Acceptance Level of Living Liver Donation Among Primary Care Nursing Personnel

INTRODUCTION

Living liver donation is not exempt from risks to the donor, although it is currently ethically accepted. It is important to examine the level of acceptance among the different health levels toward this therapeutic option, in order to design promotion and awareness-raising activities. The objective herein was to analyze the attitudes and the factors that condition them among nursing personnel in Primary Care (PC) toward living liver donation.

MATERIALS AND METHODS

This random survey was stratified by geographical location (6 health areas in our community) among PC nurses, obtaining a total of 139 nurses from 34 health centers. Attitudes toward living liver donation were evaluated using a questionnaire on donation which included different psychosocial variables. For the distribution of the questionnaire, the nursing coordinator of each centers was contacted to distribute questionnaires which were completed anonymously. The chi-square test and Student t test were applied.

RESULTS

Attitudes toward living liver donation were favorable in 89% of those questioned (n = 124) if it is related donation; 3% (n = 4) were against donating a living hemiliver and 8% (n = 11) had doubts. It is important that up to 76% (n = 106) have cared for transplant patients or patients awaiting transplant, however, no relationship was observed with attitude to this type of donation (P = .489). Of all the analyzed variables, there was only a significant relationship between attitudes and concern about possible body mutilation (P < .0005), and partners attitudes toward this matter (P < .0005). It is noteworthy that no relationship was found with attitudes toward cadaveric donation (P = .062).

CONCLUSION

Despite the risk of morbidity and mortality in the donor, the attitude of the PC nursing personnel toward living liver donation was favorable, especially if the donation is related.

Rural Primary Care Centers as a Source of Information About Organ Donation

INTRODUCTION

Primary care is an important way of promoting health in the community, and this includes organ donation. In rural areas, this way of promoting health acquires special importance. Our objective was to analyze attitudes toward organ donation among primary care workers in rural health centers to assess their importance in circulating information about donation.

MATERIALS AND METHODS

A random sample, stratified according to job category among the primary care staff (n = 160), of workers in rural areas in our autonomous community (population < 10,000 inhabitants), evaluated attitudes toward donation using a questionnaire validated in our geographic area. To distribute the questionnaire it was necessary to contact the following in each health center: the coordinating physician, the nursing coordinator, and an administrative worker.

RESULTS

Of those questioned, 78% (n = 124) were in favor of donation, as opposed to 22% (n = 36) who are against it or undecided. As for the job category, physicians and nurses showed a more favorable attitude than nonhealth workers (90% and 80% vs 61%; P = .000). The psychosocial variables that were related to such an attitude were knowledge of the concept of brain death (P = .013) and lack of fear of manipulation of the deceased person (P = .002). Regarding information about organ donation and transplantation, 54% (n = 86) reported having been provided favorable information, with up to a quarter of the physicians considering other programs to be of greater interest for primary care than organ donation and transplantation.

CONCLUSION

Attitudes toward organ donation were favorable among a high percentage of primary care workers in rural centers; more than 50% have circulated favorable information on the subject. However, there is a high percentage with a negative or undecided attitude, especially among nonhealth workers, which should be reversed with promotional activities at the level of the health center.

Inhibition of poly(ADP-ribose) polymerase attenuates the severity of acute pancreatitis and associated lung injury

The severity of acute pancreatitis results from the transmigration and activation of leukocytes within the pancreas and the local synthesis and release of proinflammatory-soluble mediators that transform a local injury into a systemic inflammatory response. Poly(ADP-ribose)polymerase-1 (PARP-1) is a nuclear DNA-binding protein that has been shown to play a relevant role in cell necrosis and organ failure in various diseases associated with inflammation. Therefore, we set out to investigate whether the genetic deletion of PARP-1 or PARP-2 (a new member of the PARP family) genes, or pharmacological inhibition of PARP activity might affect the development and severity of acute pancreatitis and pancreatitis-associated lung injury. Secretagogue-induced acute pancreatitis was achieved by 12 hourly intraperitoneal injections of cerulein in mice deficient in PARP-1 or PARP-2 genes, and wild-type (WT) littermate mice untreated or treated with PARP activity inhibitors. The severity of pancreatitis was assessed by measurements of serum amylase, lipase, interleukin-1beta and IL-6, pancreatic water content, histologic grading and pancreas myeloperoxidase (MPO) activity. Lung injury was evaluated by quantifying MPO activity and morphological changes. We found that the severity of acute pancreatitis and pancreatitis-associated lung injury was significantly attenuated in mice lacking PARP-1, but not PARP-2, compared with WT mice. Interestingly, administration of PARP inhibitors, 3-aminobenzamide or PJ34 (N-(6-oxo-5,6-dihydro-phenanthridin-2-yl)-N,N-dimethyacetamide HCl), in WT mice markedly decreased acute pancreatitis severity and pulmonary-associated injury in a larger extension than genetic deletion of PARP-1. Our results support the potential therapeutic application of PARP inhibitors in the development and severity of acute pancreatitis and associated lung injury.

[Acute liver failure caused by hepatitis C virus in the puerperium]

Hepatitis C virus (HCV) infection is a global problem in our health systems. The prevalence of infected patients in general population is about 2%. In the subgroup of pregnant woman the percentage of infected patients ranges from 1-3%. Several studies have described the relationship between pregnancy and chronic HCV infection, and in most cases serum transaminases levels return to normal values while HCV-RNA levels increase during the second and third trimester. The influence of maternal hormones after delivery in the natural history of HCV infection has not been sufficiently studied and consequently remains controversial. This case report shows the peculiar clinical course of a patient with chronic HCV infection in the puerperium.

