Transplantation proceedings
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Comparative Study
Induction immunosuppressive therapy stratified according to risk categories in renal transplantation.
Immunosuppressive therapy is critical during the induction phase for it directly affects graft outcome. Many centers use uniform regimens, although not all patients represent similar risks. The purpose of this study was to evaluate a prospective protocol of immunosuppression according to 2 significant risks in kidney transplant: acute rejection (AR) and delayed graft function (DGF). ⋯ The use of differentiate protocols was associated with better graft function and a reduced frequency of AR and DGF. Although 50% of patients required sequential or triple-drug induction, the adverse events and costs were similar. These results encourage the use of individualized immunosuppression.
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Comparative Study Clinical Trial Controlled Clinical Trial
A prospective evaluation of laparoscopic donor nephrectomy versus open donor nephrectomy.
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Orthotopic liver transplantation (OLTx) is associated with a major risk of blood loss resulting from portal hypertension, collateral circulation, and clotting disturbances. Application of a recombinant factor VIIa (rFVIIa) has been reported to promptly correct clotting abnormalities reducing the risk of intraoperative bleeding. This study included 8 patients who underwent OLTx for end-stage liver cirrhosis, with protrombin times (PT) exceeding the upper limit of normal by more than 4 seconds before surgery. ⋯ None of the patients developed thromboembolic complications. In conclusion, lower than recommended dose of rFVIIa caused rapid improvement in the PT shortly after injection. After reperfusion PT became prolonged again, which may account for the lack of thromboembolic complications observed in this group of patients.
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Several studies have proven that massive blood loss increases postoperative morbidity and mortality in liver graft recipients. Since we have successfully corrected coagulopathy preoperatively using an intravenous (IV) bolus of recombinant activated factor VII (rFVIIa) in 2 patients with fulminant liver failure, we observed that there was rapid reversal of preexisting advanced coagulopathy in another 40 patients with high risk for intraoperative bleeding by this treatment immediately before transplantation. Recently to control hemostasis we have administered rFVIIa also to patients presenting with acute coagulopathy and nonsurgical bleeding after graft reperfusion as described herein. ⋯ A single dose of rFVIIa effectively reverses the severe coagulopathy developing after graft reperfusion, establishing effective hemostasis in liver transplant recipients without an increased risk of thrombotic complications.