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O Boillot

Publications and source records attributed to O Boillot.

At least 55 records · Page 3Linked to original sources
PubMed1998

Reversal of early acute rejection with increased doses of tacrolimus in liver transplantation: a pilot study.

BACKGROUND: In this pilot study, we present the results of treatment of early (3 months after liver transplantation) acute rejection episodes by increasing only the tacrolimus doses. METHODS: Ten patients who received tacrolimus as primary treatment experienced acute mild (one case), moderate (four cases), or severe (five cases) rejection episodes. Tacrolimus dosing was increased 1-2 mg every 1 or 2 days until hepatic enzymes started to improve. Steroid basic daily doses were kept unchanged. RESULTS: With the daily dose of tacrolimus increased by a median 1.89-fold (range: 1.2-5), alanine aminotransferase, bilirubin, and gamma-glutamyltranspeptidase levels rapidly reached normal values within the first month. During a median follow-up time of 19.5 months (range: 14-24), none of the 10 patients died or lost their graft. Control liver biopsies were done 13.5 months (range: 7-19) after rejection episode in all patients, and none demonstrated evidence of rejection or sequela. CONCLUSION: This pilot study suggests that increasing tacrolimus dosage could be considered as treatment against early acute rejection episodes including the severe grade.

Acute Disease↗
PubMed1998

High-Na+ low-K+ UW cold storage solution reduces reperfusion injuries of the rat liver graft.

The isolated perfused rat liver model was used to assess graft viability after 24 h of cold preservation. Two solutions were compared for liver preservation: Belzer's original UW solution (high-K+ UW) and a solution containing the same components but with inverted concentrations of sodium and potassium (high-Na+ UW). During the 120 min of normothermic reperfusion, livers preserved in the high-Na+ UW solution released lower levels of creatine kinase-BB isoenzyme, transaminases (ALT and AST), and potassium than those preserved in the high-K+ UW solution. Bile flow and biliary excretion of indocyanine green increased when livers were preserved in the high-Na+ UW solution. We found no statistical differences for oxygen consumption and tissue ATP concentration. The results of this study support the concept that a high-Na+ UW solution is a more effective means of preserving rat livers, at least after 24 h of cold-storage and 120 min of reperfusion in the isolated perfused model, than the original high-K+ UW solution. Liver preservation in the high-Na+ UW solution reduces damage to sinusoidal endothelial and hepatocellular cells. The use of an extracellular-like Belzer cold storage solution eliminates potassium-related problems in cold preservation and subsequent normothermic reperfusion while keeping all the qualities of the original UW solution.

Adenosine↗
PubMed1998

Evaluation of parenchymal and nonparenchymal cell injury after different conditions of storage and reperfusion.

We used the isolated perfused rat liver model (IPRL) to assess parenchymal and nonparenchymal cell integrity after different conditions of storage and reperfusion. Two studies were performed. In study 1, the IPRL was applied to evaluate the effects of 30 min of normothermic reperfusion with Elohes solution, enriched William's medium (Wif), or Carolina rinse solution (CRS) following 24 h of cold preservation in high-K+ or high-Na+ UW solution. As indicated by creatine kinase-BB (CK-BB) release, reperfusion with CRS provided greater protection of endothelial cells after storage in high-K+ UW solution than after storage in high-Na+ UW solution. In study 2, livers were cold-preserved (24 h, 4 degrees C) in either high-K+ or high-Na+ UW solution, then flushed with either CRS or Wif solution at room temperature before reperfusion (120 min, 37 degrees C) with 5% albumin-William's medium E. There was no statistical difference between the rinse solutions for bile flow and transaminases release. However, CRS improved bile indocyanine green excretion, which is known to be a marker of parenchymal and nonparenchymal cell integrity. Therefore, we can assume that this rinse solution protects rat liver grafts from reperfusion-induced microvascular damage.

Animals↗
PubMed1997

Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report.

OBJECTIVE: The purpose of this study was to assess the value and timing of orthotopic liver transplantation (OLT) in the treatment of metastatic neuroendocrine tumors (NET). SUMMARY BACKGROUND DATA: Liver metastasis from NET seems less invasive than other secondary tumors. This observation suggests that OLT may be indicated when other therapies become ineffective. However, the potential benefit of this highly aggressive procedure is difficult to assess due to the scarcity and heterogeneity of NET. METHODS: A retrospective multicentric study was carried out, including all cases of OLT for NET performed in France between 1989 and 1994. There were 15 cases of metastatic carcinoid tumor and 16 cases of islet cell carcinomas. Hormone-related symptoms were present in 16 cases (55%). Only 5 patients (16%) had no previous surgical or medical therapy before OLT. Median delay from diagnosis of liver metastasis and OLT was 19 months (range, 2 to 120). RESULTS: The primary tumor was removed at the time of OLT in 11 cases, by upper abdominal exenteration in 7 cases and the Whipple resection in 3. Actuarial survival rate after OLT was 59% at 1 year, 47% at 3 years, and 36% at 5 years. Survival rates were significantly higher for metastatic carcinoid tumors (69% at 5 years) than for noncarcinoid apudomas (8% at 4 years), because of higher tumor- and non-tumor-related mortality rates for the latter. CONCLUSION: OLT can achieve control of hormonal symptoms and prolong survival in selected patients with liver metastasis of carcinoid tumors. It does not seem indicated for other NET.

