1/17. Transplantation of autologous and allogeneic bone marrow with liver from a cadaveric donor for primary liver cancer.BACKGROUND: In histocompatibility mismatched experimental animals, a combination of T-cell-depleted autologous and allogeneic marrow may induce mixed chimerism and tolerance. patients with large primary liver tumors have a poor outcome. We investigated whether it were possible to induce mixed chimerism and obtain an antitumor effect in a patient with a large primary liver cancer after combined liver and bone marrow transplantation (BMT). methods: A 46-year-old female with a primary non resectable liver cancer received a liver transplant from a cadaveric donor. Subsequently, she was conditioned with 4x2 Gy of total lymphoid irradiation, 120 mg/kg cyclophosphamide, and 7.5 Gy total body irradiation. Twelve days after liver transplantation, she received T-cell-depleted autologous:cadaveric 5/6 antigen HLA-mismatched marrow in a proportion of CD34 cells of 0.5:3.0x10(6)/kg. chimerism status was determined with polymerase chain reaction amplification of variable number tandem repeats from dna obtained from CD3 , CD19 , and CD45 magnetic-bead-separated cells. RESULTS: The early posttransplant period was uneventful; liver function was normal and the hematopoietic engraftment of donor and recipient origin was prompt. Alpha-fetoprotein levels dropped from 440 to 35 microg/l. One month after marrow transplantation, donor T-cells decreased markedly. Monoclonal antibody OKT-3 and 10(5)/kg donor T-cells were given. One month later, the patient developed diarrhea and abdominal pain. A colonoscopy showed moderate gastrointestinal acute graft-versus-host disease and a cryptosporidium infection. Three months after BMT, she became a complete donor chimera. chimera cells showed little, if any, reactivity in mixed lymphocyte cultures to recipient and donor cells, but reacted to third party. Five months after BMT, she developed progressive aspergillus fumigatus pneumonia and died. No tumor was found at the autopsy. CONCLUSION: We obtained mixed donor-recipient hematopoietic chimerism without severe acute graft-versus-host-disease, after combined T-cell depleted autologous and allogeneic BMT and a transplantation of a liver from an HLA-mismatched cadaveric donor. Additional donor T-cells enhanced donor bone marrow engraftment, but rejected the autograft. On the basis of this first attempt, further clinical studies are warranted.- - - - - - - - - - ranking = 1keywords = animal (Clic here for more details about this article) |
2/17. Domino hepatic transplantation using the liver from a patient with primary hyperoxaluria.BACKGROUND: We report a case of domino liver transplantation using the liver harvested from a patient who underwent a combined liver and kidney transplantation for primary hyperoxaluria (PH). METHOD: A cadaveric liver transplantation was performed in a 19-year-old man with PH. In a second step, the PH liver harvested from the first patient was transplanted in a 69-year-old man with hepatitis c-related cirrhosis, not a candidate for a classic liver graft owing to multifocal hepatocellular carcinoma. RESULTS: At 8 months after transplantation, the domino recipient has normal hepatic function and no signs of tumoral recurrence, but he progressively developed hyperoxalemia, hyperoxaluria, and renal insufficiency. CONCLUSION: Regarding the favorable postoperative clinical evolution, domino liver transplantations using livers from PH patients may represent a new opportunity for marginal candidates for liver transplantation. However, the progressive renal insufficiency expected in such domino recipients should limit this procedure to selected cases.- - - - - - - - - - ranking = 2.5073574331089keywords = hepatitis (Clic here for more details about this article) |
3/17. cytomegalovirus maculopapular eruption in a kidney transplant patient.cytomegalovirus (CMV) is the most important viral agent in kidney transplantation. Clinical manifestations of CMV disease in transplantation include hepatitis, pneumonitis, pancreatitis, kidney allograft dysfunction, colitis, and meningoencephalitis. However, skin involvement is rare. We describe a severely compromised cadaveric-kidney transplant recipient who developed renal failure, colonic ulcers, and a maculopapular rash accompanied by fever and malaise 4 months after transplantation. Only the skin biopsy was diagnostic and consistent with CMV disease. Intravenous ganciclovir administration resulted in clinical improvement of CMV-induced skin lesions; kidney function normalized and the patient became asymptomatic after 14 days of ganciclovir therapy. Nephrologists should consider the diagnosis of CMV disease in the febrile immunosuppressed patient with skin involvement. skin biopsy must be considered as a useful and safe procedure in patients with a rash to obtain a prompt diagnosis and efficiently treat this immunocompromised population.- - - - - - - - - - ranking = 2.5073574331089keywords = hepatitis (Clic here for more details about this article) |
