Başkent Üniversitesi Yayınları
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Item Sirolimus Conversion in Liver Transplant Recipients With Calcineurin Inhibitor-Induced Complications: Efficacy and Safety(Başkent Üniversitesi, 2012-04) Ju, Wei-qiang; Hu, An-bin; He, Xiaoshun; Zhu, Xiao-feng; Han, Ming; Tai, Qiang; Wu, Lin-wei; Liang, Wen-hua; Guo, Zhi-yongObjectives: To evaluate the efficacy and safety of conversion from calcineurin inhibitors to sirolimus among liver transplant recipients with calcineurin inhibitor-induced complications. Materials and Methods: After receiving liver transplants, 25 patients with calcineurin inhibitor-induced complications (22 renal dysfunction and 3 new-onset diabetes mellitus) were converted from sirolimus to tacrolimus. The serum creatinine, sirolimus trough level, liver function, acute rejection episodes, and drug-related adverse effects were monitored. Results: The patients were followed for 12 to 50 months (median, 25 months). The renal function of the 22 patients with renal dysfunction improved after sirolimus conversion. The serum creatinine levels were significantly lower at 3 months after conversion versus before conversion (113.2 ± 21.8 µmol/L vs 163.2 ± 45.3 µmol/L; P < .05). At the end of the follow-up, the average serum creatinine level was 101.9 ± 23.4 µmol/L among the 20 living recipients. Diabetes also was under control in 3 diabetic recipients after the conversion. Four patients experienced episodes of acute rejection, and intravenous steroid bolus therapy was administered in 2 of them. No graft was lost because of acute rejection. The adverse effects of sirolimus included hyperlipidemia (7/25), anemia (8/25), and mouth ulcers (9/25). All these adverse effects were relieved after a short-term symptomatic therapy, and no patient was withdrawn from the conversion trial. Conclusions: Sirolimus monotherapy is effective and safe in liver transplant recipients. Conversion to sirolimus was associated with a sustained improvement in renal function and diabetes mellitus without an increased incidence of acute rejection episodes.Item Hepatic Artery Thrombosis After Orthotopic Liver Transplant: A Review of the Same Institute 5 Years Later(Başkent Üniversitesi, 2011-06) Wu, Linwei; Hu, Anbin; Wang, Guodong; Ma, Yi; Zhu, Xiaofeng; Wang, Dongping; Ju, Weiqiang; He, Xiaoshun; Tai, Qiang; Guo, Zhiyong; Zhang, JianweiObjectives: Summarize the experience of managing patients with hepatic artery thrombosis after orthotopic liver transplant in a single center. Materials and Methods: A total of 726 adult patients who received a liver transplant at the Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-Sen University, between January 2004 and December 2009, were selected. Fourteen patients had hepatic artery thrombosis after the operation, and the clinical data of these patients were analyzed retrospectively. Results: The incidence rate of hepatic artery thrombosis was 1.9% (14/726), and the mean time of onset was 10 days (range, 1 - 41 d) after surgery. Six patients had acute deterioration of liver function, 4 had bile leakage, 1 had hepatic abscess, and 3 had no symptoms. Three patients received urgent rearterialization, 2 received intra-arterial thrombolysis, 3 received combined urgent rearterialization and intra-arterial thrombolysis, and 6 patients received a retransplant. The mortality rate associated with hepatic artery thrombosis was 42.9% (6/14); 2 from biliary necrosis and secondary hepatic failure after urgent rearterialization; 1 from recurrent hepatic artery thrombosis and multiple organ failure after intra-arterial thrombolysis; 1 from renal failure and severe infection after combined urgent rearterialization and intra-arterial thrombolysis, and 2 from severe infection after retransplant. The other patients recovered and were followed for 18 to 66 months. Their liver grafts all functioned well with a patent artery. Two died from tumor recurrence at 18 and 29 months after transplant. Conclusions: Hepatic artery thrombosis is a severe complication after liver transplant, which leads to graft loss and recipient death. Rearterialization as early as possible before irreversible biliary and liver