Adult↗
PubMed1997

Late resolution of hepatopulmonary syndrome after liver transplantation.

We report a 38-year-old patient with hepatopulmonary syndrome related to posthepatitis C liver cirrhosis. After liver transplantation, hypoxemia initially worsened markedly, then resolved completely 14 months after transplantation. Liver transplantation may be a reliable treatment of hepatopulmonary syndrome, but clinicians should be aware that the correction of hypoxemia may be delayed and that transient deterioration is possible.

Adult↗
PubMed1996

Adult cirrhotic liver explants: precancerous lesions and undetected small hepatocellular carcinomas.

BACKGROUND & AIMS: Despite recent advances in imaging techniques of the liver, it remains difficult to detect small precancerous lesions or hepatocellular carcinomas (HCCs) in cirrhotic livers. The goal of this study was to determine the prevalence of undetected small HCCs in liver explants of adult cirrhotic patients undergoing liver transplantation and to evaluate the association of HCCs with hepatic lesions considered premalignant. METHODS: Eighty consecutive liver explants were analyzed for the presence of macroscopically atypical nodules, which were then pathologically described as macroregenerative nodules, high-grade dysplastic nodules, areas of small liver cell dysplasia, and HCCs. RESULTS: The prevalence of HCC was 17.5% with a mean size of 11.6 mm. HCCs were more frequently found in men (22%) than in women (4.8%; P < 0.05) and in patients older than 50 years at the time of liver transplantation (35.7% vs. 7.7% in patients younger than 50 years; P < 0.05). The prevalence of HCCs was identical in alcoholic and viral cirrhosis. HCC nodules were significantly associated with the presence of high-grade dysplastic nodules. CONCLUSIONS: Small HCCs and precancerous lesions are frequently found in cirrhotic liver explants, especially in men older than 50 years. This finding should be included in the decision-making analysis for liver transplantation.

Adolescent↗
PubMed1996

Kaposi's sarcoma after liver transplantation.

BACKGROUND: Kaposi's sarcoma (KS), is a known complication following kidney transplantation. It has been reported more rarely following liver transplantation. OBJECTIVE: To assess the clinico-epidemiologic data of KS after liver transplantation. METHODS: 150 liver graft recipients were examined; those presenting with KS were studied clinically, histologically and virologically. RESULTS: Three cases of KS were observed. The three patients had been treated with OKT3 antiserum in addition to the standard regimen. The delay of appearance varied from 5 to 36 months. Two patients had a few cutaneous lesions and 1 had more extensive involvement; none of them had visceral localizations. In 2 cases, herpesvirus-like DNA sequences were detected within the lesions. Therapy consisted in decreasing the immunosuppressive treatment, in association with alpha-interferon or vindesine in 2 cases, respectively. All patients were alive after a follow-up of 19-45 months. CONCLUSION: KS seems relatively frequent (2%) and appears within a short delay after liver transplantation; the prognosis may be more favourable than previously reported.

Adult↗
PubMed1996

[Technical progress in liver transplantation].

Over the last decade, liver transplantation has become the treatment of choice of end stage chronic liver diseases and acute hepatic failure. However, once this surgical technique was mastered, widespread application of liver transplantation revealed its Achilles' heel: complicated surgery especially with the need for veno-venous bypass, limited surgery because of graft scarcity, excessively radical surgery in case of liver transplantation for acute and potentialy reversible liver failure. Improved techniques were necessary to meet these new requirements generated by the success of liver transplantation. We present alternative techniques to the veno-venous by-pass, techniques of reduced-size and split liver grafts, liver transplantation from living related donor and auxiliary liver transplantation.

Humans↗
PubMed1995

[Liver transplantation for alcoholic liver disease. Selective indications].

Alcoholic liver disease represents about 15% of all indications for liver transplantation. Patient selection is difficult, and must be rigorous. Peri-operative risks are evaluated on the same basis as for other chronic liver diseases, with special attention for alcoholic extra-hepatic morbidity and nutritional status. Definite withdrawal from alcohol is mandatory. Predictive factors of long-term abstinence are the absence of psychopathologic state, an adequate social and affective situation, the possibilities of professional reinsertion, and a strong motivation of the patient towards liver transplantation. A six-month period of complete abstinence before registration on a liver transplantation waiting list is not mandatory, although intermittent alcoholic abuse before transplantation should be an exclusion factor. Liver transplantation must be proposed based on the severity of liver failure, as assessed by pronostic scores. It must be rapidly discussed following an acute episode of decompensation, in the absence of a significant improvement despite adequate medical therapy. It must also be discussed for long-term abstinent patients, with an apparently stabilized cirrhosis, but with an important decrease of the functional liver mass. The evaluation of the functional liver mass is based upon the Child-Pugh score, associated with the results of metabolic liver function tests, the measurement of the hepatic volume and the severity of portal hypertension.

Hepatitis, Alcoholic↗