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Biomedical subjects

R Charco

Publications and source records attributed to R Charco.

51 records · Page 3Linked to original sources
PubMed1994

Adverse impact of high panel-reactive antibody (PRA) and positive cytotoxic crossmatch in liver transplantation.

Of 91 liver transplants (LTX) performed from October 1988 to December 1992, 13 (14.2%) of the patients received a liver from a lymphocytotoxic-positive crossmatch (CM) donor. Severe early rejection resulting in graft floss occurred in seven positive CM patients. Three of the remaining positive CM patients suffered several rejection episodes leading to chronic rejection and FK 506 was required as rescue treatment. A significant difference in mean panel-reactive antibody (PRA) of 8.6% and 56.9% was found in negative and positive CM patients, respectively (P = 0.012). A higher mean PRA (67.7%) was found in positive CM patients with rejection compared with positive CM patients without rejection (PRA 38%). Overall graft and patient survival were 31.9% and 35% in positive CM patients compared with 57.0% and 61.9% in negative CM patients. These differences were statistically significant (P = 0.023). In our experience the risk of developing severe acute rejection with graft failure and chronic rejection is related to PRA > 60% and positive CM. We recommend that in patients with PRA > 60%, the result of CM should be awaited before proceeding to LTX.

Adult↗
PubMed1994

Recipient hepatectomy with preservation of inferior vena cava reduces the need for veno-venous bypass in liver transplantation.

Recipient hepatectomy with inferior vena cava (IVC) preservation, the piggy back (PGB) technique, was adopted as our routine option in the management of the anhepatic phase of orthotopic liver transplantation (OLT) to avoid the use of veno-venous bypass (VV-BP). In the last 5 years, 119 OLT in adult patients have been performed in our unit. In the first period (47 OLT), VV-BP was used in 59% of the cases and cross-clamping in the rest. In the second period, following the introduction of the PGB technique, 72 OLT were performed. VV-BP was used in 5.5% of the cases, PGB technique in 87.5% and cross-clamping in 6.9%. There was a significant reduction in the need for VV-BP in the second period. Operating time and blood transfusion were significantly greater in the VV-BP group. No PGB technique related complications were observed. In conclusion, the PGB technique reduced the need for VVBP with consequent savings in time, blood transfusion and the cost of OLT.

Adult↗
PubMed1993

Adenocarcinoma in Caroli's disease treated by liver transplantation.

Caroli's disease is characterized by congenital cystic dilatation of the intrahepatic bile ducts. In 7% of cases a malignant tumor develops complicating the course of the disease. We report the case of a 25 year-old woman in whom Caroli's disease was diagnosed at the age of 11. From that time on, she had several episodes of cholangitis. In 1989, the abdominal ultrasound and CT scan showed dilatation of the intrahepatic bile ducts, intracystic lithiasis and a solid mass. FNA cytology showed a papillary adenocarcinoma. At laparotomy a tumor was found occupying both hepatic lobes, and intraoperative US showed another two nodules in the left lobe. The tumor was considered unresectable. Examination of the hilar lymph nodes was tumor-negative. Two weeks later, the patient underwent an orthotopic liver transplantation (OLT). The pathological examination confirmed Caroli's disease with adenocarcinoma. Two years after OLT, the patient is alive with normal liver function and no evidence of disease. To our knowledge this is the first case report of adenocarcinoma in Caroli's disease treated by OLT.

Adenocarcinoma, Papillary↗
PubMed1993

[Surgical technique in reduced hepatic transplantation in children].

The lack of availability of pediatric donors for liver transplant has resulted in a high mortality rate among children awaiting transplantation, especially in patients weighing less than 10 kg. Knowledge of techniques of liver reduction allows liver transplantation in low-weight children with an adult liver graft, although with increased risk. The authors studied 70 pediatric liver transplants, 14.3% of whom received a reduced-size organ. Maximal difference between donor and recipient weight was 7.7. Segments II, III and IV (right hepatectomy) were transplanted in eight cases while segments II and III were transplanted in two cases. Transfusional requirements during the 48 hour postoperative period were not significantly different between patients with reduced-size liver and patients who received the full-size organ. There was not morbi-mortality secondary to surgical technique in reduced liver transplant group of patients.

Body Weight↗
PubMed1991

[Resection of hepatocarcinomas in liver cirrhosis: the value of intraoperative echography].

In the last 3 years 21 cirrhotic patients with hepatocellular carcinoma were operated. All patients fulfilled the criteria of localized tumor and good liver function and underwent a laparotomy with the aim of resecting the tumor. Intraoperative ultrasound examination was essential to localize a non visible and non palpable tumor in 2 cases and it was useful to detect other nodules in 3 of the 16 patients who underwent a hepatic resection of the tumor. In 5 patients resection was considered not indicated. Therefore, the initial therapeutic approach of tumoral resection was changed in 23.8% of patients. Also, intraoperative ultrasonography was essential for performing a guided resection of hepatocellular carcinomas in cirrhotic liver with the aim of preserving as much liver parenchyma as possible.

Aged↗