Trasplante hepático en metástasis hepáticas irresecables de origen neuroendocrino

INTRODUCTION

Neuroendocrine tumors are rare neoplasms that present bilateral liver metastases at diagnosis. Because of the good initial results obtained, liver transplantation is considered as a potentially curative treatment.

OBJECTIVE

Present our experience of the use of liver transplantation in the management of unresectable bilateral neuroendocrine metastases.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of eight patients (four men and four women), with a mean age of 45 years, who underwent liver transplantation due to bilateral neuroendocrine liver metastases between January 1996 and January 2005. The most frequent location of the primary tumor was the pancreas in five patients (one carcinoid, one gastrinoma and three non-functioning tumors). The remaining three tumors were located in the small bowel (two) and in the lung.

RESULTS

Only one patient died due to technical complications related to the transplant, representing a mortality rate for the entire group of 14%. After a median follow-up of 3 years (range: 1 month-6 years), two patients died due to tumoral recurrence at 15 and 17 months, representing a tumoral recurrence rate of 33%. The survival rate at 1 and 3 years was 86% and 57%, respectively.

CONCLUSIONS

Despite the initial promising results obtained with liver transplantation in the management of unresectable neuroendocrine liver metastases, our results indicate that careful patient selection is required. The key to obtaining good results is individualization of the indication for this procedure.

Liver recipients harbouring anti-donor preformed lymphocytotoxic antibodies exhibit a poor allograft survival at the first year after transplantation: experience of one centre

In this retrospective study, we analyzed the effect of the presence of anti-donor preformed alloantibodies in 268 liver allograft transplants. Crossmatches were performed by complement-dependent cytotoxicity (CDC) assay and HLA antibody screening by flow cytometry (FlowPRA). Positive anti-donor crossmatch was detected in 5.2% of transplants. Acute rejection frequency in +CDC crossmatch patients was not different from that observed in -CDC crossmatch patients. None of the patients transplanted with +CDC crossmatch developed chronic rejection, but they showed a significantly lower allograft survival rate, and the majority of them had allograft failures before the end of the first post-transplant year, mainly within the 3 first months. Indeed, positive FlowPRA determination was concordant with data from the CDC assay. In conclusion, these findings show a direct correlation between the presence of anti-donor preformed antibodies and a poor allograft survival in liver transplant.

Experimental Study of the Interplay between Long-Range Electron Transfer and Redox Probe Permeation at Self-Assembled Monolayers: Evidence for Potential-Induced Ion Gating

Evidence for the competition between long-range electron transfer across self-assembled monolayers (SAMs) and incorporation of the redox probe into the film is reported for the electroreduction of Ru(NH(3)) at hydroxyl- and carboxylic-acid-terminated SAMs on a mercury electrode, by using electrochemical techniques that operate at distinct time scales. Two limiting voltammetric behaviors are observed, consistent with a diffusion control of the redox process at mercaptophenol-coated electrodes and a kinetically controlled electron transfer reaction in the presence of neutral HS-(CH(2))(10)-COOH and HS-(CH(2))(n)()-CH(2)OH (n = 3, 5, and 10) SAMs. The monolayer thickness dependence of the standard heterogeneous electron transfer rate constant shows that the electron transfer plane for the reduction of Ru(NH(3)) at hydroxyl-terminated SAMs is located outside the film | solution interface at short times. However, long time scale experiments provide evidence for the occurrence of potential-induced gating of the adsorbed structure in some of the monolayers studied, which takes the form of a chronoamperometric spike. Redox probe permeation is shown to be a kinetically slow process, whose activation strongly depends on redox probe concentration, applied potential, and chemical composition of the intervening medium. The obtained results reveal that self-assembled monolayers made of mercaptobutanol and mercaptophenol preserve their electronic barrier properties up to the reductive desorption potential of a fully grown SAM, whereas those of mercaptohexanol, mercaptoundecanol, and mercaptoundecanoic acid undergo an order/disorder transition below a critical potential, which facilitates the approach of the redox probe toward the electrode surface.

[Multivariate study of the psychosocial factors affecting public attitude towards organ donation]

INTRODUCTION

Organ transplantation is a therapy which depends on society for its development. The objectives here are: 1) to understand the structure of public opinion towards organ donation in the population aged over 15 years of age in our Community; 2) to analyse the psychosocial variables which affect this opinion and 3) to define the population profiles on this matter.

MATERIALS AND METHODS

Random sample (n = 2.000) stratified for age, sex and geographical location (error for 95.5%, e +/- 2.24) to whom we apply a questionnaire about the psychosocial aspects of organ donation. Descriptive statistics, Student's t-test, Chi-squared test and logistical regression analysis.

RESULTS

63% have a favourable attitude towards organ donation, of which 11% have a donor's card. A statistical association has been observed between favourable public opinion and different psychosocial variables (p < 0.05), with some independent variables persisting in the multivariate analysis such as age, level of education (OR = 1.78), information given by family members (OR = 1.62), health workers (OR = 2.01) and talks in educational centres (OR = 2.13); previous experience with donation and transplantation (OR = 2.02), knowledge of the concept of brain death (OR = 1.4); partner's favourable opinion towards donation (OR = 2.6), being a blood donor (OR = 3), taking part in prosocial activities (OR = 1.6) and attitude towards incineration of the cadaver after death (OR = 1.8).

