1
|
Diogo D, Pacheco C, Oliveira R, Martins R, Oliveira P, Cipriano MA, Tralhão JG, Furtado E. Influence of Ischemia Time in Injury of Deep Peribiliary Glands of the Bile Ducts Graft: A Prospective Study. Transplant Proc 2019; 51:1545-1548. [PMID: 31155189 DOI: 10.1016/j.transproceed.2019.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The deep peribiliary glands (DPBG) are a niche of progenitor cells in the wall of the biliary duct (BD) and are the second line of multiplication when severe lesion of the epithelium occurs. Previous studies have identified DPBG injury as a cause of post-liver transplant (LT) biliary stenosis; this complication is a major cause of post-LT morbidity. The incidence of biliary stenosis in our center is high (38.1%). This study evaluates the lesion of DPBG in response to ischemia. Graft BD was collected in adult LT between August 2016-July 2017, from donation after brain death. Samples of 45 grafts were collected at 2 moments: BD1-during graft preparation and BD2-before biliary anastomosis. Histological analysis of the samples was performed and then classified according to degree of lesion (0, ≤50%, and >50%). A comparison was made between the degree of lesion and graft ischemia, graft histology, donor, and procurement variables. The DPBG lesion was more frequent in BD2 (20.9% vs 7%, P = .079). BD2 lesions with DPBG lesions had higher medians and means at all times of ischemia. The difference was greater in the warm ischemia time (0: 43.3 ± 12.53 minutes vs ≤50%: 52.4 ± 14.38 minutes, P = .068). The group of BD1 with DPBG lesion presented superior median cold ischemia time (CIT). In the analysis of the remaining variables there were also no statistically significant differences. We concluded that during the period of CIT there is already lesion of the DPBG, which increases after reperfusion of the graft, in greater association with longer warm ischemia time.
Collapse
Affiliation(s)
- D Diogo
- Adult and Paediatric Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal.
| | - C Pacheco
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - R Oliveira
- Department of Pathologic Anatomy, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - R Martins
- Adult and Paediatric Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - P Oliveira
- Adult and Paediatric Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - M A Cipriano
- Department of Pathologic Anatomy, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - J G Tralhão
- Department of Surgery, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - E Furtado
- Adult and Paediatric Liver Transplantation Unit, Coimbra Hospital and University Centre, Coimbra, Portugal
| |
Collapse
|
2
|
Vieira H, Rodrigues C, Pereira L, Jesus J, Bento C, Seco C, Pinto F, Eufrásio A, Calretas S, Silva N, Ferrão J, Tomé L, Barros A, Diogo D, Furtado E. Liver retransplantation in patients with acquired familial amyloid polyneuropathy: a Portuguese center experience. Transplant Proc 2016; 47:1012-5. [PMID: 26036507 DOI: 10.1016/j.transproceed.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 1995 Furtado et al performed the first domino transplantation using a donor liver with familial amyloid polyneuropathy (FAP), thereby increasing the pool of donors. Our experience showed that the onset of FAP symptoms occurs earlier in some patients. Patients with FAP acquired by transplantation are candidates for liver retransplantation to minimize the progression of symptoms. Liver retransplantation is considered to be a high-risk procedure and has lower survival compared with the first transplantation. We evaluated the risk of liver retransplantation in patients with acquired FAP. We did a retrospective analysis of these patients based on the records of perioperative data. From 1995 to 2004 we carried out 81 domino transplantations, of which 10 were submitted to liver retransplantation because of acquired FAP. The better outcomes in this group lead us to think that the liver retransplantation in patients with acquired FAP is not associated with the same risks of liver retransplantation in candidates with graft failure.
Collapse
Affiliation(s)
- H Vieira
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - C Rodrigues
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Pereira
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Jesus
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Bento
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Seco
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Pinto
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Eufrásio
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - S Calretas
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - N Silva
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Ferrão
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Tomé
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Barros
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - D Diogo
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Furtado
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
3
|
Rodrigues C, Vieira H, Jesus J, Pereira L, Bento C, Seco C, Pinto F, Eufrásio A, Calretas S, Silva N, Ferrão J, Tomé L, Barros A, Diogo D, Furtado E. Evaluation of operative risk in de novo familial amyloid polyneuropathy retransplantation. Transplant Proc 2015; 47:1016-8. [PMID: 26036508 DOI: 10.1016/j.transproceed.2015.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Familial amyloid polyneuropathy (FAP) is the most common hereditary amyloidosis, characterized by progressive peripheral sensory and motor neuropathy. The livers of patients with FAP are used in domino liver transplantation in selected cases to increase the number of grafts available. In our department 10 patients underwent liver retransplantation (ReLTx) in the absence of liver dysfunction by de novo FAP after domino liver transplantation. Our aim was to compare the differences in the consumption of blood products and intraoperative hemodynamic support among patients with FAP undergoing liver transplantation (LTx) and patients with de novo FAP undergoing ReLTx in the same time frame. The anesthetic records of all patients who underwent LTx for FAP and ReLTx for de novo FAP were analyzed, from January 2009 to May 2014. Patients were divided into 2 groups: group 1 patients with FAP, and group 2 patients with de novo FAP. Statistical differences in the value of preoperative creatinine were found. Hemoglobin levels, preoperative international normalized ratio (INR), use of blood products, aminergic support, and surgical time showed no statistical difference. Major bleeding rates would be expected in patients undergoing ReLTx. Changes in renal function, chronic immunosuppressive therapy, and age may contribute to the increase in intraoperative complications. We did not find statistically significant differences, leading us to the conclusion that de novo FAP does not seem to be a predictor of perioperative risk.
