after a portosystemic shunt, prompted us to perform a liver-kidney transplantation. CONCLUSIONS: Portal hypertension associated with non-cirrhotic nodular liver disease can be, in general, successfully treated with medical and endoscopic measures, or in certain more serious cases with portosystemic shunting. Nevertheless, there are certain cases where liver insufficiency, associated diseases or the unawareness of the pathological diagnosis determines a liver transplantation.