CONCLUSIONS

The profile of a person who is against donation is of a man or woman, > 50 years of age, with primary studies or below, with no previous experience of the matter, who does not understand the concept of brain death nor their partner's opinion towards donation, who has not found out any information about donation through specialised forums, with an unfavourable opinion towards blood donation or pro-social activities and who is fearful of manipulation of the cadaver after death.

Public attitude toward xenotransplantation: Opinion survey

BACKGROUND

Although xenotransplantation is still in an experimental phase, it is presented herein as a possible solution to the organ shortage. However, there are few data concerning how the general public would accept treatment with animal organs, especially after recent incidents of infections of animal origin, such as "avian influenza" or "SARS disease." The aim of this study was to determine the attitude of the general public toward xenotransplantation of organs.

MATERIALS AND METHODS

Using an opinion survey, a study was performed on a random sample of 250 subjects in an urban setting. The questionnaire was administered by personnel from the regional transplant coordination center. Completion of the form was self-directed and anonymous for each respondent. The attitude toward donation of human and animal organs was evaluated by analyzing different psychosocial variables that may influence this attitude. A descriptive statistical study was performed using Student's t test and the chi-square test.

RESULTS

Ninety-eight percent of respondents completed the survey (n=245). As for human donation, 60% are in favor of cadaveric donation with 21% are in favor of living donation, a rate that increases to 74% if it is for a living partner. As for animal donation, if the results were similar to those obtained with human organs, 74% (n=181) would accept an animal organ if they needed it, as opposed to 18% (n=45) who were undecided and 8% (n=19) against (P <.005). Analysis of variables that influence attitudes toward xenotransplantation showed that this attitude was more positive among those having had a previous experience with transplantation (P=.028) and those having a positive attitude toward cadaveric donation (P=.007). Factors traditionally related to cadaveric donation, such as manipulation of the body or pro-social activities, showed no influence.

CONCLUSIONS

In the population studied, a positive attitude toward xenotransplantation was greater than toward cadaveric donation, assuming the results of these two types of transplants were comparable. Such an attitude is related to human donation, although it is not influenced by many traditional factors.

Genetic and pharmacological inhibition of poly(ADP-ribose) polymerase-1 interferes in the chlamydial life cycle

Chlamydiaceae are intracellular bacteria responsible for a variety of infections, ranging from asymptomatic to very severe, in humans and animals. We have investigated the role of poly(ADP-ribose) polymerase-1 (PARP-1) in Chlamydophila abortus infection using PARP-1-/- and their littermates PARP-1+/+ mice. Infection was resolved more efficiently by PARP-1-/- than PARP-1+/+ mice. However, the inflammatory response was similar in both strains, suggesting a potential role for PARP-1 in the cross-talk between this microorganism and the host cells. PARP-1-/- fibroblasts showed a 10-fold lower rate of chlamydiae production than PARP-1+/+. Moreover, a strong inhibition of bacterial production was also observed after pharmacological inhibition of PARP-1 activity in McCoy cells. Likewise, PARP-1 inhibition induced a higher level of cell death of infected cells, interfering in this way with the normal bacterial cell cycle. Overall, we identify PARP-1 as a new molecule involved in chlamydial developmental cycle, although the intrinsic mechanisms deserve further studies.

Socio-personal factors influencing public attitude towards living donation in south-eastern Spain

OBJECTIVES

Our aim was to determine public attitudes towards living donation compared with cadaveric donation, and to analyse psycho-social factors that may influence this attitude.

MATERIALS AND METHODS

An opinion poll was used to study a random sample in two geographical areas (urban and rural). Assessment was made of attitudes towards donation of one's own organs as a living donor to an unknown person, as a living donor to a relative and/or close acquaintance and, as a cadaveric donor, and of the different psycho-social variables that may influence this attitude.

RESULTS

In the urban setting, 60% had a favourable response towards cadaveric donation; 29% were in favour of living kidney donation to an unknown person, a percentage which increased to 89% for donation to a relative or a friend. These rates were lower for liver (21 and 74%, respectively). When asked if they would accept an organ donated by a relative or a friend, 67% would accept a kidney and 60% a liver. Attitude towards living donation to an unknown person is more positive among those in favour of cadaveric donation and those who have had previous experience of donation. With respect to level of education, university students are more undecided about living donation to an unknown person than the other groups. In terms of attitude towards donation to relatives and/or friends, there is also the influence of social factors (sex, marital status). However, if the living donation is intended for oneself, there is no variable with which to associate this attitude. In the rural setting, 56% of the respondents refused to complete the survey due to fear of living donation. No statistical study was conducted due to the bias of the rural sample.

CONCLUSIONS

There is great fear and ignorance of living donation among the rural population, and uncertainties in the urban population, although attitudes are more positive towards living donation to relatives and/or friends than towards cadaveric donation. These positive attitudes towards living donation are very strongly related to attitudes towards cadaveric donation, previous experience of donation and level of education.

