Browsing by Author "Marino, Ignazio R."

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    Bacteremia Using the Molecular Adsorbent Recirculating System in Patients Bridged to Liver Transplantation
    (Başkent Üniversitesi, 2005-06) Doria, Cataldo; Marino, Ignazio R.
    Objective: To retrospectively analyze the incidence and implications of bacteremia in patients supported by a molecular adsorbent recirculating system bridged to liver transplantation. Material and Methods: From September 2000 to April 2003, 30 patients (17 males and 13 females, aged 15-70 years; median age, 52 years) presenting with acute-on-chronic liver failure were treated with a molecular adsorbent recirculating system. Results: Nine patients (30%) developed bacteremia (positive blood culture) during treatment, 100% of them died during the same hospital admission. The most common isolates were Pseudomonas aeruginosa (44.4%) and Escherichia coli (33.3%). Sputum (44.4%) and ascites (33.3%) represented the most common sources of infection followed by urine and purely bloodborne infections (11.1% each). The isolate in the sputum was Pseudomonas aeruginosa 100% of the time, whereas Escherichia coli was found in 66.6% of the ascites cultures. The hemodynamic profile of patients who developed positive blood cultures showed significantly lower systemic vascular resistance indexes compared with those of nonbacteremic patients before and after treatment. There was a statistically significant difference (P = 0.0002) in survival between the bacteremic (who all died) and the nonbacteriemic patients treated. Conclusions: Bacteremia was found to be a negative prognostic factor for patients supported with a molecular adsorbent recirculating system and therefore, a contraindication to starting and/or continuing treatment. Infection should be carefully ruled out prior to initiating treatment using a molecular adsorbent recirculating system. Moreover, prophylaxis with broad-spectrum antibiotics that provide double coverage against Gram-negative bacteria should be mandatory.
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    Conversion From Tacrolimus to Cyclosporine-A Based Immunosuppression Following Liver Transplantation
    (Başkent Üniversitesi, 2003-06) Doria, Cataldo; Jain, Ashok Kumar B.; Scott, Victor L.; Gruttadauria, Salvatore; Marino, Ignazio R.; Doyle, Howard R.; Fung, John J.
    We examined the frequency, reasons and outcome after conversion from Tacrolimus to Cyclosporine A. From August 1989 to December 1992, 1000 consecutive liver transplantation patients were studied, which included 834 adults (age >18 yr.) and 166 children with mean follow-up of 77 months (range 56 to 96). A prospectively populated electronic database was queried to identify patients that underwent conversion, the clinical indication and outcomes. Thirty-seven out of 834 adult recipients (4.43%), mean age of 48.4 ± 12.9 years, 19 male (51.35 %) and 18 females (48.64%) required conversion from Tacrolimus to Cyclosporine A baseline immunosuppressive therapy. No pediatric patient required conversion. The mean time interval from liver transplantation to Cyclosporine A conversion was 443.45 ± 441.44 days (range 22 to 1641). The clinical indications for conversion included: 20 neurological (54%), 6 gastrointestinal (16%), 5 hematological (14%), and 6 other (16%) scenarios. Seven of the 37 patients (18.9%) died. The causes of death were multi-organ failure (2), sepsis (2), pancreatitis (1), hepatic failure due to relapse of ethanol abuse (1), and unknown cause (1). Nine out of 37 patients (24.32%) had to be reconverted to Tacrolimus (mean 282.22 ± 499.79 days; range 15 to 1583 day with a median of 135) after institution of Cyclosporine A; none showed recurrence of the original symptoms. The reasons for these re-conversions were acute cellular rejection (44%, n=4), chronic rejection (11%, n=1), increased hepatic enzymes (33%, n=3) and progressively worsening neurological symptoms (11%, n=1). The frequency of conversion from Tacrolimus to Cyclosporine A was 4.43%. Conversion is safe and efficacious if done in a controlled setting. Additionally, reconversion to Tacrolimus for lack of efficacy of Cyclosporine A did not appear to be associated with a recurrence of the condition that caused the initial switch.