Collapse
Affiliation(s)
- C Rodrigues
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - H Vieira
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Jesus
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Pereira
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Bento
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - C Seco
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Pinto
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Eufrásio
- Serviço de Anestesiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - S Calretas
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - N Silva
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - J Ferrão
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - L Tomé
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Barros
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - D Diogo
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - E Furtado
- Unidade de Transplantação Hepática Pediátrica e de Adultos, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
4
|
Eyre S, Bowes J, Diogo D, Raychaudhuri S, Stahl E, Zhernakova A, Padyukov L, Amos C, Plenge R, Klareskog L, Gregersen P, Worthington J. OP0208 High density fine mapping in rheumatoid arthritis indentifies 14 new loci:. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
5
|
Hammond C, Velard F, Ah Kioon MD, Come D, Hafsia N, Lin H, Ea HK, Liote F, Dudek M, Wallis GA, Paton K, Harris J, Kendall DA, Kelly S, Mercer L, Galloway J, Low A, Watson K, Lunt M, Dixon W, Symmons D, Hyrich K, Ntatsaki E, Watts RA, Mooney J, Scott DGI, Humphreys J, Verstappen SM, Marshall T, Lunt M, Hyrich K, Symmons DP, Khan A, Scott DL, Abraham A, Pearce MS, Mann KD, Francis RM, Birrell F, Moinzadeh P, Fonseca C, Hellmich M, Shah A, Chighizola C, Denton CP, Ong V, Croia C, Bombardieri M, Francesca A, Serafini B, Humby F, Kelly S, Migliorini P, Pitzalis C, Miles K, Heaney J, Sibinska Z, Salter D, Savill J, Gray D, Gray M, Jones GW, Greenhill CJ, Williams AS, Nowell MA, Jenkins BJ, Jones SA, McGovern J, Nguyen DX, Notley CA, Mauri C, Isenberg D, Ehrenstein M, Jacklin C, Bosworth AM, Bateman J, Allen M, Samani D, Davies D, Harris HE, Brannan S, Venters G, McQuillian A, Lovegrove F, Gibson J, Chinn D, Mclaren JS, Gordhan C, Stack RJ, Kumar K, Awad I, Raza K, Bacon P, Arkell P, Ryan S, Brownfield A, Packham J, Jacklin C, Bosworth AM, Wilkinson K, Roberts KJ, Moots RJ, Edwards SW, Headland SE, Perretti M, Norling L, Dalli J, Flower R, Serhan C, Perretti M, Naylor A, Azzam E, Smith S, Croft A, Duffield J, Huso D, Gay S, Ospelt C, Cooper M, Isacke C, Goodyear S, Rogers M, Buckley C, Greenhill CJ, Williams AS, Jones GW, Nowell MA, Moideen AN, Rosas M, Taylor PR, Humphreys IR, Jones SA, Vattakuzhi Y, Horwood NJ, Clark AR, Mueller AJ, Laird EG, Tew SR, Clegg PD, Orozco G, Eyre S, Bowes J, Flynn E, Barton A, Worthington J, Eyre S, Bowes J, Barton A, Amos C, Diogo D, Lee A, Padyukov L, Stahl EA, Martin J, Rantapaa-Dahlqvist S, Raychaudhuri S, Plenge R, Klareskog L, Gregersen P, Worthington J, Jani M, Chinoy H, Lamb J, Hazel P, Wedderburn L, Vencovsky J, Danko K, Lundberg I, O'Callaghan AS, Radstake T, Ollier WER, Cooper RG, Cobb J, Hinks A, Bowes J, Steel K, Sudman M, Marion MC, Keddache M, Wedderburn LR, Haas JP, Glass DN, Langefeld CD, Thomson W, Thompson SD, Cobb J, Hinks A, Flynn E, Hirani S, Patrick F, Kassoumeri L, Ursu S, Moncrieffe H, Bulatovic M, Bohm M, van Zelst B, Dolezalova P, de Jonge R, Wulffraat N, Newman S, Thomson W, Wedderburn L. Oral abstracts 7: Molecular mechanisms of disease--osteoarthritis * S1. Identification of novel osteoarthritis genes using zebrafish. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
6
|
Bougnoux ME, Diogo D, François N, Sendid B, Veirmeire S, Colombel JF, Bouchier C, Van Kruiningen H, d'Enfert C, Poulain D. Multilocus sequence typing reveals intrafamilial transmission and microevolutions of Candida albicans isolates from the human digestive tract. J Clin Microbiol 2006; 44:1810-20. [PMID: 16672411 PMCID: PMC1479199 DOI: 10.1128/jcm.44.5.1810-1820.2006] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida albicans is a human commensal that is also responsible for superficial and systemic infections. Little is known about the carriage of C. albicans in the digestive tract and the genome dynamics that occur during commensalisms of this diploid species. The aim of this study was to evaluate the prevalence, diversity, and genetic relationships among C. albicans isolates recovered during natural colonization of the digestive tract of humans, with emphasis on Crohn's disease patients who produce anti-yeast antibodies and may have altered Candida sp. carriage. Candida sp. isolates were recovered