Differential protein expression during growth of Acidithiobacillus ferrooxidans on ferrous iron, sulfur compounds, or metal sulfides

A set of proteins that changed their levels of synthesis during growth of Acidithiobacillus ferrooxidans ATCC 19859 on metal sulfides, thiosulfate, elemental sulfur, and ferrous iron was characterized by using two-dimensional polyacrylamide gel electrophoresis. N-terminal amino acid sequencing and mass spectrometry analysis of these proteins allowed their identification and the localization of the corresponding genes in the available genomic sequence of A. ferrooxidans ATCC 23270. The genomic context around several of these genes suggests their involvement in the energetic metabolism of A. ferrooxidans. Two groups of proteins could be distinguished. The first consisted of proteins highly upregulated by growth on sulfur compounds (and downregulated by growth on ferrous iron): a 44-kDa outer membrane protein, an exported 21-kDa putative thiosulfate sulfur transferase protein, a 33-kDa putative thiosulfate/sulfate binding protein, a 45-kDa putative capsule polysaccharide export protein, and a putative 16-kDa protein of unknown function. The second group of proteins comprised those downregulated by growth on sulfur (and upregulated by growth on ferrous iron): rusticyanin, a cytochrome c(552), a putative phosphate binding protein (PstS), the small and large subunits of ribulose biphosphate carboxylase, and a 30-kDa putative CbbQ protein, among others. The results suggest in general a separation of the iron and sulfur utilization pathways. Rusticyanin, in addition to being highly expressed on ferrous iron, was also newly synthesized, as determined by metabolic labeling, although at lower levels, during growth on sulfur compounds and iron-free metal sulfides. During growth on metal sulfides containing iron, such as pyrite and chalcopyrite, both proteins upregulated on ferrous iron and those upregulated on sulfur compounds were synthesized, indicating that the two energy-generating pathways are induced simultaneously depending on the kind and concentration of oxidizable substrates available.

Influence of different sources of information on attitude toward organ donation: a factor analysis

OBJECTIVES

To determine media through which the population receives information on donation; to analyze the association between the sources of information and the psychosocial variables with respect to the opinion on donation; and to determine how each source of information influences this opinion.

MATERIALS AND METHODS

A questionnaire on donation was administered to a random sample of 2000 persons stratified by age, gender, and geographical location, of whom 1143 respondents claimed to have no experience with donation and/or transplantation. A statistical analysis was done between the sources of information or the psychosocial variables or their co-variation to determine their specific impact on the population.

RESULTS

The medium with the greatest impact on the population is television; the second factor is the press and radio; the third is magazines and talks with friends/family; the fourth is hoardings and posters, and campaigns about organ donation; and the last factor is information given by health professionals. In the factor analysis between sources of information and psychosocial variables, an association was observed between press, radio, and information given by health professionals and a higher education level; and between information provided by discussions in schools, by age, and a higher level of education. Sources of Information sources as that have a favorable effect on donation include discussions, (P = .0079), and information by health professionals (P < .0005) and by friends (P = .0132) and by family (P = .0044).

CONCLUSIONS

Opinion on donation is more favorable among subjects who have received information on an individual basis and at specialized meetings. The only psychosocial variable associated with some sources of information is the level of education.

Eversion thromboendovenectomy in organized portal vein thrombosis during liver transplantation

Portal thrombosis is no longer considered a contraindication for transplantation because of the technical experience acquired in the field of liver transplantation and the development of various surgical techniques. All the same, the results obtained in portal thrombosis patients are at times suboptimal, and the surgical technique used (thromboendovenectomy or veno-venous bypass) is also controversial. Between May 1988 and December 2001, 455 liver transplants were performed, of which 32 (7%) presented portal vein thrombosis. Of these, eight belonged to the first 227 transplants (group I), and 24 to the other 228 (group II). Of the 32 cases with portal thrombosis, 20 (62%) were type Ib, seven (22%) type II/III and five (16%) type IV. Twenty-two were males (69%), with a mean age of 50 yr (range: 30-70 yr); the thrombosis in all cases developed over a cirrhotic liver: 15 cases of an ethanolic origin, 11 because of hepatitis C virus, two cases of autoimmune aetiology, one case of primary biliary cirrhosis, one case because of hepatitis B virus and two cases of a cryptogenic origin. Five cases had a history of surgical treatment for portal hypertension. The surgical method in all cases consisted of an eversion thromboendovenectomy (ETEV) under direct visual guidance, with occlusion of the portal flow using a Fogarty balloon. Once re-canalization was achieved, we performed local heparinization and end-to-end portal anastomosis. In no case was systemic post-operative heparinization performed. In the 32 cases in which thrombectomy was attempted it was achieved in 31 of them (96%), failing only in a case of type IV thrombosis, which was resolved by portal arterialization. Of the 31 successful cases, only one with type IV thrombosis re-thrombosed. The 5-yr survival rate of the patients in the series was 69%, with 10 patients dying, of whom only two from causes related to the thrombosis and the thrombosis treatment, both with type IV thrombosis. The ideal treatment for portal thrombosis during liver transplantation is controversial and depends on its extension and the experience of the surgeon. In our experience, ETEV resolves most thromboses (types I, II and III), but management of type IV, which occasionally can be treated with this technique, may require more complex procedures such as bypass, portal arterialization or cavoportal haemitransposition.

Socio-personal profile of teenagers opposed to organ donation

BACKGROUND

The teenage population has a more favourable attitude towards organ donation than other population groups. Teenagers represent the future of the community and their opinion directly affects other family members and friends. Therefore, teenagers who are in favour of donation become promoters of organ donation in their area of influence. Our aim was to determine the opinion and fears of the teenage population regarding organ donation in order to define the profile of the subgroup, which is opposed to donation.