4/17. Thrombotic thrombocytopenic purpura without any evidence of thrombotic lesions at autopsy.diagnosis of thrombotic thrombocytopenic purpura (TTP) is usually based upon the clinical features, and does not always involve histopathological evidence. We recently had experience with a patient who developed the five signs characteristic for TTP. He had been treated for liver cirrhosis associated with chronic hepatitis B infection, and the hepatic function was severely impaired at admission. blood levels of vWF (von willebrand factor) and factor viii were highly elevated to 506% and 632%, respectively. These findings suggested severe endothelial damage. Thus, the patient was diagnosed as having TTP secondary to severe hepatic damage, and plasma exchanges were initiated immediately. He responded poorly to the treatment, and finally died of pulmonary hemorrhage. At autopsy, hepatocellular carcinoma was identified in the cirrhotic liver, but it was surprising that thorough postmortem examination failed to show any evidence of thrombotic lesions. Our experience suggests that secondary TTP does not always involve pathological evidence of the thrombotic lesions, and that the formation of thrombi causing vessel occlusion might not be essential in the pathogenesis of some secondary TTP.- - - - - - - - - - ranking = 2.5073574331089keywords = hepatitis (Clic here for more details about this article) |
5/17. Diagnostic problems associated with cadaveric trauma from animal activity.Analysis of a series of deaths between 1986 and 2001 resulting from natural disease, accidents, suicides, and homicide, where postmortem animal activity had traumatized bodies, was undertaken at the Forensic science Center in Adelaide to demonstrate the range of lesions that may occur and problems in interpretation that result. Tissue damage had been caused by a variety of animals, including fly larvae, ants, birds, dogs, rodents, sea lice, and sharks. Postmortem animal activity had disguised injuries, modified wounds, and created the appearances of inflicted injury. Problems with identification occurred after postmortem facial trauma, and loss of organ parenchyma had interfered with, or precluded, the precise determination of the manner of death in some cases. Specific kinds of tissue and organ damage may occur after death, necessitating careful assessment of lesions in a search for characteristic features of animal activity. The pattern of lesions may enable identification of the particular species of animal involved.- - - - - - - - - - ranking = 9keywords = animal (Clic here for more details about this article) |
6/17. A patient with hepatitis c-related cirrhosis and hepatocellular carcinoma who was cured with an orthotopic liver transplantation and interferon therapy.A patient with hepatitis c virus (HCV)-related liver cirrhosis and hepatocellular carcinoma (HCC) was treated successfully with an orthotopic liver transplantation (OLT) followed by interferon therapy. The 36-year-old Japanese man was diagnosed as having liver cirrhosis in 1983. HCC was detected in 1991, and by 1994, jaundice and ascites had developed. The patient underwent OLT in June 1995, after which hepatitis c recurred, with elevated aminotransferases. His liver biopsy specimen showed chronic active hepatitis. He was given interferon-alpha three times weekly for 24 weeks in 1999. Six months after the end of the interferon treatment, the patient's serum HCV rna became negative, with normalization of aminotransferases, and his liver histology exhibited amelioration of fibrosis and inflammation. At the present time, he remains free of HCC (more than 6.5 years after the OLT) and free of HCV rna (more than 2.5 years since interferon therapy was completed). This is the first Japanese patient whose HCC was cured by OLT and HCV was eradicated by interferon therapy.- - - - - - - - - - ranking = 17.551502031762keywords = hepatitis (Clic here for more details about this article) |
