Search

Objectives: The aim of this study was to evaluate the long-term outcome of liver transplantation (LT) for hepatocellular carcinoma (HCC) with Domino LT (DLT) using the "Double Piggy-back" technique. Background data: DLT using livers from familial amyloidotic polyneuropathy (FAP) patients is a well-described technique and useful for expanding the donor pool. However, data on long-term results for HCC are limited, particularly regarding the use of the "Double Piggy-back" technique. Methods: Between 2001 and 2014, a total of 260 patients undergoing LT for HCC were analyzed from a prospective database. Of those, 114 were submitted to DLT. Comparisons between groups were performed using propensity score matching. Results: Median follow-up was 34 months (1-152). Overall and disease-free 5-year survival rates for the whole population were 58% and 56%, respectively. There were 177 (68%) patients within Milan Criteria and an additional 26 (10%) within University of California San Francisco (UCSF) criteria. Patients older than 50 years were more likely to receive an FAP liver [odds ratio (OR) 1.94, confidence interval (CI) 1.02-3.69]. DLT patients had more major complications (23.7% vs 13.0%, P=0.025). Only patients undergoing DLT presented with piggy-back syndrome (7% vs 0%, P=0.001). After adjusting for potential confounders, DLT and cadaveric LT had a similar 5- year survival rate (59% vs 44%, respectively, P=0.117). Thirteen patients (11.4%) evidenced FAP disease but not before 6 years after DLT. Conclusions: DLT for HCC is feasible and achieves equivalent results to cadaveric LT. The benefit of expanding the donor pool must be balanced against higher morbidity and a real risk of disease transmission. [ABSTRACT FROM AUTHOR]

Introduction: Hyperphosphatemia is a serious consequence of chronic kidney disease and has been associated with an increased risk for cardiovascular disease. Controlling serum phosphorus levels in patients on dialysis is a challenge for the clinicians and implies, in most cases, the use of phosphate binders (PB). Part of the reason for this challenge is poor adherence to treatment because of the high pill burden in this patient group., Objective: To assess the real-world effectiveness of sucroferric oxyhydroxide (SO) in controlling serum phosphorus levels and determine the associated pill burden., Methods: A multicenter, quantitative, retrospective, before-after study was conducted with patients receiving online hemodiafiltration. Patients who switched to SO as a part of routine care were included in the study. PB treatment, number of pills, serum phosphorus levels, and intravenous iron medication and dosage were collected monthly during the six months of treatment with either PB or SO., Results: A total of 42 patients were included in the study. After switching from a PB to SO, the prescribed pills/day was reduced 67% from 6 pills/day to 2 pills/day (p < 0.001) and the frequency of pill intake was lowered from 3 times/day to 2 times/day (p < 0.001). During the treatment with SO, the proportion of patients with serum phosphorus ≤ 5.5 mg/dL increased from 33.3% at baseline to 45% after six months of treatment., Conclusion: During the six-month follow-up with SO, serum phosphorus levels were controlled with one third of the pills/day compared to other PB.

Contrast-induced nephropathy (CIN) is an iatrogenic disorder, resulting from procedures requiring the intravascular administration of iodinated contrast media. It has an association with increased morbidity and mortality, increased costs and it remains the third most common cause of hospital-acquired kidney failure. CIN is usually defined as an increase in serum creatinine by either at least 0.5 mg/dl or by 25% from baseline within the first 48 hours after contrast administration, in the absence of other causes of renal function impairment. In its pathogenesis have been implicated 2 main mechanisms: renal vasoconstriction resulting in medullary hypoxia and direct cytotoxic effects of the contrast agents. There are several risk factors for radiocontrast nephrotoxicity but patients with underlying renal insufficiency or diabetic nephropathy with renal insufficiency have the greatest risk. Other classic risk factors include: advanced age, peri-procedural intravascular depletion, congestive heart failure. Finally, toxicity also depends on the volume, type of contrast administered and concomitant use of other nephrotoxic drugs. Since there is no specific treatment for CIN and it is limited to supportive measures, prevention is the best way to deal with this condition. In this setting it is important to use lower doses of a low or iso-osmolal agent and avoid volume depletion. Nowadays it is recommended to do volume expansion prior to and continued for several hours after the procedure. Randomized controlled trials suggest that isotonic intravenous fluids, particularly isotonic bicarbonate, confer better protection. Several pharmacologic approaches have been tested to decrease the risk of CIN in patients with preexisting renal disease, based in the mechanisms by which contrast medium is believed to cause nephrotoxicity. However, with the exception of some antioxidant agents, few of those adjunctive therapies have shown any consistent benefit. N-Acetylcysteine is the most widely studied of all prophylactic strategies and despite conflicting data it is advised to do an elevated dosage orally twice daily, the day before and the day of the procedure, based upon its potential for benefit, low toxicity and cost. This article pretends to review CIN pathogenesis, risk factors, clinical course, treatment and prevention. The authors propose themselves a prevention protocol for risk patients based on the latest clinical evidence.