METHODS

We used a random stratified sample according to gender and geographical location of 15-19-year-old adolescents. The attitude towards organ donation was assessed using the questionnaire on psychosocial aspects of donation. The variables were grouped into socio-personal, donation awareness, social interaction, pro-social activities and attitude towards the body. Data were analysed by descriptive statistics, the chi(2) test, Student's t-test and a logistic regression analysis.

RESULTS

Seventy-three per cent of teenagers have a favourable attitude towards organ donation. Twenty-seven per cent are undecided or have negative attitudes; the main reason given is fear of apparent death (48%). Variables with statistical significance, which are against donation, are a low level of education (P = 0.0456), no previous experience with organ donation (P = 0.0254), no knowledge of the brain death concept (P = 0.0054) and refusal to accept cadaver manipulation (P = 0.0037).

CONCLUSION

The profile of the teenager who is opposed to organ donation is one who has only primary schooling or who left school early, is not engaged in pro-social activities, rejects cadaver manipulation and has no knowledge of the brain death concept.

Spanish experience in liver transplantation for hilar and peripheral cholangiocarcinoma

OBJECTIVE

To assess the real utility of orthotopic liver transplantation (OLT) in patients with cholangiocarcinoma, we need series with large numbers of cases and long follow-ups. The aim of this paper is to review the Spanish experience in OLT for hilar and peripheral cholangiocarcinoma and to try to identify the prognostic factors that could influence survival.

SUMMARY BACKGROUND DATA

Palliative treatment of nondisseminated irresectable cholangiocarcinoma carries a zero 5-year survival rate. The role of OLT in these patients is controversial, due to the fact that the survival rate is lower than with other indications for transplantation and due to the lack of organs.

METHODS

We retrospectively reviewed 59 patients undergoing OLT in Spain for cholangiocarcinoma (36 hilar and 23 peripheral) over a period of 13 years. We present the results and prognostic factors that influence survival.

RESULTS

The actuarial survival rate for hilar cholangiocarcinoma at 1, 3, and 5 years was 82%, 53%, and 30%, and for peripheral cholangiocarcinoma 77%, 65%, and 42%. The main cause of death, with both types of cholangiocarcinoma, was tumor recurrence (present in 53% and 35% of patients, respectively). Poor prognosis factors were vascular invasion (P < 0.01) and IUAC classification stages III-IVA (P < 0.01) for hilar cholangiocarcinoma and perineural invasion (P < 0.05) and stages III-IVA (P < 0.05) for peripheral cholangiocarcinoma.

CONCLUSIONS

OLT for nondisseminated irresectable cholangiocarcinoma has higher survival rates at 3 and 5 years than palliative treatments, especially with tumors in their initial stages, which means that more information is needed to help better select cholangiocarcinoma patients for transplantation.

Transcription regulation of TNF-alpha-early response genes by poly(ADP-ribose) polymerase-1 in murine heart endothelial cells

Poly(ADP-ribose) polymerase-1 (PARP-1) has been involved in endothelial cell dysfunction associated with various pathophysiological conditions. The intrinsic mechanism of PARP-1-mediated endothelial cell dysfunction could be related to PARP-1 overactivation, NAD(+) consumption and ATP depletion. An alternative way could involve transcription regulation. By using high-density microarrays, we examined early tumor necrosis factor alpha (TNF-alpha)-stimulated gene expression profiles in PARP-1(+/+) and PARP-1(-/-) murine heart endothelial cells. TNF-alpha modulated a significant number of genes in both cell types. We have identified a set of genes whose expression in response to TNF-alpha is modulated by PARP-1, whereas the expression of others is PARP-1-independent. Up-regulation of several genes involved in the inflammatory response is hampered in the absence of PARP-1. Moreover, NF-kappaB-dependent transcriptional activation is partially inhibited in PARP-1(-/-) compared to PARP-1(+/+) cells. However, we found that PARP-1 might also silence transcription of several NF-kappaB target genes. Overall, our results show that PARP-1 is regulating the expression of genes by the endothelial cells both in a positive and a negative fashion, with the final effects depending on the gene. Individual studies of these genes are now necessary to clarify the intrinsic mechanism by which PARP-1 is controlling transcription and thereby finding out different therapeutic approaches involving PARP-1.

Laparoscopic iatrogeny of the hepatic hilum as an indication for liver transplantation

The introduction of biliary laparoscopic surgery led to an increase in the incidence of liver hilum injuries. These types of lesions are very serious, because they can lead to secondary biliary cirrhosis or fulminant hepatic failure and the need for liver transplantation (LT). We present three cases of liver hilum injuries, which were treated with LT; one case was due to severe and persistent cholangitis, and two cases were due to fulminant hepatic failure. The world literature is also reviewed, and published cases of iatrogenic lesions of the liver hilum caused by laparoscopic surgery and requiring LT are presented. These iatrogenic lesions of the hepatic hilum are complex and technically demanding, due to their high morbidity and mortality and even the need for LT. In conclusion, these lesions must be always managed in centers with experience in hepatobiliary surgery.