7/17. Post-mortem observations of a recent radiofrequency catheter ablation site.The acute and chronic gross and microscopic morphologic changes present in myocardium after radiofrequency catheter ablation have been previously described in animal experiments. Acute changes have also been described in four cadaveric human specimens. We describe post-mortem observations of a recent radiofrequency catheter ablation site in a patient who underwent successful ablation for refractory ventricular tachycardia. Our gross and microscopic observations are similar to those previously described in animal experiments and confirm that the animal experimental results can be extrapolated to human hearts. As the use of radiofrequency becomes more prevalent as an alternative treatment for refractory cardiac tachycardias, pathologists will be called upon to identify post-mortem the lesions described. These lesions can be specifically identified, which can serve as a useful verification for this procedure.- - - - - - - - - - ranking = 3keywords = animal (Clic here for more details about this article) |
8/17. immunoglobulin a nephropathy in a renal allograft of a black transplant recipient.Although IgA nephropathy (IgA N) is reportedly the most common form of primary glomerulonephritis worldwide, there is a very low incidence of IgA N in Black Americans, and IgA N in Black patients with renal allografts has not been reported. In this report, we present the case of a Black patient with endstage renal disease presumed secondary to hypertensive nephrosclerosis who developed nephrotic range proteinuria due to IgA N in a cadaveric renal allograft 2 years following transplantation. biopsy of the allograft in the immediate post-transplantation period had revealed no evidence of IgA N. Chronic active hepatitis related to hepatitis c preceded the development of proteinuria by approximately 1 year, raising the possibility that IgA N in the renal allograft was secondary to the liver disease. The clinical and histological features of primary IgA N and IgA N secondary to liver diseases are discussed.- - - - - - - - - - ranking = 5.0147148662177keywords = hepatitis (Clic here for more details about this article) |
9/17. Mycotic pseudoaneurysms after liver transplantation.The most frequent etiology of visceral artery aneurysms is arteriosclerosis, but vascular manipulation during hepatic transplantation may also cause a mycotic pseudoaneurysm. Treatment with embolization, stents or percutaneous thrombin injection have been recommended but surgical revascularization is indicated when interventional techniques fail. A 43-year-old man with hepatitis c virus cirrhosis who underwent orthotopic liver transplantation from a cadaveric donor was treated with cyclosporine, mycophenolate, and steroids and was discharged from hospital at 35 days. Two months later he was readmitted with a febrile syndrome. Abdominal computed tomography showed necrosis of hepatic segments IV, V, and VI. magnetic resonance imaging and angiography revealed partial thrombosis of the hepatic artery and stenosis of the portal anastomosis secondary to an aneurysm of the hepatic artery. A few hours after the radiological diagnosis, the patient suffered a bout of upper gastrointestinal bleeding and shock. Emergency surgery revealed a mycotic pseudoaneurysm of the common hepatic artery, which had ruptured into the bile tract with hemobilia. The liver graft was removed because of severe necrosis of the right liver. The patient died awaiting a new liver transplantation.- - - - - - - - - - ranking = 2.5073574331089keywords = hepatitis (Clic here for more details about this article) |
10/17. Utilization of a liver allograft from a hepatitis B surface antigen positive donor.With today's donor organ shortage, enhanced efforts must be made to utilize organs that previously would have been declined. We report a 26-year-old man with chronic hepatitis b virus (HBV) and hepatitis c virus (HCV) coinfection who received a liver transplant from an HBsAg-positive donor. HBV viremia (6,281,185 copies/ml) was seen early posttransplant despite lamivudine prophylaxis, but became negative with addition of adefovir. Virologic analysis revealed predominantly donor HBV strain immediately posttransplant. At 5 months there was an elevation of liver enzymes accompanied by histologic evidence of hepatitis. At this time, HCV-rna was positive but HBV dna was undetectable. Treatment with pegylated interferon and ribavirin resulted in sustained clearance of HCV rna. Two years posttransplant, the patient has normal liver biochemistry and HCV and HBV viral load are undetectable with persistence of HBsAg. Our experience suggests that with effective antiviral therapy, the use of HBsAg seropositive donors is feasible in selected circumstances.- - - - - - - - - - ranking = 17.551502031762keywords = hepatitis (Clic here for more details about this article) |
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