parenchyma damage can avoid retransplant.Item Diagnosis and Treatment of Acute Appendicitis After Orthotopic Liver Transplant in Adults(Başkent Üniversitesi, 2011-04) Wu, Linwei; Zhu, Xiaofeng; Wang, Dongping; Ju, Weiqiang; He, Xiaoshun; Tai, Qiang; Guo, Zhiyong; Zhang, JianweiObjectives: The incidence of acute appendicitis after orthotopic liver transplant is low but difficult to differentiate from other posttransplant complications. We sought to summarize the clinical characteristics, diagnosis, and treatment of acute appendicitis during the early posttransplant stage. Materials and Methods: Data from 4 liver transplant recipients with acute appendicitis immediately after transplant and 4 patients with misdiagnosed appendicitis, between January 2000 and December 2007, were studied retrospectively. Results: The incidence of acute appendicitis immediately after orthotopic liver transplant was 0.49%. Four patients had right lower quadrant abdominal pain with fixed tenderness, rebound tenderness, and fever on the eighth, ninth, 11th, and 13th days after surgery. White blood cells counts were elevated in all patients. Appendectomies were performed on day 1 or 2 after the onset of symptoms. No appendicular perforations were found. All patients recovered well. After an exploratory laparotomy, the 4 patients originally misdiagnosed with appendicitis were correctly diagnosed with a duodenal diverticulum perforation (1 patient), a jejunum perforation (1 patient), and bile leakage (2 patients). Two of these patients died despite aggressive treatment. Conclusions: The incidence of acute appendicitis immediately after orthotopic liver transplant is low and should be differentiated from other surgical complications, such as gastrointestinal perforation and bile leakage. Appendectomy is recommended in these patients as early as possible.Item A Retrospective Study of Conversion From Tacrolimus-based to Sirolimus-based Immunosuppression in Orthotopic Liver Transplant Recipients(Başkent Üniversitesi, 2008-06) Yu, Si; Huang, Jiefu; Ju, Weiqiang; Zhu,Xiaofeng; Ma, Yi; Yang, Lu; He, XiaoshunObjectives: Calcineurin inhibitors are used widely in liver transplant recipients. Sirolimus is a new, potent immunosuppressant considered to be nonnephrotoxic. There is limited experience with the use of sirolimus in liver transplant recipients. This study aimed to investigate the clinical experience of conversion from tacrolimus-based to sirolimus-based immunosuppression in liver transplant recipients. Patients switched to cyclosporine-based immunosuppression during the same period were enrolled as controls. Materials and Methods: This retrospective study examined liver transplant recipients who had been switched from tacrolimus-based to sirolimus-based or cyclosporine-based immunosuppressive therapy between January 2004 and January 2007 in the first affiliated hospital of Sun Yat-sen University. Patients were divided into 3 groups: those switched to sirolimus-based immunosuppression owing to acute rejection (group SIR-AR; n=11); those switched to sirolimus-based immunosuppression owing to renal insufficiency (group SIR-RI; n=18), and those switched to cyclosporine-based immunosuppression owing to acute rejection (group CsA-AR; n=15) Results: In patients switched owing to acute rejection, the rate of successful conversion was 54.5% in group SIR-AR (6/11) compared with 60% in group CsA-AR (9/15); this difference was not statistically significant (P > .05). After conversion, renal function in patients in group SIR-AR remained normal. Conversely, renal function in patients in group CsA-AR became abnormal 3 months after conversion. In patients who were switched owing to renal insufficiency in group SIR-RI, renal function improved significantly after conversion (P < .05). In the sirolimus groups, some sirolimus-associated adverse effects occurred but were limited and well controlled. Conclusions: Sirolimus can be used safely in liver transplant recipients. In the early stages after liver transplant, sirolimus combination therapy is recommended to prevent acute rejection. For patients with tacrolimus-related adverse effects, a sirolimus-based immunosuppression regimen is a rescue therapy.