Fulminant hepatic failure and liver transplantation: experience of Virgen de la Arrixaca Hospital

INTRODUCTION

For patients with fulminant hepatic failure who show a poor evolution despite medical treatment, liver transplantation is an option, with survival rates of greater than 50%. The ideal time to perform the transplant is controversial, as it must not be done too soon (when the liver disease is still reversible) or too late (when the patient is in an irreversible clinical situation).

PATIENTS AND METHODS

Retrospective review of the clinical histories of 34 patients admitted to our hospital with a diagnosis of fulminant hepatic failure included 26 who underwent transplantation. The most frequent cause was viral (n=10, 38%); with no etiology established in 11 cases (42%). Thirteen patients had preoperative complications, the most frequent being renal insufficiency. As for degree of AB0/DR compatibility, 13 cases were identical (40%), 17 compatible (51%), and the other three incompatible (9%).

RESULTS

Thirty-three transplants were performed in 26 patients: four were retransplants due to chronic rejection, two for primary graft failure, and one for hyperacute rejection. The overall mortality rate was 46% (12 patients). The most frequent cause of death was infection (50%). The overall actuarial survival rate was 68% at 1 year, 63% at 3 years, and 59% at 5 years. The factors associated with a poor prognosis were renal and respiratory insufficiency, a grade D electroencephalogram, and encephalopathy grades III and IV, the last being the only prognostic factor identified in the multivariate analysis. The prognostic factors for mortality were a grade D electroencephalogram, encephalopathy grades III and IV and respiratory insufficiency, the last being the only prognostic factor identified in the multivariate analysis.

CONCLUSION

Good results of transplantation for the management of fulminant hepatic failure depends on optimal selection of transplant candidates, which means identifying them early, reducing the waiting time, and excluding factors associated with a poor prognosis.

Description of a new auxiliary heterotopic partial liver transplantation technique with portal vein arteriolization of applicability in heterotopic liver xenotransplantation

OBJECTIVE

The aim of this study was to describe a new model of auxiliary heterotopic partial liver transplantation with portal vein arterialization.

MATERIALS AND METHODS

Three standard hepatectomies were performed in pigs. The left lateral lobe was surgically resected and portal vein arteriolization constructed by an end-to-side "Y" anastomoses between the distal to the celiac axis aorta and the portal vein.

RESULTS

The graft was placed in the left iliaca fossa using anastomoses of the donor infrahepatic inferior cava vein end-to-side to the host infrarenal inferior vein and the donor aortic stump with portal vein arteriolization end-to-side to the left iliac artery. After graft reperfusion, the 3 recipients showed intraoperative hypotension, which was treated with fluid administration and vasoactive drugs. At the end of the operation, the graft displayed normal arterial blood flow and good venous drainage. The donor liver graft appeared more red than the host liver, which was due to the increased arterial blood flow. One pig of 3 died at 24 hours after surgery, probably due to hypothermia. However, the other 2 pigs survived the procedure and remained stable. Echographic monitoring showed intrahepatic arterial expansion, which may be the result of high blood pressure due to the arteriolization procedure.

CONCLUSIONS

We have developed a novel and easy to perform technique that diminishes the number of anastomoses and does not involve vessels from other organs.

Role of liver transplantation in the management of metastatic neuroendocrine tumors

INTRODUCTION

In the majority of patients transplanted for unresectable liver metastases, long-term results are disappointing because of early tumor recurrence. Due to its biologically less aggressive nature, neuroendocrine metastases (NM) may represent a good indication for liver transplantation (LT).

PATIENTS AND METHODS

Between January 1996 and May 2000, five patients with NM were transplanted. The primary tumors were located in the pancreas (n=4) and the small bowel (n=1). In three cases there were symptoms related to hormone production: two carcinoids, and one gastrinoma. The management of primary tumors was sequential in three patients with the tumor being resected before LT (one Whipple procedure and two left pancreatectomies). In two patients the resections of the primary tumors and the LT were simultaneous namely one bowel resection and one left pancreatectomy. All patients were treated with chemotherapy.

RESULTS

Two patients developed recurrent disease succumbing at 15 months (nonfunctioning NE pancreatic head tumor) and 17 months (carcinoid of the pancreatic tail) post-LT. Another patient died at 3 months post-LT due to technical complications. The other two patients are alive and free of recurrence.

CONCLUSION

Despite the promising results obtained with LT for NM, our experience indicates that patients must be carefully selected. Perhaps the use of more aggressive chemotherapeutic protocols combined with an individualized approach will improve the results.

Liver transplantation for hilar cholangiocarcinoma: Spanish experience

INTRODUCTION

Palliative treatment for nondisseminated irresectable hilar cholangiocarcinoma (HCC) carries a 0% 5-year survival rate. The role of orthotopic liver transplantation (OLT) in these patients is controversial because the survival rate is lower than that for other indications for transplantation and the lack of available donor organs. The aim of this paper was to review the Spanish experience in OLT for HCC and identify prognostic factors for survival.

METHODS

We retrospectively reviewed 36 patients undergoing OLT for HCC over 13 years.

RESULTS

The actuarial survival rate at 1, 3, and 5 years was 82%, 53%, and 30%, respectively. The main cause of death was tumor recurrence (53%). In the univariate analysis, the factors for a poor prognosis were vascular invasion (P<.001) namely 0% survival at 3 years when present versus 63% and 35% at 3 and 5 years, respectively, when it was not; and stages III to IVA (P<.05), namely 15% survival at 5 years versus 47% for stages I to II. Lymph node and perineural invasion also reduce survival. In the multivariate analysis, the factors for poor prognosis included vascular invasion (P<.01) and stages III to IVA (P<.01).

