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Transplantation Evaluation (transplantation + evaluation)

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Medical Sciences100%

Selected Abstracts

Pilot study of pentoxifylline in hepatopulmonary syndrome,

LIVER TRANSPLANTATION, Issue 8 2008
Rajasekhar Tanikella
Hepatopulmonary syndrome (HPS) results when chronic liver disease or portal hypertension causes intrapulmonary microvascular dilatation with hypoxemia. In experimental HPS, tumor necrosis factor alpha (TNF-,) overproduction contributes to vasodilatation, which is improved by pentoxifylline, a TNF-, inhibitor. The effectiveness of pentoxifylline in humans is unknown. The aim of this open-label, single-arm clinical trial was to assess the efficacy and tolerability of pentoxifylline in patients with cirrhosis and advanced HPS undergoing liver transplantation evaluation. Nine adults with cirrhosis and moderate to severe HPS were enrolled. All patients had an initial 2-week titration to a target dose of pentoxifylline of 400 mg by mouth every 8 hours, which was continued for 6 weeks. Baseline and follow-up arterial blood gases and TNF-, levels were evaluated. Adverse effects and tolerability were assessed. The 9 patients had a mean age of 55 ± 10 years, and 67% were female. The most common causes of cirrhosis were hepatitis C virus and alcohol (55%). The mean Model for End-Stage Liver Disease score was 11 (range, 6-19), and patients had advanced hypoxemia [mean partial pressure of arterial oxygen (PaO2) = 54 ± 12 mm Hg, mean alveolar-arterial oxygen gradient (A-a PaO2) = 57 ± 15 mm Hg]. Of the 9 patients enrolled, follow-up blood gases were done in 7. There was no significant change in PaO2 (P = 0.3) or A-a PaO2 (P = 0.3) with treatment. Pentoxifylline was poorly tolerated. Nausea (100%) and vomiting (56%) were the predominant side effects, and only a single patient was able to complete full-dose therapy. Treatment with pentoxifylline did not improve arterial oxygenation in advanced HPS, and tolerance was limited by gastrointestinal toxicity. Liver Transpl 14:1199,1203, 2008. © 2008 AASLD. [source]

Sexual functioning in patients with end-stage liver disease before and after transplantation

LIVER TRANSPLANTATION, Issue 10 2006
James H. Sorrell
The effects of end-stage liver disease (ESLD) on sexual functioning are complex and often overlooked in the context of chronic illness and the transplantation evaluation. The aim of the present study is to report on the prevalence of sexual dysfunction in patients with ESLD presenting for liver transplantation evaluation, as well as to examine a cohort after transplantation. Participants included 173 consecutive adult outpatients with ESLD who presented for orthotopic liver transplantation evaluation. All transplant candidates underwent a psychiatric evaluation, and a sexual history was taken by the transplant psychiatrist. Patients who received a liver transplant were contacted by telephone for follow-up (n = 39). The following domains were explored: sexual frequency, satisfaction, ability to orgasm, sexual interest, and, for men, erectile dysfunction. Before transplantation, high levels of sexual dysfunction were found, with women showing higher levels of dysfunction than men. Increased age and more severe liver disease were related to lower sexual frequency and satisfaction. Contrary to previous work, the cause of disease (alcoholic liver disease) was not related to sexual functioning before transplantation. Those with erectile dysfunction before transplantation showed continued dysfunction after transplantation. An additional finding was an age and gender bias against taking a sexual history from older women. Overall, for both men and women, the findings point to continued and persistent sexual dysfunction after transplantation. Findings may help transplant teams routinely inquire into the sensitive domain of sexual functioning early on and thereby provide an opportunity for treatment. Liver Transpl 12:1473-1477, 2006. © 2006 AASLD. [source]

Which Patients with Congestive Heart Failure May Benefit from Biventricular Pacing?

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1p2 2003
NESTOR O. GALIZIO
GALIZIO, N.O., et al.: Which Patients with Congestive Heart Failure May Benefit from Biventricular Pacing?Background: Biventricular pacing improves the clinical status and ventricular function in patients with congestive heart failure (CHF) and intraventricular conduction delay. However, patient selection criteria including NYHA functional class, rhythm, PR interval, QRS duration (QRSd), left ventricular ejection fraction (LVEF), left ventricular diastolic diameter (LVDD), and other variables are not clearly defined. Objective: To determine which and how many patients referred for an initial cardiac transplantation evaluation may be eligible for biventricular pacing (BP) according to the criteria of recently completed trials of cardiac resynchronization therapy (CRT). Methods: This was a retrospective review of 200 patients, whose mean age was51 ± 13years (173 men). Sinus rhythm was present in 88% of the patients, 107 had a QRSd >120 ms, and 38% had left bundle branch block. LVDD was72.5 ± 12 mmand LVEF21.7 ± 9.3%; 54% had mitral regurgitation. Results: When NYHA class, electrocardiographic, and ventricular function criteria were considered separately, a high proportion of patients appeared to be candidates for CRT: 70.5% were in NYHA functional class III/IV, 34% had QRSd ,150 ms, 60% had LVDD ,60 mm and 53.5% LVEF ,35%. However, the proportions of patients eligible for CRT were different according to the selection criteria of recently completed trials: 18% of the patients with InSync criteria, 13% of the patients with MUSTIC SR criteria, 0.5% with MUSTIC AF criteria, 27% of patients with MIRACLE criteria, and 35% of the patients with CONTAK CD criteria (without considering indications for implantable cardioverter defibrillator). Conclusion: In this population-based study, a wide range of patients (13% to 35%) would have been candidates for CRT, according to the selection criteria of different completed trials.(PACE 2003; 26[Pt. II]:158,161) [source]

Seizures in children after kidney transplantation: Has the risk changed and can we predict who is at greatest risk?

PEDIATRIC TRANSPLANTATION, Issue 5 2008
Lorie D. Hamiwka
Abstract:, Children undergoing kidney transplantation are at increased risk for symptomatic seizures with a previously reported incidence of approximately 20%. Little data exist to help predict which children may be at risk. We retrospectively reviewed all children who underwent kidney transplantation evaluation at our center between October 1993 and August 2007 and identified 41 children who had an EEG prior to transplant. Demographic data as well as the following were collected: immunosuppressive medications, developmental status, history of seizures, family history of seizures, post-transplant seizures and EEG results. EEGs were classified as normal or abnormal. Prior to transplantation, one child had a history of febrile seizures and six experienced afebrile seizures. Nine (22%) children identified had an abnormal EEG prior to transplant. In eight cases the EEG was non-epileptiform and in one case was epileptiform. Abnormal EEGs did not correlate with a family history of seizures. Delayed development was noted in seven children and was not associated with an epileptiform EEG. Following kidney transplantation, no child experienced a seizure. Our single center study suggests that current rates of seizures following kidney transplantation are lower than previously reported and that routine EEG as part of the pretransplant evaluation in these children is of limited use to predict those at risk. [source]