Transplantation proceedings
-
Clinical Trial
Wound levobupivacaine continuous infusion for postoperative analgesia in living kidney donors: case-control study.
The objective of this study was to evaluate the efficacy of an analgesic regimen based on levobupivacaine continuous infusion into the surgical wound of living kidney donors (LKDs). ⋯ Continuous wound infusion with 5 mL/h(-1) levobupivacaine, 1.5 mg/mL(-1), resulted in a safe and effective analgesic protocol in LKDs both in the immediate postoperative period and in the first day after surgery, a result that was more effective than a morphine-tramadole regimen. No adverse effects were recorded, which confirmed the safety of the technique. It is probable that better results could be achieved with dedicated administration devices.
-
Acute-on-chronic liver failure (ACLF) is a systemic inflammatory reaction, which is characterized by a predominantly proinflammatory cytokine profile, causing the transition from stable cirrhosis to ACLF. The aim of the present study was to evaluate the changes in several cytokines associated with inflammatory liver disease and liver regeneration among 15 ACLF patients treated with the Molecular Adsorbent Recirculating System (MARS) compared with 15 patients treated with standard medical therapy (SMT). The subjects showed various disease etiologies but similar values for Model End-stage Liver Disease scores. ⋯ The MARS liver support device corrected pathophysiologies of ALF and may be used to enhance spontaneous recovery or as a bridge to transplantation.
-
Primary graft dysfunction (PGD) is a syndrome that may occur after lung transplantation. In some cases of severe PGD, conventional therapies like ventilatory support, administration of inhaled nitric oxide (iNO), and surfactant and intravenous prostacyclins are inadequate to achieve adequate gas exchange. The only lifesaving option is to use an extracorporeal membrane oxygenator. The Decapsmart is a new venovenous, low-flow extracorporeal device to removal carbon dioxide (CO(2)). It does not need a specialized staff. Herein we have presented a case report of a patient who underwent single lung transplantation and experienced respiratory failure. ⋯ The use of Decapsmart may be an important aid for patients with severe respiratory acidosis in association with conventional therapy during the perioperative period after lung transplantation.
-
Several transplant centers consider pretransplant extracorporeal membrane oxygenation (ECMO) as a contraindication for lung transplantation because of the poor outcomes. However, some technical improvements have changed the scenario; there is increasing evidence of ECMO efficacy as a bridge to lung transplantation. This report describes the successful use of venovenous ECMO as a bridge to an urgent bilateral lung transplantation and as treatment for primary graft dysfunction in a case of hyperacute pulmonary fibrosis in a 58-year-old man. Our experience demonstrated that ECMO, using Quadrox, supported respiratory functions for 28 days without any detrimental effects, serving as a successfully bridge to urgent lung transplantation.
-
Case Reports
Right adrenal metastases of hepatocarcinoma after liver transplantation: case report and literature review.
Hepatocellular carcinoma (HCC) represents one of the most common malignancies globally, accounting for nearly one million new cases per year. Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative, a solitary metastasis from such tumors offers a possibility of cure by surgical resection. The adrenal gland is an uncommon site for metastasis from primary liver tumors. ⋯ Carefully selected patients with solitary metastasis from HCC may be considered for resection.