CONCLUSION

OLT for nondisseminated irresectable HCC has higher survival rates at 3 and 5 years than palliative treatments, especially with initial stage tumors, which means that more information is needed to better select cholangiocarcinoma patients for transplantation.

Synthetic nanopores with fixed charges: an electrodiffusion model for ionic transport

Synthetic nanopores with fixed charges exhibit ionic equilibrium and transport properties that resemble those displayed by biological ion channels. We present an electrodiffusion model based on the Nernst-Planck flux equations, which allows for a qualitative description of the steady state ionic transport through a nanopore when the membrane fixed charges and all mobile carriers (including the water ions) are properly taken into account. In particular, we study the current-voltage curve, the electrical conductance, the reversal potential (a measure of the nanopore ionic selectivity), as well as the flux inhibition by protons and divalent cations in the nanopore. The model clearly shows how the changes in the ionization state of the fixed charges with pH and salt concentration dictate the electrical properties of the nanopore. The agreement between the model predictions and previous experimental data allows us to identify which are the main characteristics that permit a simple description of this complex system.

Psychosocial profile in favor of organ donation

INTRODUCTION

The lack of organ donation continues to be a major limiting factor in transplantation. Our aims are: (1) to define the psychosocial profile against organ donation, and (2) to determine the impact of a law on the procurement and transplantation of organs based on "presumed consent" in the population.

MATERIALS AND METHODS

The population in this study (n = 2000) was randomly selected and stratified according to sex, age, and geographic localization. The attitude toward organ donation and transplantation was evaluated according to a questionnaire that probed psychosocial aspects of donation. Statistical comparisons were performed using the chi2 and logistic regression tests.

RESULTS

The population attitude toward organ donation was favorable in 63% of subjects, unfavorable in 31%, and 6% did not respond. With regard to the law based on "presumed consent," only 24% of the population agreed with the law; 53% thought it was an abuse of authority. The population subgroup with a negative attitude to the law was characterized by: age over 40 years, low educational level, no previous experience with organ donation or transplant, no experience in prosocial activities, a refusal to accept cadaver manipulation or mutilation, and lack of knowledge of the brain-death concept.

CONCLUSIONS

The psychosocial profile against donation is a person above 40 years with a low level of education who has never performed prosocial activities, did not have previous experience with organ donation or transplantation, displays no knowledge of the brain-death concept, and rejects cadaver manipulation. For these people a law based on "presumed consent" is considered an abuse of authority.

Endothelial cell chimerism does not influence allograft tolerance in liver transplant patients after withdrawal of immunosuppression

BACKGROUND

Human liver allografts sometimes show self-induced permanent tolerance without immunosuppression. It has recently been proposed that the replacement of liver donor endothelial cells by recipient cells could confer a survival advantage. The aim of this study was to analyze liver endothelial cell replacement in relation to the response (tolerance or rejection) after withdrawal of immunosuppression in liver transplant patients.

METHODS

Nine liver recipient patients were entered into a program of immunosuppressive drug withdrawal. The authors studied liver endothelial cell chimerism in five of these patients who received a liver from a donor of the opposite sex by in situ hybridization for X and Y chromosomes.

RESULTS

Three patients (33%) achieved complete withdrawal of immunosuppression. The authors' data show similar endothelial cell chimerism in both the tolerant and nontolerant patients analyzed.

CONCLUSIONS

Endothelial cell chimerism has nothing to do with the induction of clinical tolerance in liver transplant patients after withdrawal of immunosuppression.

Isolation and characterization of immortalized porcine aortic endothelial cell lines

Primary porcine endothelial cells have a limited life span in culture. After four to five passages, they tend to de-differentiate and eventually reach senescence. The aim of this work was to establish immortalized porcine aortic endothelial cell lines (AOCs) to facilitate in vitro studies of different pathological process involving the endothelium. Primary porcine aortic endothelial cells (PAECs) were transfected with a plasmid containing the SV40 genome and selected on the basis of morphological and phenotypical features. Flow cytometry analysis demonstrated uptake of acetylated low density lipoproteins (Ac-LDL) and constitutive expression of SLA class I, CD29, CD31, CD41/61, CD80/86, CD46, SWC3, and LAMP-1 antigens by all analyzed lines and showed little differences to primary cells. The functional similarity between primary and immortalized endothelial cells was demonstrated in a cytotoxicity assay using a human natural killer cell line (NKL) as effector. The AOCs cell lines should be valuable tools for in vitro study of the human immune response against pig endothelial cells. In addition, they would be very useful to gain insight in the pathogenesis of some viral haemorrhagic diseases of pig such as African swine fever (ASF) or classical swine fever (CSF).