from 234 subjects within 25 families with multiple cases of Crohn's disease and 10 control families, sampled at the oral and fecal sites. Prevalences of Candida sp. and C. albicans carriage were 53.4% and 46.5%, respectively, indicating frequent commensal carriage. No differences in prevalence of carriage could be observed between Crohn's disease patients and healthy subjects. Multilocus sequence typing (MLST) of C. albicans isolates revealed frequent colonization of a subject or several members of the same family by genetically indistinguishable or genetically close isolates. These latter isolates differed by loss-of-heterozygosity events at one or several of the MLST loci. These loss-of-heterozygosity events could be due to either chromosome loss followed by duplication or large mitotic recombination events between complementary chromosomes. This study was the first to jointly assess commensal carriage of C. albicans, intrafamilial transmission, and microevolution. The high frequency of each of these events suggests that the digestive tract provides an important and natural niche for microevolutions of diploid C. albicans through the loss of heterozygosity.
Collapse
Affiliation(s)
- M-E Bougnoux
- Unité Postulante Biologie et Pathogénicité Fongiques, INRA USC 2019, Institut Pasteur, 25 rue du Docteur Roux, 75724 Paris Cedex 15, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Bernardes A, Dionísio J, Diogo D, Coelho P, Patrício J. A simple intra-operative maneuver to decrease a duodenal ulcer hemorrhage temporarily: description and anatomical bases. Surg Radiol Anat 2004; 27:79-85. [PMID: 15592830 DOI: 10.1007/s00276-004-0296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 09/22/2004] [Indexed: 10/26/2022]
Abstract
Intraoperative hemostatic suture to treat a bleeding duodenal ulcer is sometimes difficult when there is massive hemorrhage. The aims of this paper are: (1) to describe a practical and easy intraoperative procedure which quickly decreases a massively bleeding duodenal ulcer, allowing the surgeon to identify the bleeding site clearly and obtain definitive hemostasis by suturing the involved vessels with a low risk of common bile duct lesion; and (2) to study in cadavers the anatomical basis of this surgical procedure already successfully performed on patients. Fourteen patients with massive duodenal ulcer bleeding, after unsuccessful endoscopic hemostasis, were operated on and included in this study. After surgical anterior gastroduodenotomy, the surgeon introduced a finger in a downward and forward direction in the bursa omentalis vestibule through the omental foramen. This simple and quick procedure decreased hemorrhage by compressing the gastroduodenal artery against the first part of the posterior surface of the duodenum. Twenty-four fresh blocks of normal tissue were removed from cadavers and were injected with silicone rubber through the common hepatic artery. The distance between the gastroduodenal artery and the omental foramen was measured. With this maneuver the surgeon can clearly see the exact bleeding site and perform an adequate suture with a minor risk of common bile duct lesion.
Collapse
Affiliation(s)
- A Bernardes
- Normal Human Anatomy Institute, Coimbra University, Coimbra, Portugal.
| | | | | | | | | |
Collapse
|
8
|
Pignalberi C, Ricci R, Canale G, Testa G, Diogo D, Santini L, Miraglia F, Santini M. Paroxysmal atrial fibrillation in patients paced for atrioventricular block. Comparison between DDD and VDD single-lead pacing system. Ital Heart J 2001; 2:772-7. [PMID: 11721722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Paroxysmal atrial tachyarrhythmias have been frequently detected in patients paced for atrioventricular block. However, it is not yet clear which is the actual incidence of such arrhythmias and if they were preexisting but not recognized, or if they could be related to the device. METHODS One hundred and forty-five patients with a diagnosis of second or third degree atrioventricular block were enrolled into the study. One hundred and twenty-four received a pacemaker Medtronic Thera DDD and 21 a Medtronic Thera VDD. High rate atrial episodes were evaluated for 3 months after enrollment. Atrial electrograms documenting paroxysmal atrial fibrillation (AF) were stored and programming of atrial sensitivity and pacemaker diagnostics was very strict in order to exclude short and false positive AF episodes. RESULTS Thirty-six patients (35%) in the DDD group and 8 (42%) in the VDD group presented with AF (p = NS). The mean number o
Collapse
Affiliation(s)
- C Pignalberi
- Department of Cardiology, San Filippo Neri Hospital, Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|