An exported rhodanese-like protein is induced during growth of Acidithiobacillus ferrooxidans in metal sulfides and different sulfur compounds

By proteomic analysis we found a 21-kDa protein (P21) from Acidithiobacillus ferrooxidans ATCC 19859 whose synthesis was greatly increased by growth of the bacteria in pyrite, thiosulfate, elemental sulfur, CuS, and ZnS and was almost completely repressed by growth in ferrous iron. After we determined the N-terminal amino acid sequence of P21, we used the available preliminary genomic sequence of A. ferrooxidans ATCC 23270 to isolate the DNA region containing the p21 gene. The nucleotide sequence of this DNA fragment contained a putative open reading frame (ORF) coding for a 23-kDa protein. This difference in size was due to the presence of a putative signal peptide in the ORF coding for P21. When p21 was cloned and overexpressed in Escherichia coli, the signal peptide was removed, resulting in a mature protein with a molecular mass of 21 kDa and a calculated isoelectric point of 9.18. P21 exhibited 27% identity and 42% similarity to the Deinococcus radiodurans thiosulfate-sulfur transferase (rhodanese; EC 2.8.1.1) and similar values in relation to other rhodaneses, conserving structural domains and an active site with a cysteine, both characteristic of this family of proteins. However, the purified recombinant P21 protein did not show rhodanese activity. Unlike cytoplasmic rhodaneses, P21 was located in the periphery of A. ferrooxidans cells, as determined by immunocytochemical analysis, and was regulated depending on the oxidizable substrate. The genomic context around gene p21 contained other ORFs corresponding to proteins such as thioredoxins and sulfate-thiosulfate binding proteins, clearly suggesting the involvement of P21 in inorganic sulfur metabolism in A. ferrooxidans.

Calopogonium golden mosaic virus Identified in Phaseolus vulgaris from Western and Northern Regions of Costa Rica

Bean golden yellow mosaic virus (BGYMV, GenBank Accession No. M91604) is reported to be the main bean-infecting (Phaseolus vulgaris) begomovirus in Central America (1,2). Another begomovirus, Bean calico mosaic virus (BCaMV, GenBank Accession No. AF110189), is known to infect P. vulgaris in central Mexico. Bean samples with the viral symptom of foliar chlorosis were collected in different regions of Costa Rica from 1994 to 2001. Total nucleic acids were extracted and tested using polymerase chain reaction (PCR) with degenerate primer pair PBL1v2039/PCRc2 for DNA-B, which can give a different fragment size for some begomoviruses (4). PCR fragments were obtained from 119 bean samples. Fifty samples from the central valley produced 600-bp PCR fragments, which is typical for BGYMV (4), and one sample produced two fragments (500 and 600 bp). One sample from western Costa Rica had a 550-bp fragment, and 69 samples from the western and northern regions produced 500-bp fragments. One of the latter samples (No. 01-1152) was selected for PCR with degenerate primer pairs PAL1v1978/PAR1c715 for DNA-A and PBL1v2039/PBR1v800 for DNA-B (4). The amplified PCR fragments were 1.35 and 1.4 kb for DNA-A and DNA-B, respectively. These are expected sizes for a Western Hemisphere begomovirus. The DNA-A fragment was cloned and sequenced (GenBank Accession No. AF439402). Sequence comparisons indicated that this uncharacterized begomovirus (No. 01-1152) had 98, 97, and 93% nucleotide identities with the rep gene, common region, and coat protein gene promoter of Calopogonium golden mosaic virus (CalGMV, GenBank Accession Nos. AF439748 and AF439749, respectively) (3). CalGMV had been isolated from a weed, Calopogonium sp., collected in 1991 near Quepos in the west and Tilaran in the north of Costa Rica (3). Phylogenetic analysis of the viral sequence of the begomovirus associated with No. 01-1152 placed it in the Squash leaf curl virus clade (1). BCaMV is also in this phylogenetic clade, but sequence comparisons between CalGMV and BCaMV had <90% nucleotide identity, and so are distinct species. CalGMV is the begomovirus associated with No. 01-1152, and this is an example of the movement of a weed-infecting begomovirus into an agricultural crop. Since this Calopogonium sp. is widespread in Central America, it is important to determine if CalGMV is present in beans in other regions. The data also indicate that BGYMV and CalGMV infect beans in two geographically distinct regions of Costa Rica. References: (1) J. C. Faria et al. Phytopathology 84:321, 1994. (2) W. McLaughlin et al. Plant Dis. 78:1220, 1994. (3) M. R. Rojas et al. Annu. Rep. Bean Improv. Coop. 35:150, 1992. (4) M. R. Rojas et al. Plant Dis. 77:340, 1993.

Evidence that the proliferation stage of micropropagation procedure is determinant in the expression of banana streak virus integrated into the genome of the FHIA 21 hybrid (Musa AAAB)

Banana streak virus (BSV) is causing increasing concern in almost every producing area of banana and plantain (Musa spp.) worldwide. This situation appeared partially linked to some breeding lines and micropropagated hybrids. A complete BSV sequence integrated into the genome of a triploid plantain has been recently characterised and it has been hypothesised that it could give rise to infectious virus via recombination. In this study, we evaluated the effect of a routine micropropagation procedure on the expression of BSV in the FHIA 21 tetraploid hybrid. The widespread presence of integrated sequences and the absence of episomal BSV in thirty FHIA 21 "mother plants" selected for micropropagation were first confirmed by specific PCR and IC-PCR tests. The proliferation stage of the procedure, characterised by an intensive production of neoformed buds, appeared determinant in BSV expression whereas the rooting and acclimatisation stages had little or no effect. The duration in culture and the way of subdividing the clumps of proliferation influenced greatly the percentage of episomal BSV infections, reaching 58% of infected micropropagated lines after six in vitro subcultures. These data suggest that the expression of episomal BSV observed during the in vitro procedure is correlated with the presence of an integrated form.